Spotting Teen Dissociative Disorder
January 16, 2020
Teen Dissociative Disorder (or Dissociative Identity Disorder) was previously known by another name. Some of you may be more familiar with Multiple Personality Disorder or Split Personality Disorder. In 1994 the American Psychiatric Association officially changed the name in its diagnostic manual. A diagnosis of dissociative disorder is not very common, occurring in only one to three percent of the general population, however, as with any mental health condition, early and proper diagnosis are the most effective way to assure your teen receives prompt and appropriate treatment.
What is teen dissociative disorder?
Dissociative disorder is a severe mental health condition where the individual’s identity is split into two or more distinct personality states. To further explain the above statement, the person does not necessarily have several distinct personalities, as commonly reflected on television or in the movies. What they do experience are variations in the way they feel, think, remember, or perceive things. They will experience these variations depending on which personality state they are in.
As noted above, the incidence of dissociative disorder is not very common. The incidence is on par with other mental health conditions such as schizophrenia and bipolar disorder. Women are more likely than men to be diagnosed with dissociative identity disorder.
What causes teen dissociative disorder?
Many experts agree that one of the primary causes of dissociative identity disorder is severe childhood trauma. This trauma can be as a result of physical, emotional, or sexual abuse to the child themselves or being a witness to grave abuse of a loved one such as a parent or sibling. As the victim of trauma, the child tries to develop coping mechanisms to deal with the emotions and feelings associated with the trauma. During this process, they “wall off” or dissociate from the memories associated with the event or series of events related to the traumatic experience.
Other risks for dissociative identity disorder can include accidents the child experienced, natural disasters, or other significant traumatic events.
What are the signs and symptoms of teen dissociative disorder?
There are various signs and symptoms of dissociative identity disorder (and other dissociative disorders) visible in teenagers. Some are attributable to many dissociative disorders, whereas some are more specific to certain dissociative diagnoses. The symptoms that are inclusive to most dissociative disorders include:
- Memory loss: In most cases, the loss will be significant. The memory loss will not be complete, meaning the person loses all their memories as with degenerative memory conditions such as dementia or injury-related memory loss. The memory loss for dissociative disorders will be related to specific times, people and events. The memories “lost” will often center around the traumatic event or series of events to which the disorder can be attributed.
- Out of body experiences: The person will feel as though they were looking at themselves or watching themselves do things. They could also say they feel as though they were watching a movie about themselves where they were the star; but they do not remember what happened during the show.
- Other mental health problems: People who suffer from dissociative disorder will often experience co-occurring issues such as depression, anxiety, and thoughts of suicide. These could be related to previous traumatic events as well as related to the disorder itself.
- Detachment: People with dissociative disorders will appear to be or state they feel detached or numb to emotion.
- A lack of a sense of self-identity.
As previously mentioned, some of the symptoms of dissociative disorders will be specific to the type of disorder that has been diagnosed. There are three different types of dissociative disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). These include:
Dissociative Amnesia
The primary symptom of dissociative amnesia is difficulty or inability to remember important information about one’s self. The amnesia may be related to a specific traumatic event such as abuse or other trauma. Also, although rarely, it could be challenging to remember information about their identity or life history.
This onset of this type of dissociative amnesia is often sudden in nature and will vary in duration. For some, it may last minutes or hours, but for others, it may last months or years. The person may experience “episodes” throughout his or her lifetime, especially when confronted with a triggering event.
Depersonalization Disorder
Depersonalization disorder is characterized by ongoing feelings of detachment from one’s actions, feelings, thoughts, and sensation. Again, they may describe their experience as feeling like they were watching a movie of themselves (depersonalization). Sometimes individuals with depersonalization disorder may say or feel as though the people and things around them in the world are unreal. This is called derealization. Someone with depersonalization disorder may experience depersonalization, derealization, or both.
Symptoms of depersonalization disorder can last for minutes or can last for years, depending on the person. As with dissociative amnesia, the symptoms may subside and return throughout the person’s lifetime. This disorder generally begins around age 16. Less than 20% of those diagnosed will begin to experience symptoms after the age of 20.
Dissociative Identity Disorder
This specific diagnosis has been discussed previously. Dissociative identity disorder was formally known as multiple personality disorder; the individual may feel like one or more voices (or identities) is trying to take control of their thoughts and actions. People with dissociative identity disorder may experience “gaps” in their memories of everyday events. They may also have difficulty remembering personal information and traumatic events. Women are more likely to be diagnosed with dissociative identity as males are more likely to deny symptoms and trauma histories associated with dissociative identity disorder.
How is this disorder diagnosed?
When doctors diagnose dissociative disorders, they will speak to the individual and conduct a thorough review of their symptoms. They will also ask detailed questions about their personal history to clarify if there is a history of trauma, which could lead to dissociative symptoms. The doctor will also likely perform tests to rule out other sources of cognitive decline and memory loss, such as head injuries, brain tumors, or lesions or intoxication.
What are this disorder treatment options?
The goal or aim of treatment, whether outpatient or in a residential setting is to help the person who is experiencing symptoms of dissociative identity disorder to safely express and process the memories that are triggering the dissociative symptoms. Additional goals include helping the person to develop new life skills, restore optimal functioning, and improve relationships. One final, and fundamental purpose of treatment is to help the person develop new coping skills. The hallmark symptom of dissociative disorders is dissociation. The individual who is experiencing symptoms copes with them by shutting down and dissociating from painful memories or painful current day triggers. Treatment, in any form, aims to help the person develop coping mechanisms that allow them to process the triggers as opposed to avoiding them.
The “best treatment” approach will vary depending on the individual, severity of their symptoms, and what the triggers are that cause symptoms.
Most likely, a treatment plan will include one or a combination of the following various treatment means which can include outpatient care or one on one therapies, medication, or residential treatment options.
In an outpatient setting, a psychotherapist will utilize one or a combination of a few different psychotherapeutic techniques. Psychotherapy, also commonly referred to as “talk therapy,” is the main form of treatment for dissociative disorders. Psychotherapy is a broad term used to describe several specific forms of therapy which can include:
- Cognitive-behavioral therapy (CBT): Cognitive behavioral therapy is a form of psychotherapy that focuses on changing dysfunctional thinking patterns, feelings, and behaviors. This therapy would be used to help the person who is experiencing dissociative symptoms to address the symptoms or the triggers as opposed to utilizing coping mechanisms to dissociate from or “escape” their feelings or emotions.
- Dialectical behavioral therapy (DBT): Dialectic-behavior therapy is a therapy used when people are experiencing severe personality disturbances. This could include the symptoms associated with dissociative disorder, which often occur after an experience related to abuse or trauma. They could also include specific symptoms related to dissociative identity disorder and the feeling of “multiple identities”.
- Eye movement desensitization and reprocessing (EMDR): Eye Movement desensitization and reprocessing therapy is a technique that was developed to help treat people who are experiencing persistent nightmares, flashbacks or other symptoms associated with post-traumatic stress disorder (PTSD). Many individuals who have been diagnosed with dissociative identity disorder have also experienced a traumatic event. This event could indeed trigger not only the symptoms of dissociation but also symptoms related to post-traumatic stress disorder. Therefore, Eye movement desensitization and reprocessing therapy would be a logical choice of psychotherapy.
- Family therapy: While family therapy is not specific to the individual, it can be beneficial as a treatment. Family therapy helps to teach members of the family about the disorder. This is beneficial for two reasons. First, the family is the support structure the individual will need to turn to as they are getting treatment and beyond. Second, family therapy will help family members recognize symptoms of a recurrence and to know what to do should a recurrence happen.
- Creative therapies (for example, art therapy, music therapy): The various innovative therapies allow patients a different outlet for expression. Sometimes a traumatic event is not easily described or relayed through the spoken word. However, through the use of art or music, the individual can often express their thoughts, feelings and experiences in a way that they feel safe.
- Meditation and relaxation techniques: Mindfulness practices such as meditation and relaxation help the person to become more aware of their current state of mind. Through dissociation, the person closes off their internal emotions and though processes when they are faced with triggering events. Meditation and relaxation are can be used to help people better tolerate and confront their dissociative symptoms as opposed to closing off from them.
- Clinical hypnosis: Hypnosis can be used in a clinical setting to induce a state of intense relaxation, concentration, and focused attention. When successful, hypnosis is said to help the person achieve a state of altered consciousness, which allows them to explore thoughts, feelings and memories they have hidden from their conscious minds. These are likely the feelings and emotions that are related to their original trauma and subsequent dissociative triggers.
Each of these therapies works in different ways to help the person understand their symptoms and the root causes of what they are experiencing. While they may be beneficial for some, they may not work well for everyone.
Medications:
There is not a pharmaceutical intervention designed for the treatment of dissociative identity disorder or the other dissociative disorders. However, some individuals may benefit from the use of antidepressants and anti-anxiety medications in conjunction with therapy. It is not uncommon for those with dissociative identity disorder (or another dissociative disorder) to experience co-occurring symptoms related to other mental health conditions. These can include depression, anxiety, or suicidal ideations. Using medication to treat these conditions can help make treatment more successful for the individual.
If you have tried other outpatient methods and feel as though your child could benefit from additional or different treatment options, residential treatment may be beneficial to your child.
In a residential treatment setting such as Hillcrest, we will work with your child or teen to help them understand if they are experiencing dissociative disorder and how they can achieve control of or over them to live a fuller, more healthy life. As with any treatment at Hillcrest, your child will have the assistance of a team of medical providers and counselors available to help them learn to identify their triggers and work with, not against, their needs.