The feeling of disconnection, of being separated, apart from the goings-on of the world around you. For many, it’s just that – a fleeting feeling that has drifted in and out of the subconscious. Just as many other emotions and profound thoughts.
However, for an estimated ten to eleven percent of the American population, dissociation is a chronic condition and one that has profound effects on those who struggle with it. ¹
What are Dissociative Disorders?
Dissociation is when a person feels that they disconnected from the world through their thoughts, feelings, memory, actions or overall sense of identity.
This disconnection can come in the form of dissociative disorders. There are four classifications of these conditions – each of which are serious mental health illnesses that need to be treated by a mental health professional.
That being said, dissociative disorders can be treatable and those who suffer from them can live a fulfilling life if they are regularly being seen and treated. ²
The four types of dissociative disorders are:
- Dissociative Amnesia
- Dissociative Fugue
- Depersonalization disorder
- Dissociative identity disorder
The National Institute of Mental Health (NIMH) classifies dissociative amnesia as a type of dissociative disorder that affects the memory. Oftentimes causing the patient to lose crucial details about themselves as well as their place in the world. ³
Dissociative amnesia actually has four differing degrees, each affecting a different segment of the patient’s memory.
According to Dr. Spiegel of Stanford University School of Medicine, the four categories of dissociative amnesia are: ⁴
- Localized amnesia
- Selective amnesia
- Generalized amnesia
- Systematized amnesia
Localized amnesia is a form of dissociative amnesia wherein the patient is unable to recall a specific event or events or a specific period of time; these gaps in memory are usually related to trauma or stress.
An example of localized amnesia could be when an abused child is unable to recall the time-frame of the abuse. Or, for those that have witnessed violence, an inability to draw up details of the situation when asked about it.
Typically most patients will suffer from several episodes of localized amnesia, usually struggling with 1-2 episodes a year if the condition proves to be chronic.
Selective amnesia occurs when the patient forgets only segments of events during a given period of time. This also includes only having memories of a part of a painful or traumatic event.
It is possible for a patient to be suffering from both selective and localized amnesia as they often mirror one another. However, selective amnesia is usually more specific and pronounced, wherein the patient can only remember specific events or circumstances while forgetting other crucial details.
Generalized amnesia is the most widely known form of disassociative amnesia. Yet, it is also the rarest.
Generalized dissociative amnesia is generally common in combat veterans, people who have witnessed or are victims of physical and sexual assault, and those experience extreme stress or find themselves in situations of conflict.
Generalized amnesia occurs when a patient forgets their identity as well as their personal histories. They oftentimes will not remember who they are, where they from, where they went, or what they might’ve said. Usually, these periods of time that the patient forgets are expansive and, in some cases, the patient might forget everything entirely.
It is common for those that suffer from generalized amnesia to forget general information about the world or environment in which they live in and it can result in those losing the ability to do tasks that had once come easily to them.
Systematized amnesia involves patients who forget specific information in a specific category.
For example, this can include a person who might forget their memories of a particular person or they might forget crucial memories about their entire family.
Dissociative fugue is a phenomenon that sometimes occurs in dissociative amnesia. According to Britannica, a fugue state is when “sudden, unexpected travel away from one’s home with an inability to recall some or all of one’s past. Onset is sudden, usually following severe psychosocial stressors.”
Fugues might last for hours to months or even longer. Most of those that suffer from fugues might seem to act normal or confused, but it is common for the sufferer to have no memory leading up to and during the fugue.
They will oftentimes find themselves in new environments, situations, or experiences that would usually be foreign to them.
Depersonalization disorder (DPD), also known as derealization disorder, is a mental illness in which the patient finds themselves feeling like they are experiencing their day-to-day lives outside their bodies. It is also common for those who have suffered from depersonalization disorder to question the validity of what they are experiencing as real.
Depersonalization experiences are actually quite common. Everyone will, at one point or another, have a derealization episode in which they question what is going on around them or if what they are experiencing is even real.
However, depersonalization disorders are more serious and chronic mental illnesses that last for a long period of time.
Dissociative Identity Disorder
Dissociative identity disorder (DID) is probably what comes to mind immediately when one thinks of dissociative disorders. This condition is known more commonly as a multiple personality disorder. Although widely depicted in media and literature, the disorder is actually quite rare with 200,000 US cases per year, according to the Mayo Clinic’s estimates. ⁵
The psychological definition for dissociative identity disorder is when a patient has two or more distinct personalities existing within them. These personality-states may switch around from time to time, but there is usually one that has “ultimate control” over the patient.
According to Psychology Today, dissociative identity disorder was called “multiple personality disorder up until 1994, when the name was changed to reflect a better understanding of the condition—namely, that it is characterized by fragmentation or splintering of identity, rather than by a proliferation or growth of separate personalities.” ⁶
Symptoms of Dissociative Identity Disorder
The symptoms of DID are wide-ranging and can vary from patient to patient. The most consistent findings are those cases wherein there is at least two or more identities or “personality-states.” Usually, one is more aggressive, domineering and front and center while the other is despondent, submissive and in some cases depressed.
DID & Possession-States: Where Psychology & Culture Sometimes Disagree
In extreme cases, patients might find themselves in a “possession state,” wherein the more domineering, aggressive personality takes control of the patient. This can be a disturbing, distressing, and obviously unwanted experience.
In some cultures, this possession-state of dissociative identity disorder may resemble demonic or spiritual possession. This is a sensitive topic and it’s something that psychiatry is still trying to find answers to.
However, it may be in cases of spiritual or supernatural possession that the sufferer might actually be experiencing a possession state brought on from symptoms from an undiagnosed case of dissociative identity disorder.
There have been psychiatry research cases that looked into cases of self-identified spiritual and supernatural possessions. Many have found links to dissociative identity disorders.
In one such case, entitled Religious Beliefs, Possession States, and Spirits: Three Case Studies from Sri Lanka was published by Hindawi, a commercial publisher of scientific, technical, and medical literature. ⁷
The case followed three self-identified cases of supernatural possession from three distinct religious backgrounds and the researchers from psychiatry backgrounds found that each unique and specific case of supernatural possession had some explanation through the symptoms of DID. Each case was also followed closely by a psychiatry team which found the same results.
There are stigma and paranoia in some cases of those who suffer from DID as they might be cursed or have some sort of supernatural or unholy possession over their souls. Dissociative identity disorder is a serious and chronic mental illness that should be medically intervened but often goes undiagnosed out of this ignorance and fear.
Harvard Review of Psychiatry posted an article on the NIMH website about common misconceptions and myths about Dissociative Identity Disorder and one of the major findings was that the disorder was, in fact, underdiagnosed. ⁹
Dissociation is always a strange, paradoxical sensation whereas chronic dissociation is a truly problematic and concerning experience to have to go through.
Thankfully it’s not a problem that someone has to face alone – there are ways to treat the symptoms of dissociative disorders like DID or dissociative amnesia.
As we open ourselves up more to being communicative of our struggles and lean on each other for support and guidance, the more we can learn and find ways to ease suffering and find a more fulfilling life.
Still have questions concerning the types of dissociative disorders?
We invite you to ask them in the comments section below. If you have any further information to share – whether personal or professional – we’d also love to hear from you.
¹ The Conversation: “Dissociative disorders are nearly as common as depression. So why haven’t we heard about them?”
² BetterHealth Portal of Victorian Government Health Office: “Dissociation and Dissociative Disorders – An Overview”
³ National Alliance on Mental Health: Dissociative Disorders
⁴ Merck Professional Medical Manual Database: Definition of Dissociative Amnesia
⁵ Mayo Clinic “Depersonalization-derealization Disorder – Overview”
⁶ PsychologyToday: “Dissociative Identity Disorder (Multiple Personality Disorder) – Definition”
⁷ Hindawi: “Religious Beliefs, Possession States, and Spirits: Three Case Studies from Sri Lanka – Case Abstract”
⁸ Hindawi: Religious Beliefs, Possession States, and Spirits: Three Case Studies from Sri Lanka – Case Presentation
⁹ National Institute of Health’s Center for Biotechnology Information – Harvard Review of Psychiatry: Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder