Psychological dissociation is a mental process where there is a disconnect between thoughts, memories, feelings, actions or sense of identity. It is a common defense mechanism utilized to cope with trauma or stressful events. Dissociation causes a lack of connection in a person’s thoughts, memory and sense of identity. The term dissociation describes a wide array of experiences, ranging from mild detachment from immediate surroundings to more severe detachment from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality.
What are the signs and symptoms of dissociation?
There are varying degrees of dissociative experiences. Some potential signs and symptoms of dissociation include:
– Feeling detached from yourself, your thoughts, feelings or body. Feeling like an outside observer of yourself.
– Difficulty remembering important personal information that would not normally be forgotten.
– Zoning out for long periods of time or sudden shifts in awareness.
– Out of body experiences or feeling that your body is not your own.
– Experiencing reality as dreamlike or visually distorted.
– Emotional or physical numbness.
– Identity confusion or fragmented sense of self.
– Hearing voices inside your head.
– Gaps in awareness or memory of events or personal history.
– Depersonalization, feeling disconnected from your own body and thoughts.
What causes dissociation?
There are several potential causes of dissociative disorders:
– Trauma – Dissociation is frequently a response to trauma such as abuse, accidents, violence, military combat or natural disasters. Trauma causes the mind to disconnect from experiences that are too much to handle.
– Attachment problems – Insecure, disorganized or anxious attachment between a child and parent or caregiver can lead to dissociative tendencies.
– Substance abuse – Chronic substance abuse may lead to dissociative states.
– Medical conditions – Dissociative disorders have been linked to temporal lobe epilepsy, brain injury and sleep disorders.
– Depersonalization/derealization disorder – Chronic episodes of dissociative states of depersonalization and derealization independent of other disorders.
– Dissociative identity disorder – Alternate identities or personality states develop in those who have experienced overwhelming trauma.
What are the main types of dissociative disorders?
The main dissociative disorders listed in the DSM-5 include:
– Dissociative amnesia – Inability to recall important personal information that is too traumatic or stressful to remember.
– Depersonalization/derealization disorder – Persistent or recurring feelings of being detached from one’s body or mental processes. Feeling like an outside observer of your thoughts or body.
– Dissociative identity disorder – Presence of two or more distinct personality states or experiences of possession. Switching between alternate identities. Usually caused by severe trauma during childhood.
– Other specified dissociative disorder – Significant dissociative symptoms characteristic of dissociative disorders that don’t meet the criteria for any specific dissociative disorder.
– Unspecified dissociative disorder – Dissociative symptoms causing significant distress or impairment but do not meet criteria for a specific dissociative disorder.
Dissociative Amnesia
Dissociative amnesia occurs when someone blocks out certain information, usually associated with a traumatic or stressful event or period of time. The person cannot recall key personal information that would not ordinarily be forgotten. It may involve localized or selective amnesia for a specific event or generalized amnesia for identity and life history. Episodes of amnesia can last for minutes, hours, days or longer.
Depersonalization/Derealization Disorder
This disorder involves recurring episodes of depersonalization – feeling detached from your body, thoughts or identity. People may feel like an automaton, observer or outside spectator of themselves. Derealization is feeling detached from your surroundings, as if things around you are unreal or distorted. Depersonalization and derealization cause significant distress and impact functioning.
Dissociative Identity Disorder
Formerly known as multiple personality disorder, this involves a disruption of identity characterized by two or more distinct personality states. This may include different manners of speaking, identities, attitudes or perception. Switching between alternate identities or personality states can happen suddenly. Episodes of amnesia are also common. Extensive childhood trauma and abuse is typical in those with dissociative identity disorder.
How is dissociation diagnosed?
A mental health professional will diagnose a dissociative disorder based on:
– A clinical assessment of symptoms. Looking for signs of depersonalization, derealization, identity confusion, memory gaps, fugue states and fragmentation of identity or consciousness.
– Diagnostic criteria in the DSM-5.
– Patient history of trauma, abuse or neglect.
– Reports from friends, partners or family who may have observed dissociative behaviors.
– Mental health evaluations like psychological testing.
– Ruling out other possible causes or mental health conditions like anxiety, PTSD, seizures or substance abuse problems.
How common are dissociative disorders?
It is difficult to accurately assess how prevalent dissociative disorders are in general population. However, research indicates:
– Dissociative disorders are estimated to affect approximately 2-3% of the general population.
– Dissociative disorders affect between 10-20% of psychiatric inpatients and over 50% of patients with borderline personality disorder.
– Depersonalization disorder is estimated to affect 2% of the general population.
– Dissociative amnesia prevalence rates are estimated at 1.8% to 7.3% in the general population.
– Dissociative identity disorder is rarer, affecting less than 1% of the general population.
So while dissociative disorders are relatively uncommon in the general public, they are much more prevalent among those receiving psychiatric treatment.
Are dissociative disorders serious?
Yes, dissociative disorders can seriously impair a person’s mental health, relationships, work and quality of life. Potential risks and complications of untreated dissociative disorders include:
– Ongoing depersonalization, derealization, amnesia or identity alteration episodes.
– Self-destructive behaviors or suicide attempts.
– Prone to revictimization or abusive relationships.
– Development of PTSD, depression, anxiety or substance abuse issues.
– Interpersonal difficulties and loss of relationships.
– Difficulty maintaining work or school.
– Legal problems or encounters with law enforcement.
– Misdiagnosis of neurological or psychotic disorders.
So while dissociative disorders are treatable, lack of treatment can lead to severe and dangerous consequences. Seeking help from a trauma specialist is recommended for evaluation and tailored treatment.
How are dissociative disorders treated?
Psychotherapy is the primary treatment approach for dissociative disorders. Treatment goals include processing trauma, stabilizing mood and behavior, reducing dissociation, improving functioning and integrating a cohesive sense of identity. Treatment options may include:
– Individual talk therapy sessions to process trauma and emotions in a safe environment.
– EMDR therapy to reduce distress associated with trauma memories.
– Cognitive behavioral therapy to alter dysfunctional thought and behavior patterns.
– Dialectical behavior therapy to build coping skills for difficult emotions and improve relationships.
– Family therapy sessions to improve attachment and communication.
– Hypnosis by trained mental health professionals to recover dissociated memories.
– Art therapy, music therapy or psychodrama therapy to express repressed emotions.
– Journaling to uncover inner thoughts and emotions.
– Medications like antidepressants or anti-anxiety medication to stabilize mood or treat co-occurring disorders when necessary.
Treatment is usually long-term and must be tailored to the individual’s unique symptoms, history and circumstances. Progress will depend on the severity of dissociation, client motivation and a strong therapeutic relationship.
What is the prognosis for dissociative disorders?
With comprehensive, specialized psychotherapy treatment guided by a dissociation expert, the prognosis for recovery from dissociative disorders is good. However, it often requires long-term commitment. Treatment success depends on a number of factors:
– Severity of dissociative symptoms. More severe or ingrained symptoms typically require longer term treatment.
– History of trauma, especially childhood trauma. Early and chronic trauma causes more structural dissociation that needs extensive processing.
– Client motivation and investment in healing. Active engagement in treatment leads to better results.
– Presence of a strong therapeutic relationship and trauma-informed treatment. Essential for processing traumatic memories safely and integrating dissociated aspects of identity or memory.
– Support system of friends and family. Supportive relationships aid recovery.
– Absence of substances abuse issues or severe mental illness. These complicate treatment if not properly addressed.
With comprehensive treatment, many people with dissociative disorders see a significant reduction in symptoms and improvement in functioning within 2-3 years. But some severe cases may take 5 years or longer depending on individual circumstances. Relapses may occur during periods of high stress. Ongoing support is necessary.
What coping skills help manage dissociative symptoms?
In addition to professional treatment, developing positive coping strategies can help minimize the impact of dissociation. Helpful coping skills include:
– Grounding techniques – Mantras, mental games or physical sensations (squeezing a stress ball) can help anchor you in the present moment.
– Mindfulness meditation – Quieting the mind and training focus on the present can reduce dissociation.
– Spending time in nature – Connecting with natural environments can improve grounding.
– Physical exercise – Aerobic activity, yoga, dance or sports helps discharge pent-up energy and release emotions in a healthy way.
– Art, music or journaling – Creative outlets give voice to inner thoughts and feelings.
– Social interaction – Supportive relationships are grounding and build healthy attachment.
– Stress management – Relaxation practices like deep breathing, massage and healthy sleep habits minimize dissociation triggers.
– Emotion regulation skills – Learning to understand, express and manage emotions adaptively reduces overwhelm.
– Internal communication – Talking compassionately to inner parts that hold different emotions and memories builds integration.
Developing these skills in therapy paired with processing trauma can help make symptoms more manageable. But professional treatment is essential for improvement.
Conclusion
Dissociation involves disruptions in consciousness, memory, identity, emotion, perception or behavior. Dissociative disorders are usually rooted in trauma and reflect a detachment from physical and emotional experiences that are overwhelming. Common dissociative disorders include dissociative amnesia, depersonalization/derealization disorder and dissociative identity disorder. Warning signs include memory gaps, depersonalization, out of body experiences and fragmentation of identity or memory. Though sometimes misdiagnosed as other mental illnesses, dissociative disorders are treatable with specialized psychotherapy approaches. Trauma processing, symptom management skills and identity integration are key treatment components. While dissociative disorders can certainly impair quality of life if untreated, the prognosis for recovery is good with expert, comprehensive therapy.