What are Dissociative Disorders?
A Guide to Understanding DPDR, Dissociative Amnesia, OSDD, and DID
Alex Penrod, MS, LPC, LCDC — Founder & EMDR Therapist | Neuro Nuance Therapy and EMDR, PLLC | Austin, TX
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.
As a therapist specializing in dissociative disorders and EMDR therapy 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 for this page is to provide education and instill optimism for treatment.
This page provides an overview of four main types of dissociative disorders:
Table of Contents
Depersonalization/Derealization Disorder (DPDR)
Definition
Depersonalization/Derealization Disorder (DPDR) is a dissociative disorder marked by persistent or recurrent experiences of depersonalization, derealization, or both.
Depersonalization refers to feeling detached from oneself, observing your thoughts, feelings, or body from a distance, as if you’re not fully “in” yourself.
Derealization involves a sense that the external world feels unreal, dreamlike, or visually distorted.
Even while these experiences can feel profoundly unsettling, reality testing remains intact, meaning the person recognizes that these sensations are not literally true but are a disturbance in perception and consciousness.
Distinction from Other Dissociative Disorders
DPDR differs from other dissociative disorders in several important ways:
It does not involve amnesia, identity fragmentation, or alternate personality states, as seen in Dissociative Identity Disorder (DID).
Individuals with DPDR maintain a stable sense of identity and can describe their experiences with awareness that something feels “off” or detached.
Depersonalization and derealization symptoms can also occur temporarily in conditions such as PTSD, panic disorder, or major depression, but DPDR is diagnosed only when these symptoms are persistent, distressing, and not better explained by another disorder or substance use.
Diagnostic Criteria
To meet criteria for Depersonalization/Derealization Disorder, the following must be present:
A. Persistent or recurrent experiences of one or both of the following:
1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions.
2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
B. During these experiences, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures).
E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.
(Adapted from DSM-5-TR, American Psychiatric Association, 2022.)
Risk and Protective Factors
Risk factors associated with DPDR include:
History of childhood trauma or emotional neglect
Severe stress or acute anxiety
Depression and other mood disorders
Substance use, particularly cannabis or hallucinogens, which can precipitate depersonalization/derealization episodes
Protective factors may include:
Strong social support and attachment security
Emotion regulation and grounding skills
Early recognition and trauma-informed treatment
Prevalence and Demographics
Lifetime prevalence is estimated around 1–2% of the general population, though transient symptoms are much more common.
In clinical populations, 5–20% of psychiatric outpatients may meet criteria for a dissociative disorder.
Symptoms often emerge in adolescence or early adulthood, with onset after age 40 being rare.
Men and women appear to be affected at similar rates.
Common Co-Occurring Disorders
DPDR frequently co-occurs with:
Anxiety disorders (especially panic disorder and generalized anxiety)
Major depressive disorder
Posttraumatic stress disorder (PTSD) and other trauma-related conditions
Obsessive-compulsive disorder (OCD) or substance use disorders (in some cases)
Evidence-Based Treatment Approaches
Psychotherapy
Psychotherapy is considered the primary treatment for depersonalization/derealization disorder.
Cognitive Behavioral Therapy (CBT) helps clients identify and challenge catastrophic misinterpretations of detachment experiences, strengthen present-moment awareness, and reduce anxiety that perpetuates dissociation.
Grounding and mindfulness techniques can restore sensory and emotional connection to the present.
Trauma-focused and parts-informed therapies such as EMDR, Internal Family Systems (IFS), or ego-state therapy may be helpful when depersonalization is rooted in early trauma.
Medication
There is no medication proven to specifically treat DPDR, but pharmacotherapy may target co-occurring anxiety or depression.
SSRIs or mood stabilizers can be used adjunctively when emotional regulation is impaired.
Research into lamotrigine and naltrexone has shown mixed and preliminary results.
Prognosis and Recovery
The course of DPDR is variable:
Some individuals experience episodic symptoms that improve with therapy, stress reduction, and lifestyle stabilization.
Others may experience chronic or fluctuating detachment lasting months or years.
With appropriate treatment, particularly when trauma, anxiety, and mood factors are addressed, many clients regain a stronger sense of presence and embodiment over time.
When to Seek Help
Persistent feelings of being “unreal” or detached from your body are not a sign of losing your mind, they’re a dissociative defense mechanism that once helped you survive overwhelming stress. If these experiences are causing distress or disrupting your life, specialized trauma therapy can help you restore connection, safety, and self-presence.
Dissociative Amnesia
Definition
Dissociative Amnesia is a dissociative disorder characterized by an inability to recall important autobiographical information, typically of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness. This form of memory loss functions as a psychological defense mechanism, protecting the mind from overwhelming distress by separating painful experiences from conscious awareness. The forgotten material usually remains stored in memory but is inaccessible to voluntary recall and may return spontaneously or with therapeutic support.
Distinction from Other Dissociative Disorders
Dissociative Amnesia differs from other dissociative conditions in both symptom pattern and mechanism:
Dissociative Identity Disorder (DID) involves distinct identity states with amnesia between them; dissociative amnesia involves memory loss only, without identity fragmentation.
Unlike Depersonalization/Derealization Disorder (DPDR), it does not include detachment from self or surroundings, identity and perception remain intact, while autobiographical recall is disrupted.
It is distinct from neurological amnesia, where memory impairment stems from brain injury or illness; dissociative amnesia is psychogenic, linked to psychological trauma or stress.
Subtypes of Amnesia
The DSM-5-TR describes several presentations:
Localized amnesia: Inability to recall a specific event or period (e.g., an assault).
Selective amnesia: Recall of only parts of an event.
Generalized amnesia: Loss of memory for one’s entire life history or identity (rare).
Continuous amnesia: Inability to retain new information following a traumatic event.
Systematized amnesia: Memory loss confined to specific categories (e.g., one’s family or a particular setting).
A rare specifier, “with dissociative fugue,” refers to sudden travel or wandering away from home, often with confusion about identity and subsequent amnesia for the fugue period.
Diagnostic Criteria
A. Inability to recall important autobiographical information, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The disturbance is not attributable to the physiological effects of a substance or a neurological or other medical condition.
D. The disturbance is not better explained by another mental disorder (e.g., DID, PTSD, somatic symptom disorder, or major neurocognitive disorder).
(Adapted from DSM-5-TR, American Psychiatric Association, 2022.)
Risk and Protective Factors
Risk Factors
Exposure to trauma or abuse, particularly in childhood
Severe stress, loss, or combat exposure
Previous dissociative symptoms or family history of dissociation
High suggestibility or hypnotizability
Protective Factors
Stable, supportive relationships and secure attachment
Early trauma-informed therapy and safety planning
Strong coping and emotion-regulation skills
Prevalence and Demographics
Estimated lifetime prevalence: ~1–2% in the general population
Dissociative disorders overall occur in 5–10% of psychiatric populations
More common in women and in individuals with a history of chronic trauma
Onset typically follows severe psychological stress or trauma
Common Co-Occurring Disorders
Frequently associated with:
Posttraumatic Stress Disorder (PTSD)
Major Depressive Disorder (MDD)
Anxiety disorders (panic, generalized anxiety)
Somatic symptom disorders
Substance use disorders (often as a coping strategy)
Evidence-Based Treatment Approaches
Psychotherapy
Psychotherapy is the primary and most effective treatment for dissociative amnesia, focusing on stabilization, safety, and gradual integration of memories.
Trauma-focused therapy helps integrate experiences once grounding and coping are established.
Cognitive Behavioral Therapy (CBT) addresses avoidance, anxiety, and distorted beliefs around memory loss.
Psychodynamic therapy explores underlying conflicts and supports reintegration of dissociated material.
Eye Movement Desensitization and Reprocessing (EMDR) can aid in processing traumatic memories when applied within a phase-oriented trauma model emphasizing safety before reprocessing.
Adjunctive Techniques
Hypnosis: When conducted by clinicians trained in both clinical hypnosis and trauma therapy, hypnosis can serve as a supportive adjunct, enhancing grounding, ego-strengthening, and gentle access to dissociated material. It should never be used to forcibly recover memories, and is appropriate only after stabilization, in line with ISSTD Guidelines (2011).
Medication: No pharmacologic treatment specifically targets dissociative amnesia. Antidepressants, mood stabilizers, or anxiolytics may help alleviate comorbid mood or anxiety symptoms but are considered adjuncts to psychotherapy.
Prognosis and Recovery
The course is variable:
Some individuals recover memories spontaneously once safety is restored.
Others experience gradual, partial, or delayed recovery within therapy.
Chronic or trauma-complex cases may require long-term, phase-oriented treatment emphasizing stabilization, integration, and prevention of retraumatization.
Overall, outcomes improve when treatment addresses both the underlying trauma and current stressors maintaining the dissociation.
When to Seek Help
If you experience gaps in memory after trauma or stress, it may indicate a dissociative process rather than ordinary forgetfulness. A trauma-informed therapist experienced in dissociative disorders can help you safely recover continuity, reduce distress, and restore a cohesive sense of self.
Other Specified Dissociative Disorder (OSDD)
Definition
Other Specified Dissociative Disorder (OSDD) is a diagnosis used when an individual experiences clinically significant dissociative symptoms that cause distress or impairment but do not meet the full criteria for any specific dissociative disorder such as Dissociative Identity Disorder (DID), Dissociative Amnesia, or Depersonalization/Derealization Disorder (DPDR).
OSDD captures the wide range of dissociative experiences that fall along the continuum between full identity fragmentation and milder dissociative states.
Common presentations include:
Chronic or recurrent mixed dissociative symptoms that only partially meet criteria for DID.
Dissociative trance or possession-like states that are not culturally normative.
Identity disturbance or partial dissociation following coercive persuasion (e.g., prolonged abuse, captivity, indoctrination).
Amnesia, depersonalization, or internal division that cause impairment but don’t fit neatly into another diagnostic category.
Distinction from Other Dissociative Disorders
OSDD serves as a “bridge category” for presentations that overlap with, but don’t fully satisfy, the criteria for other dissociative disorders.
Versus Dissociative Identity Disorder (DID): OSDD lacks fully distinct personality states separated by strong amnesic barriers. However, functionally distinct parts or ego states often exist and may have semi-independent memories or perspectives.
Versus Depersonalization/Derealization Disorder (DPDR): OSDD may include depersonalization or derealization, but these are not required or defining features. Emotional numbing, identity confusion, or amnesia are often more prominent.
Versus Dissociative Amnesia: Memory gaps may occur, but OSDD typically involves broader identity disturbance or internal compartmentalization beyond amnesia alone.
Clinically, many experts conceptualize OSDD through the theory of structural dissociation, a framework describing how the mind divides into parts to contain trauma while maintaining outward stability.
Symptoms
Symptoms of OSDD vary widely and can resemble aspects of multiple dissociative disorders. Common symptoms include:
Identity confusion or feeling internally divided.
Amnesia or time loss for ordinary events or behaviors.
Intrusive thoughts, emotions, or sensations that feel ego-dystonic or “not me.”
Depersonalization or derealization episodes during stress or flashbacks.
Internal dialogue or conflict between parts of self.
Significant distress or impairment in daily, relational, or occupational functioning.
Diagnostic Criteria
A. Dissociative symptoms that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
B. The symptoms do not meet full criteria for any specific dissociative disorder (e.g., DID, Dissociative Amnesia, DPDR).
C. The disturbance is not attributable to the physiological effects of a substance (e.g., drug of abuse, medication) or another medical condition (e.g., seizures).
D. The presentation is not better explained by another mental disorder, such as PTSD, psychotic disorders, or major depressive disorder.
(Adapted from DSM-5-TR, American Psychiatric Association, 2022.)
Risk and Protective Factors
Risk Factors
Chronic developmental trauma, attachment disruptions, or emotional neglect
Prolonged coercive control or captivity
High hypnotizability or dissociative capacity
Prior dissociative or somatoform symptoms
Protective Factors
Stable, supportive relationships and trauma-informed social environments
Access to specialized dissociation-informed therapy
Development of grounding, mindfulness, and affect-regulation skills
Early intervention before identity fragmentation becomes entrenched
Prevalence and Demographics
Prevalence estimates vary, as OSDD includes heterogeneous presentations.
In clinical populations, OSDD is often more common than formally diagnosed DID due to its subtler presentation.
True population prevalence is unknown but likely below 1%.
Women are diagnosed more frequently than men, largely reflecting differences in trauma exposure and help-seeking rather than biological factors.
Onset commonly follows chronic or cumulative trauma during childhood or early adulthood.
Common Co-Occurring Disorders
OSDD frequently co-occurs with:
Posttraumatic Stress Disorder (PTSD) or Complex PTSD (C-PTSD)
Major Depressive Disorder (MDD)
Anxiety disorders
Borderline Personality Disorder (BPD) or borderline traits
Somatic symptom and substance use disorders
Evidence-Based Treatment Approaches
Psychotherapy
Psychotherapy is the cornerstone of treatment for OSDD, generally structured around the phase-oriented trauma model recommended by the ISSTD:
Phase 1 – Stabilization:
Establish safety, grounding, and affect regulation before addressing traumatic material.Phase 2 – Trauma Processing:
Process traumatic memories using carefully titrated methods (e.g., EMDR, somatic, or parts-informed interventions).Phase 3 – Integration and Rehabilitation:
Support cooperation and cohesion among self-states to restore continuity and daily functioning.
Effective modalities include:
Internal Family Systems (IFS) or Ego-State Therapy to improve communication among dissociative parts.
Dialectical Behavior Therapy (DBT) for emotion regulation and distress tolerance.
Eye Movement Desensitization and Reprocessing (EMDR) once stabilization is achieved.
Medication
There is no specific pharmacologic treatment for OSDD. Antidepressants, mood stabilizers, or anxiolytics may be prescribed to manage co-occurring anxiety, depression, or sleep difficulties. Medication serves as an adjunct, not a replacement for psychotherapy.
Prognosis and Recovery
The prognosis for OSDD is generally positive with specialized, consistent therapy.
Most clients experience improvement in stability, emotional regulation, and self-cohesion over time.
Recovery often means integration and cooperation among self-states, not elimination of parts.
Duration of treatment depends on trauma severity, comorbidities, and therapeutic alliance.
As with other dissociative disorders, early detection and trauma-informed care significantly improve outcomes.
When to Seek Help
If you experience identity confusion, internal conflict, time loss, or emotional detachment that interferes with daily life, you may be experiencing a form of dissociation that falls within the OSDD spectrum. Working with a trauma-informed therapist trained in dissociative disorders can help you increase self-understanding, improve regulation, and build internal cooperation.
Dissociative Identity Disorder (DID)
Definition
Dissociative Identity Disorder (DID), formerly Multiple Personality Disorder, is characterized by two or more distinct identity states (sometimes called parts or self-states) that recurrently influence behavior, accompanied by recurrent gaps in autobiographical memory that are inconsistent with ordinary forgetting. Identities may differ in sense of self, affect, memories, and behaviors and can sometimes be experienced as possession-like in certain cultural contexts (which must be differentiated from culturally normative practices). DID is strongly associated with severe, chronic childhood trauma and attachment disruption.
Distinction from Other Dissociative Disorders
Versus Depersonalization/Derealization Disorder (DPDR): DID involves identity fragmentation and amnesia; DPDR centers on perceptual detachment with intact reality testing and without identity fragmentation.
Versus Dissociative Amnesia: DID includes identity disturbance plus amnesic gaps; dissociative amnesia is primarily memory loss (localized, selective, or generalized) without distinct identity states.
Diagnostic Criteria (DSM-5-TR, 2022)
A. Disruption of identity characterized by two or more distinct identity states, involving marked discontinuity in sense of self and agency, with related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.
B. Recurrent gaps in recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts during intoxication) or another medical condition (e.g., complex partial seizures).
(Adapted from DSM-5-TR, American Psychiatric Association, 2022.)
Risk and Protective Factors
Risk Factors: Chronic childhood interpersonal trauma (physical or sexual abuse, neglect), attachment disruptions, and high hypnotizability/dissociative capacity are commonly reported in DID samples.
Protective Factors: Stable, supportive relationships, early trauma-informed therapy, and skills in grounding and emotion regulation may mitigate chronicity and symptom burden.
Prevalence and Diagnostic Delay
General population: Estimates vary; multiple sources cite ~1–1.5% lifetime prevalence, though this remains debated.
Clinical settings: DID has been identified in ~2–6% of psychiatric outpatients in some studies, with higher rates for any dissociative disorder.
Under-/misdiagnosis: DID is frequently misdiagnosed (often as psychotic, mood, or personality disorders). Median diagnostic delay commonly ranges ~5–12 years from first help-seeking, with several prior incorrect diagnoses.
Sex differences: DID is more often diagnosed in females in clinical samples; differences likely reflect trauma exposure, help-seeking, and recognition patterns.
Common Co-Occurring Disorders
High comorbidity with Posttraumatic Stress Disorder (PTSD)/Complex PTSD, Major Depressive Disorder, anxiety disorders (including panic disorder), Borderline Personality Disorder or traits, substance use disorders, and eating disorders is reported. Psychotic-like symptoms (e.g., internal voices) can lead to misdiagnosis as schizophrenia, but phenomenology and course differ.
Evidence-Based Treatment Approaches
Psychotherapy (cornerstone of care)
Treatment follows a phase-oriented model endorsed by the ISSTD:
Phase 1 – Stabilization & Safety: Build grounding, affect regulation, and daily functioning; reduce self-harm and crises.
Phase 2 – Trauma Processing: Carefully titrated work with traumatic memories (e.g., EMDR delivered with extended preparation and parts-informed modifications; narrative or CBT elements as appropriate).
Phase 3 – Integration & Rehabilitation: Strengthen cooperation, co-consciousness, and continuity of self; “integration” is individualized and may mean increased cohesion rather than fusion.
Therapeutic modalities and techniques:
Parts-informed therapies (e.g., Ego-State Therapy, Internal Family Systems) to improve internal communication and compassion among self-states.
CBT elements for avoidance and cognitive distortions.
EMDR with extended preparation and parts work before reprocessing.
DBT skills for emotion regulation and distress tolerance when indicated.
Medication
No medication treats DID itself. Pharmacotherapy targets comorbid conditions such as depression, anxiety, or sleep disturbance. Antipsychotics may be used cautiously for severe dysregulation or psychotic-like phenomena but are viewed as adjunctive to psychotherapy.
Prognosis and Recovery
Outcomes vary. With consistent, trauma-informed, phase-oriented psychotherapy, many patients achieve substantial symptom reduction, improved co-consciousness, and functional gains. Full “fusion” of identities is not required for recovery; stable harmonization or cooperation among parts is often an appropriate goal. Treatment is typically long-term, especially for individuals with complex trauma histories.
When to Seek Help
Experiences such as marked time loss, internal voices or “others,” unexplained shifts in behavior or skills, or significant memory gaps, especially in the context of childhood trauma, warrant evaluation by a trauma-informed clinician experienced in dissociative disorders. Early, specialized care improves stabilization and long-term outcomes.
Conclusion
Dissociative disorders encompass a range of conditions characterized by disruptions in consciousness, memory, identity, and perception. While they share some similarities, each disorder 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. To learn more about me and my approach, visit my page on dissociative disorders therapy in Austin, TX or schedule a free 15-minute consultation.
Alex Penrod, MS, LPC, LCDC
Founder | EMDR Therapist | Neuro Nuance Therapy and EMDR, PLLC
Austin, TX
Disclaimer: This article is meant for educational purposes only and should not be taken as clinical or medical advice for the diagnosis or treatment of any condition. Seek guidance from a licensed professional for personalized care.
Last updated October 12, 2025
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