DPDR Facts and Statistics

All listed information represents current statistics regarding DPDR, but more research is needed to better understand the disorder and its affected populations.

  • 50% of people will suffer at least 1 to 2 DPDR Disorder attacks over the course of their life.
  • 30-70% of college students will experience DPDR
  • 1 out of every 50 people or 2% of the population experience DPDR as a chronic condition
  • Two-thirds of people who experience a traumatic event, such as an accident, sexual assault, or natural disaster will suffer from some form of DPDR
  • One-third of war veterans affected by PTSD are also believed to be affected by DPDR Disorder and veterans suffering from Major Depressive Disorder are twice as likely to be affected by DPDR
  • People suffering from psychiatric problems have a 40% chance of also suffering from some form of DPDR
  • One-third of people with a life-threatening or terminal disease are prone to experiencing DPDR
  • Traditionally, it has been thought that women have been more likely to suffer from some form of Dissociative Disorder, but dissociative symptoms do not differ between genders.
  • 16 is the average age of onset for DPDR Disorder
  • Two-thirds of people who sustain a mild head injury may experience symptoms of DPDR
  • Those affected by DPDR do not typically display any distinguishable symptoms
  • DPDR has been recognized as an adverse mental health symptom since the 1800’s
  • A Dissociative Disorder usually occurs as a way of coping with trauma or bad memories
  • Dissociative Disorders will often co-occur with other mental health disorders such as anxiety, depression, or PTSD

Societal Impacts

General Statistics
  • [DPDR] patients were younger, had a significant preponderance of male sex, longer disease duration, an earlier age of onset, and a higher education but were more often unemployed. They tended to show more severe functional impairment. They had higher rates of previous or current mental health care utilization. Nearly all patients desired symptom specific counseling. Patients had lower levels of self-rated traumatic childhood experiences and current psycho-social stressors. However, they reported a family history of anxiety disorders more often. [2]
  • African and Asian Americans reported significantly higher rates of dissociation compared to Whites. There were no differences in psychological adjustment indicators as a function of race. The findings indicate that race moderates the relationship between dissociation and psychological adjustment outcomes for Blacks (all models) and Asian Americans (1 model), such that higher rates of dissociation are associated with lower rates of psychological distress as compared to Whites. [3]
  • [Dissociative Disorders] are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior…Failure to properly diagnose and treat DD has a very high human cost…By the time many DD patients are correctly diagnosed, they are demoralized and have suffered substantial secondary losses from years of unproductive treatment, hospitalizations, suicide attempts, disfiguring self-harm, disability, and careers as chronic “treatment resistant” patients…Males with DD may particularly go unrecognized. The powerful relationship of dissociation, DD, and suicidal and self-destructive behavior needs to be part of efforts to lower suicide risk in general and clinical populations. [9]
  • Several researchers have postulated a link between dissociation and avoidance behaviour. Dissociation belongs to the construct of ‘experiential avoidance’. Experiential avoidance is the ‘phenomenon that occurs when a person is unwilling to remain in contact with particular private experiences (e.g. bodily sensations, emotions, thoughts, memories, behavioral predispositions) and takes steps to alter the form or frequency of these events and the contexts that occasion them.’ The concept of structural dissociation of the personality postulates that dissociation is characterized by avoidance and that affected people suffer from a range of phobias, e.g. phobias of different personality parts, phobias of bodily signals and phobias of emotional experience leading to avoidance behaviour. [11]
  • Exposure to multiple types of trauma over multiple developmental epochs is associated with a wide range of clinical problems including emotion dysregulation, behavioral dysregulation, identity problems including difficulties with body image and eating disorders, disruption in meaning, interpersonal problems, and somatization and medical problems including chronic fatigue, heart disease and autoimmune disorders. [10]
  • Emotion dysregulation is a core feature of chronic complex dissociative disorders. One of the strongest predictors of dissociation is antecedent trauma, particularly early childhood trauma, as well as difficulties with attachment and parental unavailability. [10]
Substance Abuse and Self-Destructive Behaviors
  • Dissociative disorders yielded lifetime prevalence rates around 10% in clinical populations and in the community. Special populations such as psychiatric emergency ward applicants, drug addicts, and women in prostitution demonstrated the highest rates. [14]
  • Fifteen percent of the sample in this study were diagnosed as having a dissociative disorder. The results support earlier findings suggesting that patients with substance abuse disorder should be routinely screened for dissociative symptoms and disorders. [12]
  • Dissociative disorders are common among those in escort, street, massage, strip club and brothel prostitution, and are frequently accompanied by posttraumatic stress disorder, depression, and substance abuse. The existing data suggest that almost all who are in prostitution suffer from at least one of the following types of disorders; dissociative, posttraumatic, mood or substance abuse.[13]
Violence and Aggressive Behaviors
  • This study examined the relationship between dissociative tendencies and aggressive behaviors in adolescents. Among the subscales of the DES, depersonalization was most related to aggressive behaviors. The results suggest that adolescents who have high dissociative tendencies are inclined to show aggression toward others directly. [5]
  • Dissociation predicts violence in a wide range of populations and may be crucial to an understanding of violent behavior. Recommendations for clinical applications include the routine screening of offenders for dissociative disorders and adequate consideration of dissociation and dissociative disorders in the development and implementation of violence treatment and prevention programs. [6]
  • Although the findings of this study are preliminary and the results should be interpreted with caution, the study provides the first data regarding pathological dissociation and its relationship with aggression and delinquency in Hong Kong. In addition, more studies are essential to further examine the relationships between pathological dissociation, aggression, and delinquency in both clinical and nonclinical populations. [8]
  • Agitation and aggression in Alzheimer’s disease and mild cognitive impairment is associated with neurodegeneration affecting the anterior salience network that may reduce capacity to process and regulate behaviors properly. Greater agitation and aggression severity was associated with greater atrophy of frontal, insular, amygdala, cingulate, and hippocampal regions of interest. [15] These symptoms are consistent with the symptoms of Depersonalization.
Parenting Behavior
  • Dissociative Disorders are very cyclical. The results in this study indicated a correspondence between fathers’ and sons’ dissociation scores. In addition, links were found between parental dissociation, parental inconsistency and rejection, and child dissociation. [15]
  • They found that the functioning of these mothers, as well as their subjective experience of mothering, was poorer than that of either clinical or nonclinical control mothers. Our goal was to provide a clearer, richer picture of their problems in parenting. Using the mothers’ own words, we describe how the five symptom areas of dissociation (amnesia, depersonalization, derealization, identity confusion, and identity alteration) impeded their parenting efforts. [16]
  • While many studies have demonstrated relationships between trauma and dissociation, relatively little is known about other factors that may increase children’s risk for developing dissociative symptoms. Maternal dissociation was found to relate positively to maternal betrayal trauma history. Additionally, both mothers’ and children’s betrayal trauma history were found to significantly predict children’s dissociation. Implications for the intergenerational transmission of betrayal trauma and dissociation are discussed. [17]
 Self-Harm
  • Presence of a dissociative disorder was strongly associated with all measures of self-harm and suicidality. Dissociative disorders are commonly overlooked in studies of suicidality, but in the population within this study, they were the strongest predictor of multiple suicide attempter status.[7]
  • Individuals with DDs and BPD also frequently experience major fluctuations in identity and emotional states, and depersonalization and derealization during stress, as well as exhibit high rates of self-harm and suicidality (e.g. Suicidal and/or self-injurious behaviors are common among DD patients with 67% of DD patients reporting a history of repeated suicide attempts and 42% reporting a history of self-harm. [10]
 

Importance of Timely Diagnosis

  • Dissociative disorders constitute a hidden and neglected public health problem. Better and early recognition of dissociative disorders would increase awareness about childhood traumata in the community and support prevention of them alongside their clinical consequences. Due to their link to early-life stress in the form of childhood abuse and neglect, better recognition of dissociative disorders would be of historical value for all humanity including global awareness about and prevention of adverse childhood experiences and their lifelong clinical consequences. [1]
  • This case series supports the view that the course of the [DPDR] tends to be long-lasting. [DPDR] patients are severely impaired, utilizing mental health care to a high degree, which nevertheless might not meet their treatment needs, as patients strongly opt for obtaining disorder specific counseling. In view of the size of the problem, more research on the disorder, its course and its optimal treatment is urgently required. [2]
  • Participants with a dissociative disorder had borderline personality disorder, somatization disorder, major depression, PTSD, and history of suicide attempt more frequently than did participants without a dissociative disorder. Childhood sexual abuse, physical neglect, and emotional abuse were significant predictors of a dissociative disorder diagnosis. Revisions in diagnostic criteria of dissociative disorders in the DSM-IV are recommended. [4]
  • [Dissociative Disorders] are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior. Prospective treatment outcome studies of severely ill DD patients show significant improvement in symptoms including suicidal/self-destructive behaviors, with reductions in treatment cost. A major public health effort is needed to raise awareness about dissociation/DD, including educational efforts in all mental health training programs and increased funding for research. [9]
  • Failure to properly diagnose and treat DD has a very high human cost. By the time many DD patients are correctly diagnosed, they are demoralized and have suffered substantial secondary losses from years of unproductive treatment, hospitalizations, suicide attempts, disfiguring self-harm, disability, and careers as chronic “treatment resistant” patients. [9]
  • Diagnosis and treatment of dissociation/DD is a major public health issue. DD patients represent a large underserved population whose lack of recognition leads to substantial human and societal costs. Males with DD may particularly go unrecognized. The powerful relationship of dissociation, DD, and suicidal and self-destructive behavior needs to be part of efforts to lower suicide risk in general and clinical populations. [9]

Treatment Implications

  • Dissociation is crucial to assess because it has often been shown to have a negative impact on treatment outcome. Psychotherapy has been reported to be more difficult in individuals with DID who have comorbid BPD. Dissociation inhibits amygdala-based emotional learning in patients with BPD and may thus interfere with the psychotherapeutic process. In support of this hypothesis, dissociation has been shown to be associated with response to treatment among acutely traumatized individuals. [10]
  • The differences in severity of dissociation and trauma across treatment samples likely also contribute to differences in outcomes observed. Several studies have found that traumatized patients with the highest level of dissociation do not respond as well to treatment as those with lower levels of dissociation. [10]
  • Those with severe depersonalization did not show as large a decrease in depression as did those with low depersonalization. [10]
  • A trial of standard exposure therapy found a similar rate of improvement among low and moderate dissociation groups, although 10% of the low dissociation versus 69% of the moderate dissociation group met PTSD criteria at follow-up, suggesting that those with moderate levels of dissociation will need longer treatment to achieve good outcomes. [10]
  • Specifically, dissociation during treatment sessions was the only significant predictor among several variables in predicting poor response to early intervention for individuals treated at an emergency department. Individuals with PTSD and mild to moderate dissociation have shown different responses to trauma treatments. Moderately dissociative patients responded better to phase-oriented treatment that provided emotion regulation skills training prior to doing trauma exposure narrative work, as compared to doing exposure without skills training. [10]
  • In a study of exposure therapy conducted with adults who had experienced complex trauma, 45% of whom were in the range of dissociation suggestive of a DD, patients showed a worsening of symptoms, including a trend level worsening of a physiological marker of emotion regulation. Despite exposure therapy being considered a first-line treatment for PTSD, this severely dissociative sample did not benefit from exposure therapy; rather, they showed more improvement in response to psychodynamic treatment and stress inoculation therapy. [10]

Sources

 

2. A case series of 223 patients with depersonalization-derealization syndrome

3. Racial and ethnic differences in dissociation: an examination of the dissociative experiences scale in a nonclinical population.

4. Prevalence of dissociative disorders among women in the general population.

5. The Relationship between Dissociation and Aggression in Adolescents with Using P–F Study

6. Dissociation and violence: a review of the literature.

7. Dissociative disorders and suicidality in psychiatric outpatients.

8. Pathological Dissociation and Its Relationships with Aggression and Delinquency in a College Student Sample in Hong Kong

9. Dissociation debates: everything you know is wrong

10. Chronic complex dissociative disorders and borderline personality disorder: disorders of emotion dysregulation?

11. The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder

12. Comorbidity of dissociative disorders among patients with substance use disorders.

13. Dissociation Among Women in Prostitution

14. Epidemiology of Dissociative Disorders: An Overview

15. Child dissociation and the family context.

16. The parenting experiences of mothers with dissociative disorders.

17. Development of dissociation: examining the relationship between parenting, maternal trauma and child dissociation.