RELATED STORIES • Depersonalization: A feeling of being 'outside' your body MENTAL HEALTH Mental Disorders • Compulsive sexual behavior • Schizophrenia • Bipolar disorder • Borderline personality disorder • Compulsive gambling • Body dysmorphic disorder • Personality disorders • Dissociative disorders • Narcissistic personality disorder • Cyclothymia • Intermittent explosive disorder • Self-injury/cutting • Antisocial personality disorder • Schizotypal personality disorder

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Compelling books, movies and plays often are enjoyable because they allow you to escape from yourself for a short while. As the story draws to a close, you can savor the characters' experiences while slowly allowing thoughts of your own life to trickle back into consciousness. Getting "lost" in this way is pleasurable and healthy and allows you to return to reality refreshed.

People with dissociative disorders chronically escape their reality in involuntary, unhealthy ways ranging from suppressing memories to assuming alternate identities. These dissociative patterns usually develop as a reaction to trauma and function to keep difficult memories at bay. An estimated 3 percent of U.S. adults are affected.

Treatment may include psychotherapy, hypnosis and medication. Although the course of therapy can be difficult, many people with dissociative disorders are able to learn new ways of coping and lead healthy, productive lives.

There are four major dissociative disorders:

• Dissociative amnesia
• Dissociative identity disorder
• Dissociative fugue
• Depersonalization disorder

Symptoms common to all types of dissociative disorders include:

• Memory loss (amnesia) of certain time periods, events and people
• Mental health problems, including depression and anxiety
• A sense of being detached from yourself (depersonalization)
• A perception of the people and things around you as distorted and unreal (derealization)
• A blurred sense of identity

Each of the four major dissociative disorders is characterized by a distinct mode of dissociation. Signs and symptoms of each disorder may include:

• Dissociative amnesia. Memory loss that's more extensive than normal forgetfulness and can't be explained by a physical or neurological condition is the hallmark of this condition. Sudden-onset amnesia following a traumatic event, such as a car accident, happens infrequently. More commonly, conscious recall of traumatic periods, events or people in your life — especially from childhood — is simply absent from your memory.
• Dissociative identity disorder. This condition, formerly known as multiple personality disorder, is characterized by "switching" to alternate identities when you're under stress. In dissociative identity disorder, you may feel the presence of one or more other people talking or living inside your head. Each of these identities may have their own name, personal history and characteristics, including marked differences in manner, voice, gender and even such physical qualities as the need for corrective eyewear. There often is considerable variation in each alternate personality's familiarity with the others. People with dissociative identity disorder typically also have dissociative amnesia.
• Dissociative fugue. People with this condition dissociate by putting real distance between themselves and their identity. For example, you may abruptly leave home or work and travel away, forgetting who you are and possibly adopting a new identity in a new location. People experiencing dissociative fugue typically retain all their faculties and may be very capable of blending in wherever they end up. A fugue episode may last only a few hours or, rarely, as long as many months. Dissociative fugue typically ends as abruptly as it begins. When it lifts, you may feel intensely disoriented, depressed and angry, with no recollection of what happened during the fugue or how you arrived in such unfamiliar circumstances.
• Depersonalization disorder. This disorder is characterized by a sudden sense of being outside yourself, observing your actions from a distance as though watching a movie. It may be accompanied by a perceived distortion of the size and shape of your body or of other people and objects around you. Time may seem to slow down, and the world may seem unreal. Symptoms may last only a few moments or may wax and wane over many years.

Dissociative disorders usually develop as a mechanism for coping with trauma. The disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable.

Personal identity is still forming during childhood, and during these malleable years a child is more able than is an adult to step outside herself or himself and observe trauma as though it's happening to a different person. A child who learns to dissociate in order to endure an extended period of his or her youth may reflexively use this coping mechanism in response to stressful situations throughout life.

Rarely, adults may develop dissociative disorders in response to severe trauma.

People who experience chronic physical, sexual or emotional abuse during childhood are at greatest risk of developing dissociative disorders. Children and adults who experience other traumatic events, including war, natural disasters, kidnapping, torture and invasive medical procedures also may develop these conditions.

If you or someone you love has significant, unexplained memory loss or experiences a dramatic change in behavior when under stress, talk to a doctor. A chronic sense that your identity or the world around you is blurry or unreal also may be caused by a dissociative disorder. Effective treatment is available for these conditions. Seek medical help.

If you or your child experiences abuse or another traumatic situation, talk to a doctor as soon as possible. Early intervention and counseling may help prevent the formation of dissociative disorders.

Doctors diagnose dissociative disorders based on a review of your symptoms and your personal history. As part of your evaluation, your doctor may perform tests to rule out physical conditions — including head injuries, certain brain diseases, sleep deprivation and intoxication — that can cause symptoms such as memory loss and a sense of unreality. If your doctor rules out physical causes, he or she will likely refer you to a mental health professional for an in-depth interview.

To help diagnose dissociative identity disorder, some doctors use medication or hypnosis. These aids may help your doctor identify alternate personalities or may help you describe repressed memories that played a role in the development of dissociative patterns.

People with a dissociative disorder are at increased risk of complications that include:

• Self-mutilation
• Suicide attempts
• Sexual dysfunction, including sexual addiction or avoidance
• Alcoholism and substance abuse
• Depression
• Sleep disorders, including nightmares, insomnia and sleepwalking
• Anxiety disorders
• Eating disorders
• Severe headaches

Dissociative disorders are also associated with significant difficulties in relationships and at work. People with these conditions often aren't able to cope well with emotional or professional stress, and their dissociative reactions — from tuning out to disappearing — may distress loved ones and cause colleagues to view them as unreliable.

Psychotherapy is the primary treatment for dissociative disorders. This form of therapy, also known as talk therapy, counseling or psychosocial therapy, involves talking about your disorder and related issues with a mental health professional. Your therapist will work to help you understand the cause of your condition and to form new ways of coping with stressful circumstances.

Psychotherapy for dissociative disorders often involves techniques that help you remember and work through the trauma that triggered your dissociative symptoms. The course of your psychotherapy may be long and painful, but this treatment approach often is very effective in treating dissociative disorders.

Other treatments for dissociative disorders may include:

• Creative art therapy. This type of therapy uses the creative process to help people who might have difficulty expressing their thoughts and feelings. Creative arts can help you increase self-awareness, cope with symptoms and traumatic experiences, and foster positive changes. Creative art therapy includes art, dance and movement, drama, music and poetry.
• Cognitive therapy. This type of talk therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other people or situations — determine how you behave. Even if an unwanted situation has not changed, you can change the way you think and behave in a positive way.
• Medication. Although there are no medications that specifically treat dissociative disorders, your doctor may prescribe antidepressants, anti-anxiety medications or tranquilizers to help control the mental health symptoms associated with dissociative disorders.

Children who are physically, emotionally or sexually abused are at increased risk of developing mental health disorders, including dissociative disorders. If stress or other personal issues are affecting the way you treat your child, seek help. Talk to a trusted person such as a friend, your doctor or a leader in your faith community. Ask for his or her help locating resources such as parenting support groups and family therapists. Many churches and community education programs offer parenting classes that also may help you learn a healthier parenting style.

If your child has been abused or has experienced another traumatic event, see a doctor immediately. Your doctor can refer you to mental health professionals who can help your child recover and adopt healthy coping skills.

Your therapist may recommend using hypnosis, which is sometimes referred to as hypnotherapy or hypnotic suggestion, as part of your treatment for a dissociative disorder.

Hypnosis creates a state of deep relaxation and quiets the mind. When you're hypnotized, you can concentrate intensely on a specific thought, memory, feeling or sensation while blocking out distractions. Because you're more open than usual to suggestions while under hypnosis, there is some controversy that therapists may unintentionally "implant" false memories by suggestion. However, when conducted under the care of a trained therapist, hypnosis is generally safe as a complementary treatment method.