Dissociative disorder


Dissociative disorder is a generic term for a number of mental illnesses. Those affected rule on very stressful experiences with the splitting off of memories or even whole personality shares. This way you can hide unbearable experiences. Dissociative disorders include dissociative amnesia and multiple personality disorder. Read here how to recognize a dissociative disorder, how it develops and how to treat it.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. F44

In dissociative disorders, the symptoms range from memory loss to seizures. Behind this, however, are no physical causes, but mostly traumatic experiences.

Marian Grosser, DoctorArticle SurveyDissociative Disorder
  • description
  • symptoms
  • Causes and risk factors
  • Examinations and diagnosis
  • treatment
  • Disease course and prognosis

Dissociative disorder: description

A dissociative disorder is a complex psychological phenomenon. Responding to an unbearable experience, those involved hide memories of their own identity.

Healthy people experience their "I" as a unity of thoughts, actions and feelings. In a dissociative disorder, this stable picture breaks up one's own identity. Hence the term dissociation (Latin for separation, decay).

Such a division of consciousness is usually associated with a traumatic experience or serious conflicts. Dissociative disorder is often associated with other mental disorders, such as depression, schizophrenia, or borderline personality disorder.

Dissociative disorder: forms of the disorder

Dissociative amnesia:

This is a partial or complete loss of memory in connection with stressful events or problems. In very rare cases, the memory of the entire life is lost.

Most often, amnesia occurs in connection with a traumatic event. The loss of memory usually only affects certain scenes of the stressful experience or the time afterwards. Such a dissociative disorder could occur, for example, after a car accident. The person can no longer or only partially remember the accident. However, she has suffered no brain damage that could explain the loss of memory. The memory loss is usually as fast as it occurred. Relapses are rare.

It is estimated that the risk of suffering dissociative amnesia during life is seven percent.

Dissociative Fugue:

Triggered by a stressful event, the person suddenly leaves home or work and assumes a new identity (fugue = escape). He can not remember his previous life (amnesia). If he later returns to his old life, he usually has no memories of his departure and the interlude in another identity.

The risk for this dissociative disorder during life is only 0.2 percent, experts estimate.

Dissociative stupor:

Those affected hardly or no longer move, do not speak or respond to light, sounds or touch. In this condition, it is not possible to contact them. However, the person is not unconscious because the muscles do not relax and the eyes move. The symptoms of dissociative stupor are not due to organic problems, but a mental burden.

Dissociative stupor rarely occurs. Experts believe that this dissociative disorder occurs throughout life in 0.05 to 0.2 percent of the population.

Dissociative disorders of movement and sensation:

Unlike the other dissociative disorders, no memory loss (amnesia) occurs here. Rather, there are motor or sensory deficits that have no organic cause: For example, with the dissociative movement disorder, those affected can no longer stand free, have coordination problems, or can not perform voluntary movements in certain areas, such as those needed for speech.

Some sufferers experience dissociative seizures that are similar to epileptic seizures. A dissociative attack, however, goes hand in hand without the loss of consciousness. In the case of dissociative sensory and sensory disturbances, either the normal sensation of the skin at specific parts of the body or the whole body is lost. Or the affected persons can only partly see or even not see, smell or hear.

The frequency of dissociative disorders of movement and sensations is estimated to be about 0.3 percent. Women are affected more often than men.

Dissociative Identity Disorder (Multiple Personality Disorder):

Dissociative identity disorder is the most severe form of dissociative disorder. It is also known by the term "multiple personality disorder".

The personality of those affected is divided into different parts. Each share has its own individual memory, preferences and patterns of behavior. Often, the different personality parts differ greatly from each other. They never appear at the same time, but alternate.

In many cases, Dissociative Personality Disorder is the result of severe abuse experiences.

Read more in the article Multiple Personality Disorder.

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Dissociative disorder: symptoms

A dissociative disorder varies from patient to patient. Some just lack the memory of a particular experience and may not even be aware that they have a memory lapse. Others suffer from a complete amnesia that obliterates the memory of their entire lives. In the case of a dissociative identity disorder, the ego splits into different personalities who then lead their own lives.

Other people in turn suffer from strong physical symptoms, such as paralysis. But even with the same person, the symptoms can change from one moment to the other. A change of symptoms is characteristic of a dissociative disorder.

Although the symptoms of various dissociative disorders vary greatly from memory loss to physical discomfort, they share two common features.

According to the International Classification of Mental Disorders (ICD-10), dissociative disorders have no physical illness that could explain the symptoms, and there is a convincing temporal relationship between the symptoms of the dissociative disorder and distressing events or problems.

If a dissociation affects movement, the symptoms are very similar to those of neurological disorders. It is therefore not easy to see if it is a dissociative disorder or another disease. Those affected can suffer from paralysis all over the body. Some can not stand or walk anymore. The loss of voice can also indicate a dissociative disorder. In many cases, however, the symptoms disappear quickly. Depending on the form of the day, the symptoms often vary in severity. Stressful situations can exacerbate the dissociative disorder.

A dissociative disorder can also be manifested by self-harming behaviors. For example, some patients incise cuts or burns to return from the dissociative state to reality.

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Dissociative Disorder: Causes and Risk Factors

A dissociative disorder usually occurs in connection with traumatic life experiences. Strong stress situations, such as accidents, natural disasters or abuses overwhelm the psyche. The symptoms of dissociative disorders are a stress response to this excessive demand.

But not every person reacts to stress situations with a dissociation. Individual personality and environmental influences have an influence on the development of dissociative disorders. Among other things, the bond between the parent and the child influences how resilient children are to stress. Children who lack the necessary safety and security at home are more susceptible to dissociative disorders.

The effects of negative experiences are also evident at the biological level. Heavy stress can alter structures in the brain. For example, too much of the stress hormone cortisol damages the hippocampus, which is a major contributor to our memories. Researchers assume that the tendency to dissociation is also innate. However, the role of the genes could not be clarified clearly.

Dissociative Disorder: Causes of Different Forms

As the cause of amnesia and the Fugue the dissociation is considered. Stressful or traumatic experiences can be stored in this way so that they are no longer accessible to the person concerned. Experts believe that this is a protective mechanism. If the psyche can not handle a situation because it is too threatening, it relieves itself of the split-off.

The exact causes of Stupors, in which patients do not respond to the outside world, are still under-researched. Some experts compare the symptoms of dissociative stupor with the dead reflex in animals. A threatening situation causes the person to freeze all over. The deadleg reflex is a survival strategy that some animals use when they have no way out.

As the cause of Multiple personality disorder Above all, serious experiences of abuse in childhood apply. The splitting into different personalities is a protection against unbearable experiences.

The dissociative Disorders of movement and sensation are also referred to as conversion disorders. Psychologists speak of conversion when mental states become visible through physical complaints. Already the psychoanalyst Sigmund Freud stated that people push out unbearable mental stress from the consciousness and this conflict then turns out to be a physical symptom. The conversion disorders are difficult to distinguish from physical disorders. Therefore, many sufferers move from doctor to doctor, hoping to find a physical explanation for the symptoms.

However, there is also the assumption that conversion symptoms are more or less consciously used by those affected to avoid problems. The physical symptoms relieve the person in a situation that seems otherwise unresolvable to the person concerned. Experts speak in this case of primary disease gain. Due to the physical restriction, those affected also need care and often receive more affection than before. This positive aspect of impairment can sustain the dissociative disorder as it benefits sufferers.

Dissociative disorder: risk factors

The susceptibility to a dissociative disorder increases when the body is not adequately supplied. A dissociative disorder can be triggered by lack of sleep, lack of drinking or lack of exercise.

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Dissociative disorder: examinations and diagnosis

Important for the diagnosis of a dissociative disorder are the symptoms and symptoms, about which the affected person reports. For example, some patients suffer from frequent memory lapses or often find themselves in places without knowing how they got there.

Personal background questions also help the doctor / therapist to diagnose the dissociative disorder (for example, questions about the current life situation, family background, potential family mental health problems). Information from third parties (for example, previous medical findings, for minors: reports from parents and teachers) is also helpful here.

In addition, a therapist or doctor in conversation with the patient pays attention to possible signs of a dissociative disorder. For example, frequent memory gaps that a patient shows during visits to the therapist may indicate a dissociative disorder.

A dissociative disorder can only be diagnosed if organic causes have been excluded. Because the symptoms can also be triggered by epilepsy, migraine, tumors in the brain or other diseases. The doctor examines, for example, the visual, olfactory and taste nerves, as well as the movements and reflexes. In some cases, an image of the brain is additionally made using computed tomography (CT). For minors, the doctor also looks for possible signs of abuse or abuse.

The therapist bases his or her diagnosis on special questionnaires or given interview guidelines ("diagnostic interviews"). To determine the dissociative disorder, the therapist might ask the following questions: