Is a dissociative identity disorder curable

Dissociative disorder

Dissociative disorder: description

Dissociative disorder is a complex psychological phenomenon. In response to an unbearable experience, those affected hide memories or even erase their own identity.

Healthy people perceive their ā€œIā€ as a unity of thoughts, actions and feelings. In the case of a dissociative disorder, this stable image of one's own identity is broken. Hence the name dissociation (Latin for separation, decay).

Such a split in consciousness is mostly related to a traumatic experience or serious conflict. Dissociative disorder often accompanies other mental disorders, such as depression, schizophrenia, or borderline personality disorder.

Dissociative disorder: forms of the disorder

Dissociative amnesia:

This is understood to mean a partial or complete loss of memory in connection with stressful events or problems. In very rare cases the memory of the entire previous life is lost.

Most of the time, the amnesia occurs in connection with a traumatic event. The loss of memory usually only affects certain scenes of the stressful experience or the time afterwards. Such a dissociative disorder could occur after a car accident, for example. The person can no longer remember the accident, or only partially. However, she did not suffer any brain damage that could explain the loss of memory. The memory loss usually gives up just as quickly as it occurred. Relapses are rare.

It is estimated that the risk of developing dissociative amnesia at some point in life is seven percent.

Dissociative fugue:

Triggered by a stressful event, the person affected suddenly leaves his home or workplace and assumes a new identity (fugue = flight). He cannot remember his previous life (amnesia). If he later returns to his old life, he usually no longer has any memories of his departure and the interlude in a different identity.

Experts estimate that the risk of this dissociative disorder over the course of life is only 0.2 percent.

Dissociative stupor:

Those affected hardly move or no longer move at all, no longer speak or do not react to light, noise or touch. In this state it is not possible to contact them. However, the person is not passed out because the muscles do not relax and the eyes move. The symptoms of dissociative stupor are not due to organic problems, but to psychological distress.

The dissociative stupor rarely occurs. Experts estimate that this dissociative disorder occurs over a lifetime in 0.05 to 0.2 percent of the population.

Dissociative disorders of movement and sensation:

In contrast to the other dissociative disorders, there is no memory loss (amnesia). Instead, there are motor or sensory failures that have no organic cause: Due to the dissociative movement disorder, for example, those affected can no longer stand freely, have coordination disorders or cannot perform voluntary movements in certain areas, for example as they are necessary for speaking.

Some people have dissociative seizures that are similar to epileptic seizures. However, a dissociative seizure is accompanied by no loss of consciousness. In the case of dissociative sensitivity and sensation disorders, either the normal skin sensation is lost in certain parts of the body or in the whole body. Or those affected can only partially or no longer see, smell or hear.

The incidence of dissociative disorders of movement and sensory perception is estimated to be around 0.3 percent. Women are affected more often than men.

Dissociative Identity Disorder (Multiple Personality Disorder):

Dissociative identity disorder is the most severe form of dissociative disorder. It is also known under the term "multiple personality disorder".

The personality of those affected is split into different parts. Each part has its own individual memory, preferences and behavior. Often the different parts of the personality differ greatly from one another. They also never occur at the same time, but alternate with one another.

In many cases, Dissociative Personality Disorder is the result of severe abuse.

You can read more about this in the article Multiple Personality Disorder.

Dissociative disorder: symptoms

A dissociative disorder manifests itself very differently from patient to patient. Some just lack the memory of a particular experience and may not even be aware that they have a memory gap. Others suffer from complete amnesia that obliterates the memory of their entire life. In the case of a dissociative identity disorder, on the other hand, the ego splits into different personalities, which then lead a life of their own.

Others suffer from severe physical symptoms such as paralysis. But even with one and the same person, symptoms can change from one moment to the next. A change in symptoms is characteristic of dissociative disorder.

While the symptoms of the various dissociative disorders, from memory loss to physical discomfort, vary widely, they have two characteristics in common.

According to the International Classification of Mental Disorders (ICD-10), there is no physical illness in dissociative disorders that could explain the symptoms and there is a convincing temporal relationship between the symptoms of the dissociative disorder and stressful events or problems.

If a dissociation affects the movement sequences, the symptoms are very similar to those of neurological diseases. It is therefore not easy to tell whether it is a dissociative disorder or another disease. Those affected can suffer from paralysis all over the body. Some can no longer stand or walk. Loss of voice can also indicate a dissociative disorder. In many cases, however, the symptoms resolve quickly. Depending on the form of the day, the symptoms often vary in severity. Stressful situations can make dissociative disorder worse.

A dissociative disorder can also manifest itself through self-harming behaviors. For example, some patients inflict cuts or burns in order to return to reality from the dissociative state.

Dissociative disorder: causes and risk factors

Dissociative disorder usually occurs in connection with traumatic life experiences. Severe stressful situations, such as accidents, natural disasters or abuse, overwhelm the psyche. The symptoms of dissociative disorders are a stress reaction to this excessive demand.

But not everyone reacts to stressful situations with a dissociation. The individual personality and environmental influences have an influence on the development of dissociative disorders. Among other things, the bond between parents and child influences how resistant children are to stress. Children who lack the necessary security and security in their parents' home are more prone to dissociative disorders.

The effects of negative experiences are also evident on a biological level. Extreme stress can change structures in the brain. For example, too much of the stress hormone cortisol damages the hippocampus, which is largely responsible for our memories. Researchers assume that the tendency to dissociate is also innate. However, the role of genes has not yet been clearly clarified.

Dissociative Disorder: Causes of Different Forms

As the cause of the amnesia and the Fugue the division of consciousness (dissociation) is considered. In this way, stressful or traumatic experiences can be saved in such a way that they are no longer accessible to the person concerned. Experts believe that this is a protective mechanism. If the psyche cannot process a situation because it is too threatening, it relieves itself through the separation.

The exact causes of the Stuporsin which patients do not respond to the outside world have not yet been adequately researched. Some experts compare the symptoms of dissociative stupor to the play dead reflex in animals. A threatening situation makes the person freeze all over. The play dead reflex is a survival strategy that some animals use when they have no way out.

As the cause of the Multiple personality disorder Above all, severe abuse experiences in childhood apply. The division into different personalities is a protection against unbearable experiences.

The dissociative Disorders of movement and sensation are also referred to as conversion disorders. Psychologists speak of conversion when mental states become visible through physical complaints. The psychoanalyst Sigmund Freud already stated that people suppress unbearable psychological stress from their consciousness and that this conflict then shows itself as a physical symptom. Conversion disorders are difficult to distinguish from physical illnesses. As a result, many sufferers switch from doctor to doctor in hopes of finding a physical explanation for the symptoms.

However, there is also the assumption that conversion symptoms are used more or less consciously by those affected to avoid problems. The physical symptoms relieve the person in a situation that does not seem otherwise solvable to the person concerned. In this case, experts speak of primary gain from illness. Due to the physical limitation, those affected also need care and often receive more affection than before. This positive aspect of the impairment can perpetuate the dissociative disorder as it benefits those affected.

Dissociative disorder: risk factors

The susceptibility to a dissociative disorder increases if the body is not adequately supplied. A dissociative disorder can be triggered by a lack of sleep, too little drinking, or a lack of exercise.

Dissociative Disorder: Investigations and Diagnosis

When diagnosing a dissociative disorder, the complaints and symptoms reported by the person concerned are important. For example, some patients suffer from frequent memory lapses or often find themselves in places without knowing how they got there.

Personal background questions also help the doctor / therapist to diagnose the dissociative disorder (e.g. questions about the current life situation, family background, possible psychological problems in the family). Information from third parties is also helpful here (e.g. previous medical reports, for minors: reports from parents and teachers).

In addition, a therapist or doctor pays attention to possible signs of a dissociative disorder when talking to the patient. Frequent gaps in memory that a patient shows during visits to the therapist / doctor can, for example, indicate a dissociative disorder.

A dissociative disorder can only be diagnosed when organic causes have been ruled out. Because the symptoms can also be triggered by epilepsy, migraines, tumors in the brain or other diseases. The doctor therefore examines the visual, olfactory and taste nerves, for example, as well as the movement sequences and reflexes. In some cases, an image of the brain is also taken using computed tomography (CT). In the case of minors, the doctor also looks for possible signs of mistreatment or abuse, among other things.

For the diagnosis, the therapist orients himself on special questionnaires or given conversation guidelines ("diagnostic interviews"). To determine the dissociative disorder, the therapist might ask the following questions:

  • Are you missing memories of certain parts of your life?
  • Do you sometimes find yourself in places without knowing how you got there?
  • Do you sometimes feel like you've done something that you can't remember? For example, do you find things in your home that you don't know how got there?
  • Do you sometimes feel like a completely different person?

Dissociative disorder: treatment

Dissociative disorders are treated as part of psychotherapy. Therapy usually consists of stabilization in the initial phase, symptom reduction and dealing with traumatic experiences. In order to bring hidden memories (such as dissociative amnesia) to the surface, patients are sometimes also hypnotized. Once access has been established, the person affected can begin to deal with the trauma with the help of the therapist. Depending on the severity, duration and severity of the symptoms, patients with dissociative disorders are treated on an outpatient, day-care or in-patient basis.

Dissociative disorder: stabilization and symptom reduction

At the beginning of the therapy, the therapist explains to the patient in detail about the clinical picture of the dissociative disorder. Even if the patient cannot be addressed, the therapist informs him of the disorder. Psychotherapists refer to this information as psychoeducation.

In the further course, the patient learns to be aware of his feelings and to relieve tension in good time. In order to reduce dissociative symptoms, the therapist works with the patient to develop strategies that will help them cope with stress. In addition, the patient learns to notice signs of an upcoming dissociative disorder in good time and to take action against it. If the patient nevertheless falls into a dissociative state, the therapist brings them back with the help of breathing and thought exercises. Strong smells or loud music are also used to bring the patient back to reality.

Dissociative disorder: dealing with the trauma

If there are traumatic experiences in the past, they are dealt with in therapy. If the patient is heavily stressed, the therapist pays attention to a step-by-step discussion that does not overwhelm the person concerned. The therapist uses various techniques so that patients do not fall into dissociation again during trauma processing. For this purpose, the person concerned should stand on a shaky surface, for example, while he talks about the memories.

Therapy for dissociative disorders of movement or sensation

People with a dissociative disorder of movement or sensation usually seek help from a doctor rather than a therapist because they believe their symptoms are physical. Many also do not want to be confronted with the fact that their problems may be psychological, which makes treatment difficult. The therapist tells the patient that the symptoms are real but that there is no physical cause. Only when the patient is convinced of this can the cause of the symptoms be tackled as part of psychotherapy.

Dissociative disorder: disease course and prognosis

A dissociative disorder often begins suddenly, triggered by a stressful event. Symptoms usually go away after a few weeks or months. In severe cases, however, those affected suffer from the symptoms for the rest of their lives or experience relapses again and again. There is a higher risk of an unfavorable outcome if the dissociative disorder Has been untreated for a long time and there are other mental disorders.

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