dissociative

Dissociative refers to experiences or disorders in which there is a disruption in the integration of consciousness, memory, identity, or perception. Dissociation can be a normal psychological response to stress, but when it becomes persistent or impairing, it may be classified as a dissociative disorder.

Dissociative disorders include dissociative amnesia, depersonalization/derealization disorder, and dissociative identity disorder. Dissociative amnesia involves impaired recall for personal information, typically related to trauma or stress, and may be localized, selective, or generalized; in rare cases memory loss is accompanied by travel or identity confusion (dissociative fugue). Depersonalization/derealization disorder features persistent or recurrent experiences of unreality regarding oneself or the surrounding environment. Dissociative identity disorder is characterized by two or more distinct identity states that recurrently take control of behavior, with significant gaps in memory for everyday events.

Causes and risk factors often relate to exposure to severe or chronic trauma, especially in childhood. Dissociation is viewed by many researchers as a coping mechanism that may help individuals survive overwhelming experiences. Genetic, neurobiological, and environmental factors can contribute, and dissociative symptoms frequently co-occur with PTSD, anxiety disorders, or personality disorders.

Diagnosis depends on clinical evaluation and standardized interviews to identify dissociative symptoms while ruling out medical or other psychiatric conditions. Differential diagnosis includes mood disorders, psychotic disorders, and factitious or malingering conditions.

Treatment primarily relies on psychotherapy aimed at trauma processing and integration of dissociated experiences. Therapies may include trauma-focused approaches, cognitive-behavioral therapy, dialectical behavior therapy, and, for some patients, EMDR. Medications are used to treat co-occurring symptoms rather than dissociation itself. Prognosis varies, with many individuals improving with sustained treatment, while others experience persistent symptoms or relapse.