Disruptions of consciousness, identity, memory, or perception of self and surroundings, typically linked to trauma.
Also known as: DID, dissociative identity disorder, dissociative amnesia, depersonalization, derealization
Overview
DSM-5-TR dissociative disorders include: (1) Dissociative Identity Disorder (DID) — disruption of identity with ≥2 distinct personality states + recurrent gaps in recall of everyday events, personal information, or traumatic events; (2) Dissociative Amnesia — inability to recall important autobiographical information (usually trauma- or stress-related), beyond ordinary forgetting; with or without dissociative fugue specifier; (3) Depersonalization/Derealization Disorder — persistent or recurrent experiences of detachment from one's self (depersonalization) or surroundings (derealization) with INTACT reality testing.
Epidemiology
DID 12-month prevalence ~1.5%; female:male ~6:1 in clinical samples but ~equal in community surveys. Dissociative amnesia 12-month prevalence ~1.8%. Depersonalization/derealization disorder ~0.8-2% lifetime; onset usually adolescence/early adulthood. Transient depersonalization is much more common (~50% lifetime).
Try a board-style Dissociative Disorders question
Real questions from the FirstPassPA bank, with the full explanation. Pick an answer — no signup, no email.
Question 1PsychiatryMedium
A 32-year-old male has had episodes since age 15 of suddenly feeling as though he has no control over his body, watching himself from outside, and feeling that the world is unreal like a dream. Episodes last 20-30 minutes, occur several times weekly, and cause significant distress. He has no drug use, seizures, or psychosis, and remains oriented during episodes. He has comorbid moderate anxiety and depression. Which of the following is the most likely diagnosis?
ADissociative identity disorder
BPost-traumatic stress disorder
CDepersonalization-derealization disorder
DPanic disorder with agoraphobia
Reveal answer & full explanation
Correct answer: C — Depersonalization-derealization disorder
ADissociative identity disorder
BPost-traumatic stress disorder
CDepersonalization-derealization disorder✓
DPanic disorder with agoraphobia
Why Depersonalization-derealization disorder is correct
Depersonalization-derealization disorder (DPDR): persistent or recurrent episodes of depersonalization and/or derealization causing distress or impairment.
Reality testing stays intact — the patient recognizes the experience is not real, which distinguishes it from psychosis.
Depersonalization is detachment from one's own body, thoughts, or feelings; derealization is surroundings feeling unreal, dreamlike, or distorted.
Onset is typically adolescence to early adulthood with a chronic course; prevalence is up to 2%.
Commonly comorbid with anxiety, depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
Why the others are wrong
Dissociative identity disorder — requires two or more distinct personality states plus recurrent gaps in recall for everyday events; this patient has neither, and he retains a continuous sense of identity throughout each episode (confused-with, since both are dissociative disorders).
Post-traumatic stress disorder — requires exposure to a qualifying traumatic event with intrusion, avoidance, and hyperarousal symptoms, none of which is described; dissociation occurs in the PTSD dissociative subtype, making this the closest near-miss.
Panic disorder with agoraphobia — features an autonomic surge and acute fear peaking within minutes; anchoring on the comorbid anxiety rather than the core dissociative phenomenology.
Additional high-yield points
Treatment: treat comorbid anxiety/depression with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs); cognitive behavioral therapy (CBT) specifically for DPDR; mindfulness/grounding; avoid cannabis.
Lamotrigine and naltrexone have some evidence for severe DPDR.
🔒 Free preview limit reached
Keep reading — start your free trial
You've read your 2 free diagnosis previews. Create your free account to unlock the full Dissociative Disorders (DID, Dissociative Amnesia, Depersonalization/Derealization) outline — plus all 514 diagnoses, 6,500+ board-style questions, flashcards, and an AI tutor. Your 7-day free trial includes everything, and there's no credit card required.
Comorbid PTSD, borderline personality disorder, mood and anxiety disorders
Substance use, especially hallucinogens, cannabis (depersonalization)
Pathophysiology
Trauma-related disruption of integrative brain function — altered prefrontal-limbic regulation, hyperactive prefrontal inhibition of emotion (in depersonalization, an emotional 'shutdown'), and impaired hippocampal encoding/retrieval (in dissociative amnesia). DID is conceptualized as an extreme adaptation to inescapable trauma in early childhood.
Differential diagnosis
PTSD — Dissociative subtype with depersonalization/derealization is common; PTSD focuses on reexperiencing/avoidance/hyperarousal
Borderline personality disorder — Transient stress-related dissociation is part of BPD criteria; chronic identity disturbance differs from DID's distinct identity states
Psychotic disorders — Depersonalization preserves reality testing; psychosis does not
No FDA-approved medication for the core dissociative symptoms themselves
Lamotrigine has limited evidence for depersonalization disorder
Complications
Suicide and self-harm (especially DID — high lifetime rates)
Substance use disorders
Revictimization
Functional impairment, occupational loss
Comorbid mood, anxiety, eating, and personality disorders
PANCE pearls
DID is associated with severe early childhood trauma; question carefully and avoid suggestive techniques.
Depersonalization/derealization is the only dissociative disorder with intact reality testing — this distinguishes it from psychosis.
Dissociative fugue is now a specifier of dissociative amnesia (no longer a separate diagnosis).
First-rank Schneiderian symptoms (voices, passivity experiences) can occur in DID and are sometimes misdiagnosed as schizophrenia.
There is no FDA-approved medication for the core symptoms of any dissociative disorder; psychotherapy is the mainstay.
References
DSM-5-TR — American Psychiatric Association. DSM-5-TR. 2022.
ISSTD 2011 — International Society for the Study of Trauma and Dissociation. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. J Trauma Dissociation 2011;12:115-187.
Spiegel 2013 — Spiegel D et al. Dissociative disorders in DSM-5. Annu Rev Clin Psychol 2013;9:299-326.
Practice Psychiatry/Behavioral questions on FirstPassPA
Turn this outline into retention. 6,500+ board-style questions with an AI tutor that explains every answer — free to start, no card required.
Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA or PAEA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants; End of Rotation™ is a program of the Physician Assistant Education Association.