Dissociative Disorders

By the clinical team at Next Step Psychiatry • Lilburn, GA

What Is Dissociation?

Dissociation is a disconnection between a person's thoughts, feelings, surroundings, or identity. Mild dissociation is common and normal, like zoning out during a long drive or becoming so absorbed in a book that you lose track of time. Dissociative disorders occur when dissociation becomes chronic, involuntary, and disruptive to functioning. They almost always develop as a response to overwhelming trauma, particularly in childhood. The dissociative response essentially allows the mind to distance itself from an experience that is too much to process, creating a protective buffer between the person and their pain.

Types of Dissociative Disorders

The DSM-5 recognizes three primary dissociative disorders. Dissociative Identity Disorder (DID), formerly called multiple personality disorder, involves the presence of two or more distinct personality states with discontinuities in sense of self. It is far more common than previously believed, affecting approximately 1 to 1.5 percent of the general population. Depersonalization/Derealization Disorder involves persistent feelings of being detached from your own body (depersonalization) or that the world around you is unreal (derealization). Dissociative Amnesia involves inability to recall important autobiographical information, usually related to trauma, that goes beyond normal forgetting.

Symptoms Beyond the Diagnosis

Dissociative symptoms exist on a spectrum. People may experience gaps in memory for daily events, feeling like they are watching themselves from outside their body, emotional numbness or detachment, difficulty recognizing themselves in the mirror, hearing internal voices, finding evidence of actions they do not remember performing, time loss, and sudden shifts in mood, behavior, or skills. These symptoms are often misdiagnosed as other conditions including bipolar disorder, schizophrenia, ADHD, or borderline personality disorder. Accurate diagnosis typically requires clinicians experienced with dissociative presentations.

Treatment Approaches

Treatment for dissociative disorders follows a phased approach. The first phase focuses on stabilization, safety, and skill-building, including grounding techniques, emotion regulation, and establishing a therapeutic alliance. The second phase involves processing traumatic memories at a pace the patient can tolerate. The third phase focuses on integration and building a cohesive life narrative. There are no medications specifically approved for dissociative disorders, but psychiatric medications can effectively treat co-occurring symptoms like depression, anxiety, insomnia, and PTSD. Treatment is typically long-term but can be profoundly life-changing.

Finding Specialized Care

Dissociative disorders require clinicians with specialized training and experience. At Next Step Psychiatry, we can evaluate for dissociative symptoms, manage co-occurring psychiatric conditions with medication, and provide referrals to therapists trained in dissociative disorder treatment in the Atlanta area. If you experience persistent dissociative symptoms, it is worth pursuing an evaluation. Understanding what you are experiencing is the first step toward gaining control over it.

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider. If you or someone you know is in crisis, call 911 or the 988 Suicide & Crisis Lifeline.