Signs and Symptoms

Dissociative Disorders are highly prevalent disorders, affecting around 10% of the population. They can result in significant changes in identity, cognition, personality, behavior, and physical health, as well as immune dysfunction. They are resistant to current treatments, but those who receive a diagnosis show much better outcomes in terms of quality of life.

Depersonalization
- Feeling like you are an outside observer of your thoughts, feelings, your body, or parts of your body
- Feeling like you are on autopilot or going through the motions
- Feeling like your mind is blank, as if it is foggy, fuzzy, or a blur
- Feeling that you are not in control of your speech or movements
- A deadpan or monotone voice
- Shakiness, reduced balance and coordination
- Cognitive impairments (e.g. Needing to hear something multiple times to retain information or an inability to focus)
- The sense that your body, legs, or arms appear distorted, enlarged or shrunken
- Tension headaches, feeling like your head is wrapped in cotton, pressure behind your eyes
- Emotional or physical emptiness/numbness of your senses or responses to the world around you
- Physical analgesia, an inability or decreased ability to feel pain
- A sense that your memories lack emotion and that they may or may not be your own memories
Derealization
- Feelings of being alienated from or unfamiliar with your surroundings – like you are living in a movie or a dream
- Questioning reality, as if the outside world is unreal or distorted
- Feeling emotionally disconnected from people you care about, as if you were separated by a glass wall
- Surroundings that appear distorted, blurry, colorless, two-dimensional or artificial
- Heightened awareness of your surroundings
- Distorted perception of time, such as recent events feeling distant
- Distortion of distance, size, and shape of certain objects

It is possible to have dissociation and not know it. If you have a dissociative disorder, for example, you may keep your symptoms hidden or explain them another way. [20]

Common signs you or a loved one should watch out for include:

- Rapid mood swings
- Trouble remembering personal details
- Forgetfulness about things you’ve said or done
- Behavior or abilities that change (altered identities)
- Depression, anxiety, or panic attacks
- Thoughts of suicide or self-harm
- Substance abuse
- Failed treatments or hospitalizations for mood disorders

Children with a dissociation disorder may:

- Seem spacey
- Stare out the window a lot
- Have imaginary friends
- Forget they’ve said or done something
- Have ADHD or other learning disabilities

Impacts on Physical Health and Behavior

Diagnosing Depersonalization within a timely manner is of great importance, as affected individuals may engage in more uncharacteristic or destructive behaviors and experience more physical complications as it progresses.

Depending on the time of it’s onset, DPDR may lead to arrested psychological and emotional development, and the symptoms that present may depend on the age and developmental period of when a trauma took place. Our insula plays an important role in our pain response and because of the changes in identity due to the under-activity within this and other emotionally sensitive regions, individuals may not view these changes in behaviors as negative or detrimental.

Trauma 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. [19]

Changes in Behavior

Due to the over-regulation of emotional brain regions, individuals may have more difficulty with intimate relationships. [16]
- They may feel emotionally drained with significant others as time goes on, as they lack critical regions important for supporting partners.
- Aggressive behaviors are more likely to present themselves over time, especially with significant others. Relationships require more emotional support, but depersonalized individuals increasingly lack emotional capabilities as the disorder progresses. [7] [18]
- Friendships are often less affected or not as visibly affected because they do not need the same level of emotional support a significant other may need.
Individuals will often experience emotional blunting, social withdrawal, and enjoy being alone more as time goes on.
Those affected are more likely to have substance abuse problems, may drink more heavily, and will often have an increased number of sexual partners.[5] [6] [13] [14] [15] [16] [17]
Clinical presentations show more rational, straightforward thought processes and an absence of emotional, subjective thought processes.
Parenting behavior is often impacted. Affected parents have more difficulty with patience and supportive, nurturing behaviors. [10] [11] [12]

Physical Health Complications

Impaired cognitive function
Depersonalisation disorder has been associated with autonomic blunting and hypothalamic-pituitary-adrenal axis dysregulation, which can lead to difficulty with: [9] [16]
- Heart rate
- Blood Pressure
  - Individuals may often feel colder, have poor circulation, and feel more lightheaded
  - Syncope has been associated with those reporting symptoms of DPDR
- Perspiration
  - Hypohidrosis is often associated with difficulty perspiring
  - Difficulty with perspiration has also been seen in those reporting symptoms of DPDR
- Arousal
  - Individuals may have more difficulty climaxing [4]
- Sleep
  - Our Hypothalamus is responsible for our Circadian Rhythm and may make sleep more difficult. Even after a full night of sleep, individuals will often wake up feeling tired, as they are less likely to experience restful sleep.
- Appetite
  - Eating disorders are common in those with Dissociative and other Anxiety Disorders
- There can be changes to thirst and body temperature as well, but these are observed less often than the aforementioned symptoms.
Vision impairments may arise, as things seem more foggy or distant
Chronic pain and muscle aches are more likely as time goes on, as natural blood flow is impaired and the body is less able to relax itself and release tension that has built up over time.

As of right now, the average number of years before diagnosis is 10 years, but an argument can be made that this is inaccurate as many still never receive a diagnosis. Dissociative disorders constitute a hidden and neglected public health problem. Diagnosis and treatment of Dissociative Disorders is a major public health issue. Dissociative patients represent a large under-served population whose lack of recognition leads to substantial human and societal costs. Better recognition of Dissociative Disorders would be of historical value for all humanity. [2] [3]

Diagnostic Criteria

A. The presence of persistent or recurrent experiences of depersonalization, derealization or both:

Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted.

B. During the depersonalization or derealization experiences, reality testing remains intact.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or other medical condition (e.g., seizures).

E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

Diagnostic Tools

Despite their frequency, major dissociative disorders are often overseen for a long time. Screening-scales have proved to be effective to support clinical diagnosis. The aim of this study was to test, whether the Fragebogen für dissoziative Symptome (FDS), the German version of the Dissociative Experiences Scale (DES), differentiates between patients with dissociative disorders, non-dissociative disorders and non-clinical controls…Screening for major dissociative disorders with the FDS, DES and FDS-20 allows to identify patients with or without major dissociative disorders correctly in about 90 % of the cases. Therefore, the FDS should be used routinely in psychiatric and psychotherapeutic clinics and practices to identify high risk patients. Such a procedure would be an important step towards an improvement of the diagnostic and therapeutic care of patients with major dissociative disorders, which is still often unsatisfactory at present. [1]