Dissociative Disorders

Dissociative Disorders are some of the most overlooked conditions in mental health and in general medical practice as well. It is important to mention as Dissociative Symptoms can often appear ADHD-like and/or ASD-like. When more extreme, they can even be misdiagnosed as Psychotic and/or Bipolar conditions.

I describe dissociation to clients as our brains way of checking out when we are too bored or too distressed. And there is a wide continuum of dissociative experiences.

At the normal end of the continuum is spacing out for a few moments or minutes. Or driving to work on auto-pilot and not realizing or remembering how you actually drove, moment by moment, to work. We have all experienced these at one time or another. While spacing out for an hour or two regularly might be a sign of the developmental of mild dissociative symptoms.

Common moderate severity dissociative symptoms include depersonalization or derealization. Depersonalization is when you or your body does not feel real. For example, when looking in the mirror you do not recognize your reflection. Derealization is when others and/or the world around you do no feel real. For example, feeling like you are in a simulation or that other people are video game characters.

More severe dissociative symptoms surface when dissociation has not been identified or treated for 10+ years. Common severe dissociative symptoms include a diffuse sense of identity, feeling internally fragmented with multiple internal voices, perplexing shifts in emotions, not knowing how you ended up somewhere that you did not plan on going, extremely poor memory for daily events, etc. Severe dissociative symptoms are due to a number of developmental delays that occur for individuals who are experiencing chronic dissociative symptoms or who are employing chronic dissociative coping strategies.

In extremely severe cases, Dissociative Identity Disorder or what used to be labeled Multiple Personality Disorder is present. Hollywood’s portrayal of dissociation centers on these extreme sensationalized cases, which is not how most individuals with this condition actually present.

Dissociative symptoms are more likely to develop after traumatic events as individuals struggle to process and cope with what occurred to them. It can be a single traumatic event or after a series of less significant, but nonetheless, traumatic events. Although dissociative symptoms can also develop over time for individuals who have not experienced traumatic events, and who have preferred and routinely employed dissociative coping strategies. For example, a child who never grows out of having imaginary friends continues to engage in retreat into internal worlds all day long up through middle school and high school. Over time, they may begin to develop dissociative symptoms that they are unable to stop from occurring (e.g., depersonalization and derealization) and will also display significant developmental delays in their sense of identity and ability to develop age appropriate coping skills.

For individuals experiencing  these types of symptoms, it is important to find a specialized evaluator to accurately identify what is occurring, to rule out what is not occurring, and to provide effective education on symptoms and treatment options.