Names that open the right door
Dissociation, OCD, eating disorders, personality patterns, and substances are treatable. They are not character verdicts.
22.1 Dissociation
Dissociation is a mental process of disconnecting from thoughts, feelings, memories, or sense of identity. It exists on a spectrum from normal to pathological.
Normal: daydreaming; highway hypnosis; getting absorbed in a book or movie.
Pathological: depersonalisation (disconnected from the body); derealisation (world feels unreal); memory gaps (dissociative amnesia); identity fragmentation (DID).
Depersonalisation / derealisation disorder
Persistent feeling of being detached from body or thoughts; like an outside observer; world feels unreal, dreamlike, or distorted. Reality testing remains intact — the person knows it is a feeling, not a fact.
Dissociative amnesia
Inability to recall important personal information, usually related to trauma or stress, more than normal forgetting. Can be localised (a specific event), selective (parts of an event), or generalised (entire life).
Dissociative identity disorder (DID)
Formerly called multiple personality disorder. Two or more distinct personality states; gaps in memory for everyday events, personal information, or trauma. Usually develops from severe childhood trauma. Controversial diagnosis; requires specialised assessment. Not the same as schizophrenia.
Causes: often trauma, especially childhood trauma; a coping mechanism that can persist as a maladaptive pattern.
Treatment: trauma-informed therapy; grounding; building safety and stability; processing traumatic memories when ready; integration work for DID.
22.2 Obsessive-compulsive disorder
OCD is characterised by obsessions (intrusive thoughts) and compulsions (repetitive behaviours or mental acts).
Obsessions: intrusive, unwanted thoughts, images, or urges that cause anxiety; the person tries to ignore or suppress them. Themes: contamination, harm, symmetry, forbidden thoughts.
Compulsions: repetitive behaviours or mental acts performed to reduce anxiety; often excessive or not realistically connected to what they are meant to prevent. Examples: washing, checking, counting, ordering, mental rituals.
Common themes
- Contamination: fear of germs, dirt, chemicals; washing, cleaning, avoidance.
- Harm: fear of harming self or others; intrusive violent thoughts; checking, reassurance, avoidance.
- Symmetry / ordering: need for things to be just right; arranging, repeating.
- Forbidden thoughts: intrusive sexual, religious, or aggressive thoughts; mental rituals, prayer, reassurance.
- Responsibility: excessive fear of being responsible for something bad; checking, lists, reassurance.
Treatment
- Exposure and Response Prevention (ERP): gold standard. Face fears without performing compulsions; learn that anxiety decreases; build tolerance for uncertainty.
- Medications: SSRIs, often at higher doses than for depression.
- ACT: accept thoughts without engaging them.
- Support groups: reduce shame and isolation.
OCD is not being tidy. OCPD (below) is a different pattern.
22.3 Eating disorders
Eating disorders are serious mental-health conditions involving disturbed eating behaviours and preoccupation with food, weight, and body image. They have physical and psychological components and can be medically dangerous.
Anorexia nervosa
Restriction of energy intake leading to significantly low body weight; intense fear of gaining weight; distorted body image; often excessive exercise. Physical complications: malnutrition, heart problems, osteoporosis, infertility, organ failure. Highest mortality rate of any psychiatric disorder. Treatment: medical stabilisation, nutritional rehabilitation, psychotherapy, family-based treatment for adolescents.
Bulimia nervosa
Recurrent binge eating with a sense of loss of control; compensatory behaviours; self-evaluation unduly influenced by body shape and weight; often normal or above-normal weight. Complications: electrolyte imbalance, dental erosion, oesophageal and heart problems. Treatment: CBT-E, SSRIs, nutritional counselling.
Binge-eating disorder
Recurrent binge eating without regular compensatory behaviours; eating rapidly, until uncomfortably full, when not hungry; disgust, depression, or guilt afterwards; often leads to obesity. Treatment: CBT, interpersonal therapy, sometimes medicines.
ARFID
Limited food intake due to lack of interest, sensory issues, or fear of consequences. Not driven by body-image concerns. Can lead to malnutrition. Common in children and autism spectrum. Treatment: nutritional support, exposure, family involvement.
OSFED
Symptoms cause significant distress but do not meet full criteria for the disorders above. Still serious and requires treatment.
Underlying factors: genetic predisposition; cultural pressure about thinness; perfectionism, low self-esteem; trauma; co-occurring anxiety, depression, OCD; family dynamics.
Treatment principles: medical monitoring; multidisciplinary team (therapist, dietitian, physician, psychiatrist); address underlying psychology; nutritional rehabilitation; family involvement for adolescents; support groups.
22.4 Personality disorders
Enduring patterns of thinking, feeling, and behaving that differ from cultural expectations, are inflexible, and cause distress or impairment. Chapter 11 introduced the clusters. Here is the full list.
Cluster A (odd / eccentric)
- Paranoid: pervasive distrust; motives read as malevolent; reluctant to confide; hidden meanings in benign remarks.
- Schizoid: detachment from relationships; limited emotional expression; prefers solitude; indifferent to praise or criticism.
- Schizotypal: social deficits with cognitive distortions; odd beliefs, magical thinking; unusual perceptual experiences; eccentric behaviour.
Cluster B (dramatic / emotional / erratic)
- Antisocial: disregard for others' rights; deceitful, impulsive, aggressive; lack of remorse; often conduct disorder in childhood.
- Borderline (BPD): instability in relationships, self-image, emotions; fear of abandonment; impulsivity; recurrent suicidal behaviour or self-harm in some people; chronic emptiness; intense anger. DBT is the gold-standard therapy.
- Histrionic: excessive emotionality and attention-seeking; uncomfortable when not the centre; shallow, rapidly shifting emotions.
- Narcissistic: grandiosity, need for admiration, lack of empathy; fantasies of success; exploitative; fragile self-esteem.
Cluster C (anxious / fearful)
- Avoidant: social inhibition, inadequacy, hypersensitivity to criticism; avoids contact despite wanting connection; fear of rejection.
- Dependent: excessive need to be taken care of; submissive, clinging; fear of separation; difficulty deciding without reassurance.
- OCPD: preoccupation with orderliness, perfectionism, control; ego-syntonic (feels like 'me'), unlike OCD which is ego-dystonic; rigid; workaholic; neglects leisure and relationships.
Treatment: long-term psychotherapy; DBT for BPD; schema therapy; mentalisation-based treatment; medicines for specific symptoms, not for the personality disorder itself. Challenging but treatable with commitment.
22.5 Substance use disorders
A problematic pattern of substance use leading to impairment or distress. Signs: taking more than intended; wanting to cut down but unable; much time obtaining, using, recovering; cravings; failure to fulfil obligations; continued use despite problems; giving up activities; using in dangerous situations; tolerance; withdrawal.
Substances named: alcohol; opioids (heroin, prescription painkillers); stimulants (cocaine, methamphetamine, ADHD medicines); cannabis; sedatives (benzodiazepines, sleep medicines); hallucinogens; tobacco/nicotine.
Treatment: medically supervised detoxification; rehabilitation; medication-assisted treatment for opioids and alcohol; CBT and motivational interviewing; support groups (AA, NA, SMART Recovery); relapse prevention; treat co-occurring mental-health conditions.
22.6 One companion verse
Reflection activity
- Which of these conditions have you encountered (personally or in others)?
- How does understanding these conditions reduce stigma?
- What would you say to someone struggling with these issues?
- Where could they seek help?
- How can you be supportive without enabling?
This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.