Dissociation is a psychological phenomenon that involves a disconnection between a person's thoughts, emotions, memories, or sense of identity. It is a common coping mechanism used to deal with traumatic or stressful situations, allowing the individual to distance themselves from the overwhelming emotions and experiences.
Dissociation is better understood as an umbrella term for various types of dissociation. Dissociation can be mild, such as common and normal experiences of daydreaming, getting lost in thoughts, or getting lost in a book or movie, or severe, where are person acts with no memory or purpose as if they are sleepwalking.
It is estimated that approximately 2% of the general population experiences some form of dissociative disorder. However, the prevalence of dissociation may be higher in certain populations, such as individuals who have experienced trauma, abuse, or other adverse life events.
Three types of Dissociative Disorders
1. Depersonalisation/Derealisation Disorder
This involves significant and ongoing experiences of depersonalisation or derealisation
Depersonalisation involves experiences of unreality or detachment from one’s:
It is can feel as though one is outside their body (either beside or above) and watching events happening to them.
Derealisation involves experiences of unreality or detachment from one’s surroundings. Individuals experiencing derealisation often feel as if people, objects, and the world around them are not real.
Both depersonalisation and derealisation can occur in the absence of a dissociative disorder, such as part of extreme stress, Panic Disorder or PTSD.
Individuals report depersonalisation and derealisation as an experience involving extreme terror, and can lead to a state of anxiety and distress long after the event.
2. Dissociative Amnesia
This involves not significant memory loss about oneself, and is usually related to a traumatic or stressful event. Dissociative amnesia can be:
- Localised – where the individuals is unable to remember an event or period of time. This is the most common type of dissociative amnesia
- Selective – where the individual is unable to remember a specific aspect of an event or some events within a period of time
- Generalised – where the individuals has a complete loss of identity and life history. This form of dissociative amnesia is extremely rare.
Dissociative amnesia is associated with having experiences of childhood trauma, particularly with experiences of emotional abuse and emotional neglect. People may not be aware of their memory loss or may have only limited awareness until prompted with reminders.
3. Dissociative Identity Disorder (DID)
DID, previously known as Multiple Personality Disorder (MPD), occurs when someone has two more separate personalities (or identities) as a result of:
- Overwhelming experiences
- Traumatic events
- And/or abuse
When present, each identity controls the person’s behaviour has its own personal traits, preferences, and history. DID can lead to gaps in memory and hallucinations.
Symptoms of DID (criteria for diagnosis)
- The existence of two or more distinct identities (also known as personality states) that are accompanied by changes in behaviour, memory and thinking. The signs and symptoms may be observed by others or reported by the individual
- Ongoing gaps in memory about everyday events, personal information and/or past traumatic events
- The symptoms cause significant distress or problems in social, occupational or other areas of functioning
The shift in between personalities is unwanted, happens involuntarily, and causes distress to the individual. People with DID may feel that they have suddenly become observers of their own speech and actions, or their bodies may feel different (as it may be that of a different gender or a young child. It is important to keep in mind that although these alternate states may feel or appear to be very different, they are all manifestations of a single, whole person.
Other terms used to describe these alternate states include:
- Alternate personalities
- Alters
- States of consciousness
- Identities
People often try to minimise the impact of their symptoms due to anxiety and shame.
Symptoms and Signs of Dissociation
Dissociative experiences can manifest in various ways, including:
- Feeling detached from one's emotions, thoughts, or body
- Memory gaps or amnesia for specific events, people, or periods
- Difficulty recognising oneself in the mirror or feeling disconnected from one's body
- Experiencing a sense of unreality or feeling as if the world around you is distorted or unreal
- Switching between different identities or personality states (in cases of DID)
It is essential to note that dissociation can occur on a continuum, and not everyone who experiences dissociation will meet the criteria for a dissociative disorder.
Dissociation Causes and Contributing Factors
Dissociation is often linked to traumatic or highly stressful experiences, such as:
- Childhood abuse or neglect
- Emotional, physical, or sexual trauma
- Natural disasters or accidents
- Prolonged stress or adversity
Dissociation is an attempt of the brain to make overwhelming stress or trauma bearable by allowing the individual to disconnect from the painful emotions and memories. However, when dissociation becomes a habitual coping mechanism, it becomes increasingly dysfunctional (leading to the individual to struggle to connect to positive emotions as well as negative even when they strongly desire to) and can lead to the development of dissociative disorders.
Treatment Options and Strategies for Dissociation and Dissociative Disorders
Treatment for dissociation and dissociative disorders typically involves a combination of psychotherapy, medication, and self-help strategies. Some common treatment approaches include:
- Cognitive Behavioural Therapy (CBT), psychodynamic therapy, and Dialectical Behaviour Therapy (DBT) can help individuals understand and manage their dissociative symptoms
- CBT based Trauma Therapy, Imagery Rescripting (ImRS), and Eye Movement Desensitisation and Reprocessing (EMDR) are all specifically designed to help individuals process and integrate traumatic memories, which can be beneficial for those experiencing dissociation due to trauma
- Parts Work Therapy (taken from Internal Family Systems therapy, Ego States Work, and Gestalt Therapy) can be used to treat DID. Parts work views the self as made up of inner parts. These inner parts are not multiple personalities but the sum of a unified whole. Parts work aims to address the differences and conflicts between parts (eg. child vs. adult self) as a way to integrate all parts of the self to move towards healing
- Medication - Antidepressants, anti-anxiety medications, or mood stabilisers may be prescribed to help manage co-occurring symptoms such as depression or anxiety
- Support groups - Connecting with others who have experienced dissociation can provide valuable emotional support and practical coping strategies.
Tips for Managing Dissociation and Dissociative Disorders
- Develop grounding techniques, such as deep breathing, mindfulness, or focusing on physical sensations, to help reconnect with the present moment during dissociative episodes and practice them daily
- Create a safe and supportive environment to minimise triggers and stressors that may contribute to dissociation
- Establish a consistent daily routine to promote a sense of stability and predictability
- Try to reduce blame and shame by reminding yourself that it is not your fault
- Develop a plan for when you dissociate
- Seek professional help to address any underlying trauma or stressors contributing to dissociative experiences
Dissociation is a complex psychological phenomenon that can significantly impact an individual's daily functioning and overall well-being. By understanding the causes, symptoms, and treatment options, individuals experiencing dissociation can take steps towards recovery and develop healthier coping mechanisms. If you or someone you know is struggling with dissociation, it is essential to seek professional help from a mental health professional experienced in treating dissociative disorders.
