Dissociative disorder is the generic term for a number of mental illnesses that are mostly related to traumatic experiences or severe psychological stress. Those affected lose the ability to combine perceptions into a normal, extensive experience – this manifests itself, for example, in memory loss, movement or identity disorders. How the dissociation shows and what helps against it.
- If started early, psychotherapy can have a very beneficial effect on the course of a dissociative disorder.
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Dissociative disorders are characterized by signs of loss of perception, memory or physical functions as well as by disorders of the identity consciousness. They rarely occur as a single disorder, but often in connection with other mental disorders such as anxiety, depression, schizophrenia or borderline personality disorder. An estimated 1.4 to 4.6 percent of the population are affected, women three times more often than men. When they first appear, those affected are usually under 30 years old.
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Forms and symptoms of dissociative disorder
A dissociative disorder results in a partial or complete separation (Latin: dissociatio) from normally related psychological abilities. The term "dissociative disorder" is used as a generic term for various clinical pictures that occur in isolation or in combination. Despite their great diversity, all dissociative phenomena have in common that they are perceived by those affected as unpleasant and worrying – often accompanied by the fear of "going crazy" or being mistaken for it. All symptoms can occur at different times and vary in intensity, often exacerbated by stressful situations.
Dissociative amnesia
In the case of dissociative amnesia, the person affected completely or partially lacks the memory of important, current events – mostly stressful or traumatic events such as a car accident or a robbery. The memory gap goes beyond normal forgetfulness: it is more pronounced or lasts longer.
Dissociative fugue
In the case of a dissociative fugue (escape), the person concerned unexpectedly leaves his home or his workplace and moves to another place. The fugue condition can last from a few hours to several months. The affected person appears normal to the outside and can continue to take care of himself. During the fugue he usually cannot remember his real identity, after the fugue he cannot remember the events during the flight.
Dissociative stupor
In the dissociative stupor, the voluntary movements, language and normal reactions to external stimuli are significantly reduced or are completely absent. Those affected are completely frozen, do not speak, do not respond to speech and do not eat or drink. At the same time, however, they breathe normally, have normal muscle tension and can assume an upright posture.
Dissociative trance
In a dissociative trance state, those affected lose their sense of their own identity. At the same time, their perception is limited to their immediate surroundings, the same movements and sentences are repeated again and again. Sometimes those affected act as if they are "possessed" or as if a higher power controls them.
Dissociative movement disorders
This disorder results in partial or complete paralysis of parts of the body, inability to coordinate movements and / or loss of speech. Shivering, cramping, muscle twitching and gait disorders occur without any detectable organic cause.
Dissociative seizures
These are sudden spasmodic movements that are reminiscent of an epileptic seizure. However, no loss of consciousness can be observed; no findings are shown in the EEG.
Dissociative sensitivity disorder
In this disorder, all or part of the sensory sensations are lost without any neurological findings. An impairment of the skin sensitivity or disturbances of the sight and hearing or the sense of smell are typical.
Depersonalization / derealization
We speak of “depersonalization” when one's own self is perceived as changed, alienated and unreal. Those affected do not experience any emotional reactions, their own actions appear automatic. At the same time, however, they react normally and appropriately to their environment.
With “derealization”, however, the environment is perceived as unreal and strange. For example, a previously known environment may suddenly appear strangely unknown to the person concerned or an unknown environment may be strangely known (“Deja-vu”).
Ganser syndrome
In this rare disorder, those affected talk or respond to the content of the conversation. This also applies to the simplest questions such as "What is 2 plus 2?", Which is why the disorder is also known as pseudodemence or pseudodebility. It often occurs in younger to middle-aged male patients and often in a forensic environment ("prison psychosis").
Dissociative Identity Disorder
The most severe form of dissociative disorder is dissociative identity disorder, which was formerly referred to as "multiple personality disorder". There are at least two clearly distinguishable personalities within a person who take turns controlling the behavior of the person concerned. The actions of the other sub-personalities are either not remembered at all or only vaguely.
Causes of a dissociative disorder
In 90 percent of cases, a dissociative disorder is preceded by a traumatic experience. Experts believe that it is a protective mechanism that protects the psyche from unbearable stress. Due to the increased release of the stress hormone cortisol, the ability to store and recall memories is impaired, unbearable experiences are pushed out of consciousness. If the person concerned is repeatedly exposed to stress, a mechanism is gradually established that runs automatically and is no longer dependent on specific loads as a trigger.
However, since only ten percent of people who have experienced trauma develop a dissociative disorder, it is believed that individual characteristics also increase the likelihood of dissociative symptoms. Traumatic childhood experiences seem to increase the risk of developing a dissociative disorder after another trauma. In addition, there seems to be a genetic disposition for dissociative disorders, and people who are particularly suggestible or particularly hypnotizable seem to have a greater tendency to dissociate.
Diagnosis: This is how a dissociative disorder is diagnosed
Dissociative disorders are often not recognized or misdiagnosed. On the one hand, this is because the symptoms are often associated with neurological diseases or a borderline disorder. On the other hand, there are often other mental illnesses that seem to explain the dissociative symptoms.
The first indication of the existence of a dissociative disorder is often the stories of the person concerned or their relatives. Typical are descriptions of gaps in memory or situations in which the person finds himself in a strange place without knowing how he got there. Sometimes the doctor or therapist notices that the person concerned keeps losing the thread or that his behavior suddenly and noticeably changes. In conversation, he tries to find out whether there has been trauma or severe psychological stress in the past. Standardized questionnaires are often used as a test for the structured recording of symptoms.
Before starting therapy, organic tests must be ruled out as the cause of the symptoms. Therefore, the reflexes, the visual, olfactory and taste nerves and the movement sequences are examined in order to rule out a brain tumor, epilepsy, a migraine or other diseases of the brain. In some cases, a computed tomography of the brain is also made.
Therapy: how to treat dissociative disorders?
As a rule, dissociative disorders are treated psychotherapeutically. Sometimes the affected person is only capable of therapy if the symptoms are reduced – in this case medication, exercise, art and / or music therapy are used. The therapy itself usually proceeds in two phases:
- In the Stabilization phase the person concerned is first informed in detail about the clinical picture. Gradually, the therapist builds a relationship of trust with the person concerned and helps him with emotional stabilization. Only when the person concerned feels safe and has learned methods for coping with stress and symptom control can the actual causes of the disease be addressed.
- In the Exposure phase possible trauma are then dealt with explicitly. With the help of various, gentle methods, the affected person is brought back to the traumatic experience, so that the previously separated experiences can be integrated into the other life memories and a return to normal everyday life is possible.
Dissociative disorder: course of the disease and prognosis
Most dissociative disorders last for a few weeks or months and then spontaneously go away. In some cases, however, chronic courses develop. The earlier the dissociative disorder is treated, the better its prognosis.