Understanding Dissociation

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“People have a range of capacities to deal with overwhelming experience. Some people, some kids particularly, are able to disappear into a fantasy world, to dissociate, to pretend like it isn’t happening, and are able to go on with their lives. And sometimes it comes back to haunt them.”

 – Bessel van der Kolk

Dissociation is a fairly common occurrence for those who have experienced trauma.[1] It allows the mind to cope with overwhelming stress as a result of a traumatic event. Dissociative experiences can last for a relatively short time (hours or days) or for much longer (weeks, months, or even years).

In this article, we will explore what disassociation means why it happens, and when it can become a problem for the sufferer.

What is Dissociation?

Dissociation is a state of psychological disruption and refers to the phenomena of disconnecting from oneself. We all experience periods of time where we daydream or feel “spaced out” during habitual, routine patterns of behavior such as brushing your teeth or driving a vehicle.  Those experiencing dissociation, however, suffer a disconnect, or an “out of body experience,” as a way of avoiding negative thoughts or feelings related to past trauma. The mind disassociates as a coping mechanism, as it provides distance from the perceptions, physicality, memories, emotions, and behavior that the person finds too painful or challenging to face. This disconnect is usually automatic and beyond the person’s control.

Most researchers view dissociation as a protective response post-trauma, and some have noted that a specific traumatic event is stored in our somatic memory and expressed through changes in our biological stress –or our fight, flight, freeze– response.[2]

Controversy around the precise causes of dissociation and dissociative disorders (DD) has existed since the beginning of modern psychiatry and psychology. While the exact root of dissociation is still up for debate, we know it is usually associated with significant trauma.[3] Research has shown that dissociation commonly affects those who have experienced childhood trauma, sexual or physical abuse, kidnapping, a natural disaster, a war zone, or a sudden accident like a car crash.[4]

Dissociation, at least in the short term, can enable trauma survivors to continue functioning in their lives without becoming overwhelmed by painful memories and negative emotions.

Signs & Symptoms of Dissociation

There are five core symptoms of Dissociation:[5]

  • Amnesia: A loss of memory that can range from mere minutes to years
  • Depersonalization: Feeling disconnected from your thoughts, sensations, and emotions
  • Derealization: Feeling disconnected from the world around you
  • Identity alteration: The sense of being markedly different from another part of yourself
  • Identity confusion: Difficulty remembering personal information and details around your identity

It is important to note here that a person can experience the above symptoms without having a dissociative disorder. The above symptoms can also be experienced as part of another mental condition such as anxiety.

People who suffer from these symptoms usually experience them as frightening, unpleasant, and uncomfortable.[6] These symptoms can significantly impact people’s lives and their ability to function within interpersonal relationships, at work, or at school.

Dissociative Disorders

If someone is experiencing recurring, pronounced, or prolonged symptoms, they are likely suffering from a Dissociative Disorder.

The current “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5)[7] identifies three types of Dissociative Disorders:

  • Dissociative Amnesia – A condition characterized by memory loss that can take three main forms:[8]
    • Localized: The most common type–where events from a specific traumatic event cannot be recalled.
    • Selective: Only particular aspects from a specific event can be recalled.
    • Generalized: A rare type–where an individual loses large sections of their memories.
  • Dissociative Identity Disorder (DID) – This is where a person has at least two distinct identities or personalities. It was previously known as “multiple personality disorder.“ These identities and personalities can have different names, histories, ages, and mannerisms. Memory loss can occur between personality shifts, and people suffering with this disorder usually experience significant impairment to daily functioning.[9]
  • Depersonalization/Derealization Disorder – This dissociative disorder is characterized by persistent or recurring episodes of detachment from or unfamiliarity with the self.[10]
    • Depersonalization can be experienced as a lack of connection to the body alongside emotional or physical numbness.
    • Derealization describes an unfamiliarity or detachment from the world around you, where objects can appear dreamlike and a person may experience visual or auditory distortions.  

Dissociative Fugue, although not recognized as a Dissociative Disorder within the DSM-5, is also worth mentioning here. It is considered extremely rare and is a type of amnesia caused by an extreme psychological trauma. Someone with dissociative fugue has lost all memory of their past as well as all personal recollection of themselves.[11]

Treatment

Dissociation can become a serious issue when it manifests as a long-term coping mechanism. Studies have shown that more than 70% of outpatients exhibiting severe symptoms as a result of dissociative disorders attempted suicide and that self-injurious behaviour is common.[12]

However, with appropriate treatment, many sufferers are able to successfully address the causes of their dissociation. Common treatment modalities include Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and Psychotherapy, as these encourage the client to become more familiar with themselves and their emotions, experiences, and memories.

These types of therapy allow a client to regain control over the dissociative process and re-integrate the fragmented parts of themselves. New coping mechanisms can be found in therapy that allow the symptoms of dissociation to dissipate and enable the client to live out a productive, fulfilling life away from the constraints of past trauma.

If you are concerned about any issues discussed in this blog, please contact Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.


[1] van der Kolk, Bessel A. “The Body Keeps The Score: Memory And The Evolving Psychobiology Of Posttraumatic Stress”. Harvard Review Of Psychiatry, vol 1, no. 5, 1994, pp. 253-265. Ovid Technologies (Wolters Kluwer Health), doi:10.3109/10673229409017088. Accessed 10 Mar 2021.

[2] van der Kolk, Bessel A. “The Body Keeps The Score: Memory And The Evolving Psychobiology Of Posttraumatic Stress”. Harvard Review Of Psychiatry, vol 1, no. 5, 1994, pp. 253-265. Ovid Technologies (Wolters Kluwer Health), doi:10.3109/10673229409017088. Accessed 10 Mar 2021.

[3] Dissociation Debates: Everything You Know Is Wrong”. Vol 20, no. 3, 2018, pp. 229-242. Servier International, doi:10.31887/dcns.2018.20.3/rloewenstein. Accessed 10 Mar 2021.

[4] Granieri, Antonella et al. “Trauma-Related Dissociation Is Linked With Maladaptive Personality Functioning”. Frontiers In Psychiatry, vol 9, 2018. Frontiers Media SA, doi:10.3389/fpsyt.2018.00206. Accessed 10 Mar 2021.

[5] Şar, Vedat. “The Many Faces Of Dissociation: Opportunities For Innovative Research In Psychiatry”. Clinical Psychopharmacology And Neuroscience, vol 12, no. 3, 2014, pp. 171-179. Korean College Of Neuropsychopharmacology, doi:10.9758/cpn.2014.12.3.171. Accessed 10 Mar 2021.

[6] Rehan, Muhammad Awais et al. “A Strange Case Of Dissociative Identity Disorder: Are There Any Triggers?”. Cureus, 2018. Cureus, Inc., doi:10.7759/cureus.2957. Accessed 10 Mar 2021.

[7] Kocsis, Richard N. “Book Review: Diagnostic And Statistical Manual Of Mental Disorders: Fifth Edition (DSM-5)”. International Journal Of Offender Therapy And Comparative Criminology, vol 57, no. 12, 2013, pp. 1546-1548. SAGE Publications, doi:10.1177/0306624×13511040. Accessed 10 Mar 2021.

[8] Staniloiu, Angelica, and Hans J Markowitsch. “Dissociative Amnesia”. The Lancet Psychiatry, vol 1, no. 3, 2014, pp. 226-241. Elsevier BV, doi:10.1016/s2215-0366(14)70279-2. Accessed 11 Mar 2021.

[9] Marsh, Rosemary J. et al. “Inter-Identity Amnesia For Neutral Episodic Self-Referential And Autobiographical Memory In Dissociative Identity Disorder: An Assessment Of Recall And Recognition”. PLOS ONE, vol 16, no. 2, 2021, p. e0245849. Public Library Of Science (Plos), doi:10.1371/journal.pone.0245849. Accessed 10 Mar 2021.

[10] Sedeño, Lucas et al. “How Do You Feel When You Can’t Feel Your Body? Interoception, Functional Connectivity And Emotional Processing In Depersonalization-Derealization Disorder”. Plos ONE, vol 9, no. 6, 2014, p. e98769. Public Library Of Science (Plos), doi:10.1371/journal.pone.0098769. Accessed 10 Mar 2021.

[11] Loewenstein, Richard J. “Dissociative Amnesia And Dissociative Fugue”. Handbook Of Dissociation, 1996, pp. 307-336. Springer US, doi:10.1007/978-1-4899-0310-5_15. Accessed 10 Mar 2021.

[12] Rehan, Muhammad Awais et al. “A Strange Case Of Dissociative Identity Disorder: Are There Any Triggers?”. Cureus, 2018. Cureus, Inc., doi:10.7759/cureus.2957. Accessed 10 Mar 2021.

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