Dissociative Disorders
Dissociative Disorders involve a dissociation or interruption from consciousness, awareness, identity or memory. They may result from psychological trauma or severe stress. Dissociative disorders are further categorized into dissociative amnesia, dissociative identity disorder, and depersonalization disorder. Dissociative symptoms can interfere with normal functioning, adversely affecting work, school or interpersonal relationships.
Dissociative Disorders develop in response to severe stress. Examples may include wartime experiences, natural disasters, rape, incest, or even psychotic episodes (including placement in psychiatric hospitals). Dissociative amnesia involves the inability to remember past experiences or personal information. Memory loss is more extensive than normal forgetfulness. Dissociative identity disorder was formerly known as multiple personality disorder. Alternate personalities arise related to exposure to stress. Individuals with this disorder experience the presence of one or more people talking and “living” inside of them. Dissociative identity disorder is also associated with dissociative amnesia. Depersonalization disorder is a period where a person has the sensation they are outside of their body, observing their own actions from a different vantage point. Depersonalization disorder can be associated with body image distortions and feelings that the world is "unreal."
Persons with a dissociative disorder may exhibit severe memory loss, behavior changes under stress, or, as discussed, the presence of multiple personalities within themselves.
This was not depression. This was not workaholism. I have a fairly severe mental illness that makes it hard to do my job -- in fact, makes me totally ill suited for my job. I have a form of dissociative disorder that makes the world seem like it's not real, as if things aren't taking place. It's hard to explain, but you feel untethered. And because nothing seems real, it's hard to connect with the world or the people in it because they're not there. You're not there. That's why I rarely saw my family back then: It's hard to care when everything feels as if it's taking place in your imagination. And if you're distant with people, especially a woman you're romantically involved with, they eventually leave.
-- Adam Duritz, Counting Crows.
Dissociative disorders are a pathological response to trauma, real or threatened. They often arise from childhood experiences of sexual or severe physical abuse, during a time when personal identity is developing. In dissociating, feelings, thoughts, perceptions and memories of the trauma can be pushed away from consciousness. This allows a child to be able to function more normally. Less frequently, dissociation arises in adulthood, again in response to severe trauma including wartime experiences, violence, rape, or assault.
How is a Dissociative Disorder diagnosed?
The diagnosis of a Dissociative Disorder is made by eliciting a history of exposure to a traumatic event with a subsequent dissociative response such as amnesia, depersonalization or development of multiple identities. The assessment is very similar to that for Post-traumatic Stress Disorder. Evaluation of a dissociative disorder requires a thorough exploration of any trauma history, and a delineation of current symptomatology with identification of dissociative episodes or alternate identities.
What is the Prognosis for a Dissociative Disorder?
Dissociative Disorders can be effectively managed with intensive psychotherapy, and medication, when necessary. Psychotherapy, sleep and stress management, and psycho-education can significantly diminish the frequency and intensity of dissociative episodes. The earlier in life a person is diagnosed and treated, the better the prognosis. However, dissociative symptoms may be so disabling, a person with a Dissociative Disorder may have difficulty seeking help or staying in treatment. People with Dissociative Disorders may also experience depression, mood lability, suicidal thoughts or attempts, sleep disorders (insomnia, night terrors, and sleep walking),or panic attacks and phobias (flashbacks, reactions to reminders of the trauma). Furthermore, compulsions and rituals, borderline psychotic symptoms, somatization issues such as headaches, trances or "out of body experiences" or eating disorders may occur.
What factors can slow recovery?
Persons with a Dissociative Disorder and history of psychological trauma may be reluctant or afraid to seek treatment. Finding the proper diagnosis and appropriate treatment plan is especially important. Chemical dependency or alcoholism, or co-occurring psychological problems may also be prevalent among persons with dissociation. Concurrent substance abuse dramatically interferes with effective psychological and medical treatment. Persons with a Dissociative Disorder may have isolated themselves from family or loved ones, thus lacking an effective social support structure that is important to assist with their recovery.
How Can Friends and Family Help?
Family members, a spouse, or friends can educate themselves to understand when a person with a Dissociative Disorder and history of psychological trauma is dissociating or is in crisis. At these times, they can compel the person to seek professional help. They can also monitor medications and ensure that therapy appointments are maintained. Family members are likely to help a person with dissociation enter a treatment facility, providing emotional support and financial resources.
When Should a Client enter a treatment center?
Any person with a severe history of psychological trauma or Dissociative Disorder should seek help from a qualified mental health professional. When dissociative episodes are occuring with frequency, or are profound, or when a person suffers from multiple identities, an intensive treatment program is an important choice. Weekly psychotherapy or medication will be ineffective at managing serious consequences of a Dissociative Disorder. A treatment facility, like PCH Treatment Center, has extensive experience working with persons suffering from dissociative episodes related to psychological trauma.
How does PCH Treatment Center treat Dissociative Disorders?
Dr. Jeff Ball, the Executive and Clinical Director at PCH Treatment Center, has treated persons with Dissociative Disorders for over 25 years, in both outpatient and inpatient settings. Dr. Ball has assembled a highly qualified and experienced treatment team that understands psychological trauma and dissociation. Upon admission to PCH Treatment Center, a doctoral level therapist performs a thorough initial assessment. A precise diagnosis is established, and incorrect diagnoses or stigmatizing labels are discarded. Each Client is also evaluated by our Psychiatrist, Dr. William Wirshing, who is an expert in psychopharmacology. Dr. Wirshing complements the PCH Treatment Center philosophy emphasizing minimal medication usage and holistic healing. The foundation of our treatment of Dissociative Disorders is individual psychotherapy. Clients receive up to five individual sessions per week, coupled with other therapies including Dialectical Behavioral Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), anger management, sleep hygiene, psycho-education, neurofeedback. Yoga, acupuncture, massage, mindfulness meditation, and art and music therapy also help in recovery and healing. Family therapy groups are available, which incorporate family members or significant others into the Client’s treatment environment. At PCH Treatment Center, we have helped many Clients overcome their past psychological trauma, to find happiness and return to their home and family and workplace or school with confidence and hopefulness.
