Dissociative Disorders Therapist in Austin, TX
What are Dissociative Disorders?
Understanding Dissociative Disorders
As a therapist specializing in dissociative disorders in Austin, TX, I can attest that dissociation is often one of the most overlooked and misunderstood trauma responses in the mental health field. This is unfortunate because because there are more people living with dissociative disorders than other more well known conditions that are sometimes over diagnosed. My goal with this page is to provide education and instill optimism for treatment.
Dissociative disorders are a group of mental health conditions that involve disruptions or discontinuities in consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. These conditions often develop as responses to traumatic experiences and serve as coping mechanisms that help individuals distance themselves from overwhelming or intolerable memories, emotions, or experiences. Considering the nature of the trauma that typically causes dissociation, it can be considered an adaptive response when being fully aware or present for the trauma would have been too overwhelming. However these responses can also greatly interfere with a person’s life and cause significant or severe distress.
This page provides an overview of four main types of dissociative disorders: Depersonalization/Derealization Disorder, Dissociative Amnesia, Other Specified Dissociative Disorder (OSDD), and Dissociative Identity Disorder (DID). We will explore their definitions, distinctions, symptoms, treatments, and recovery rates.
Depersonalization/Derealization Disorder (DPDR)
Definition
Depersonalization/Derealization Disorder (DPDR) is characterized by persistent or recurrent episodes of depersonalization (feeling detached from oneself) and/or derealization (feeling detached from reality). Individuals may feel as though they are observing themselves from outside their body or that the world around them is unreal or distorted. These experiences are often distressing and can impair functioning.
Distinction from Other Dissociative Disorders
Depersonalization is an experience of feeling detached from one’s thoughts, body, or self, while derealization involves feelings that the external world is unreal or distorted. Unlike other dissociative disorders, DPDR does not involve a loss of memory or identity fragmentation.
Unlike Dissociative Identity Disorder (DID), individuals with DPDR maintain a consistent sense of identity and are aware that their experiences a distorted perception of reality.
Symptoms
Persistent or recurrent experiences of depersonalization (e.g., feeling detached from one’s body, mind, or self).
Persistent or recurrent experiences of derealization (e.g., feeling that the world is unreal, dreamlike, or distorted).
Reality testing remains intact (the person knows these feelings are unusual and different from their usual perceptions.)
Significant distress or impairment in social, occupational, or other areas of functioning.
Diagnostic Criteria
According to the DSM-5, the criteria for diagnosing DPDR include:
Persistent or recurrent experiences of depersonalization, derealization, or both.
During these experiences, reality testing remains intact.
Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not due to the physiological effects of a substance, medical condition, or another mental disorder.
Risk and Protective Factors
Risk Factors: Childhood trauma, emotional neglect, stress, anxiety, depression, and substance abuse.
Protective Factors: Strong social support, coping strategies, and early therapeutic intervention.
Prevalence Among Various Populations
Estimated to affect about 1-2% of the general population. Prevalence rates for all dissociative disorders in psychiatric populations is estimated to be around 10%.
Higher prevalence in individuals who have experienced trauma, particularly in childhood.
Common Co-occurring Disorders
Anxiety disorders
Major depressive disorder
Obsessive-compulsive disorder (OCD)
Substance use disorders
Evidence-Based Treatments
Psychotherapy: Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and trauma-focused therapy.
Medication: Selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers may be used to manage associated anxiety or depression.
Recovery Rates
Recovery rates vary; many individuals experience episodic symptoms that may remit over time with treatment. A minority may experience chronic, long-term symptoms.
Dissociative Amnesia
Definition
Dissociative Amnesia involves an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness. This condition is often associated with traumatic experiences and serves as a psychological defense mechanism.
Distinction from Other Dissociative Disorders
Unlike Dissociative Identity Disorder (DID), which involves fragmented identities, dissociative amnesia is characterized solely by memory loss related to personal information.
It differs from DPDR as it does not involve feelings of detachment from oneself or the environment.
Symptoms
Sudden inability to recall important autobiographical information, often related to trauma or stress.
Memory loss can be localized (specific event), selective (certain details of an event), or generalized (entire life history).
Significant distress or impairment in social, occupational, or other areas of functioning.
Diagnostic Criteria
According to the DSM-5, the criteria for diagnosing Dissociative Amnesia include:
Inability to recall important autobiographical information, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting.
Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the effects of a substance, neurological condition, or other medical condition.
The disturbance is not better explained by other mental disorders, such as DID or PTSD.
Risk and Protective Factors
Risk Factors: Trauma (especially childhood abuse), stressful experiences, and a history of dissociation.
Protective Factors: Supportive relationships, early therapeutic intervention, and coping skills.
Prevalence Among Various Populations
Affects approximately 1-2% of the general population. Prevalence rates for all dissociative disorders in psychiatric populations is estimated to be around 10%.
More common in women than men, particularly in those with a history of trauma.
Common Co-occurring Disorders
Post-traumatic stress disorder (PTSD)
Major depressive disorder
Anxiety disorders
Evidence-Based Treatments
Psychotherapy: Trauma-focused therapies, Cognitive Behavioral Therapy (CBT), and psychodynamic therapy.
Hypnosis and EMDR (Eye Movement Desensitization and Reprocessing): Can help in accessing and processing dissociated memories.
Medication: No specific medications, but antidepressants or anti-anxiety medications may be used for co-occurring conditions.
Recovery Rates
Recovery rates vary widely. Some cases of dissociative amnesia may resolve spontaneously, while others may require long-term therapy.
Other Specified Dissociative Disorder (OSDD)
Definition
Other Specified Dissociative Disorder (OSDD) is a category of dissociative disorders where individuals experience dissociative symptoms that do not fully meet the criteria for any specific dissociative disorder, such as DID or DPDR. It includes presentations like dissociative trance, identity disturbance due to prolonged and intense coercive persuasion, and chronic or recurrent dissociative symptoms that do not meet the criteria for another dissociative disorder.
Distinction from Other Dissociative Disorders
Unlike DID, OSDD does not involve fully distinct personality states separated by dissociative barriers, but often does involve various ego states with functions related to containing and avoiding memories and psychological defenses.
Differs from DPDR as it does not necessarily involve depersonalization or derealization experiences.
Symptoms
Symptoms can vary widely but may include depersonalization, derealization, amnesia, or identity confusion.
Chronic or recurrent episodes of dissociation.
Symptoms cause significant distress or impairment in functioning.
Diagnostic Criteria
According to the DSM-5, the criteria for diagnosing OSDD include:
Dissociative symptoms that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Symptoms do not meet the full criteria for any specific dissociative disorder.
The disturbance is not attributable to the effects of a substance, neurological condition, or other medical condition.
Risk and Protective Factors
Risk Factors: Trauma, severe stress, emotional neglect, and a history of dissociation.
Protective Factors: Strong social support, access to mental health care, and healthy coping mechanisms.
Prevalence Among Various Populations
Precise prevalence rates are difficult to determine due to the varied nature of presentations but are generally considered less common than other dissociative disorders.
Common Co-occurring Disorders
Depression
Anxiety disorders
PTSD
Borderline personality disorder (BPD)
Evidence-Based Treatments
Psychotherapy: Individual therapy focusing on integration, stabilization, and processing of traumatic memories.
Dialectical Behavior Therapy (DBT): Helps with emotional regulation and distress tolerance.
Medication: No specific pharmacological treatment for OSDD, but medications can help manage co-occurring disorders.
Recovery Rates
Recovery rates depend on the severity of symptoms and access to appropriate, trauma-informed therapy. Many individuals show improvement with consistent treatment.
Dissociative Identity Disorder (DID)
Definition
Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is characterized by the presence of two or more distinct identity states or personality states that control an individual’s behavior at different times. These identities may have their own names, ages, histories, and characteristics. DID is strongly associated with severe, chronic childhood trauma, such as abuse or neglect.
Distinction from Other Dissociative Disorders
Unlike other dissociative disorders, DID involves a fragmentation of identity into distinct personality states.
Differentiates from DPDR and Dissociative Amnesia due to the presence of multiple identities and recurrent gaps in memory.
Symptoms
Presence of two or more distinct identity states or personalities, each with its own patterns of perception, relating, and thinking.
Recurrent gaps in the recall of everyday events, important personal information, or traumatic events.
Significant distress or impairment in social, occupational, or other areas of functioning.
Diagnostic Criteria
According to the DSM-5, the criteria for diagnosing Dissociative Identity Disorder (DID) include:
Two or more distinct identity states: The presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
Recurrent gaps in memory: Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
Distress or impairment: The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Not a normal part of cultural or religious practices: The disturbance is not a normal part of a broadly accepted cultural or religious practice.
Not attributable to substance use or another medical condition: The symptoms are not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (e.g., complex partial seizures).
Risk and Protective Factors
Risk Factors: Chronic and severe childhood trauma (especially emotional, physical, or sexual abuse), neglect, attachment disruptions, and high levels of suggestibility or hypnotizability.
Protective Factors: Supportive relationships, stable environment, early therapeutic intervention, and adaptive coping strategies.
Prevalence Among Various Populations
The estimated prevalence of DID is about 1-2% of the general population and about 5% in psychiatric populations. Due to the difficulty of diagnosis, skepticism, and unwillingness of many mental health providers to consider it as a possibility, DID is likely highly underdiagnosed, making prevalence rates inaccurate. It can take an average of 10 years from first contact with mental health professionals for a person with DID to receive the correct diagnosis. Many people with DID are incorrectly diagnosed with psychotic disorders and medicated in ways that are ineffective.
DID is more commonly diagnosed in females, possibly due to higher rates of reported childhood abuse and neglect.
Common Co-occurring Disorders
Post-traumatic stress disorder (PTSD)
Depression
Anxiety disorders
Borderline personality disorder (BPD)
Substance use disorders
Eating disorders
Evidence-Based Treatments
Psychotherapy: Long-term, trauma-focused therapy is the cornerstone of DID treatment. Approaches may include elements of Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Eye Movement Desensitization and Reprocessing (EMDR) with extended preparation using Ego State Therapy (Parts Work). Although elements of many therapies can be used, treatment is grounded in an understanding of structural dissociation theory. The dynamics of the internal system of identity states are what guides the approach and application of techniques. Therapy focuses on facilitating more communication, compassion, and collaboration among parts prior to focusing on trauma. Therapeutic techniques from many areas can be applied in this context. This can take years in many cases.
Phase-Oriented Treatment: Involves three phases—(1) stabilization and symptom reduction, (2) trauma processing, and (3) integration and rehabilitation.
Medication: While there is no specific medication for DID, antidepressants, antipsychotics, or mood stabilizers may be prescribed to manage symptoms of co-occurring disorders.
Recovery Rates
Recovery Rates: Recovery rates for DID vary significantly. With comprehensive, trauma-informed therapy, many individuals experience symptom reduction and improved functioning over time. However, full integration of identities is a complex process and may not be necessary or desired for all individuals. Having harmony and co-consciousness between identities is often sufficient for therapy to have benefits without full integration.
Conclusion
Dissociative disorders encompass a range of conditions characterized by disruptions in consciousness, memory, identity, and perception. While they share some similarities, each disorder—Depersonalization/Derealization Disorder (DPDR), Dissociative Amnesia, Other Specified Dissociative Disorder (OSDD), and Dissociative Identity Disorder (DID)—has distinct features, symptoms, and treatment needs. Understanding these differences is crucial for accurate diagnosis and effective, evidence-based treatment. Early intervention, trauma-informed care, and ongoing support play pivotal roles in recovery and improving quality of life for individuals experiencing dissociative disorders. As a therapist with training and experience in long-term treatment for dissociative disorders, I’ve seen recovery first hand and I would be honored to help you.
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References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.
Steinberg, M. (1995). Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). American Psychiatric Publishing.