Description

• 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, 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

Geriatric Considerations
Decrease in frequency and intensity of dissociative symptoms; medication side effects are more likely.

Pediatric Considerations
Suspect abuse or neglect.

Epidemiology

Incidence

• Predominant age: adolescents and young to middle-aged adults; rare as a new illness in the elderly
• Predominant sex: female > male (2:1)

Prevalence

• Transient symptoms of depersonalization or derealization in the general population are common but are typically self-limited and resolve spontaneously without any treatment.
• Lifetime prevalence rate ranges from 10% in the general population up to 46% in psychiatric inpatients.
• 31–66% occur at the time of a traumatic event.
• Dissociative amnesia occurs in 2–7% of the general population.

Etiology and Pathophysiology

History of emotional/physical trauma is common.

Risk Factors

• Exposure to chronic neglect, abuse, and trauma in childhood or adolescence (2,3)
• Sudden and severe trauma or threat to psychological or physical integrity
• Exposure to watching others being killed or severely injured (tendency to cope with life stressors, trauma, and interpersonal conflict by excessive use of escape mechanism of daydreaming and/or dissociation)
• Psychological/social support to cope with the trauma/abuse was unavailable.
• Family history of dissociative disorders or posttraumatic stress disorder (PTSD)

General Prevention

• 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, borderline personality disorder, avoidant personality disorder, substance abuse