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Overview of Dissociative Disorders

by David Spiegel, MD

Everyone occasionally experiences a failure in the normal automatic integration of memories, perceptions, identity, and consciousness. For example, people may drive somewhere and then realize that they do not remember many aspects of the drive because they are preoccupied with personal concerns, a program on the radio, or conversation with a passenger. Typically, such a failure, referred to as nonpathologic dissociation, does not disrupt everyday activities.

In contrast, people with a dissociative disorder may totally forget a series of normal behaviors occupying minutes or hours and may sense a missing period of time in their experience. In dissociative disorders, the normal integration of consciousness, memory, perceptions, identity, emotion, body representation, motor control, and behavior is disrupted, and continuity of self is lost.

People may experience the following:

  • Unbidden intrusions into awareness with loss of continuity of experience, including feelings of detachment from self ( depersonalization) and/or the surroundings (derealization) and fragmentation of identity

  • Memory loss for important personal information ( dissociative amnesia)

Dissociative disorders frequently develop after overwhelming stress. Such stress may be generated by traumatic events or by intolerable inner conflict. Dissociative disorders are related to trauma- and stressor-related disorders; acute stress disorder and posttraumatic stress disorder can cause dissociative symptoms (eg, amnesia, flashbacks, numbing, depersonalization/derealization).

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