Why can't I recognize myself in the mirror?

Dear Faceless, 

What you’ve described can be scary and certainly disorienting. It’s possible that this sense of unfamiliarity with your own reflection is simply a side effect of puberty changing how your face looks. However, if it’s something more serious, only a trained health care or mental health professional would be able to tell you for certain. In the meantime, here’s some information on dissociative disorders—specifically dissociative identity disorder (DID) and depersonalization-derealization disorder (DDD)—which are typically characterized the presence of two or more distinct and separate identities present in a person. You also mention schizotypal personality disorder (SPD), which is typically characterized by the distortion of one's perceptions and impressions of themself and others. 

SPD can cause abnormal or eccentric behavior, such as responding to things that aren't really there or responding to people in a suspicious or guarded way. SPD is often mistaken for schizophrenia; however, episodes of SPD are often shorter, less intense, and less common than episodes caused by schizophrenia. However, research has shown that people with schizophrenia can also have problems with recognizing their own faces, meaning it’s not outside the realm of possibility that a person who has schizotypal personality disorder could have a difficult time knowing their own face. In order to be accurately diagnosed with SPD, a mental health professional would have to do an assessment which often involves them observing whether the person has symptoms related to the following: 

• changes in beliefs concerning who one is and how the world works 
• illusions regarding one's body 
• eccentric thinking and speech patterns 
• paranoia and heightened suspicion of others 
• lack or loss of friends and schoolmates other than first-degree relatives 

What causes SPD isn’t known for certain, but it's thought to be a combination of changes in the way the brain functions, genetics, environmental factors, and learned behavior. Your risk of schizotypal personality disorder is also greater if you have a relative with schizophrenia or another psychotic disorder. 

You mentioned dissociative identity disorder (DID), which is a type of dissociative disorder, along with depersonalization-derealization disorder (DDD) and dissociative amnesia. Dissociative disorders are a group of mental health conditions characterized by disruptions in many mental and cognitive functions. This may affect how someone sees themself, other people, or how they understand and react to the world around them. While anyone can experience short periods of time where they’ve lost track of their surroundings (like daydreaming or getting lost in thought), dissociative disorders are much more severe. These disorders are often triggered after a traumatic and stress-inducing event such as an accident, disaster, crime, or from ongoing physical or sexual abuse in childhood. Survivors of these tragedies or mistreatment will often distance themselves from these memories as a coping mechanism. They try to avoid processing what happened to them—pushing the problem away to avoid the trauma. Unfortunately, this makes it difficult to remember the details of the experience later in life. 

Dissociative identity disorder (DID), formerly known as multiple (or split) personality disorder, is characterized by the presence of two or more distinct identities in one individual. These identities are each unique, with their own interests, behavior patterns, and personal histories. DID can lead to gaps in memory when different identities take over. A person may be unable to remember past events or day-to-day moments in one’s life, Or, they may have hallucinations—believing something is real when it isn’t. This is why people with DID report "losing time," such as being unsure how they got to a certain place. Signs of DID usually show up in early childhood between five and ten years old, although it’s often mistaken for other behavioral or learning problems common in children like attention deficit hyperactivity disorder (ADHD). For this reason, DID usually isn’t diagnosed until adulthood. However, experts say that diagnosing and treating DID early is crucial to prevent it from progressing since this disorder can severely impact one’s day-to-day life and ability to function. 

What you’re experiencing, however, may be more similar to a different dissociative disorder called depersonalization-derealization disorder (DDD). This disorder is defined by frequent or persistent feelings that one’s detached from themself and observing at a distance from outside their body (depersonalization) or that their surroundings aren’t real (derealization), or both. Symptoms of depersonalization include feeling like you’re an outside observer of your own thoughts, emotions, memories and even parts of your body, and that these don’t belong to you. Depersonalization can also make you feel as though you aren’t in control of your own speech and movement, and that someone else is “behind the wheel.” 

Derealization can manifest as a feeling of unfamiliarity with or alienation from your surroundings, as though your life were taking place in a dream or movie. It can also cause a distortion in distance and the size and shape of objects, causing them to appear blurry, colorless, two-dimensional, or artificial. It can also impact your perception of time, making recent events feel like the distant past. When any of these feelings continue to appear or never fully go away and interfere with your ability to function, they are considered DDD. 

While this information is good to know, in order to receive an accurate diagnosis, it’s important to consult with a health care provider or mental health professional.  They’ll review your symptoms and medical history to determine a diagnosis, if any. If a diagnosis is made, then the two of you can work together on the next steps, including treatment options. Although these disorders are typically a lifelong battle, psychotherapy, medication, or a combination of the two have all seen success at treating symptoms of DID, DDD, and SPD. If you’re a student, you might consider contacting your school's medical or counseling services to make an appointment for an evaluation. You may also be able to get a referral to a mental health professional through your pediatrician or family health care provider if you have either of those available to you. Hopefully this information can assist you in finding the answers you seek.