Dissociative disorder and PTSD

Clinically, the dissociative subtype of PTSD is linked to higher levels of PTSD severity, a higher prevalence of derealization and depersonalization symptoms, a longer history of early life trauma, and more comorbid mental disorders. When traumatic memories are recalled, PTSD patients with dissociative symptoms have diverse psychophysiological and neurological reactions.

Dissociative disorder
Dissociative disorders are serious disorders characterized by a loss of connection and continuity between ideas, memories, environment, activities, and identity. Dissociative disorders generate problems in everyday life because people with them flee reality in uncontrollable and unhealthy ways.

Dissociative disorders are a type of psychosis that develops in response to trauma and aids in the eradication of painful memories. The sort of dissociative disorder you have influences your symptoms, which can range from amnesia to alternate identities. Stress can exacerbate symptoms and make them more visible for a short period of time.

Types of dissociative disorders
The three types of dissociative disorders include:

  1. Dissociative amnesia
  2. Depersonalization/derealization disorder
  3. Dissociative identity disorder

Dissociative amnesia:
The main symptom of dissociative amnesia is memory loss that is more severe than typical forgetfulness and cannot be explained by a medical condition. This includes difficulty remembering details about yourself, events, or people in your life, especially if it happened during a difficult period of your life.

Dissociative amnesia can be localized to events in a specific time frame, such as severe warfare, or it can more uncommonly be full memory loss. It may occasionally entail travel or a disoriented wandering away from your life (dissociative fugue).

Amnesia normally strikes suddenly and lasts minutes, hours, or, in rare cases, months or years.

Dissociative amnesia is uncommon; approximately only 1 percent of men and 2.6 percent of women in the overall population suffer from it. The environment plays a role as well; dissociative amnesia rates tend to rise after natural disasters and during wartime.

Depersonalization/derealization disorder:
This is characterized by an ongoing or episodic experience of detachment or being outside of yourself as if watching a movie and observing your actions, feelings, ideas, and self from afar (depersonalization).

Other people and objects around you may appear disconnected, foggy, or dreamy; time may appear to be slowed or sped up, and the world may appear surreal (derealization).

Depersonalization, derealization or both may occur. Symptoms, which can be quite upsetting, can last only a few minutes or linger for years.

Severe stress is a common trigger for the illness. After all other causes have been ruled out, the diagnosis is based on symptoms. Psychotherapy is used with medication to treat any concomitant depression and/or anxiety.

Around half of the population has undergone at least one temporary experience of depersonalization or derealization. Only approximately 2 percent of persons, on the other hand, fit the criteria for depersonalization/derealization disorder.

Dissociative identity disorder:
This disorder, formerly known as multiple personality disorder, is marked by the “switching” of identities. There is a disjointed sense of identity with certain behaviors, or “identities” that can lead to distorted senses of time, difficulties with memory, and erratic behaviors.

Each identity may have its own name, personal history, and traits, such as voice, gender, mannerisms, and even physical characteristics like the necessity for spectacles.

There are also distinctions in how one identity is acquainted with the others. Usually the personalities only are present one at a time. Dissociative identity disorder is frequently accompanied by dissociative amnesia and dissociative fugue.

Dissociative identity disorder may be predominantly caused by a psychological reaction to interpersonal and environmental pressures, particularly during early childhood when emotional neglect or abuse can disrupt personality development.

Studies show that only 1 percent of the population suffers from this disorder. There is no one current treatment that can cure dissociative identity disorder but engaging in long term treatment of various kinds can be helpful overall. Psychotherapy and Clinical Hypnosis can be helpful. Treatment of co-morbid disorders like Borderline Personality Disorder can be helpful in reducing the distress and dysfunction overall.

Media representation for dissociative identity disorder has been problematic for a long period of time. Movies represent people with this disorder to be the evil antagonist where their disorder is the key element in making them carry out evil activities. Media can contribute to the barrier of shame and unacceptance around people with dissociative identity disorder, further isolating them. As a result of the stigma, often, they refuse to seek help or even acknowledge their disorder due to fear of rejection by those around them.

Understanding psychiatric disorders can take some time, and using reliable resources to learn more about disorders is far more helpful than making generalized sweeping assumptions based on media. It’s important we do not represent incorrect information, and not aid in perpetuating misinformation.

Signs and symptoms of dissociative disorders:
Symptoms may vary depending on what kind of disorder one is suffering from, but common signs include:

  • Certain time periods, events, persons, and personal information are lost in memory (amnesia).
  • A feeling of being cut off from yourself and your feelings
  • A skewed and surreal perception of the people and things around you
  • A muddled sense of self
  • Significant troubles or stress in your relationships, employment, or other vital aspects of your life
  • Inability to handle emotional or professional stress effectively

Causes and risk factors of dissociative disorders:
The majority of people develop dissociative disorders as a means of coping with trauma. Children who have been subjected to long-term physical, sexual, or emotional abuse or, less frequently, a terrifying or extremely unpredictable home environment are more likely to develop these diseases. Dissociative disorders can also be triggered by the stress of war or natural disasters.

Complications and associated problems are more common in people with dissociative disorders, such as:

  • Self-harm
  • Suicidal ideas and actions
  • Sexual dysfunction
  • Drug abuse and alcoholism
  • Anxiety and depression disorders
  • Post-traumatic stress disorder (PTSD)
  • Psychiatric disorders
  • Sleep disorders such as nightmares, insomnia, and sleepwalking.
  • Anorexia nervosa and bulimia nervosa

Diagnosis and treatment:
Typically, diagnosis entails assessing symptoms and ruling out any medical conditions that could be causing them. To determine your diagnosis, you may be referred to a mental health specialist for testing and diagnosis.

Evaluation for the same may include:

  • Physical exam
  • Psychiatric exam
  • Diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment includes psychotherapy and medication, if necessary. Medication may include anti-depressants and others that help control the symptoms that appear as a result of the disorders. There is no singular, specific medication to treat dissociative disorders.

Post-traumatic stress disorder:
People who have encountered or witnessed a traumatic incident such as a natural disaster, a catastrophic accident, a terrorist attack, war/combat, rape, or who have been threatened with death, sexual violence, or serious injury, may develop post-traumatic stress disorder (PTSD).

PTSD affects about 3.5 percent of adults in the United States each year, and 1 in every 11 people will be diagnosed with it at some point in their lives. PTSD affects twice as many women as it does males. Three ethnic groups are disproportionately afflicted and have greater rates of PTSD than non-Latino whites: U.S. Latinos, African Americans, and American Indians.

An individual with PTSD may avoid circumstances or people that remind them of the traumatic experience, and they may have intense, unpleasant reactions to seemingly innocuous things like loud noises or unintentional touches.

The link between post-traumatic stress disorder and dissociative disorder:
Trauma (particularly childhood abuse and/or neglect) and dissociative disorders have a strong association, and the relationship is crucial in both directions.

Long-term trauma is regarded to be a fundamental cause of dissociative disorders, with dissociation emerging as a coping method by allowing people to detach themselves from an otherwise painful tragedy.

Dissociation and post-traumatic stress disorder (PTSD) are linked and often occur simultaneously, with some believing dissociative disorders to be a subtype or subgroup of PTSD. However, the symptoms of the two illnesses, as well as their consequences, might be extremely different.

PTSD can emerge as a result of a single traumatic event as a child or as an adult (for example, witnessing a violent event or natural disaster). PTSD is less dependent on age and more connected to the severity of the traumatic experiences; dissociative disorders, on the other hand, are more associated with vulnerability in specific age groups. Trauma and stress in childhood, not adulthood, are the most common causes of dissociative disorders. They are also the result of long-term trauma (for example, repeated episodes of physical, emotional, or sexual abuse).

With PTSD, dissociation is common, although not to the extent of dissociative disorders. The symptoms of PTSD can exacerbate dissociation in those with PTSD, however, it is usually only temporary.

Even though some disorders are life-long, seeing a mental health professional and seeking help may help you lead a better life by adopting healthier coping mechanisms. You don’t have to carry the burden of how your body and mind choose to respond to traumatic experiences alone!

REFERENCES:

Inland Psychiatric Medical Group

Inland Psychiatric Medical Group



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