The term “dissociative disorders” refers to disorders of movement, perception, identity, memory, and consciousness. They are also known as conversion disorders. These are disorders of a physical function (sensation, sensory perception, and motor function) that do not correspond to the concepts of the anatomy and physiology of the central or peripheral nervous system. Initially, however, one might suspect a neurological (“pseudoneurological”) or other somatic disorder. The treatment of choice is psychodynamic or psychoanalytic psychotherapy. In severe cases, inpatient treatment may also be indicated.
Below you will find further information as well as a selection of specialists in dissociative disorders.
Definition: Dissociative Disorders
Dissociative identity disorder typically develops during childhood as a result of traumatic experiences.
Most conversion disorders occur acutely and temporarily and remit (subside) quickly. They can therefore appear suddenly and disappear just as suddenly after a few weeks or months. If they persist for more than two years, the untreated course is often chronic.
Those affected often experience other disorders at the same time. These include, in particular, personality disorders or somatoform disorders.
Patients are often regarded as physically ill and treated somatically (for physical symptoms) for years. For this reason, the prevalence of dissociative disorders cannot be accurately estimated. Overall, between 0.5 and 4.5 percent of the population may be affected, with women being three times as likely to be affected as men.
What are the symptoms of dissociative disorders?
In dissociative disorders,
- memory content,
- body sensations, or
- movements
become separated from normal consciousness and are no longer under the person’s control. In the case of bodily functions, this can manifest as paralysis or convulsive-like symptoms. There are no underlying organic abnormalities.
Dissociative amnesia: Recurrent (repeated) or one-time memory gaps regarding specific life events or life phases. The amnesia often relates to traumatic, otherwise stressful, or conflict-ridden life situations.
Dissociative fugue (pathological wandering): A sudden and unexpected departure from one’s familiar surroundings. Amnesia regarding the past and one’s personal circumstances during this state.
Dissociative stupor (dissociative paralysis): A state of stupor characterized by a lack of movement and cessation of movement, as well as
- mutism,
- inactivity, and
- failure to respond to environmental and pain stimuli,
- refusal to eat or drink.
Depersonalization and derealization syndromes: One’s sense of self is altered, alienated, and perceived as unreal (depersonalization). Thoughts, feelings, and actions are no longer experienced as belonging to the self (as if one were a robot). Other sensory perceptions (hearing, seeing, etc.) and general bodily sensations (hunger, thirst, appetite, etc.) may also be disturbed.
Dissociative Seizures: Paroxysmal (occurring in episodes), involuntary behavioral patterns that mimic epileptic seizures. No seizure activity can be detected in the brain. They are also characterized by a sudden, temporary disruption of control over motor, sensory, autonomic, cognitive, and emotional behavioral patterns.
Dissociative Identity Disorder: This syndrome (also known as multiple personality disorder) is the most severe form of dissociative identity disorders. The prevalence of this condition is relatively unclear.
A central feature is the presence of at least two distinguishable sub-identities or personality states. Each of these takes control of the affected person’s behavior. At the same time, there is amnesia regarding the other identity.
These are dissociated aspects of the overall personality, each of which manifests in
- specific abilities,
- age,
- gender,
- emotional state, and other factors
. The shift between these states can be triggered by various stimuli, often associated with trauma. In addition, all symptoms of other dissociative disorders (amnesia, fugue, etc.) may be present.
Extremely severe childhood trauma is believed to be responsible for the development of these dissociative disorders. This disorder has been little studied scientifically.
Dissociative disorders can be treated with psychotherapy © Photographee.eu | AdobeStock
Treatment of Dissociative Disorders
Dissociative disorders should be treated with psychotherapy. The goal of treatment is for the patient to understand the psychological nature of their condition and to seek psychological or social solutions. This is often difficult because those affected are firmly convinced that they are suffering from a physical illness. When they are referred for psychotherapy, they feel that their providers are labeling them as malingerers.
Depending on the severity, either short-term psychodynamic therapy or long-term psychodynamic treatment may be necessary. The latter may also require inpatient care and should be supplemented by specific forms of trauma therapy, such as imaginative trauma therapy or EMDR therapy.
Medical treatment is also indicated for relevant comorbid conditions, such as depression.
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