The Dissociative Disorders

There are many Dissociative Disorders and the research surrounding them is ever changing. Some used to be recognized and have been removed, some have been added since the most recent full edition of the DSM-5 and have been added to extensions, so we will make this an all-encompassing list as best we can. (If you or a loved one in the past was diagnosed with DDNOS and now are confused as to why you never hear about it, we’ve got you! It’ll be added to this list and we’ll explain what happened with it and why it’s no longer a current disorder that gets diagnosed today).

DID (Dissociative Identity Disorder)

Description

Dissociative Identity Disorder is a trauma disorder that comes from repeated childhood trauma. In very specific scenarios, someone can develop DID. This will result in them having two or more identities with their own distinct memories and behavior patterns existing within the same body.

Symptoms Can Include

• Memory Loss (Amnesia) of time periods, events, people, and personal information
• Detachment from one’s self and/or emotions
• Anxiety
• Depression
• Suicidal Thoughts/Self Harm

Prevalence

Dissociative Identity Disorder is estimated to have a global prevalence of 1.5%.

What Causes This Disorder to Form?

This disorder comes from repeated childhood trauma before the age of 7-9 years of age. Another common factor is a disorganized attachment from caregivers whether those be parents, nannies, grandparents, babysitters – anyone who is regularly in a position of being a carer for the child.  

Additional Facts

Treatment

• Identifying and processing past trauma and abuse
• Developing coping strategies for daily life
• Managing triggers in daily life
• Working on system communication
• Some systems work on fusing to one identity. This used to be considered the only treatment plan.
• Some systems work toward lowering amnesia between alters, building communication, and mitigating triggers. This is commonly referred to as ‘functional multiplicity’ if the goal is to remain multiple.

History

This needs to be double and triple checked still

The first documented case of Dissociative Identity Disorder that we have was in 1584. Back then (and for a long time after that point) DID was viewed as possession. Jeanne Fery’s possession and exorcism was extremely documented, however, and through studies can be deduced to have very likely been a case of Dissociative Identity Disorder. In 1623 Sister Benedetta was supposedly “possessed” by three angelic boys. Once again, in review of her symptoms, many signs point strongly to a case of DID. When DID was first recognized as a disorder it went under a different name – ironically, given the nature of the disorder. Dissociative Identity Disorder used to be called Multiple Personality Disorder. Louis Auguste Vivet was the first person to be given the diagnosis of Multiple Personality Disorder in 1882. During this time DID (or MPD at the time) was being considered a form of hysteria and psychosis. In 1994, MPD (Multiple Personality Disorder) changed to DID (Dissociative Identity Disorder) when they realized it fell into the classification of a dissociative disorder, not a personality disorder or a disorder of hysteria or psychosis.

Dissociative Amnesia

Description

Dissociative Amnesia is a condition that impairs the person’s ability to remember important information about their own life. This may be more specific memories (thematic) or more general life history/identity (general). 

There are (rarer) cases called dissociative fugue where a person may forget much if not all of their own information (their own name, their personality, their family, etc) and sometimes even leave their home and adopt an entirely new identity and start a new life. 

In all cases of dissociative amnesia, your memory loss is at a significantly higher rate that would be expected as ‘normal forgetting’.

Symptoms Can Include

• Localized: The memory loss affects specific parts of the person’s life (i.e. two years during highschool, or a certain ex). Often the memory loss is connected to trauma.
• Generalized: The memory loss affects major parts of the person’s life and/or identity. They may not be able to recognize their own name, family, job, house, etc.
• Fugue: The memory loss is generalized and the person adopts an entirely new identity. For example an office worker with a family named Susan doesn’t come home one day and is reported missing. Three months later she’s discovered going under the name Barbara living across the country with a new family working in a gas station and has no recollection of her old family.

Prevalence

It is estimated that 1.8% of the population is diagnosed with Dissociative Amnesia.

What Causes This Disorder to Form?

Additional Facts

Dissociative Amnesia is caused by overwhelming stress, often caused by trauma. Dissociative amnesia cases are higher in locations where there have been wars, natural accidents, or disasters. A person with Dissociative Amnesia may have experienced or witnessed something traumatic that caused them to develop the condition. There also may be some genetic component as close relatives often have a tendency to develop amnesia, although this is not solidly proven yet. 

Treatment

• Psychotherapy (“talk therapy”)
• CBT (Cognative-Behavioral Therapy)
• EMDR (Eye Movement Desensitization and Reprocessing)
• DBT (Dialectic-Behavior Therapy)
• Family Therapy
• Creative Therapies (music therapy, art therapy, etc)
• Meditation
• Clinical Hypnosis
• Medication

History

Depersonalization/Derealization Disorder (DPDR)

Description

Depersonalization/Derealization Disorder is when you feel severely detached from your own thoughts and feelings and your physical body (depersonalization), and disconnected from the environment around you (derealization). 

People with this disorder are aware that their experiences are abnormal. They are not losing touch with reality, they are simply having an abnormal experience that they are able to identify as abnormal. DPDR can also be a sign of other conditions such as brain diseases, seizure disorders, and psychiatric disorders like dementia and schizophrenia. 

Symptoms Can Include

• Feelings of being an observer in one’s own thoughts, feelings, body, and/or life in general
• Feeling out of control of one’s own movements/speech or feeling robotic
• Sensations that limbs may be distorted to different sizes or shapes or your head is muffled
• Emotional or physical numbness

Prevalence

It is estimated that 2% of the global population is diagnosed with DPDR.

What Causes This Disorder to Form?

Researchers don’t know what causes this disorder to form. Most everyone experiences depersonalization and derealization transiently (briefly). It only becomes a disorder when it is prolonged and becomes a major affecting issue on the person’s life. 

Biological and environmental factors can have an effect in an individual developing the disorder. Some may be at a higher risk for developing DPDR due to:

• A nervous system that’s naturally less reactive to emotions.
• Other personality or mental health disorders.
• Physical conditions or seizure disorders.

Dissociative disorders can also occur due to trauma or intense stress such as (but not limited to):

• Having a parent with a severe mental illness.
• Abuse (witnessing or experiencing it)
• Life threatening danger
• Accidents
• Natural disasters
• Death of loved ones
• Violence
• War
• Medical Trauma

Other cases can include:

• Certain drugs, such as hallucinogens
• Extreme sleep deprivation
• Sensory stimulation

Additional Facts

This disorder tends to develop earlier in life. The average age for developing this disorder is 16. It will rarely develop after the age of 40. 

Treatment

• Psychotherapy (talk therapy)
• Cognitive-Behavioral Therapy (CBT)
• Dialectic-behavior Therapy (DBT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Family Therapy
• Creative Therapies
• Meditation and relaxation techniques
• Clinical hypnosis (hypnotherapy)
• Medication (there is no specific medication for DPDR, but treating co-morbids like depression or anxiety can lessen other symptoms that are causing issues that might be contributing to DPDR and might therefore help lessen DPDR’s affects on the patient’s daily life.)

History

*This needs to be double and triple checked still

Depersonalization was first ever used as a term by Ludovic Dugas in 1898. It was used to refer to “a state in which there is the feeling or sensation that thoughts and acts elude the self and become strange; there is an alienation of personality – in other words a depersonalization.”

DDNOS (Dissociative Disorder Not Otherwise Specified) 

Description

Symptoms Can Include

Prevalence

What Causes This Disorder to Form?

Additional Facts

Treatment

History

DDNOS used to be the diagnosis given that has since been changed to OSDD. It is no longer diagnosed, which is why you don’t hear about it much anymore. 

OSDD (Otherwise Specified Dissociative Disorder)

There are several subtypes of OSDD that we will break down here.

OSDD 1a

Description

Just notes from Charlie, not finalized at all 

Very similar to DID, though the different identities may not be as distinctly different. (Might be more like the same person at different life stages instead of fully different people). Still has amnesia.

Symptoms Can Include

Prevalence

What Causes This Disorder to Form?

Additional Facts

Treatment

History

Current conversations being had within the DID/OSDD community that both OSDD 1a and 1b should be subtypes of DID and not their own disorders. DID itself is a spectrum, and it makes a lot of sense for both OSDD’s to fall within the DID spectrum. I’ll do research on if we know if that conversation is being had amongst psychologists, but we know it’s a big one within the community of people with the disorders

OSDD 1b

Description

Just notes from Charlie, not finalized at all 

Very similar to DID, but without as much if any day-to-day amnesia. Amnesia around trauma memories will still be present but amnesia between alters (alternate identity states) day to day is not as present.

Symptoms Can Include

Prevalence

What Causes This Disorder to Form?

Additional Facts

Treatment

History

Current conversations being had within the DID/OSDD community that both OSDD 1a and 1b should be subtypes of DID and not their own disorders. DID itself is a spectrum, and it makes a lot of sense for both OSDD’s to fall within the DID spectrum. I’ll do research on if we know if that conversation is being had amongst psychologists, but we know it’s a big one within the community of people with the disorders

OSDD 2

Description

OSDD-2 is generally associated with brainwashing, torture, programming, etc. In short, OSDD-2 is referenced towards coercion-based dissociation. 

OSDD 3

Description

OSDD-3 is diagnosed when severe dissociative symptoms are present immediately after a traumatic event. These symptoms often last only a short time and the diagnosis often clears after that time.

OSDD 4

Description

OSDD-4 is connected specifically to dissociative trances. These trances do not have other causes (other conditions, drug use, spiritual practices, etc). 

History of OSDD

In the past, DDNOS (Dissociative Disorder not Otherwise Specified) was used as a ‘catchall’ in previous DSM iterations. Now DDNOS is an outdated diagnosis and we use OSDD for more specific diagnoses. This is why if you or a loved one may have had a DDNOS diagnosis you may be confused as to the lack of conversation about that disorder nowadays. It no longer gets diagnosed and if you were to get diagnosed today, you would likely get diagnosed with one of the OSDDs. 

PDID (Partial DID)

Description

Partial DID refers to a system who’s host is much more ‘primary’ than any other alters and whose alters switch in much less or perhaps not at all and when they do it’s for shorter periods of time or perhaps they only function internally and/or through interference/bleedthrough/co-consciousness/etc. This however is a very new term and is still being discovered/figured out, so (as with many things in this community), you may see different descriptions in different places as the terminology, understanding, and decisions around it evolves.

According to the ISST-D, PDID is a diagnostic term you’ll most likely find used outside of North America. It’s most similar to OSDD type 1 (A&B). When dealing with PDID, the patient experiences a disruption of identity similar to DID, but there is a ‘dominant’ personality which is usually at the front. Switches are infrequent/rare, possibly only happening during particularly emotional or stressful experiences.

Symptoms 

Prevalence

What Causes This Disorder to Form?

Additional Facts

Treatment

History

not finalizedPartial DID (PDID) Seems to be a new term/title being used that is finding its place in this community/sector of psychiatry.