Dissociative disorders - causes, symptoms, diagnosis, treatment, pathology

Summary

This script delves into dissociative disorders, a group of conditions marked by a disconnection from one's thoughts, actions, and identity, often stemming from early trauma. It outlines three main types: depersonalization/derealization disorder, characterized by a sense of detachment; dissociative amnesia, involving memory loss, especially around traumatic events; and dissociative identity disorder, where individuals exhibit multiple distinct identities. The script also touches on the complexities of diagnosis and the importance of psychotherapy in treatment.

Takeaways

• 🚗 Driving on 'autopilot' is a common example of dissociation, a mental state of disconnection from one's surroundings.
• 🌐 Dissociation is normal in brief instances but can become a disorder when it's pervasive and interferes with daily life.
• 🤔 Dissociative disorders affect awareness of one's actions, thoughts, physical sensations, and identity, often stemming from early childhood trauma.
• 🔑 There are three main types of dissociative disorders: depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder.
• 🕵️‍♂️ Depersonalization/derealization disorder involves feelings of detachment from oneself or the world feeling unreal.
• 🗝️ Dissociative amnesia is characterized by the blocking out or forgetting of important personal information, with four subtypes: localized, generalized, systematized, and continuous.
• 🎭 Dissociative identity disorder, previously known as multiple personality disorder, involves the presence of two or more distinct identities or 'alters'.
• 🏥 Diagnosing dissociative disorders can be complex due to overlapping symptoms with other conditions like substance intoxication, seizures, and mental health disorders.
• ⏳ The symptoms of dissociative disorders can persist for years, contrasting with the temporary symptoms of conditions like anxiety or bipolar disorder.
• 🛠️ Treatment typically involves psychotherapy to help individuals process trauma and, in the case of dissociative identity disorder, integrate fragmented identities.

Q & A

What is dissociation?

Dissociation is a mental state of disconnection from one's surroundings, characterized by a feeling of being detached from one's own actions, thoughts, physical sensations, or identity.

How does normal dissociation differ from dissociative disorders?

Normal dissociation is a temporary and mild daydreamy state that most people can snap out of when needed, whereas dissociative disorders are more pervasive, intense, and can significantly impair a person's daily functioning.

What are the three main types of dissociative disorders?

The three main types of dissociative disorders are depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder.

What is depersonalization/derealization disorder and how does it manifest?

Depersonalization/derealization disorder involves feelings of detachment from oneself (depersonalization) and a sense that the world around is not fully real (derealization). Individuals may feel emotionally or physically numb and have a weak sense of self.

What are the four types of dissociative amnesia?

The four types of dissociative amnesia are localized, generalized, systematized, and continuous. Localized amnesia involves memory loss around a traumatic event, generalized amnesia affects all past memories, systematized amnesia involves forgetting a category of information related to trauma, and continuous amnesia is characterized by forgetting new events as they happen.

What is dissociative identity disorder and what was it previously called?

Dissociative identity disorder is a condition where a person has two or more distinct identities or 'alters' that take control of their behavior. It was previously known as multiple personality disorder.

How does covert dissociative identity disorder differ from overt dissociative identity disorder?

Covert dissociative identity disorder involves sudden shifts in perception and behavior, with the person being aware that their experiences are unusual. Overt dissociative identity disorder, on the other hand, involves the assumption of two or more distinct identities that the person is not aware of, leading to periods of amnesia and potential risky behavior.

What are some potential dangers associated with overt dissociative identity disorder?

Potential dangers with overt dissociative identity disorder include self-mutilation, risky behavior, and a high rate of suicide attempts. Individuals may also find themselves in unfamiliar places or with unexplained injuries due to periods of fugue.

How can dissociative disorders be misdiagnosed, and what other conditions can mimic their symptoms?

Dissociative disorders can be misdiagnosed due to symptoms that overlap with substance intoxication, seizures, brain trauma, dementia, anxiety disorders, bipolar disorder, and schizophrenia. It's crucial to consider the duration and context of symptoms when making a diagnosis.

What is the typical treatment approach for dissociative disorders?

The typical treatment for dissociative disorders involves psychotherapy, which aims to help individuals process their trauma and, in the case of dissociative identity disorder, integrate their personality states to feel more whole.

How do dissociative disorders develop and what is their relationship with trauma?

Dissociative disorders often develop as a coping mechanism in response to severe or prolonged trauma, particularly from early childhood abuse or neglect. They represent an attempt to adapt to and distance oneself from negative feelings and experiences.

Outlines

00:00

🚗 Dissociation and Dissociative Disorders

The paragraph introduces the concept of dissociation, a mental state where a person feels disconnected from their surroundings. It explains how normal dissociation differs from dissociative disorders, which can severely impact daily life. Dissociative disorders are linked to trauma, particularly from early childhood, and manifest in three main types: depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder. These disorders range in severity, with depersonalization/derealization being the least severe and dissociative identity disorder the most severe. The paragraph describes the symptoms of depersonalization/derealization disorder, which include feelings of detachment from oneself and the world, emotional or physical numbness, and difficulty forming relationships.

05:04

🧠 Types of Dissociative Amnesia and Dissociative Identity Disorder

This paragraph delves into the specifics of dissociative amnesia, detailing its four types: localized, generalized, systematized, and continuous. It explains how localized amnesia involves memory loss around a traumatic event, while generalized amnesia affects all past memories. Systematized amnesia is characterized by the forgetting of a specific category of information related to trauma, and continuous amnesia is akin to living only in the present moment, unable to retain new memories. The paragraph then discusses dissociative identity disorder, which includes covert and overt types. Covert dissociative identity disorder is marked by shifts in perception and behavior, while overt dissociative identity disorder features the assumption of distinct identities or 'alters' that take over the person's body and mind. The paragraph concludes with the challenges in diagnosing dissociative disorders due to overlapping symptoms with other conditions and the importance of psychotherapy in treatment.

Keywords

💡Dissociation

Dissociation refers to a mental state where an individual feels disconnected from their surroundings, actions, or identity. In the context of the video, dissociation is a normal, everyday experience that can become pathological when it is pervasive and interferes with daily functioning. The script describes dissociation as a potential response to trauma, where the mind disconnects as a coping mechanism.

💡Dissociative Disorders

Dissociative disorders are a group of mental health conditions characterized by impaired awareness of one's actions, thoughts, physical sensations, and identity. The video explains that these disorders often stem from trauma, such as childhood abuse or neglect, and manifest in various ways, including depersonalization, amnesia, and identity disorders. The disorders are categorized based on severity, with the video detailing the spectrum from less severe to most severe forms.

💡Depersonalization/Derealization Disorder

Depersonalization refers to a feeling of detachment from oneself, while derealization is the feeling that the world around one is not fully real. This disorder is mentioned as the least severe of the dissociative disorders in the video. Individuals may feel as if they are observing their lives from an external perspective, which can lead to emotional or physical numbness and difficulty forming relationships.

💡Dissociative Amnesia

Dissociative amnesia is a condition where an individual blocks out or forgets important personal information, often related to a traumatic event. The video outlines different types of dissociative amnesia, including localized, generalized, systematized, and continuous, each with varying degrees of memory loss and impact on the individual's life.

💡Dissociative Identity Disorder

Dissociative identity disorder (formerly known as multiple personality disorder) is characterized by the presence of two or more distinct identities or personality states. The video describes two types: covert, where shifts in perception and behavior occur, and overt, where distinct identities take control of the person's actions and memory. This disorder is considered the most severe on the dissociative spectrum.

💡Trauma

Trauma, often stemming from early childhood experiences such as abuse or neglect, is identified in the video as a primary cause of dissociative disorders. It is suggested that these disorders can be an adaptive response to negative feelings and experiences associated with trauma, as the mind attempts to cope with overwhelming situations.

💡Psychotherapy

Psychotherapy is mentioned as a common treatment approach for dissociative disorders. The video emphasizes the importance of processing trauma in a safe environment, with the goal of integrating fragmented identities in the case of dissociative identity disorder. This therapeutic process aims to help individuals feel more whole and less disconnected.

💡Fugue State

A fugue state is described in the video as a temporary period of disorientation and wandering that can accompany dissociative amnesia, particularly in the generalized form. During a fugue state, individuals may be confused about their identity, believe they are someone else, or lose deeply ingrained skills, illustrating the profound impact of dissociation on memory and identity.

💡Systematized Amnesia

Systematized amnesia is a type of dissociative amnesia where an individual forgets a specific category of information associated with a trauma. The video provides an example of forgetting everything about a certain person or location, even if it was a significant part of their life, highlighting how trauma can selectively affect memory.

💡Continuous Amnesia

Continuous amnesia is a rare form of dissociative amnesia where a person forgets each new event as it happens, retaining only the present moment. The video likens this to the fish Dora from the movie 'Finding Nemo,' emphasizing the extreme disruption to daily life and memory continuity.

💡Suicide

The video notes that individuals with dissociative identity disorder have a high risk of suicide, with nearly three-quarters attempting it at least once in their lives. This statistic underscores the severity of the psychological distress and the importance of early diagnosis and treatment for these disorders.

Highlights

Dissociation is a mental state of disconnection from one's surroundings.

Dissociative disorders cause impaired awareness of actions, thoughts, sensations, and identity.

These disorders often stem from early childhood trauma or neglect.

Dissociative disorders are categorized into depersonalization/derealization, dissociative amnesia, and dissociative identity disorder.

Depersonalization involves feeling detached from oneself.

Derealization is the feeling that the world around is not fully real.

Individuals may feel as if they are watching their life from the outside.

Dissociative amnesia involves blocking out or forgetting important personal information.

Localized amnesia is the most common form, affecting recall of a traumatic event.

Generalized amnesia affects memory of the entire past, even non-traumatic parts.

Dissociative fugue is a state of disorientation and wandering that may accompany amnesia.

Systematized amnesia involves forgetting a category of information associated with trauma.

Continuous amnesia is characterized by forgetting each new event after it happens.

Dissociative identity disorder involves the presence of two or more distinct identities.

Covert dissociative identity disorder is marked by sudden shifts in perception and behavior.

Overt dissociative identity disorder features complete assumption of distinct identities.

Individuals with overt DID may not be aware of their alternate identities.

Dissociative disorders can be misdiagnosed due to overlapping symptoms with other conditions.

Treatment typically involves psychotherapy to process trauma and integrate identities.

Transcripts

Maybe you’ve had the experience of driving on “autopilot.”

One minute you got in your car, and the next minute you’ve arrived at your destination,

but you can’t actually remember the details of the drive.

This is an example of normal, everyday dissociation, a term that describes a mental state of disconnection

from what is going around you.

Normally this day-dreamy state doesn’t last very long, and most people can snap out of

it if something or someone requires their attention.

But for some people, dissociation is more pervasive, and can’t be turned off so easily.

In fact, the feeling of disconnection may become so intense and happen so often that

it stops a person from functioning in their daily life.

When this is the case, we say the person has a dissociative disorder.

Dissociative disorders are a group disorders that cause an impaired awareness of your own

actions, thoughts, physical sensations, and even identity, which is a sense of who you

are.

Dissociative disorders tend to stem usually stem from trauma, usually early childhood

abuse or neglect, and are thought to be a way of adapting to negative feelings and experiences.

Dissociative disorders are divided into three main types: depersonalization/derealization

disorder, dissociative amnesia, and dissociative identity disorder.

Each of these disorders fall along a spectrum of severity, with depersonalization/derealization

disorder being the least severe of the dissociative disorders, dissociative amnesia falling somewhere

in the middle, and dissociative identity disorder being the most severe.

Typically, individuals with more severe dissociative disorders may have elements of less severe

ones as well.

With depersonalization/derealization disorder, depersonalization refers to a feeling of detachment

from oneself, your own person, while derealization refers to a feeling that that the world around

you is not fully real.

Those with the disorder often feel as if they are watching themselves from the outside,

maybe watching a movie about their life.

They might feel emotionally or physically numb, or have a weak sense of self.

Individuals with depersonalization/derealization disorder might speak in a deadpan manner,

with little emotion, and have trouble forming relationships.

In severe cases, a person may have trouble recognizing familiar places, people, or objects,

and this can make it had to learn tasks.

Other symptoms include an altered sense of time, where things seem to move too fast or

slow, brain fog or light-headedness, and being prone to rumination and anxiety.

Dissociative amnesia is when a person blocks out or forgets important personal information

that most people would remember for a lifetime, like where they lived as a child, or what

their mother looked like.

Dissociative amnesia can be divided into four types: localized, generalized, systematized,

and continuous.

Most people with dissociative amnesia have localized amnesia, meaning they have trouble

recalling a traumatic event.

Sometimes the memory loss is broader, and includes months or years surrounding the event.

Generalized amnesia is where a person can’t remember any of their past, even the non-traumatic

parts.

The onset of generalized amnesia can be sudden, stress-induced, and may be accompanied by

a dissociative fugue, meaning a temporary period of disorientation and wandering or

travel.

In a fugue state, a person may be confused about who they are, or they may believe they

are someone else.

They may also temporarily lose deeply-ingrained skills.

For example, a computer engineer might forget how to use a laptop.

In systematized amnesia, a person only forgets a category of information which is in some

way associated with a trauma, like forgetting everything about a certain person, or a specific

location, even if it was a significant part of their life.

And finally, continuous amnesia happens when a person forgets each new event after it happens,

and retains nothing but the present moment-- a bit like the fish Dora in movie Finding

Nemo.

And continuous amnesia doesn’t always relate back to psychological trauma.

The third type of dissociative disorder is dissociative identity disorder, which used

to be called multiple personality disorder.

Dissociative identity disorder can be broken down into two types: covert dissociative identity

disorder, and overt dissociative identity disorder.

By far the most common type, covert dissociative identity disorder occurs when a person experiences

sudden and dramatic shifts in the way they perceive, think, or feel, as if they have

taken on characteristics of a different person or people.

Some people with covert may hear that person’s voice, and feel that it is speaking to them.

Those with covert dissociative identity disorder are usually aware that their experience is

unusual, and may feel disoriented and powerless to understand their moods and behavior.

On the other hand, those with overt dissociative identity disorder outright assume two or more

distinct identities, sometimes called personalities, or alters.

The identities are distinct because they tend to talk and act differently than the original

person.

They may have opposing tastes or political views, be different ages, genders, or nationalities.

These alternate identities completely take a person’s body and mind, suppressing all

other identities temporarily.

Those with overt dissociative identity disorder are not aware that this is happening, and

may report forgetting whole portions of their day.

They may find groceries they can’t recall buying, or discover injuries to their body

that they can’t recall getting, and it’s not unusual for some people to have a period

of fugue, and suddenly find themselves in a different town or city.

Having overt dissociative identity disorder can potentially endanger the person, especially

if one identity engages in self-mutilation or risky behavior.

The prevalence of suicide among those with the condition is very high, with almost three

quarters attempting suicide at least once in their life.

Diagnosing dissociative disorders can be tricky, and some of the symptoms can be seen in substance

intoxication, especially of hallucinogens like LSD, and dissociative drugs like PCP

and Ketamine.

Other causes include seizures, brain trauma, as well as chronic conditions like dementia.

Psychiatric conditions like an anxiety disorder can cause an impaired sense of identity, time,

and sensation, especially during a panic attack, but these symptoms usually last minutes to

hours.

With dissociative disorders, the symptoms can persist for years.

Finally, bipolar disorder and schizophrenia can also cause dramatic mood swings mimicking

dissociative identity disorder, but while these depressive or euphoric moods can last

for at least a week, the change in personality in dissociative identity disorder only last

for minutes to hours each time.

Treatment for dissociative disorders typically involves psychotherapy so people can process

their trauma safely.

In the case of dissociative identity disorder, the goal of therapy is to facilitate fusion

of identities, where a person’s personality states are integrated and the person feels

more whole.

All right, as a quick recap, dissociative disorders often develop in as an attempt to

adapt to severe or prolonged trauma.

Falling on the least severe end of the spectrum, depersonalization/ derealization disorder

is due to a disruption in the normal perception of events.

Falling in the middle of the spectrum, dissociative amnesia is due to a disruption in memory.

Falling on the most severe end of the spectrum, dissociative identity disorder is due to a

problem with having

a single, complete identity.