Hidden in Plain Sight: Dissociation Across Psychiatric Presentations

Abstract
Background
Dissociative disorders remain among the most underrecognized psychiatric conditions, frequently misclassified as other DSM-5 or ICD-11 diagnoses. Because dissociative symptoms can resemble a wide range of psychiatric presentations, accurate diagnosis is often missed. Dissociation can present as attentional lapses, memory disturbances, emotional numbing or blunting, detachment from feelings, and reduced affective range, as well as sudden shifts in mood or behavior, alterations in perception, somatic symptoms, identity disturbance, discontinuities in agency, distortions of time, and interpersonal disconnection. Evidence suggests that individuals often spend many years in the mental health system before receiving an accurate diagnosis. During this time, treatments are commonly provided that address surface-level symptoms rather than the underlying dissociative processes.

Objectives
This seminar will:
-Examine how dissociative symptoms resemble other psychiatric presentations.
-Highlight the role of dissociative defensive structures—including discontinuity of memory and identity, trauma-related triggers, and fluctuating states of consciousness—in symptom expression.
-Provide guidance on using narrative history-taking, trauma-informed assessment, and the practical use of diagnostic instruments to improve the accuracy of diagnosis.
-Illustrate the clinical consequences of misdiagnosis and the benefits of early recognition.
-Offer practical tools for differential diagnosis and treatment planning.

Methods
The session will integrate a review of recent literature and meta-analyses with clinical case examples. Didactic content will be combined with discussion of assessment strategies, including careful exploration of trauma history, attention to lived experience, and the structured use of diagnostic tools for dissociation.

Expected Outcomes
Participants will:
-Increase their ability to recognize dissociative symptoms within complex psychiatric presentations.
-Strengthen diagnostic precision by differentiating dissociative features from those of other psychiatric conditions.
-Understand the limitations of non-dissociation-focused interventions
-Gain trauma-informed strategies for treatment planning

Significance
Misdiagnosis of dissociative disorders has significant clinical consequences, delaying access to effective trauma-informed care and often reinforcing distress. By enhancing awareness and diagnostic precision, clinicians can more effectively identify dissociative presentations and tailor interventions that promote stabilization, integration, and long-term recovery.