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.