Dissociation FAQs - ISSTD (2024)

JThere are four main categories of dissociative disorders as defined in the standard catalogue of psychological diagnoses used by mental health professionals in North America, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The four dissociative disorders are: Dissociative Amnesia, Dissociative Fugue, Dissociative Identity Disorder, and Depersonalization Disorder (American Psychiatric Association, 2000; Frey, 2001; Spiegel & Cardeña, 1991).

DISSOCIATIVE AMNESIA is characterized by an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness. The amnesia must be too extensive to be characterized as typical forgetfulness and cannot be due to an organic disorder or DID. It is the most common of all dissociative disorders, frequently seen in hospital emergency rooms (Maldonado et al., 2002; Steinberg et al., 1993). In addition, Dissociative Amnesia is often embedded within other psychological disorders (e.g., anxiety disorders, other dissociative disorders). Individuals suffering from Dissociative Amnesia are generally aware of their memory loss. The memory loss is usually reversible because the memory difficulties are in the retrieval process, not the encoding process. Duration of disorder varies from a few days to a few years (American Psychiatric Association, 2000; Frey, 2001; Maldonado et al., 2002; Spiegel & Cardeña, 1991; Steinberg et al., 1993).

DISSOCIATIVE FUGUE is characterized by a sudden, unexpected travel away from home or one’s customary place of work, accompanied by an inability to recall one’s past and confusion about personal identity or the assumption of a new identity. Individual’s suffering from Dissociative Fugue appear “normal” to others. That is their psychopathology is not obvious. They are generally unaware of their memory loss/amnesia (American Psychiatric Association, 2000; Frey, 2001; Maldonado et al., 2002; Spiegel & Cardeña, 1991; Steinberg et al., 1993).

DEPERSONALIZATION DISORDERis characterized by a persistent or recurrent feeling of being detached from one’s own mental processes or body. Individuals suffering from Depersonalization Disorder relate feeling as if they are watching their lives from outside of their bodies, similar to watching a movie (American Psychiatric Association, 2000; Frey, 2001; Guralnik, Schmeidler, & Simeon, 2000; Maldonado et al., 2002; Simeon et al., 2001; Spiegel & Cardeña, 1991). Individuals with Depersonalization Disorder often report problems with concentration, memory and perception (Guralnik et al., 2001). The depersonalization must occur independently of DID, substance abuse disorders and Schizophrenia (Steinberg et al., 1993).

DISSOCIATIVE IDENTITY DISORDER(previously known as Multiple Personality Disorder) is the most severe and chronic manifestation of dissociation, characterized by the presence of two or more distinct identities or personality states that recurrently take control of the individual’s behavior, accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. It is now recognized that these dissociated states are not fully-formed personalities, but rather represent a fragmented sense of identity. The amnesia typically associated with Dissociative Identity Disorder is asymmetrical, with different identity states remembering different aspects of autobiographical information. There is usually a host personality who identifies with the client’s real name. Typically, the host personality is not aware of the presence of other alters (American Psychiatric Association, 2000; Fine, 1999; Frey, 2001; Kluft, 1999; Kluft, Steinberg & Spitzer, 1988; Maldonado et al., 2002; Spiegel & Cardeña, 1991; Steinberg et al., 1993). The different personalities may serve distinct roles in coping with problem areas. An average of 2 to 4 personalities/alters are present at diagnosis, with an average of 13 to 15 personalities emerging over the course of treatment (Coons, Bowman & Milstein, 1988; Maldonado et al., 2002). Environmental events usually trigger a sudden shifting from one personality to another (Maldonado et al., 2002).

DISSOCIATIVE DISORDER NOT OTHERWISE SPECIFIED (DDNOS): DDNOS includes dissociative presentations that do not meet the full criteria for any other dissociative disorder (American Psychiatric Association, 2000; Steinberg et al., 1993). In clinical practice, this appears to be the most commonly presented dissociative disorder, and may often be better characterized by Major Dissociative Disorder with partially dissociated self states (Dell, 2001).