What Are Dissociative Disorders? A Guide from an NYC Psychiatrist

Imagine waking up in a strange place with no memory of how you got there. Or looking in the mirror and feeling like the reflection isn’t quite “you.” These experiences may sound like scenes from a movie, but for people living with dissociative disorders, they can be part of daily life.

As a NYC psychiatrist specializing in both therapy and medication management, I’ve worked with many patients who experience these kinds of disconnections from self, memory, or reality. Dissociation isn’t just “spacing out” — it can be deeply distressing and disruptive. This blog post breaks down the types of dissociative disorders, why they happen (often tied to early trauma), and how we approach treatment, especially for individuals in marginalized communities like the LGBTQ+ population.

What Is Dissociation?

At its core, dissociation is a disruption in the normal integration of consciousness, memory, identity, emotion, perception, body representation, or behavior. It exists on a spectrum:

• Mild dissociation: Daydreaming, zoning out during a long drive

• Moderate to severe dissociation: Feeling like you’re outside your body, gaps in memory, or even feeling like you are “more than one person”

For most people, dissociation is a temporary reaction to stress. But when it becomes chronic and interferes with functioning, it may fall under a dissociative disorder.

The Three Main Types of Dissociative Disorders

1. Dissociative Identity Disorder (DID)

Formerly known as Multiple Personality Disorder, DID involves the presence of two or more distinct personality states or identities. Each may have its own name, voice, memories, and behaviors.

Common features include:

• Memory gaps for everyday events or traumatic experiences

• Feeling like you're watching yourself act without control

• Sudden shifts in mood, skills, or handwriting

DID often develops in response to severe childhood trauma, especially repeated abuse. Dissociation acts as a defense mechanism — parts of the mind wall off overwhelming memories, creating "alter" identities to handle them.

While often sensationalized in media, DID is real, complex, and treatable with long-term psychotherapy.

2. Depersonalization/Derealization Disorder

In this condition, individuals feel detached from themselves (depersonalization) or the world around them (derealization).

Symptoms might include:

• Feeling like a robot or like you're watching yourself from outside your body

• Surroundings feel foggy, dreamlike, or artificial

• Emotional numbing

Unlike psychosis, people with this disorder know their experiences are not “real” — they maintain insight, which makes it even more distressing.

Depersonalization/derealization often arises during periods of intense anxiety, panic attacks, or trauma, and may fluctuate with stress levels.

3. Dissociative Amnesia

This involves inability to recall important personal information, often related to trauma or stress. It goes beyond ordinary forgetfulness.

• The amnesia may last minutes, hours, days — or longer

• In rare cases, people may wander and adopt a new identity (called dissociative fugue)

People with this disorder aren’t faking. Their brains are blocking access to overwhelming or threatening memories to protect them. Sometimes, memories return gradually or after triggering events.

What Causes Dissociative Disorders?

1. Childhood Trauma and Neglect

Research consistently links dissociative disorders to early, chronic trauma — especially during the ages when a child’s identity and sense of safety are developing. These may include:

• Physical, emotional, or sexual abuse

• Neglect or abandonment

• Exposure to domestic violence

When caregivers are abusive, absent, or emotionally misattuned, children may develop dissociative defenses to survive. Over time, these defenses become patterns.

2. Identity Threats and Shame

Dissociation can also be a response to identity-based trauma, especially when a person is marginalized or stigmatized.

This is especially relevant for LGBTQ+ individuals, who may:

• Experience chronic invalidation or rejection by family, community, or religious groups

• Feel unsafe expressing their true gender or sexual identity

• Live with persistent fear of violence or exclusion

The shame and isolation from this mismatch between self and surroundings can drive dissociation as a way to escape emotional pain.

Common Misdiagnoses

Dissociative disorders are frequently misdiagnosed as:

• Bipolar disorder: Sudden shifts in mood or behavior may be seen as mood cycling

• Psychotic disorders: Detachment or memory gaps may resemble hallucinations or delusions

• Borderline Personality Disorder: Identity disturbance and dissociation are also features here, but in DID they’re more pronounced and longer-lasting

Unfortunately, many mental health professionals receive limited training in dissociation. Patients may spend years receiving treatment for the “wrong” disorder — often without getting better.

If you suspect dissociation, seek out a provider with experience in trauma and identity-sensitive care, especially if you belong to an LGBTQ+ population.

Can Autism Cause Dissociation?

Yes — while autism is not a dissociative disorder, individuals on the autism spectrum may experience dissociation, especially in response to sensory overload, social trauma, or chronic invalidation.

Many autistic people describe moments of:

• Feeling like they’re “shut down” or “numb”

• Watching themselves from outside their body

• Mentally disconnecting during social interactions

• Losing track of time during overstimulating environments

These experiences are often misunderstood or dismissed, especially in autistic women, nonbinary people, and those with co-occurring trauma.

Why Does This Happen?

Autistic individuals may be more vulnerable to dissociation for several reasons:

• Sensory overload: When lights, sounds, or touch become overwhelming, the brain may disconnect as a protective measure.

• Masking and social performance: Many autistic individuals learn to “mask” their true selves to fit in socially — a process that can be exhausting and alienating, leading to a fractured sense of identity.

• Repeated invalidation: Being misunderstood, punished for natural behaviors, or not believed can lead to chronic shame, dissociation, and internal fragmentation.

• High rates of trauma: Studies show that autistic people experience higher rates of bullying, abuse, and medical trauma, all of which increase the risk for dissociative symptoms.

Dissociation in Autistic LGBTQ+ Individuals

For LGBTQ+ autistic individuals, the experience is often compounded. Navigating a world that misunderstands both gender identity and neurodivergence can lead to profound disconnection from the self.

How Dissociation Affects Daily Life

Living with a dissociative disorder isn’t just about losing memories or “switching” identities. It often includes:

• Feeling chronically unsafe or confused

• Trouble concentrating or staying grounded in the present

• Chronic fatigue or pain (due to trauma being held in the body)

• Difficulties in relationships (others may not understand their internal world)

For LGBTQ+ individuals or trauma survivors, the added pressure of hiding parts of themselves or navigating unsafe environments can worsen symptoms.

Diagnosis and Assessment

Diagnosis is clinical and often involves:

• Thorough psychiatric interviews

• Specific tools like the Dissociative Experiences Scale (DES) or SCID-D

• Collateral reports from loved ones (if safe and appropriate)

Neuroimaging and lab tests are not helpful for dissociative symptoms but may be used to rule out other medical conditions.

Treatment for Dissociative Disorders

1. Psychotherapy Is the Main Treatment

The most effective treatment for dissociative disorders is long-term psychotherapy, particularly trauma-focused or integrative approaches.

Types of therapy that help:

• Phase-oriented trauma therapy (e.g., ISSTD model): Helps patients stabilize, process traumatic memories, and integrate fragmented parts

• Internal Family Systems (IFS): Supports dialogue between different parts of the self in a non-pathologizing way

• Psychodynamic therapy: Explores unconscious defenses and early relational wounds

• EMDR (Eye Movement Desensitization and Reprocessing): Helps reprocess traumatic memories in some individuals

Therapy takes time — but people do improve. Many go on to lead full, meaningful lives.

2. Medication Management

There are no medications that directly treat dissociation, but medication can help with comorbid symptoms like:

• Depression, anxiety (e.g., SSRIs like sertraline or fluoxetine)

• PTSD-related insomnia (e.g., prazosin)

• Clonidine can also be helpful to calm down the body’s fight or flight response

In my practice as a medication management psychiatrist in NYC, I carefully tailor prescriptions to avoid overmedicating or numbing affect, especially in dissociative patients who already feel emotionally detached.

3. Holistic and Lifestyle Support

Grounding techniques, body-based therapies, and safe community connections are all important.

• Yoga and somatic therapies can help people reconnect with their bodies

• Mindfulness and breathwork reduce anxiety and improve grounding

• Support groups (including LGBTQ+ specific groups) reduce isolation and promote healing

Final Thoughts: There Is Hope

Living with a dissociative disorder can feel terrifying — like you’re losing time, losing control, or losing yourself. But you are not alone. Dissociation is a survival response, not a flaw or weakness. It’s a sign that your mind did what it needed to do to survive.

With the right support, healing is possible. Your story makes sense. And it deserves to be told in your own voice, at your own pace.

If you’re in New York City and looking for a trauma-informed, LGBTQ+ affirming provider, I offer comprehensive therapy and medication management tailored to your needs.