Understanding Dissociation

In my post about Complex PTSD I described alterations in consciousness, or dissociation, as one of the hallmark features. As promised, I want to talk more about dissociation and the role it plays in the lives of trauma survivors. Perhaps all you know about dissociation is Dissociative Identity Disorder (DID), formerly called Multiple Personality Disorder. Or you may have been exposed to a lot of sensationalized or just plain wrong depictions of DID in the media. See my article, United States of Tara Controversy, for example. Not all dissociation is DID. It exists on a spectrum and at one level is normative and experienced by most at times.

In fact, four main categories of dissociative disorders are identified in the DSM-IV-R. These are: Dissociative Amnesia, Dissociative Fugue, Dissociative Identity Disorder, and Depersonalization Disorder. Those who do not meet all the criteria for one of those four may be diagnosed Dissociative Disorder Not Otherwise Specified. According to the International Society for the Study of Trauma and Dissociation, this is perhaps the most common dissociative disorder seen by therapists. They suggest that it might be best understood as “Major Dissociative Disorder with partially dissociated self states“. Even those that do not meet the criteria for a dissociative disorder may in fact be frequently dissociating as part of their PTSD experience.

The Sidran Institute describes dissociation as

a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who he or she is. This is a normal process that everyone has experienced. Examples of mild, common dissociation include daydreaming, highway hypnosis, or “getting lost” in a book or movie, all of which involve “losing touch” with awareness of one’s immediate surroundings.

Some people describe it as feeling “spacey”, “numb” or “checked out”. Dissociation is a common reaction to traumatic events. For example, someone who is mugged may dissociate or “forget” part of the experience or the associated feelings as a way to cope with the experience. For those who experience ongoing, repetitive trauma like survivors of childhood abuse do, dissociation occurs so frequently that it interferes with other aspects of life or functioning. It is difficult to have meaningful relationships, or to know how to make healthy relationship choices, if you do not have access to all the information about people in your life.

Most trauma survivors dissociate to some extent. Maybe you dissociate from your body or bodily sensations. Maybe you have no access to forbidden feelings like anger, sadness, fear. Maybe you are missing pieces of information about events from the past. Maybe during stress you feel like you are watching yourself from a distance. Maybe in situations that would evoke feelings in others you feel spacey or distracted. It may not be readily apparent and therefore it is important for therapists to learn how to recognize dissociation, which may include asking about it in therapy sessions. How can healing/learning take place if someone isn’t really present?

One the one hand, given  the context of chronic, severe childhood trauma, dissociation can be considered adaptive because it reduces the overwhelming distress created by the traumatic experiences. On the other hand, if dissociation continues to be used in adulthood, when the dangerous situations/abusive experiences that led to it no longer exist, it can be maladaptive. So why is dissociating as and adult or in the absence of actual danger a problem? The dissociative person may automatically disconnect from situations that are perceived as dangerous or threatening, without taking time to determine whether there is any real danger. This leaves the person “spaced out” in many situations in ordinary life, unable to learn alternative coping skills and behaviors, and in fact more at risk of being unable to protect themselves when there is an actual threat.

In my experience dissociation and affect disregulation interact with each other in a vicious cycle. Given the ineffective family environment most complex trauma survivors grow up in, basic skills for coping with emotions have never been learned. Repeated neglect or abuse further overwhelms the child, creating intense feelings that are hard to manage especially given the developmental deficits. Dissociation becomes the way the child copes; feelings are split off and not experienced, which in turn makes it difficult to learn to identify, tolerate and express a natural range of feelings.

Maybe you are so used to living with dissociation you do not even recognize it for what it is. It is important for you as a survivor to learn about dissociation, how it functioned as a protective mechanism during periods of abuse and how it isn’t so helpful in the present. This includes learning the early warning signs of dissociating for you as an individual. You can learn and employ grounding techniques successfully at that point.

Awareness and education are the first steps. My go to resources for all things related to dissociation are The Sidran Institute and International Society for the Study of Trauma and Dissociation. They both have a wealth of resources and articles geared toward clients, loved ones and professionals. They even have resources for finding knowledgable therapists. Well worth checking out!

If you dissociate it is important to first understand this and honor it as the survival tactic it is. You survived things no one should have to face! That is good news. It is also important to understand the ways dissociation might be hampering your ability to live life fully in the present. The good news is that can change! You can work with a therapist who gets dissociation, at whatever level it happens for you. You can learn what it means to be present, develop other skills for managing distress and emotions in general and make meaning of the trauma you have experienced.

Kathleen Young Psy.D.

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29 Responses to Understanding Dissociation

  1. good words here for the DID community. so many more books and stories have been written since the early movies made the screen. I’ve not gotten to see the series the State of Tara show so I can’t comment on that yet there are many of us who have started talking and sharing on youtube about who we are on the inside. I wish they’d make a few documentrys from them. Thanks for sharing this here

  2. Jeanette says:

    As a person with DID, I can say that coming to understand this disorder is difficult enough for the person who suffers with it, let alone for people who don’t – to be able to comprehend what takes place internally and then manifesting externally – it really is hard to fathom, and the sensationalizing of DID doesn’t help any of us who are trying to work through it.

    I’ve suffered my whole life with this disorder and never knew what was happening with me and I can tell you that nobody in my life had a clue either, it is very subtle in its presentation but wreaks a tremendous amount of havoc in a person’s life. I’m very thankful that the mental health community is learning more about the reality of the disorder and able to help those of us who suffer find our way to healing and integration. A long, painful road, but not as long and painful as a life already lived this way in confusion and despair.

    Thank you for bringing this topic to your readers, I look forward to reading more from you on this. :)

    • You are raising a really important point, Jeanette!

      Sometimes I think of DID as being all about not knowing. Not only are different parts ot the person not in touch with each other or certain information, but often it functions to keep others outside from knowing what is going on for you as well. Understandable as a safety mechanism, but sure makes it hard to work with! So much, like you say, can be going on beneath the surface while you look “fine” to anyone outside.

      And yes, I always want to emphasize that help is available and can make a huge difference!

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  5. LindaF says:

    You are so right, “Awareness and education are the first steps.”

    When I first became aware (diagnosed with DID), my immediate reaction was fear, “I’m crazy and need to be institutionalized,” I thought. I just cried to depths I can’t explain. That was 2003.

    Now, seven years later (2010), through learning about my “disorder” ( I use the term loosly), I have a completely different perspective and appreciation for it (them).

    Undoubtably, in the beginning of my adult years, dissociation caused havoc, confusion, and unexplainable uncertainties. Today, however, I have a working relationship with my alters (which I call my “inner family”) and no longer view them as something to be rid of. In fact, they too have learned and changed (most of them). We now have a great working relationship both personally and in “outside” relationships. In fact, unlike the “traditional” expected outcome, we do not intend to integrate.

    I am thankful that “The United States of Tara” has been received so well – mainly for the sheer destruction of the the stigma and false association of DID to schizophrenia.

    Indeed, “awareness and education are the first steps” to understanding, healing, and acceptance.

    Thank you,

    Linda F

    • Thanks so much for sharing your experience, Linda! It is so helpful for others newer to this to hear that things shift and get better.

      It sounds like you have made tremendous progress. :)

      You are making me think: a post about the early stages of therapy, receiving and accepting a diagnosis, might be a good idea…

      Thanks again!

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  12. Ben says:

    I live in England and am 40. I am suffering with chronic disassociation. Nobody’s got a clue what I’m talking about. Who can help me. Does anyone know anyone in the UK who can help me. Is there anyone on this planet who can help me with this.
    Ben

  13. Ben says:

    PS I don’t want to meet someone who understands it, I want to meet someone who can solve, cure or otherwise treat it. I’m sick and tired of hearing blah blah blah from a bunch of medical wafflers, I want results.
    Ben

  14. Ben says:

    PPS I haven’t been able to read this webpage because most of the time I can’t settle enough ‘in the moment’ to be able to manage such tasks. I can’t settle to anything because all I want to do is feel better. It has taken a long time, decades, since I was 6, to notice that I even exist, except I still can’t live in me. I know I am me but I can’t live in it. The longest I have been able to do it was for ten minutes. That was over a month ago. In 34 years that’s the best it’s been. Had no life at all. And every doctor I meet is a complete moron. No, that’s not true, none of them have been that smart. I can’t wait to meet a moron doctor because that will be SUCH a step up.

  15. Jeanette says:

    Ben, I am going to post a link to the Sidran Institute. They are here in the U.S. but have a resource database where they can assist you in finding qualified professionals as near to you as possible. They also have great information on their site.

    http://www.sidran.org/sub.cfm?contentID=19&sectionid=5

    I wish you well in your search for help, I know it isn’t easy. And once you do find someone who knows how to help you, it is still a long journey from there. Please don’t give up, it is a journey well worth all the effort involved, even the effort of finding help.

    Take care!
    Jeanette,
    Survivor and Thriver

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  17. brandic32 says:

    Really nice post. Thanks.

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  19. Hello Dr. Young!

    I was searching for some things about DID that I found explained exceptionally well here. Thank you for all the work you are doing to bring knowledge to the world about what DD’s really are.

  20. Laurie says:

    This is all great information to have about DID and PTSD but what I’d like to know is, does DID complicate the treatment of PTSD. I’ve been through many years of counseling and SSRIs. I’d like to be able to reduce my symptoms enough to be medication free. Further information and suggestions would be much appreciated.

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  22. Vanessa says:

    Hi there, many thanks for your very helpful explanation of dissociation. It’s true that most on-line info focusses on DID and the more severe forms of dissociation, which has been somewhat frustrating as my experience has been mainly that of depersonalization / derealisation and there’s much less info around on these experiences. I also have a lot of difficulty making connections or experiencing intimacy because the ‘self’ that functions in the world is not the part of me that needs to be healed and I never experience the feeling that I’m known. The ‘self’ that makes connections with others is my traumatized self and is hidden from everyone and I cannot bear the thought of being seen. I don’t know what events took place that made me divorce myself from my body but for many years I had no sense of physical reality at all. I have one question around treatment – I live in the UK and when I finally plucked up courage to speak to my doctor about my experiences I was referred for an assessment with a therapist who specializes in personality disorders. I do not meet the criteria for borderline or any other personality disorder but was offered Mentalization Based Treatment (MBT) anyway. I’ve found the whole process deeply upsetting because the therapists do not agree with my own interpretation of what’s going on for me and instead believe my difficulties are to do with an inability to mentalize my own self. I keep being triggered into states of distress which are overwhelming. I can’t help wishing I lived in the US! What is your opinion on the use of MBT to treat dissociation?

    • Hi Vanessa-

      I am not familiar with MBT so I cannot speak to its use in treating dissociation. I do clearly hear that this is not feeling helpful to you and that surely matters! I hope you can find other resources that are a better fit!

  23. michael says:

    Dr. Young

    My wife has been diagnosed with dissociation. I have been doing my research on it. And what I have read it is pretty accurate on my side of the story. Like you have said it starts with tramatic events when the person gets at their lowest low mentally. And doesn’t know how to cope with the sudden strain. But in her case it is a demon that stayed with her and manafested, got attached to her somehow that I don’t understand. (Probably not meant to). But we have been through hell. And we are still together. She has been living with it way before we got together. That’s been 5 years. This thing does stuff that my wife would never do. I.e. take a lot of pills…etc. and I didn’t know how bad it reaaly was. So information does need to be spread. Thank you for what your doing. God bless you all

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