Dissociative disorders, including dissociative identity disorder, depersonalization-derealization disorder and dissociative amnesia, involve disruptions in memory, identity and sense of reality, usually rooted in trauma. Treatment is phase-based, trauma-informed psychotherapy over months to years, with medication for co-occurring depression, anxiety, PTSD and sleep problems. No medication treats dissociation itself, but structured therapy produces meaningful, measurable improvement.
These conditions are almost always rooted in trauma, and they are frequently misdiagnosed for years as bipolar disorder, schizophrenia or borderline personality disorder. At Stedfast Psychiatry we provide careful diagnosis and phase-based, trauma-informed treatment that prioritizes safety and stability, with psychotherapy as the core and medication used honestly for the symptoms it can actually address.
Symptoms of dissociative disorders
- Gaps in memory for everyday events, not just traumatic ones
- Finding items, writing or messages you do not remember producing
- Being told about behavior you do not recall
- Feeling detached from your body, as if watching yourself from outside
- Feeling that the world is unreal, foggy, dreamlike or distant
- A sense of more than one self, or marked shifts in voice, preferences and skills
- Losing time, or arriving somewhere without knowing how
- Hearing internal voices or commentary that feel like they belong to someone else
- Emotional numbness or feeling like a robot
- Flashbacks, nightmares and other PTSD symptoms
Causes and risk factors
Dissociative identity disorder and dissociative amnesia are strongly associated with severe, repeated trauma in early childhood, usually before age nine, such as physical or sexual abuse, extreme neglect, or being raised by a frightening or unpredictable caregiver. Dissociation in childhood is an adaptive escape when physical escape is impossible: the mind compartmentalizes unbearable experience so the child can keep functioning. When this happens repeatedly during the years when identity is normally integrating, separate self-states can persist into adulthood.
Depersonalization-derealization disorder has a broader range of triggers. It often begins in adolescence or early adulthood after severe stress, a panic attack, depression, sleep deprivation, or the use of cannabis, hallucinogens or ketamine, and it can persist long after the trigger has passed. Emotional neglect and emotional abuse in childhood are more common in people who develop it. Biologically, dissociation involves altered connectivity between brain regions governing emotion, body awareness and memory, and a dampening of the normal emotional response to threat.
Dissociative identity disorder affects about 1.5 percent of adults in community samples, a rate similar to bipolar I disorder and schizophrenia.
Source: American Psychiatric Association, DSM-5-TR; Johnson et al., Journal of Psychiatric Research, 2006
Depersonalization-derealization disorder has a lifetime prevalence of about 1 to 2 percent, with onset usually in the mid-teens; fewer than 20 percent of cases begin after age 25.
Source: American Psychiatric Association, DSM-5-TR; Simeon, CNS Drugs, 2004
People with dissociative identity disorder spend an average of six to twelve years in the mental health system before receiving the correct diagnosis.
Source: International Society for the Study of Trauma and Dissociation, Treatment Guidelines, 2011
More than 70 percent of outpatients with dissociative identity disorder have attempted suicide, and multiple attempts are common.
Source: American Psychiatric Association, DSM-5-TR
How we diagnose it at Stedfast Psychiatry
Dissociative disorders are among the most frequently misdiagnosed conditions in psychiatry, with an average of six to twelve years between first contact with mental health care and an accurate diagnosis. At Stedfast Psychiatry we screen for dissociation whenever there is a trauma history, memory gaps, or a diagnosis such as bipolar disorder or schizophrenia that has not responded to standard treatment. We use the Dissociative Experiences Scale as a screen and, when it is elevated, a structured interview such as the Multidimensional Inventory of Dissociation or the SCID-D to clarify the diagnosis. We take the history slowly, over more than one visit if needed, because pressing for trauma details before a person is stable can worsen symptoms.
We distinguish dissociative disorders from psychotic disorders (internal voices in DID are experienced as inside the head and tied to identity states, not as external hallucinations), from bipolar disorder (shifts between identity states happen in minutes, not days or weeks), from borderline personality disorder (which often coexists), from PTSD (which also usually coexists), and from seizure disorders, head injury, substance effects and medication side effects. We order basic labs and, when there are neurological features such as loss of consciousness or convulsive movements, refer for an EEG or neurological evaluation to rule out epilepsy.
Treatment options
Phase-based psychotherapy
Psychotherapy is the primary treatment for all dissociative disorders, and the expert consensus from the International Society for the Study of Trauma and Dissociation describes a three-phase approach. Phase one is safety and stabilization: establishing a therapeutic relationship, building skills for grounding and managing emotion, reducing self-harm and crises, improving sleep and daily functioning, and, in DID, developing internal communication and cooperation among identity states. Phase two, entered only when stability allows, is processing traumatic memories using methods such as EMDR, adapted trauma-focused CBT or structured narrative work, carefully paced to avoid retraumatization. Phase three is integration and rehabilitation: consolidating gains, building relationships and work life, and, for some people with DID, moving toward a more unified sense of self, though a cooperative internal system is also a legitimate goal. Treatment is measured in years rather than weeks for DID, and in months for many cases of depersonalization-derealization disorder, where CBT targeting the catastrophic interpretation of symptoms, attention retraining and grounding techniques has good evidence.
Medication management
No medication treats dissociation itself, and we are direct about that. Medication targets the conditions that accompany it. SSRIs such as sertraline or fluoxetine treat the depression and PTSD that nearly all patients with dissociative disorders have. Prazosin reduces trauma-related nightmares. Trazodone or other non-habit-forming options help sleep, which is often badly disrupted. Naltrexone has limited evidence for reducing self-harm and dissociative episodes in some patients. Lamotrigine has small studies in depersonalization-derealization disorder, usually combined with an SSRI, with modest results. We avoid benzodiazepines, which can worsen dissociation and memory, and we use antipsychotics only when there is a genuine psychotic disorder or severe agitation, not to suppress internal voices in DID, where they are generally ineffective. Medication follow-up is every four to eight weeks, and the prescriber works closely with the therapist.
What to expect
Your first visit is a 60-minute psychiatric evaluation, in person or by video, that focuses on current symptoms, safety and functioning rather than trauma details, which we approach only when you are ready. Diagnosis may take two or three visits, and we tell you what we are considering along the way. Treatment typically combines weekly therapy with a clinician experienced in trauma and dissociation and medication management every one to two months. Telehealth works well for many patients and allows continuity if you move within Florida or South Carolina; in-person care is available at all 13 offices. We track dissociation, PTSD and depression scores over time and set goals in terms of daily function.
When to seek help
Seek an evaluation if you lose time or find evidence of actions you do not remember, if you feel chronically unreal or detached from yourself in a way that frightens or disables you, if you have been given several psychiatric diagnoses that never quite fit, or if a trauma history is accompanied by memory gaps. Earlier accurate diagnosis shortens the years of ineffective treatment. If you are having thoughts of suicide or self-harm, which are common in dissociative disorders, call or text 988, go to the nearest emergency room, or call 911 if you are in immediate danger.
The dissociative disorders in detail
Dissociative identity disorder requires two or more distinct identity states that recurrently take control of behavior, with gaps in memory for everyday events, personal information or trauma that exceed ordinary forgetting. The states often differ in age, name, gender, voice, posture and what they know. Dissociative amnesia is the inability to recall important autobiographical information, usually traumatic, that is inconsistent with ordinary forgetfulness; in its rare fugue form a person travels or wanders with no memory of identity. Depersonalization-derealization disorder involves persistent or recurrent experiences of detachment from one's body or mental processes, or from the surroundings, with intact reality testing. Other specified dissociative disorder covers presentations such as identity disturbance without full amnesia, and it is actually the most common dissociative diagnosis in clinical settings.
Why these conditions are so often misdiagnosed
Patients rarely report dissociation spontaneously. They describe depression, anxiety, mood swings, voices or memory problems, and each of those points clinicians toward a different diagnosis. Rapid shifts between identity states look like mood swings and get called bipolar disorder; internal voices get called schizophrenia; self-harm and unstable relationships get called borderline personality disorder, which often does coexist. The result is years of medications that do not work, because none of them treat dissociation. The remedy is simple: ask. A short screening scale and a structured interview identify most cases, and we use them whenever trauma history, memory gaps or treatment resistance raise the question.
Co-occurring conditions
PTSD is present in nearly all patients with DID and most with dissociative amnesia. Depression, anxiety disorders, substance use disorders, eating disorders, somatic symptom disorders and borderline personality disorder are each common. Self-harm and suicide attempts are frequent and are addressed in the first phase of treatment with safety planning and skills. Sleep disturbance, including nightmares and insomnia, is nearly universal and worsens dissociation, so it is treated early. Medical conditions such as migraine, chronic pain and functional neurological symptoms occur at elevated rates.
Grounding and daily stabilization
Grounding techniques anchor you in the present when dissociation rises: naming objects in the room, feeling your feet on the floor, holding something cold, describing sounds, or using a scent. They work best when practiced daily, not only in crises. Regular sleep, limited caffeine and alcohol, no cannabis, and predictable routines all reduce dissociation. Keeping a simple log of time lost, triggers and what helped gives you and your therapist a map. For people with DID, internal communication tools such as a shared journal or scheduled check-ins among parts support cooperation between sessions.
Prognosis
With phase-based, trauma-informed treatment, people with dissociative disorders improve. Prospective studies of patients with DID in treatment show reductions in dissociation, depression, PTSD, self-harm and hospitalization over time, with better work and relationship functioning. Depersonalization-derealization disorder responds to targeted CBT in a majority of patients, though a chronic course is possible. Dissociative amnesia often remits once the person is safe. These are not conditions that are cured in a month, and they are not conditions people have to live with unchanged. The decisive factor is an accurate diagnosis followed by the right kind of treatment, delivered by a team that stays.
Frequently asked questions
Is dissociative identity disorder real?
Yes. DID is recognized in the DSM-5-TR and the WHO's ICD-11, it has a consistent clinical presentation across cultures, and brain imaging studies show measurable differences between identity states that actors instructed to simulate them cannot reproduce. The controversy that surrounded it in the 1990s has largely given way to a research consensus that it is a trauma-related condition. It is, however, often portrayed inaccurately in film, which contributes to both overdiagnosis by the public and underdiagnosis by clinicians.
How is DID different from schizophrenia?
They are frequently confused because both can involve hearing voices. In DID, voices are experienced as coming from inside the head, often have distinct ages or personalities, and are tied to identity states and memory gaps; reality testing is otherwise intact, and there is a trauma history. In schizophrenia, hallucinations are typically experienced as external, delusions and disorganized thinking are present, and antipsychotics help. Antipsychotics do not resolve DID voices. A structured dissociation interview sorts this out, and the distinction changes treatment entirely.
Is there a medication for dissociation?
No. No medication has been shown to treat dissociation directly, and anyone who tells you otherwise is overselling. Medication is still useful: SSRIs for the depression and PTSD that almost always accompany dissociative disorders, prazosin for nightmares, non-habit-forming sleep aids, and in some cases naltrexone or lamotrigine with modest evidence. We avoid benzodiazepines, which can worsen dissociation. The core treatment is phase-based psychotherapy, and medication supports it by making you more able to engage.
What is the goal of DID treatment? Do the parts go away?
The first goals are safety, stability and function: fewer crises, less time lost, better sleep and relationships. As treatment progresses, the identity states learn to communicate and cooperate, and the memory gaps and sudden switches diminish. Some people eventually experience full integration into a single sense of self; others reach a stable, cooperative internal system and consider that the right outcome for them. Both are legitimate. We do not try to eliminate parts, and we never use confrontation or forced memory recovery.
How long does treatment take?
For dissociative identity disorder, treatment is typically measured in years, often three to five or more, with most of the early work on stabilization. That sounds daunting, but functioning usually improves well before the end, and studies following patients in treatment show steady reductions in dissociation, depression, self-harm and hospitalization. Depersonalization-derealization disorder often responds to a few months of targeted CBT. Dissociative amnesia frequently resolves on its own, with therapy addressing the trauma underneath.
Does insurance cover treatment for dissociative disorders?
Yes. Dissociative disorders are recognized diagnoses covered for psychiatric evaluation, medication management and psychotherapy under most major commercial plans and Medicare, which Stedfast Psychiatry accepts. Because therapy for these conditions is long-term, we help you understand session limits and any authorization requirements in your plan, and we document medical necessity when insurers ask for it. For patients without insurance, a self-pay new-patient visit is $185, with therapy fees quoted in advance.
Can dissociative disorders be treated by telehealth?
Yes, with care. Evaluation, medication management and much of phase-one therapy work well by video for patients anywhere in Florida or South Carolina, and video can feel safer for people who find offices overwhelming. We establish a safety plan and grounding techniques early and may recommend in-person sessions for trauma processing or during unstable periods. Many patients use a mix of in-person visits at one of our 13 offices and video sessions.
I feel unreal and detached all the time, but I know it is not real. What is that?
That is likely depersonalization-derealization disorder, and the fact that you know the feeling is not accurate is part of the diagnosis; it is what separates it from psychosis. It is common, under-recognized and highly distressing, and it often follows a panic attack, severe stress, depression or cannabis use. CBT that targets the fear of the symptoms, attention retraining and grounding, often with an SSRI for accompanying anxiety or depression, helps most people. Many have been told for years that nothing is wrong, which is not true.
Where to get treatment for dissociative disorders
Evaluation and treatment for dissociative disorders is available at every Stedfast Psychiatry office and by video across Florida and South Carolina.
Related conditions
If you are thinking about harming yourself, call or text 988 now, or go to the nearest emergency room. This page is educational and does not replace an evaluation. Clinical content reviewed by Dr. David Husted, board-certified psychiatrist.