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- According to Diagnostic and Statistical Manual of Mental Disorders (DSM-5), dissociative disorders are manifested by a disruption in the continuity of normal integration of consciousness, memory, identity, emotion, body representation, motor control, perception of self and reality, and behavior (1).
- Common symptoms to all dissociative disorders include depersonalization, derealization, fragmentation of identity, episodes of amnesia, dysphoria, and maladaptive behaviors.
- Disorders include dissociative identity disorder, dissociative amnesia, depersonalization/derealization disorder, other specified dissociative disorder, and unspecified dissociative disorder.
- System(s) affected: nervous
- Synonym(s): hysteria, hysterical neurosis—dissociative type; Ganser syndrome
Decrease in frequency and intensity of dissociative symptoms; medication side effects are more likely.
Suspect abuse or neglect.
- Predominant age: adolescents and young to middle-aged adults; rare as a new illness in the elderly. If untreated, it may linger from childhood into adulthood and old age.
- Predominant sex: female > male (2:1)
- Transient symptoms of depersonalization or derealization in the general population are common.
- Lifetime prevalence rate is 26–74%.
- 31–66% occurring at the time of a traumatic event
- Up to 70% of young adults report short periods of dissociative experiences that are self-limiting and resolve spontaneously without any treatment.
- Dissociative amnesia occurs in 2–7% of the general population.
Etiology and Pathophysiology
Common link to a history of emotional/physical trauma
- Exposure to neglect, abuse, and trauma in childhood (2)[A],(3)[B]
- Physical, emotional, verbal, or sexual abuse in childhood and adolescent years
- Sudden and severe trauma or threat to psychological or physical integrity
- Sudden and unexpected exposure to watching others being killed or severely injured (as in industrial or car accident)
- Tendency to cope with life’s stresses by excessively using an escape mechanism of daydreaming and/or dissociation
- A tendency of coping with trauma, internal, and interpersonal conflicts by the use of dissociation
- Psychological/social support to cope with the trauma/abuse was unavailable.
- Family history of dissociative disorders or posttraumatic stress disorder (PTSD)
- Child abuse prevention via parent education and community agency intervention
- Crisis intervention following individual trauma or disasters may prevent dissociative disorders.
Commonly Associated Conditions
PTSD, anxiety disorders, depression, somatoform disorders, chronic pain, insomnia, gender dysphoria