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Course and Prevalence of Dissociative Disorders

Prevalence of Dissociative Symptoms and Disorders

Dissociative symptoms (not necessarily occurring in the context of a full Dissociative Disorder) may be quite common in the general population, with studies finding that as many as 12.8% of people report that they experience substantial levels of dissociative symptoms [ref], and about 5% report levels of symptoms that would be compatible with having a Dissociative Disorder [ref, ref]. These symptoms seem to occur as frequently in men as in women and show no major differences between socioeconomic classes, but tend to diminish with age [ref].

Among individuals with other psychiatric disorders, the rates of dissociative symptoms are even higher. Substantial dissociative symptoms can be found in about 10% of people with Mood Disorders, 15% in Eating Disorders, 20% in Schizophrenia, 25% in Borderline Personality Disorder, and close to 50% in PTSD [ref].

One study found that Dissociative Disorders can be diagnosed in 70% of people with a Cluster B Personality Disorder, 60% in Cluster A, and close to 40% in Cluster C [ref]. Another study found that close to a third of hospital-treated psychiatry patients can be diagnosed with a Dissociative Disorder, especially in those who have a history of childhood physical or sexual abuse [ref].

The prevalence of actual Dissociative Disorders has not been clearly determined, but a reasonable estimate is that collectively they affect about 1% of the general population [ref, ref]. Dissociative Amnesia has been estimated to have a prevalence of 0.26-1.8% and Dissociative Fugues to occur in about 0.3% of the population [ref]. The prevalence rates of Depersonalization Disorder are not well known. Dissociative Identity Disorder (Multiple Personality Disorder) is probably very rare, but some estimate that it may occur in up to 1% of the population [ref].

In the 1980's there was a dramatic increase in the number of people being diagnosed with Dissociative Disorders in the US, which occurred after a few cases of Multiple Personality Disorder had received a lot of media attention. Many clinicians have cautioned that people who are suggestible and who are searching for a somewhat dramatic and impressive diagnostic label to attach to their experiences of psychological distress might be too quick to endorse the symptoms of these disorders [ref].

Course of Dissociative Disorders

Not a lot is known about the course and outcome of the Dissociative Disorders. Dissociative Identity Disorder likely represents the most severe and pervasive kind of Dissociative Disorder, and has been viewed by some as a kind of personality disorder [ref]. This would imply that this condition is likely to be a longstanding problem for individuals and to be associated with a high rate of other mental health problems.

About two-thirds of individuals with Depersonalization Disorder are unmarried, and most report feelings of disconnectedness and loneliness and difficulties in interpersonal relationships [ref]. Many also report difficulties with concentration in work settings [ref]. Depersonalization Disorder usually begins in adolescence, and thereafter can persist for decades [ref]. Some people described continuous symptoms, while others report that the symptoms occur periodically [ref].

Dissociative Amnesia can occur at any age, but is most common in the third and fourth decades of life. The majority of episodes last about 1-5 days, though there are rare reports of episodes lasting up to 20 years [ref]. Dissociative Fugues usually last for a period of a few days or weeks [ref].

Associated Conditions (Comorbidity) of Dissociative Disorders

Among patients with Depersonalization Disorder, about 90% will experience a Depressive or Anxiety Disorder, including Dysthymia in 30% [ref]. About half of these individuals will have a Personality Disorder, with a quarter suffering from either Borderline Personality Disorder, Avoidant Personality Disorder or Obsessive-Compulsive Personality Disorder [ref].

Dissociative Identity Disorder also tends to be associated with high rates of various other mental illnesses [ref].

One study found that about two thirds of people with Dissociative Disorders have Somatization Disorder [ref]. These individuals are also at high risk for engaging in self-harm behaviors and attempting suicide [ref].

 

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