Dissociative disorders are conditions in which memory, identity, awareness or the sense of self become disconnected, often as a response to severe trauma. They include dissociative amnesia, depersonalization or derealization disorder and dissociative identity disorder, and trauma-focused psychotherapy is the main treatment.
Key symptoms
- Gaps in memory for personal events or periods of time
- Feeling detached from one's body or that the world is unreal
- Finding oneself in places without knowing how one got there
- Sense of two or more distinct identities in some patients
- Anxiety, low mood, self-harm, history of trauma
What you find on exam
- Mental status exam: orientation, memory, mood, thought content
- Neurologic exam to look for a medical cause
- Ask about trauma gently and about current safety
- Ask about suicidal thoughts and self-harm
Tests
- Diagnosis is clinical, after medical causes are excluded
- Urine drug screen and alcohol level
- EEG if seizures are possible; brain imaging if neuro signs
- Screening scales such as the Dissociative Experiences Scale
Treatment basics
- Build a safe, trusting relationship and keep the patient safe
- Trauma-focused psychotherapy in stages
- Grounding skills for dissociative episodes
- Treat depression, anxiety or PTSD with therapy and medication
- Address ongoing abuse or unsafe living situations
Red flags
- Suicidal thoughts or self-harm
- New memory loss with neuro signs, head injury or seizure
- Current abuse or danger at home
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.