Dissociative Disorder Treatment
Expert evaluation for dissociation, depersonalization, and derealization
What Is Dissociative Disorders?
Dissociative disorders involve disruptions in consciousness, memory, identity, emotion, perception, behavior, and sense of self. They are closely linked to trauma, with many individuals having a history of childhood abuse or other significant traumatic experiences. DSM-5 dissociative disorders include DID, dissociative amnesia, and depersonalization/derealization disorder.
Signs & Symptoms
- Gaps in memory for events, people, or personal information
- Feeling detached from one's own thoughts, feelings, or body
- Perception of surroundings as unreal or dreamlike
- Identity confusion or disruption
- Hearing voices or distinct "parts" of the self
- Significant distress or functional impairment
- Symptoms not due to substances or medical conditions
Treatment Approaches
Trauma-focused psychotherapy is the primary treatment for dissociative disorders, with EMDR and phase-based trauma treatment showing the most evidence. Medication addresses co-occurring depression, anxiety, PTSD, and sleep disturbances rather than the dissociation directly. Establishing safety and stabilization must precede trauma processing work.
Why Concierge Psychiatry?
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Learn About Concierge CareFrequently Asked Questions
The vast majority of dissociative disorders are linked to significant trauma, particularly chronic childhood abuse or neglect. Dissociation develops as a protective mechanism when the mind cannot process overwhelming experiences. While trauma is the primary cause, dissociative symptoms can also occur with severe anxiety, substance use, or certain medical conditions.
The DSM-5 recognizes three main types: dissociative identity disorder (DID), involving distinct personality states; dissociative amnesia, involving inability to recall important personal information; and depersonalization/derealization disorder, involving persistent feelings of detachment from self or surroundings. Each requires specialized psychiatric evaluation and treatment.
Everyday dissociation like daydreaming or highway hypnosis is mild and brief. Clinical dissociation involves significant disruptions in memory, identity, or perception that cause distress or impair daily functioning. If you experience gaps in memory, feel detached from your body regularly, or lose time you cannot account for, a psychiatric evaluation is warranted.
There is no medication that directly treats dissociation itself. However, medications effectively manage co-occurring symptoms like depression, anxiety, PTSD, and sleep disturbances, which are nearly universal in dissociative disorders. Trauma-focused psychotherapy remains the primary treatment, with medication providing stabilization support.
Dissociative disorders are frequently misdiagnosed as bipolar disorder, schizophrenia, or borderline personality disorder because symptoms can overlap. A psychiatrist experienced with dissociation can accurately diagnose the condition and avoid treatments that may be ineffective or harmful. Dr. Agresti provides thorough evaluation to ensure correct diagnosis and appropriate treatment planning.