Decoding dissociation: Everything you need to know about dissociative disorders

Dissociation is a condition that can pull people away from their own thoughts, identity or even reality itself. It is the mental process of disconnecting from yourself and the world around you, disrupting everyday functioning.

These complex disorders have far-reaching effects on the self, often explored in a psychology course to understand their profound impact on both the development of personality and the protection mechanisms to overcome trauma.

The types of dissociative disorders

Dissociation itself is a problem that manifests in different ways; some disorders cause changes in one’s identity, while others affect the ability to recall information or persistent detachment.

There are three main types of dissociative disorders listed in the Diagnostic and Statistical Manual (DSM-5):

Dissociative Identity Disorder (DID)

This identity disorder that starts in childhood is relatively rare, with only about 1-1.5 per cent of people experiencing DID, however, it can have far-reaching effects on someone’s life.

The most striking symptom of DID – formerly known as multiple personality disorder – is the presence of two or more distinct ‘personality states’. The DSM stipulates this as “disruption of identity characterised by two or more distinct personality states”. These states must affect “behaviour, consciousness, memory, perception, cognition and/or sensory-motor functioning”.

Split personality aside, the DSM requires four other categories to be met for a diagnosis: recurrent gaps in recalling everyday events (while the ‘other’ personalities dominate), the symptoms must cause distress or impairments in functioning, and the symptoms are not caused by a drug (e.g. blackouts or ambien sleepwalks). Finally, the disturbance cannot be part of a specific cultural practice, like a shamanic trance state or vodou possession.

While movies aren’t exactly the best case studies, anyone who has seen Fight Club can conceptualise what DID might look like.

Dissociative Identity Disorder (DID) often develops in response to severe physical or emotional abuse, typically during childhood. The trauma prevents the formation of a unified sense of self because some aspects of the experience are just too painful to integrate into the overall personality.

In other words, dissociation to survive, cope and protect, is a recurrent theme among these disorders.

Dissociative amnesia

Not being able to remember crucial information about yourself can be worrying, and that’s the hallmark of dissociative amnesia. According to the DSM-5, this disorder involves an inability to recall important autobiographical information, often related to trauma or stress, that goes beyond normal forgetfulness.

The other DSM criteria stipulate that the dissociative amnesia must not be due to drugs or neurological problems like seizures and that the symptoms are not better explained by other disorders like DID, posttraumatic stress disorder, or acute stress disorder.

The key here is that the missing information is important and autobiographical – something that one would usually remember, like people’s names or whole periods of time.

Depersonalisation or derealisation disorder

Up until now, we have described the experience of dissociation, so where do the other two aspects come into it?

• Depersonalisation: Feelings of unreality or detachment, as if observing oneself from the outside, including one’s thoughts, emotions, sensations, body or actions. This may involve altered perceptions, a distorted sense of time, a sense of being disconnected from oneself, or emotional and physical numbness.
• Derealisation: A sense of unreality or detachment from the environment, where people or objects may appear unreal, dreamlike, foggy, lifeless or visually distorted.

When these symptoms occur together, the individual must still be able to know that what they’re experiencing is a symptom, not a change in reality. This is known as reality testing.

Again, the symptoms cannot be due to drugs, neurological changes or be better described by another mental health condition, like schizophrenia, panic attacks, depression, stress-related disorders, PTSD or another dissociative disorder.

This disorder is episodic and can last for hours to days, usually beginning around 16. It may emerge suddenly during periods of intense stress or emotional conflict, and while the person remains aware that their experiences are unreal, the symptoms can be deeply distressing and interfere with daily life.

Dissociation and trauma

In essence, dissociation allows the self to escape the horrors of a traumatic experience. In psychology, this is described as a primitive or immature defence mechanism, because in the moment it is a useful way to protect yourself from trauma, but in the long run it can interfere with normal personality development. Hence why conditions like DID are far more likely in children who experience neglect or abuse.

Of course, compartmentalising emotions and assigning them to ‘someone else’ does not exactly protect you from an abuser, so those with DID can take on strong alter ego personalities like Tyle Durdon in Fight Club, who is capable of combating the fears the narrator’s original self cannot.

Common misconceptions and misdiagnoses

Many aspects of dissociation are common across psychiatric disorders. For instance, borderline personality disorder (BPD) involves depersonalisation and derealisation, but in response to emotional distress rather than distinct identity states or dissociation.

DID can be mistaken for schizophrenia as delusions and disorganised thought/speech can look like multiple identities. However, DID is not a psychotic disorder, meaning the symptoms do not revolve around an altered perception of reality; instead, the focus is on the manifestation of personality.

A common misconception of both schizophrenia and DID is that these people are inherently dangerous – they are not. People with DID are statistically no more dangerous than anyone else, and most schizophrenics are not violent to others; sadly, the same cannot be said for themselves.

Living with dissociative disorders

Living with a dissociative disorder can be confusing, isolating, and exhausting but understanding the condition is the first step toward healing. And healing is entirely possible. There are several treatments for dissociative disorders, the most common being talk therapy. In the case of DID, trauma-focused Cognitive Behavioural Therapy (tf-CBT) is effective in managing symptoms.

Ultimately, raising awareness about dissociative disorders helps challenge the harmful myths that surround them. Media misrepresentations have done real damage, but education, empathy and proper diagnosis can change lives. Dissociative disorders deserve the same level of seriousness, care and clinical attention as any other mental health condition.

Whether you’re a student, a clinician, or someone living with these experiences, understanding dissociation can foster greater compassion – and a more accurate view of the human mind’s incredible ability to adapt, protect and survive.

Disclaimer: Please note, this article does not serve as medical advice. If you suspect you or someone you care for is suffering from a dissociative disorder, contact one of the many health helplines, your family doctor or a hospital.