How Are Dissociative Disorders Treated Alongside Substance Use?

What are Dissociative Disorders?

Dissociative disorders are characterized by an involuntary escape from reality characterized by a disconnection between thoughts, identity, consciousness, and memory.² Dissociation, in itself, is a common phenomenon. Research indicates that as many as 75% of individuals have experienced at least one episode of dissociation/derealization at some point in their lives. For example, if you’ve ever been involved in a car accident and realize you anything from the point of impact on, you probably dissociated to some degree.^1,2 That can be relatively normal. However, only 2% of individuals, who have experienced dissociation, meet the full criteria for chronic episodes.²

Dissociation is a common response to trauma. Some individuals, who experience a traumatic event—such as an accident or a violent crime—may experience dissociation, which provides a psychic escape when there is no physical escape. Dissociative disorders typically stem from chronic and repeated trauma, are generally associated with increased symptom severity across diagnoses and higher psychiatric relapse rates.³

Types of Dissociative Disorders

There are several types of dissociative disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The three most common ones include:²

• Dissociative amnesia. This condition may involve not remembering or having incomplete memories of a specific event or events (such as abuse or military combat), or it may involve the loss of memory about a great deal of the person’s life or identity.
• Depersonalization/derealization disorder. This disorder is marked by a sense that one’s life, thoughts, feelings, actions, and/or sensations are separate from oneself, as though they are watching a movie (depersonalization). Sometimes the person’s surroundings may feel unreal (derealization). Sometimes, a person experiences depersonalization, derealization, or both.
• Dissociative identity disorder. Previously called multiple personality disorder, this condition involves the person alternating between separate and distinct identities. Dissociative identity disorder may involve large gaps in memory and an inability to recall everyday events, personal information, or traumatic experiences.

Often, dissociative disorders develop as a result of overwhelmingly traumatic experiences. Studies indicate that the lifetime prevalence of dissociative disorders ranges from about 9% to 18%.³

Typically, dissociative disorders develop as a coping mechanism to trauma. Dissociative disorders often form in children, who are exposed to long-term physical, sexual, or emotional abuse—though they may also develop as a result of natural disasters and combat.²

Additionally, trauma-induced dissociative disorders commonly co-occur with other mental health disorders, including:^2,4

• Post-traumatic stress disorder (PTSD).
• Somatic symptoms, which occurs when a person places significant focus on physical symptoms, such as pain, weakness, or shortness of breath.
• Borderline personality disorder.
• Substance use disorders.
• Depression.
• Anxiety.

Signs and Symptoms of a Dissociative Disorders

While the symptoms for each of the types of dissociative disorders vary, some general symptoms of dissociative disorders may include:²

• Experiencing significant lapses in memory.
• Having out-of-body experiences, such as watching events of your life transpire before you as though it’s all taking place in a movie.
• Feeling depressed, anxious, or having thoughts of suicide.
• Being emotionally detached and/or numb.
• Feeling a lack of personal identity.

What Causes Dissociative Disorders?

As previously mentioned, dissociative disorders may develop as a coping mechanism for trauma.^2,3 Dissociative disorders are often the result of chronic and repetitive developmentally stressful events from an individual’s childhood. These may include abuse, emotional neglect, disturbed attachment, and/or boundary violations.⁵

Risk Factors of Dissociative Disorders

Studies indicate that individuals, who experience dissociation or have a diagnosed dissociative disorder, may be at a heightened risk for other issues that could lead to serious mental or physical health problems, including:^6,7

• Self-harm.
• Acute and chronic stress.
• Working memory and cognitive deficits.
• Decreased pain perception.
• Altered body ownership.
• Fearful attachment.
• Problems with sleep, such as insomnia, nightmares, and sleepwalking.
• Maladaptive functioning and symptom severity associated with other mental health disorders, such as borderline personality disorder, depression, eating disorders, panic disorders, and obsessive compulsive disorder (OCD).
• Poorer response to psychotherapeutic interventions.

Dissociative Disorders and Addiction

For individuals who suffer from co-occurring substance use and dissociative disorders, research indicates that they often experience a higher severity of substance dependence than those without dissociation issues.³

How are Dissociative Disorders Treated?

Psychiatrists diagnose dissociative disorders based on a review of symptoms and personal history.² This includes screening to assesses several factors, including:⁹

• The presence of trauma-related symptoms.
• The severity and characteristics of the trauma.
• Depressive or dissociative symptoms, sleep disturbances, and unwanted thoughts.
• Past and present mental disorders.
• Substance use.
• Social support and coping styles.
• Availability of resources.
• Risks of self-harm, suicide, and violence.

This thorough screening is an essential part of the treatment planning process.⁹

Psychotherapy is the cornerstone of treatment for dissociative disorders. The goal of therapy for dissociative disorders aims to reduce dissociation and integrate the functioning of the mind. Although there are no medications that directly treat dissociation, medications may be used to treat other co-occurring disorders such as PTSD, depression, or anxiety.¹⁰

Interventions that may be utilized in an individual setting may include:¹⁰

• Dialectical behavior therapy (DBT). DBT seeks to help individuals find balance between acceptance and change through mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. It can help decrease destructive behaviors, change unwanted emotions, and make individuals aware of and help them regulate vulnerable emotions. DBT also aims to increase self respect in relationships to improve relationships with self and others.
• Eye movement desensitization and reprocessing (EMDR). Research shows that EMDR can mitigate the suffering associated with traumatic memories, and is therefore generally used to treat PTSD. It helps individuals replace negative emotions in response to traumatic memories with less powerful or positive responses.

Whether or not you’ve experienced trauma in your life, if you’re worried about your mental health or that of a loved one, you should make an appointment with your doctor or a mental healthcare professional, who can assess and evaluate you and refer you for treatment.