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 with indicates that the manifestations of dissociation are very similar world wide.
a) 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.
b) 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.
c) eating disorders. People with eating disorders including anorexia, and binging often experience inner feelings of dissociation and may have a coexisting dissociative disorder.
d) alcohol or drug abuse. People with undetected dissociative disorders frequently self medicate with alcohol or drugs.
e) anxiety disorders. People with undetected dissociative disorders often experience generalized anxiety, panic attacks, 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. Some times, 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 and continued mood swings and self destructive behaviors.
Advances in the Diagnosis of Dissociative 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 tests ability to accurately diagnose dissociative symptoms and disorders. In fact, research with the SCID-D indicates that the features of dissociation are virtually identical world wide.
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.
The SCID-D can evaluate whether a person is experiencing specific dissociative symptoms and whether these symptoms are interfering with one’s relationships or work and whether the symptoms are causing distress. The five symptoms of dissociation include:
These five symptoms of dissociation are often hidden and cause much inner turmoil and suffering. Often the person experiences a lot of other symptoms such as anxiety, depression and mood swings. The figure titled “Obvious and Hidden Signs of DID” depicts the inner symptoms of dissociation and the more external symptoms a person might describe to a therapist.
For a more detailed description of these five symptoms, see Steinberg M, Schnall M: The Stranger in the Mirror: Dissociation-The Hidden Epidemic, HarperCollins, 2001.
The five disorders can be distinguished from one another by the nature and duration of their stressors, as well as the type and severity of the symptoms. A brief review of each dissociative disorder is presented below.
Dissociative Identity Disorder (DID) occurs in people with varied backgrounds, educational levels, and from all walks of life. DID is believed to follow severe trauma including persistent psychological, physical, or sexual abuse during one’s childhood. In this condition, distinct, coherent identities exist within one individual and are able to assume control of the person's behavior and thought (American Psychiatric Association, 1987). Unlike depictions in sensationalistic movies, most people with DID do not have dramatic shifts in personality and only persons very close to them are aware of mood swings. In DID, the patient experiences amnesia for personal information, including some of the identities and activities of alternate personalities. Some people with DID experience subtle memory problems, and may only appear to have memory problems associated with attention deficit disorder.
DID is often difficult to detect without the use of specialized interviews and/or tests, due to: 1) the hidden nature of the dissociative symptoms, and 2) the coexistence of depression, anxiety, or substance abuse which may mask the dissociative symptoms, and 3) feelings of disconnection that are often difficult to verbalize.
Because people with DID may experience depression, mood swings, anxiety, inattention, transient psychotic like states, and may self-medicate with drugs or alcohol, they are frequently diagnosed as having solely bipolar disorder, major depression, attention deficit disorder, anxiety disorders, psychotic or substance abuse disorders. Studies indicate that previous diagnoses in these areas are common to people with DID. It is not uncommon for a decade or more to pass before a correct assessment of DID is made. Research with the Structured Clinical Interview for Dissociative Disorders has identified five distinct dissociative symptoms experienced in individuals who have DID (see section above, Five Dissociative Symptoms.)
Though DID is the most severe of the dissociative disorders, this disorder can respond well to specialized psychotherapy which focuses on understanding the dissociative symptoms and developing new constructive ways of coping with stress. Medication can be used as an adjunct to psychotherapy, but is not the primary form of treatment.
Dr. Steinberg has private practices in Northampton, MA and Naples, FL. She is the author of The Stranger in the Mirror: Dissociation: The Hidden Epidemic and is also the originator of The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the breakthrough diagnostic test that allows therapists worldwide to diagnose dissociative disorders based on rigorous scientific testing. Dr. Steinberg has also authored The Handbook for the Assessment of Dissociation: A Clinical Guide, a resource for therapists offering systematic guidelines for assessing dissociative symptoms and disorders.
This article is © Copyright 2008 Marlene Steinberg, MD. All rights reserved.