Dissociative disorders are frequently misunderstood. They can greatly affect how someone sees reality and their own identity. These disorders involve disruptions in memory, awareness, identity or perception, making it challenging for both, those experiencing them and those trying to understand.

Psychologist Rashmita Tamang, who has over a decade of experience working in mental health, sheds light on dissociative disorders, their treatment and how they differ from regular dissociation. Tamang is a project coordinator at the Centre for Mental Health and Counselling-Nepal.

What is dissociation?

Dissociation is how humans cope with both positive and negative experiences in their social lives. Positive interactions bring happiness and good feelings, while negative events can lead to stress and anxiety. Dissociation helps to push away reactions and difficult memories caused by shocking or painful events like childhood abuse or conflicts. It's important to understand that the mind and body are not separate; they are interconnected. Negative events and stress can affect our mood, emotions, thoughts and beliefs.

How do you differentiate between normal dissociation and dissociative disorders?

Dissociation encompasses a mental process where individuals disconnect from distressing thoughts, emotions or identity, often serving as a coping mechanism during periods of extreme stress or anxiety. While normal dissociation aids in managing overwhelming situations, traumatic experiences like abuse or neglect can lead to dissociative symptoms such as feeling disconnected from one's body or developing multiple identities to navigate distressing memories.

Conversely, dissociative disorders are persistent mental health conditions characterised by a loss of connection between thoughts, memories, behaviour and identity, hindering everyday functioning. These disorders stem from distressing events and involve unwanted detachment from reality, with symptoms ranging from memory loss to identity fragmentation, exacerbated by periods of stress.

What are the common symptoms of this disorder?

The symptoms of dissociative disorders vary depending on the type. Some common symptoms are impaired sense of self, memory loss (amnesia) for certain periods, events or personal information, emotional numbness, and out-of-body experiences.

Individuals may also experience difficulty concentrating, sudden mood swings and severe stress, which will impact their relationships, work and other areas of life. Moreover, coping poorly with emotional or work-related stress is often a hallmark of dissociative disorders. Mental health issues such as depression, anxiety, and suicidal thoughts and behaviours frequently coexist with dissociative disorders.

What are the different types of dissociative disorders?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, defines three major types of dissociative disorders.

First, dissociative amnesia is characterised by an individual’s inability to recall significant details of their past. Second, depersonalisation disorder involves a detachment from reality, leading individuals to feel disconnected from themselves or their surroundings. Finally, dissociative identity disorder (DID) manifests when individuals possess two or more distinct identities or personality states, often accompanied by gaps in memory regarding personal information or significant life events.

What are some of the potential causes of dissociative disorders?

Dissociative disorders often stem from traumatic experiences, particularly during early childhood, where repetitive and overwhelming trauma, such as emotional, physical or sexual abuse, can significantly increase the likelihood of developing such disorders.

Additionally, traumatic events experienced during adulthood, such as war, natural disasters, crime or kidnapping, can also precipitate dissociative symptoms. Genetics may play a role as well, with a potential genetic predisposition if family members have experienced dissociative disorders or related conditions, thereby increasing the risk of developing dissociative disorders.

Moreover, excessive stress and persistent worry over various life issues, including family conflicts, academic pressures, or relationship strains, can further contribute to the onset and exacerbation of dissociative symptoms.

What treatment options are available for individuals with dissociative disorders?

Dissociative disorders can be effectively treated through therapeutic and medicinal interventions, although complete recovery may take several years. Common management methods include developing positive coping mechanisms like maintaining connections with trustworthy friends and family, engaging in positive self-talk and adopting healthy lifestyle habits like proper nutrition, regular exercise and sufficient rest. Additionally, mindfulness exercises and keeping a journal can help process thoughts and experiences.

Psychotherapy, administered by clinical psychologists or psychologists, offers tailored treatments such as cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT) to help individuals manage symptoms and regain control over their lives by addressing past traumas and identity issues.

For individuals with severe dissociative disorders, medication may be prescribed by psychiatrists to complement therapy and alleviate symptoms. Combining psychotherapy with medication can provide comprehensive support for individuals navigating dissociative disorders and facilitate their journey towards recovery and improved well-being.