About
Dissociation

What is Dissociation:

Dissociation is a common defense to stressful or traumatic situations and is different to daydreaming, as the latter leads to a disconnection from the world and from things usually associated with each other. It causes a break in how our minds handle information, meaning that dissociated experiences cannot integrate into our sense of self and may become lost from our awareness. Even when we remain aware, we may feel disconnected from our thoughts, feelings, memories, and surroundings. It can affect our sense of identity and disrupt our perception of time. An example would be thinking about an event that was originally very upsetting, yet we experience no feelings while talking or thinking about it. Clinicians refer to this as emotional numbing, which is common to both post-traumatic stress disorder and dissociative disorders.

More severe forms of dissociation may affect us subjectively as thoughts, feelings, and actions and that don’t belong to us. These may seem ‘made,’ and as though they come out of nowhere. Or we may carry out an action as if being controlled by a force other than ourselves. It may feel like our minds and/or bodies have been ‘taken over’ by emotions that don’t seem appropriate to our activities or make sense

5 Main Types of Dissociation

Depersonalization

Depersonalization is the sense of our inner self being detached from the body. Sometimes while feeling dissociated, we may look in the mirror and feel like we don’t recognize who we’re seeing, or feel disconnected from our body in a way that feels numb, or in my case, like my body is a cloud.

Derealization

Derealization is the sense of the world around us not being real. For me, it feels like I’m watching the world through an old-fashioned television set with poor sound. Others describe derealization as the world looking phony, foggy, or far away, or as though they’re detached.

Amnesia

Amnesia refers to memory loss beyond the realms of ordinary forgetfulness. Some people with dissociative disorders may have amnesia of the classic fugue variety, where they travel long distances before becoming alert and disoriented. At other times, amnesias are associated with important events that are forgotten, such as abuse, a troubling incident, or a block of time. Most commonly, we experience multiple micro-amnesias where discussions are not remembered. Amnesia affects our perception of our own pasts, including our childhood, plus our moment-to-moment living. It causes a discontinuity in our sense of self, and can cause problematic relationships with others.

Identity Confusion

Identity confusion causes an insecurity about who we are or what we can do. For example, I learned to fly light aircraft before realizing I had a dissociative disorder. While I never lost the ability to pilot an aircraft, I did notice that I could feel very different between or even within flights. My sense of self and emotions could swing from confident, to cautious, and then terrified.

Identity Alteration

Identity alteration refers to a more profound sense of alteration. As an example, I have absolutely no recollection of jumping up during a therapy session and informing my therapist that her sessions were, “dumb and stupid.” Later, while rubbing my forehead and disclosing that a voice inside my head wouldn’t stop complaining about therapy, she reported what had happened. That was quite a shock. However, it doesn’t have to be this extreme. There are more subtle forms of identity alteration, which may involve changes in voice tones, use and range of language, and minute changes in facial expressions.

Causes of Dissociation

A combination of environmental and biological factors, though the genetic tendency to dissociate is estimated to be zero.
Repetitive childhood physical and/or sexual abuse
Severe neglect or emotional abuse, even when there has been no overt physical or sexual abuse
Families in which the parents are frightening, unpredictable, are dissociative themselves, or make highly contradictory communications

Note: it’s important to understand that dissociation in the context of chronic, severe childhood trauma is considered adaptive because it can reduce distress created by trauma.

Within Childhood

Within Adulthood

Experiencing ongoing trauma in childhood significantly increases the likelihood of developing dissociative disorders in adulthood.
The development of dissociative disorders in adulthood appears to be related to the intensity of dissociation during the actual traumatic event(s); severe dissociation during the traumatic experience increases the likelihood of generalization of such mechanisms following the event(s)

Note: When dissociation learned in childhood continues into adulthood, and the original danger no longer exists, it may be considered maladaptive.

Affect Regulation & Dysregulation

What is affect regulation & dysregulation?

The term affect regulation, refers to our ability to tolerate and regulate intense emotional experiences. Affect dysregulation refers to the opposite, or our difficulties tolerating emotional experiences.

This problem results (in part) from

having had little opportunity to learn to soothe oneself or modulate feelings
not being taught these skills by an adult.

Problems in affect regulation are compounded by

the sudden intrusion of traumatic memories
overwhelming emotions that accompany these memories.

The inability to manage intense feelings may

trigger a change in self-state from one prevailing mood to another.
cause depersonalization, derealization, amnesia and identity confusion.
change the ability of the person to tolerate a particular emotion, such as feeling
cause an overwhelmed mind to escape from fear when there is no escape, a person may unconsciously adapt by believing, incorrectly, that they are somebody else.

Common Misdiagnoses

Many people with a detected or undetected dissociative disorder experience depression. While prescribed antidepressants can relieve the feelings of depression, antidepressants neither reduce nor improve symptoms of dissociation. Some people may be misdiagnosed as having psychotic disorders and are treated with antipsychotic medication. Listed are other common diagnoses that people with dissociative disorders receive:

1. Alcohol or drug abuse

People with diagnosed or undetected dissociative disorders may self-medicate with alcohol or drugs. In my experience, the sensation of being ‘drunk’ helps normalize my feelings of dissociation. Sometimes the alcohol lowers my resistance and allows my parts to speak, while at other times I use it to quieten them. I know this is unhealthy and have to work through it with my therapist.

2. Anxiety disorders

People with diagnosed and undetected dissociative disorders often experience generalized anxiety, panic attacks, obsessive compulsive symptoms. Treating anxiety alone does not help dissociative symptoms.

3. Attention deficit (hyperactivity) disorder

 People with dissociative disorders commonly experience problems with attention and their memory, particularly when sufferers experience amnesia. Medication for ADHD may help with poor attention, but will not help dissociation and amnesia.

4. Bipolar disorder

Mood swings are common in people who have a dissociative disorder. It was these symptoms that my sons questioned first, actually going as far to say, ‘Mom, you’re so bipolar - go see a doctor.’ Professionals are often mistaken too, defaulting to considering bipolar disorder as the reason for a person’s mood swings. Lack of training and knowledge about dissociative disorders can find a person taking anti-psychotic drugs which may cause long-term problems.

5. No Idea

This isn’t a joke. Common clues that a person might have a dissociative disorder include experiencing many different symptoms that come and go. I was in treatment for years and was diagnosed with histoplasmosis, asthma, lyme disease, partial seizures, non-epileptic seizures, depression, anxiety, sleep apnea, and so on. It was only once I found an experienced trauma therapist that all the dots made any sense.

6. Other Coexisting Diagnoses or Misdiagnoses include:

Eating disorders
Impulse control disorders
Obsessive-compulsive disorder
Sleep disorders

Personal Experience:

As a personal example, I may feel suddenly excited, without obvious reason and inappropriate to the context, and then the excitement can leave in much the same manner as it came. The same applies with sadness - coming out of nowhere, then disappearing as rapidly. Or I may do something that I wouldn’t normally do - cue smoking a cigarette - but find myself unable to stop, almost as if I’m being compelled to do it. While we all have urges, it’s important to remember that dissociation takes these feelings and urges to a different level. I liken it to being a ‘passenger’ in our bodies, rather than the driver, feeling as though my everyday presence has been pushed to the rear of my head. Sometimes, I may recall the event, while at other times, I have absolutely no recollection.

Impact on author:

We all have different parts of ourselves - daughter, mother, worker, cook, athlete - and we use these parts to provide a rich source of literary inspiration. Communicating with parts of ourselves is normal and enriching, but can be challenging too. Writing with a dissociative disorder further complicates the experience, bringing both positive and negative influences over which words make the page.

The positive: there are times when I wake my computer to find a chunk of writing I have no memory or knowledge of typing. These segments typically employ a voice very different to the one I use. Sometimes this is exciting - particularly when the segments are well-written and usable. Sometimes less so. I’ve found segments so fragmented and confusing that I’ve deleted them, or found paragraphs that mention a memory I don’t know to be true.

The negative: it’s not uncommon for me to wake my computer with the intention of working on something I’m excited about, only to find my prior work deleted and gone. If I’m lucky, it can be retrieved from my trash can and double-saved, or emailed to myself or to my therapist for safe-keeping.

After several months of playing tug-of-war with my story, I employed an editor/coach to help me find a way to structure myself and my work. Margaret Kinsbury has been my editor, coach, friend and ear throughout the process. This project could never have been accomplished without her support and guidance.

Seeking help:

If dissociation is happening because you've had an extremely troubling experience or you have a mental health disorder, you may need to seek professional help. Dissociation is a psychological process often found in people seeking mental health treatment and if you have any concerns, I highly recommend contacting a skilled therapist. Note that clinicians require skillful clinical approaches to help build confidence in a person’s ability to tolerate their feelings, learn, and grow as a person. Not all therapists have the training and experience required.

If you would like to find a therapist with specialist training in dissociative disorders, the International Society for the Study of Trauma and Dissociation (ISSTD) can help you locate one:

https://isstd.connectedcommunity.org/network/network-find-a-professional