Psychiatric diagnoses

Trauma, dissociation and DID

Dissociation may occur when we are overwhelmed by impressions that are too difficult to handle. The cause is usually traumatic stress, and the symptoms can be numerous and dramatic. Misinterpretations and a long struggle to obtain a diagnosis are common.

What is dissociation?

Dissociation means that the body keeps experiences and actions detached from their conscious awareness. The condition causes disordered interactions between a person’s memory, identity, perception, emotions, motor control and behaviour.

Traumatic stress is the most common cause of dissociation. In a traumatic situation, some people may block out their experience so that they feel as if they are “outside themselves”. As a result, they may not understand the situation and are unable to react rationally. Dissociation is the body’s way of blocking out terrible or shameful memories and events, in order to reduce the anxiety they produce. It may manifest itself when the person does not remember the events or the feelings they aroused.

Dissociation may be caused by difficult childhood circumstances where there was abuse, natural disasters, genocide or family crises with infidelity. Comorbidity with other mental disorders is common, especially PTSD but also depression, anxiety and addiction. Dissociation is common in emotionally unstable personality disorder (read more about this diagnosis here).

What does dissociative identity disorder (DID) mean?

Dissociative identity disorder was formerly known as multiple personality disorder. It is a rare illness that causes parts of the personality to “separate” from each other. This produces a fragmented personality that disrupts a person’s sense of who they are and control over their actions. The condition can be mistaken for schizophrenia, and it feels as though someone else is taking control over a person’s body.

The sick person has several different personalities with different patterns of movement, voices, behaviours, memories and experiences, and alternates rapidly between them. 90 percent of people who develop this illness have experienced traumatic events such as abuse or sexual abuse during childhood. Most are women and half of them have tried to commit suicide.

How does this affect a person’s life?

Dissociative disorders may give the sick person feelings of unreality, numbing or feelings of being detached from their body (depersonalisation) or the environment (derealisation). In more severe cases, the person may become inaccessible, stop responding to sensations and have difficulty controlling their body of their own will. Seizures similar to epilepsy may occur. Many people may believe they have developed a serious bodily disease.

Diagnosis and treatment

Patients seeking care for dissociative conditions are often misunderstood or not believed, which contributes to the difficulty healthcare services have in diagnosing the illness. Thorough medical examinations are required to rule out the symptoms being due to a physical illness, which may take a long time. Next the most important task is to find out what caused the problems, often with a therapist in the psychiatric field.

If you suspect that you or a relative suffers from dissociation, you can contact the health centre or Allmänpsykiatrin, the mental health services, for further guidance. Although dissociative symptoms may be dramatic and difficult to understand, it is important to remember that treatment that helps this condition is available. Treatment may consist of psychotherapy focused on trauma treatment, as well as medication.