In-Depth: Understanding Dissociative Disorders
Dissociation is a common defense/reaction to stressful or traumatic situations. Severe isolated traumas or repeated traumas may result in a person developing a dissociative disorder. A dissociative disorder impairs the normal state of awareness and limits or alters one’s sense of identity, memory, or consciousness.
Once considered rare, recent research indicates that dissociative symptoms are as common as anxiety and depression, and that individuals with dissociative disorders (particularly dissociative identity disorder and depersonalization disorder) are frequently misdiagnosed for many years, delaying effective treatment. In fact, persons suffering from dissociative identity disorder often seek treatment for a variety of other problems including depression, mood swings, difficulty concentrating, memory lapses, alcohol or drug abuse, temper outbursts, and even hearing voices, or psychotic symptoms. People with dissociation often also seek treatment for a variety of medical problems including headaches, unexplained pains, and memory problems.
Many people have symptoms that have gone undetected or untreated simply because they were unable to identify their problem, or were not asked the right questions about their symptoms. Because dissociative symptoms are typically hidden, it is important to see a mental health professional who is familiar with recent advances in the ability to diagnose dissociative disorders through the use of scientifically tested diagnostic tests.
What kind of events or experiences are likely to cause symptoms of dissociation? There are various types of traumas. There are traumas within one’s home, either emotional, physical, or sexual abuse. Other types of traumas include natural disasters, such as earthquakes, political traumas such as holocausts, hostage situations, wars, random acts of violence (such as the Oklahoma city bombing and the Columbine shootings), or the grief we feel after the death of a family member or loved one. Dissociation is a universal reaction to overwhelming trauma and recent research indicates that the manifestations of dissociation are very similar worldwide.
Misdiagnosis of People with Dissociative Identity Disorder
Most people with undetected dissociative identity disorder (or the spectrum diagnosis of dissociative disorder, not otherwise specified) experience depression and often are treated with antidepressant medications. While antidepressant medications may help some of the feelings of depression, it does not alleviate symptoms of dissociation. Some people suffering from undetected dissociative symptoms are misdiagnosed as having psychotic disorders including schizophrenia and are treated with antipsychotic medication resulting in long term side effects. Some other common diagnoses that people with dissociative identity disorder receive include:
- Bipolar disorder.
Mood swings is a very common experience in people who have a dissociative disorder. If you seek help with a professional who is not familiar with dissociative disorders they may only consider bipolar disorder as the reason for your mood swings, when symptoms of dissociation may be the underlying cause.
- Attention deficit disorder.
People with dissociative identity disorder commonly experience problems with attention and their memory. Treatment with medication for ADHD may help some of the symptoms associated with poor attention, but again will not help all the symptoms associated with underlying dissociation.
- Eating disorders.
People with eating disorders including anorexia, and binging often experience inner feelings of dissociation and may have a coexisting dissociative disorder.
- Alcohol or drug abuse.
People with undetected dissociative disorders frequently self medicate with alcohol or drugs.
- Anxiety disorders.
People with undetected dissociative disorders often experience generalized anxiety, panic attacks, and obsessive-compulsive symptoms. Treating only their anxiety will not help their dissociative symptoms.
Other common clues to a dissociative disorder include the fact that a person seems to experience a lot of different symptoms that come and go, and that they have been in treatment for many years and they still seem to have many of their symptoms.
Some people with undetected dissociative symptoms can function well at work or school. Only close friends or family are aware of the person’s inner struggles or suffering. Sometimes, a person with undetected dissociation may need to be hospitalized because of feelings of low self esteem, self hatred, self-destructive feelings and/or suicidal ideation. The delay in accurate diagnosis results in difficulty maintaining close relationships, working below one’s potential as well as years of unnecessary suffering. This can result in worsening depression, continued mood swings, and self destructive behaviors.
Coexisting Diagnoses or Misdiagnoses
- Major depression
- Generalized anxiety disorder
- Bipolar disorder
- Attention deficit hyperactivity disorder
- Obsessive-compulsive disorder
- Eating disorders
- Substance abuse disorders
- Sleep disorders
- Impulse control disorders
Advances in the Diagnosis of Dissociative Disorders
Over the past twenty five years, there has been an increase in scientific research on the diagnosis and treatment of dissociative disorders.
Screening tools such as the Dissociative Experience Scale and diagnostic tools such as the Structured Clinical Interview for Dissociative Disorders (or SCID-D) have helped advance work in the identification and treatment of these disorders. Screening tests cannot diagnose people with a dissociative disorder but can help identify people who have dissociative symptoms and need to be evaluated further. Diagnostic tests require the time of a knowledgeable mental health professional to allow for the definitive diagnosis of dissociative symptoms and disorders.
Raising the Standard of Care: The Structured Clinical Interview for DSM-IV Dissociative Disorders
Before the development of specialized diagnostic tests, people suffering from dissociative disorders were misdiagnosed for many years preventing the start of effective treatment. Some mental health professionals are still unfamiliar with or skeptical of recent specialized screening and diagnostic tests for dissociation. As more mental health professionals become familiar with advances in detecting dissociative symptoms, there will be less of a delay in accurate diagnosis and treatment.
The use of specialized diagnostic interviews allows for early detection of dissociative symptoms preventing years of ineffective treatments. The Structured Clinical Interview for DSM-IV Dissociative Disorders (The SCID-D) is a diagnostic test that has been proven to be reliable and effective in identifying dissociative symptoms and disorders. The SCID-D is the only diagnostic test in the field of dissociation whose scientific testing has been evaluated and funded by the National Institute of Mental Health. Endorsed by experts in the field, this diagnostic tool is considered the ‘gold standard’ to which all other tests of this type should be compared.
Over a hundred scientific publications by researchers in the United States and abroad have documented this test’s ability to accurately diagnose dissociative symptoms and disorders. In fact, research with the SCID-D indicates that the features of dissociation are virtually identical worldwide.
People suffering from dissociative disorders can now be identified with the same degree of accuracy as people suffering from other psychiatric or medical disorders. Just like an electrocardiogram can diagnose heart rhythm abnormalities worldwide, individuals who are suffering from a dissociative disorder can now be accurately identified with the SCID-D. Since dissociation is a universal response to overwhelming trauma, it should not be surprising that dissociative symptoms are the same in cultures that may be very different.
A trained therapist can administer the Structured Clinical Interview for Dissociative Disorders (or SCID-D) in order to detect whether a person is experiencing dissociative symptoms and/or a dissociative disorder. Evaluation with the SCID-D can take three to five hours. Since accurate identification of dissociative symptoms can prevent many years of missed diagnosis and ineffective treatments with medications that can cause potentially serious side effects, it is recommended that one seek out a specialized evaluation with a trained mental health professional as soon as possible.
Steinberg, M. (2020). In-Depth: Understanding Dissociative Disorders. Psych Central. Retrieved on March 28, 2020, from https://psychcentral.com/disorders/dissociative-identity-disorder/in-depth/