This shows a woman's face.
So what are dissociative disorders, why is diagnosis controversial and how can people be treated? Credit: Neuroscience News

Unmasking Dissociative Disorders: Growing Mental Health Problem Often Overlooked

*Updated* Dissociative disorders are nearly as common as depression. So why haven’t we heard about them?

Summary: Dissociative disorders, contrary to popular belief, might affect up to 10-11% of the global population, rivaling the prevalence of mood disorders. These conditions manifest when individuals feel a profound detachment from themselves, their memories, and their emotions, often as a coping mechanism to compartmentalize traumatic events.

Despite the debate between trauma and fantasy models, a comprehensive analysis suggests these disorders are real, rooted in trauma, and vastly under-diagnosed.

Timely psychotherapy, especially one that acknowledges trauma’s physiological impact, offers substantial improvements for those afflicted.

Key Facts:

  1. Dissociative disorders could affect 10-11% of the population, making them almost as prevalent as mood disorders.
  2. While two theories exist (trauma and fantasy models), evidence strongly suggests that dissociative disorders are trauma-based.
  3. Despite its prevalence, many with dissociative disorders remain undiagnosed due to misconceptions and lack of professional education.

Source: The Conversation

Dissociative disorders are often said to be rare. But our soon-to-be-published analysis of international studies suggest they affect 10-11% of the population at some point in their lives. This makes them nearly as common as mood disorders (such as clinical depression).

So what are dissociative disorders, why is diagnosis controversial and how can people be treated?

What is dissociation?

Dissociation occurs when a person experiences being disconnected from themselves, including their memories, feelings, actions, thoughts, body and even their identity.

Credit: Neuroscience News

People with dissociative disorders have one or more of the following symptoms:

  • amnesia and other memory problems
  • a sense of detachment or disconnection from their self, familiar people or surroundings
  • an inner struggle about their sense of self and identity
  • acting like a different person (identity alteration).

For some people, symptoms can last days or weeks, but for others, they can persist for months, years, or a lifetime.

Dissociation allows the person to compartmentalize and disconnect from aspects of traumatic and challenging experiences that could otherwise overwhelm their capacity to cope.

A person whose spouse has died may become emotionally numb, allowing them to focus on arranging the funeral; a man who has separated from his wife and lost his job soon afterward may become so disconnected from his identity that he no longer recognizes himself in the mirror and feels his life is happening to someone else; and a young woman who is sexually assaulted may remember her attacker moving too quickly towards her, recalls being safely back in her family home, but cannot remember the assault.

If the traumatic and overwhelming experiences happen repeatedly over a long period of time, the person’s personality may become fragmented. The traumatized part of the personality that contains the emotions, thoughts, sensations, and experiences relating to the trauma becomes separated from the part of the personality that is trying to get on with daily life.

This allows young children to be with frightening and abusive caregivers they can neither fight nor flee from as they are dependent on them.

The person may have no (or only some) conscious awareness of the compartmentalized memories, thoughts, feelings, and experiences.

These may, however, intrude into the person’s awareness. For example, the person may be aware of thoughts, feelings and internal voices that don’t “belong” to them or may speak or act in ways that are completely out of character.

The most extreme form of structural dissociation is dissociative identity disorder, once known as multiple personality disorder. This is where the person has at least two separate personalities that exist independently of one another and that emerge at different times.

These personality differences are not just psychological. Neuroimaging confirms structural differences in the brains of people with dissociative identity disorder.

A controversial diagnosis

There are two competing theories about what causes dissociation: trauma and fantasy.

With the trauma model, dissociative symptoms arise from physical, sexual and emotional abuse; neglect, particularly in childhood; attachment problems if a child fears the caregiver or the caregiver is not adequately attuned to the child’s emotional or safety needs; and other severe stress or trauma, such as experiencing or witnessing domestic violence.

This trauma model is reflected in the World Health Organisation and the American Psychiatric Association past and present diagnostic criteria.

However, the fantasy model is based on the idea that dissociative disorders are not “real”. Instead, they are the delusion of people who are troubled (and often traumatized), suggestible, fantasy-prone and sleep-deprived.

Fantasy model theorist Joel Paris describes dissociative disorders as a North American “fad” that has nearly died out.

Yet my analysis of 98 studies found rates are not declining. In fact, I found dissociation is an international phenomenon far more common in countries that are comparatively unsafe. This is supported by other research which finds dissociation more common in people that have experienced trauma, such as refugees.

All up, the evidence indicates dissociative disorders are real (not imagined) and caused by trauma (not fantasy).

Dissociative disorders are under-diagnosed and misdiagnosed

Even though there are accurate ways of diagnosing dissociative disorders, most people will never be diagnosed. This is due to the lack of health professional education and training about dissociation, the symptoms being less obvious to observers, and skepticism that the disorder even exists.

The person also may not realize they have dissociative symptoms. Even if they do, they may not reveal them due to fear or embarrassment or may find them difficult to put into words.

At least three-quarters of people with a dissociative disorder will also have one or more other mental disorders. They may be diagnosed with and treated for other mental health difficulties, such as post-traumatic stress disorder, mood disorders, anxiety disorders, sleep disorders, borderline personality disorder, or psychosis. They may also be treated for addictions, self-harm, and/or suicidal thoughts (2% of those diagnosed complete suicide).

They may also be misdiagnosed with schizophrenia because hearing voices is common to both.

But their dissociative disorder usually remains undiagnosed. However, treatment for other mental health issues is not likely to be effective unless the underlying dissociation is addressed.

How to treat? What does the evidence say works?

The mental health and quality of life of people with a dissociative disorder improves significantly with psychotherapy (a type of talk therapy) that recognizes the impact of trauma is physiological (affecting the brain and body) as well as psychological.

This shows a depressed woman
Some people feel so disconnected, they don’t even recognise themselves in the mirror. The image is in the public domain.

In therapy consistent with international treatment guidelines, people can learn skills to cope with unbearable emotions, thoughts, and physical sensations. Once people are stable and have constructive coping strategies, therapists can then help people process traumatic and dissociated memories. Dissociative, post-traumatic, and depressive symptoms improve. And hospitalizations, self-harm, drug use, and physical pain declines.

There is no medication that specifically treats dissociation.

Where to get help

Dissociative disorders are one of the most common, yet most unrecognised, mental disorders. Symptoms are often debilitating, but significant improvements are possible if the dissociation is diagnosed and treated correctly.

If you are concerned, you can speak to your GP and ask for a referral to a therapist knowledgeable about trauma and dissociation. A list of therapists with this expertise in Australia is available from the Blue Knot Foundation and worldwide from the International Society for the Study of Trauma and Dissociation.

Funding: Mary-Anne Kate received an Australian Postgraduate Award from the Department of Education and Training. She is affiliated with International Society for the Study of Trauma and Dissociation.

About this neuroscience research article

The Conversation
Media Contacts:
Mary-Anne Kate – The Conversation
Image Source:
The image is in the public domain.

Feel free to share this Psychology News.
Join our Newsletter
I agree to have my personal information transferred to AWeber for Neuroscience Newsletter ( more information )
Sign up to receive our recent neuroscience headlines and summaries sent to your email once a day, totally free.
We hate spam and only use your email to contact you about newsletters. You can cancel your subscription any time.
  1. to all those who need help understanding DID there’s a book named “The body keeps the score” by Bessel Van Der Kolk – an american researcher in psychiatry. He explains in detail what is DID, why it hasn’t been accepted as a diagnosys in the DSM-5, ways to overcome it ….

  2. This article called me out.
    Well written though, and I appreciate that someone is taking the time to study dissasociative disorders.

  3. We have not heard more about d.i.d. because if does not fit the current economic model. Gives more control to industry to run economy as they see fit. D.i.d. is brainwashing or dumbing down of society so that you are pigeonholed into professions of their choosing not your own.

  4. It is of my opinion that these “multiplicity of voices” are simply an over – firing of high alpha amplitude coming from the limbic/amylgdala brain region.

    When one’s breaker box repetitively surges over and over with reactivity, the mind desperately tries to attach some semblance of meaning. When this fails, the mind has no choice but to double-down on these attempts.

    The result is sadly and painfully a cocaphany of internal dialog that overloads the entire CNS 24 hours per day.

    When sleep blows out, negativity and paranoid thinking then take over.

    The solution for this (psychotherapy?) over thinking is not more professional over thinking.

    Selective use of EEG biofeedback can first calm the cortical layer, then Alpha Theta neurofeedback can help the limbic to reduce the high alpha spiking associated with symptoms of trauma.

    Once relief is established, and reactivity is brought to a minimum, only then can therapy be of any benefit.

    Dave Mayen

  5. Thank you for this insightful article. Unfortunately, I have no idea how to get a diagnosis of my grandson and help for him without having thousands of dollars to pay doctors here in the U.S. He is heartbroken because at Navy bootcamp he said he was fine one minute, than a multitude of thoughts came into his mind, an overwhelming feeling and next thing he knew he was waking up from being unconscious. They told him he had a mental meltdown and was suicidal. His dream since 8 years old has been to join the Navy. He passed the test 2 points below a perfect score. He worked months with a recruiter to run the 7 minute mile, etc.. Now his dream is gone and he does not know what happen.

  6. Very interesting to read. I have experienced dissociation alot. I wonder if i have it, since being diagnosed with Eupd. Its such a shame that so many things are over looked and underfunded and not understood enough.

Comments are closed.