DISSOCIATIVE DISORDERS

Dissociative Disorders are dissociations (duh) from reality. Compare that to psychosis, which is the loss of reality. DDs are a kind of variant of psychosis. These patients perceive and understand reality, but they just weirdly remove their consciousness from the whole situation. DDs are (a) rare, (b) always caused by overwhelming stress and (c) almost always in females. Dr. Smith suggests that DDs don’t exist as discrete entities, but are rather colorful late-stage symptoms of chronic untreated PTSD. Furthermore, treatment is aimed at fixing the comorbids. Just know how to spot these. 

Dissociative Identity Disorder

dissociation from personality

A.k.a. multiple personality disorder. They aren’t delusional or psychotic, they dissociate from reality to such a degree that they end up creating these discrete personality states. It’s rare and variable, but often one personality (or alter) can’t remember what happened while the other personality took over. 100% overlap with PTSD. Usually associated with severe childhood sexual trauma. Treatment consists of the kitchen sink (therapy, hypnosis, antipsychotics, electricity).

Dissociative Amnesia

dissociation from identity

During a stressful period, these patients selectively forget their own autobiographical memories (name, job, home). It usually wears off pretty quickly, and the memories will return. If the patient is alone when it starts, they’re at risk for entering a Fugue State. “Fugue” is Latin for “flee.” These guys wake up one day without any memory of their former selves. They tend to set off on the open road, and begin new lives (get jobs, date, etc)! They may “come to” in a few weeks/months/years. 

Depersonalization Disorder

dissociation from the self

Dissociation from your own persona during extreme stress. It’s a foggy, dream-like state of separation from one’s self, and they no longer relate to their own body. Basically it’s an out of body experience. They can’t control their actions. Meanwhile their surroundings seem quite normal to them. 

Derealization Disorder

dissociation from the surroundings

Dissociation from their surrounding reality during extreme stress. It’s also a foggy, dream-like state where their surroundings don’t feel real to them. The room that they’re currently in will suddenly feel quite alien. In comparison, their own self seems very normal to them.