In this video I describe some symptoms and prevalence of several disorders in the Dissociative Disorders category of the DSM-5. These include dissociative amnesia, dissociative fugue, dissociative identity disorder, and depersonalization/derealization disorder. Please note that the symptoms described in this video are not comprehensive and there are other symptoms involved in diagnosis for each of these disorders.

Video Transcript

Hi, I’m Michael Corayer and this is Psych Exam Review. In this video we’re going to look at the category of dissociative disorders in the DSM-5. So we’ll start by defining what dissociation refers to. It’s really the opposite of association, where things go together, because in a dissociation we have a separation or splitting of things and in the case of these dissociative disorders this separation refers to a separation of thoughts and experiences from conscious awareness. Now that might sound bizarre but it’s actually fairly common. You’ve probably experienced some minor types of dissociation. So if you’ve ever wondered whether you actually did something or if you just thought about doing it then that would be a type of dissociation, or if you’ve had a daydream or a fantasy that was very vivid and it felt real and so you weren’t sure if that actually happened or not, or if you’ve lost time while you’re driving on a long trip. So you might know that you were consciously aware for a certain period of time because you were driving, so you must have been conscious at that time, but you can’t recall anything from that particular period of time, say from 3 to 5 p.m. I don’t have any idea what happened, the time just seems to be gone or missing. Or maybe you’ve even felt that part of your body is not actually your own for a short period of time.

Now of course these experiences can occur in response to drugs or medications. So if you’ve ever blacked out from drinking too much alcohol, where you were consciously aware at the time but then later you have no recollection of those events, so your friends say “oh you did this” or “you said that” and you have no recollection of it, that would be the type of dissociation. And this can also happen in response to other drugs like pain killers or anesthetics. Recreational users of ketamine sometimes describe falling into a “k-hole” where they have this dissociation; they lose time or they don’t have any conscious awareness of certain experiences, or they may even feel that they lose their sense of self temporarily under the influence of this drug. Now of course in the DSM-5 if these symptoms are occurring in response to substances or medications then they wouldn’t be considered symptomatic of a dissociative disorder.

Ok, so let’s look at our first disorder which is dissociative amnesia and so this refers to selective or global memory loss for autobiographical information and what that means is this is not just normal everyday memory loss. This is not forgetting where you put your keys or temporarily misplacing your phone or something like that. This is where you lose autobiographical information; you forget where you live or you can’t remember names of your family members, things like this, that you should be able to recall, right? This is a different type of memory loss than just your everyday forgetting. And this often occurs following traumatic events.

Now the estimated 12-month prevalence for dissociative amnesia in the DSM-5 is 1.8% in the United States but this can be difficult to assess because there are some situations where people may exaggerate their memory loss or they may claim to not have certain memories that we would expect them to have. And an example of this is if we look at homicide cases, we see about 50% of defendants will claim some memory loss for the events in question. So we might wonder whether this is actual memory loss where they can’t remember certain periods of time and maybe that relates to the stressfulness of certain events or whether this is just a defense strategy where they’re trying to reduce their sense of culpability for a crime by claiming that they don’t remember doing it. They don’t have any recollection of those events.

Now it’s also worth noting that these symptoms are not in response to a physical injury. So if you get into a car accident and you have some physical injury, maybe you have some brain damage, you have a head injury, and you can’t recall certain autobiographical information following the event or you can’t recall events leading up to the accident, or something like that, you have some lost memory there, that would not be considered symptomatic of dissociative amnesia. It would just be seen as directly related to the physical injury that you sustained.

Okay so now we’ll look at the next disorder which is dissociative fugue and this also has some dissociative amnesia, where the person loses their identity, they can’t remember who they are they don’t remember lots of autobiographical information, and then they have a fugue which refers to a fleeing. And so they relocate to a new location and they adopt a new identity and they may not have any recollection of their prior life, although some of those events may be able to be recovered subsequently. Now this disorder, this dissociative fugue, is commonly used as sort of a trope in certain types of TV shows or movies or things where we have basically a chance to sort of restart a character with a new identity, maybe this makes you think of certain soap operas and things like this. We also saw this in season 4 of “Archer” where they did a crossover episode with “Bob’s Burgers” where Sterling Archer appeared working at Bob’s Burgers and not having any memory of his prior life, and this was in reference to the fact that H. Jon Benjamin is the voice actor for both of those characters on both of those shows.

Okay so let’s move to our next disorder which is this dissociative identity disorder. Now this is a controversial diagnosis and it was previously known as multiple personality disorder and the reason that it’s no longer called multiple personality disorder is the separation is meant to refer more to identity rather than personality, and that it would possible to have multiple identities that, of course, have very similar personality traits. And so we have a dissociation of identity into two or more distinct states and other symptoms are disrupted sense of self agency and memory, so the person feels they have more than one identity at certain times, maybe they’re one identity, at other times they’re another, and they have distorted memory or they have dissociated memories or senses of how much they’re in control of their behavior.

And it’s important to note that this is not related to cultural or religious practices that are accepted in a certain area. So for instance if somebody’s in a culture where they are in a religious tradition where they have trance states or there’s ideas about possession by spirits, then the person’s loss of agency or maybe their distortion of memory following these types of events would not be considered symptomatic of dissociative identity disorder.

Now the prevalence is difficult to estimate for this. The DSM-5 refers to a small community study that estimated the prevalence of 1.5%, it’s likely much lower, and other studies have suggested it’s much lower and they’ve also suggested that there’s greater prevalence in women compared to men. And one explanation for this dissociative identity disorder is that it relates to coping with traumatic events by separating out certain experiences from one’s sense of identity then that might allow them to cope with certain traumatic events and so it’s estimated about 90% of people who get this dissociative identity disorder diagnosis also suffered from childhood abuse. And so perhaps by splitting their identity into multiple identities that was a way of coping with this abuse, although this can be very difficult to assess and it’s pretty controversial because it brings in the role of suggestion in therapy.

So if these people are going to therapy for certain symptoms that they’re experiencing, it might be the case that they have dissociation of memory, they have some distorted memories or things they don’t recall quite well, and it might be the case that these memories are being suggested to them by the therapist; that memories of childhood abuse may not necessarily be accurate. Or it could be the case that these symptoms of dissociative identity disorder are being suggested by the therapist and that the person maybe does experience some dissociations but the suggestion that that means they have multiple identities that are operating at different times might be taken in by a patient who is vulnerable to this because they’re experiencing dissociation and they want to understand what’s happening. And so it might be the case that provides an explanation for them and that it’s more of a suggestion from the therapist rather than an actual occurrence of this separation of identity. Now dissociative identity disorder is comorbid with a number of other disorders including PTSD, depression, anxiety disorders, and substance use disorders and it carries with it an elevated risk of suicide.

Okay the last disorder that we’ll look at is depersonalized or derealization disorder and so this refers to a disassociation with reality, with the person feeling that they the world that they’re experiencing is not real or that they’re detached from reality. They might describe this as being an outside observer of their thoughts, their feelings their sensations, their body, or their actions. They feel they are not actually in control, they’re like somebody else is just watching their body going through the motions or this is sometimes described as an out-of-body experience. And in some cases people report feeling that they have no sense of self or that they’re no-one. And they may have a diminished sense of agency so they don’t feel that they’re in control of their actions and an altered sense of time; they can’t seem to track how much time is passing or the time is moving more slowly or more quickly at different times. And derealization refers more to this sense that the world around them is not real. So they might feel that they’re in a fog, or a bubble, or a dream, even though they’re actually experiencing the real world. In this derealization they may have some distortion of their senses; they might feel that their sense of distance is disrupted they can’t tell how far away things are whether something is close to you or far away or the size of things might appear to change, so something seems very, very large and then very, very small. Or they might have a distorted sense of sounds around them being muffled or like they hear like voices sort of are echoey as if they were you know or muffled as if they were coming through glass or something like that. And this may last from just a few hours to several days.

Now the estimated prevalence of this depersonalization or derealization disorder is about 2% and it’s roughly equal for males and females but these experiences are actually much more common. So it’s also estimated about half of adults will experience some sort of episode of these types of symptoms at some point in their life. So they may have a temporary experience although it’s usually not severe enough to warrant a diagnosis of this depersonalization or derealization disorder. Okay so those are some of the disorders in this dissociative disorders category of the DSM-5. I hope you found this helpful, if so, please like the video and subscribe to the channel for more. Thanks for watching!