Dissociation is a separation from reality that may include the development of alternate identities or conditions such as amnesia. It is similar to psychosis in that it involves a detachment from reality; however, people who are dissociating are often aware of their detachment, while people having psychotic episodes may not be similarly aware. Many people experience mild forms of dissociation, such as daydreaming or becoming removed from thought while driving, but when dissociation becomes a long-term defense mechanism or dissociative behavior becomes unavoidable, the help of a mental health professional may be beneficial.
Dissociation is a disturbance in thought, memory, awareness, or identity that is often described as feeling out of one's body. Mild dissociation, which includes daydreaming and "losing oneself" while engaging in activities such as driving or reading, may be experienced by anyone: About one third of Americans report occasional episodes of mild dissociation, often described as watching oneself as if in a movie. These experiences seem to occur more frequently before the age of 20.
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Another type of dissociative behavior is a period of impulsive behavior, often called a dissociative fugue, not remembered later, in which a person carries out tasks, travels, speaks, and so on, but all as if in a trance or a dream.
Dissociation may be experienced in several ways, such as:
- Depersonalization, or feeling that one's body is unreal (out-of-body experience).
- Derealization, or feeling as if the world is changing or unreal (hallucinations).
- Identity alteration or confusion, or experiencing noticeable changes in behavior or identity, a feeling of uncertainty regarding one's self-identity, taking on a different identity temporarily, or completely losing touch with the surrounding world, imagining oneself to be in another place or time.
- Amnesia, or memory loss.
Sometimes those experiencing a dissociative episode temporarily cannot speak or hear what is said to them, and they may not have any memory of the dissociative episode after its occurence.
There are currently five recognized dissociative disorders, as listed in the Diagnostic and Statistical Manual (DSM):
- Dissociative identity disorder involves the development of one or more alternative personalities and is also characterized by gaps in both remote and dependable memory and significant impairment to daily functioning. Symptoms might also include seizures. About 90% of those with DID report childhood abuse or neglect, and the condition is believed to often develop as a result of trauma. Dissociative fugues, or mental separation from familiar surroundings that may include dissociated travel, occur often with DID.
- Depersonalization/derealization disorder is characterized by feelings of detachment from reality. Depersonalization typically describes detachment from or unfamiliarity with the self and may include temporal distortions or physical/emotional numbness. Derealization describes a detachment from or unfamiliarity with the surrounding world, and it may be accompanied by visual/auditory distortions. However, those with this condition are typically aware that their experiences are not reality.
- Dissociative amnesia may be localized (where events from a particular period of time cannot be recalled), selective (where certain events from a particular period of time cannot be recalled), or generalized (a complete loss of memory). Generalized amnesia is not common.
- Other specified/unspecified dissociative disorder is a diagnosis used when dissociative symptoms present in such a manner as to cause significant impairment and distress in daily function but do not meet the criteria for any specific dissociative condition. "Specified" is used when a reason is given for the criteria not being met, "unspecified" to describe a case when the reason is not given.
Dissociation may occur with anxiety, panic, or obsessions and compulsions, and it is often a symptom of PTSD. Severe dissociation is often a sign of past trauma, such as physical abuse or sexual abuse. Child abuse in particular seems to play a role in the development of dissociative behavior, which often becomes a method of coping with the intense feelings of distress, such as terror or rage, that often accompany a painful experience.
Dissociation may also occur during a traumatic incident, and alcohol and drug use may cause temporary episodes of situational dissociation, as might brain-related illness or injury. In some cases, the precise cause of dissociation cannot be found.
Severe forms of dissociation can be persistent and intense and will often interfere with the ability to stay in touch with reality, complete tasks at school or work, be responsible for one's actions, care for oneself, or maintain relationships. Those who often experience dissociative behavior may often find it difficult to maintain employment, and they may experience a diminishment in sensations such as hunger or sexual pleasure. It is not uncommon for a dissociative episode to be completely forgotten when it is over, but it may also be remembered immediately or much later. Some dissociative episodes may be characterized by a lack of awareness of what is happening, but at times a person may be aware of the dissociation, albeit in a numb or detached way.
Therapy is the most common method of treatment for dissociative issues. People generally dissociate as a method of coping with an experience that is too painful or overwhelming for them to handle in an adaptive way. Thus, therapy for dissociation generally focuses on acknowledging and processing the painful emotions that are being avoided. When dissociation is caused by trauma, treatment generally focuses on any underlying anxiety and depression that may have resulted from the trauma. Trauma relief therapies and other techniques aimed at transforming the emotional response to the traumatic event can be extremely beneficial. Cognitive or dialectical behavior therapies may help reduce symptoms during a dissociative episode and can lead to improved coping methods.
When dissociation causes memory difficulties, a combination of therapy and lifestyle changes aimed at re-establishing memory may be effective. In some cases, psychotropic medication prescribed by a psychiatrist may help during the treatment for dissociation.
- Dissociating during sexual encounters: Pat, 29, recently ended a relationship with a man because she found herself dissociating during sexual encounters. She is aware that she was sexually abused as a child but is not sure how to get over it. Her therapist helps her identify some of her fears, both rational and irrational, along with ways to protect herself from the things she fears. She also refers Pat to a support group where she can talk about her experience and her emotions with others who have experienced similar trauma. The therapist also gives Pat a referral for eye movement desensitization and reprocessing (EMDR), a proven technique for overcoming trauma. Meanwhile, in therapy, Pat is able to begin to confront and work through feelings of helplessness, rage, and grief, and she begins to develop communication skills for use with potential future sexual partners. With the therapist's help, she also explores possible ways to choose appropriate sexual partners, something that has always been difficult for her. During their sessions, the therapist uses redirection and encouragement to keep Pat fully present (as opposed to dissociating) as they discuss the abuse Pat experienced, which helps Pat learn how to do so on her own.
- American Psychological Association. APA Concise Dictionary of Psychology. Washington, DC: American Psychological Association, 2009. Print.
- Dissociation and Dissociative Disorders. (n.d.). Retrieved from http://www.mentalhealthamerica.net/conditions/dissociation-and-dissociative-disorders.
- Dissociative disorders. (n.d.). Retrieved from http://www.mind.org.uk/information-support/types-of-mental-health-problems/dissociative-disorders/#.VWTc2EarzK8.
- Duckworth, K., & Freedman, J. (2012, November 1). Dissociative Disorders. Retrieved from http://www2.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/By_Illness/Dissociative_Disorders.htm.
- Spitzer, C., Barrow, S., Freyberger, H., & Grabe, H. (2006). Recent developments in the theory of dissociation. World Psychiatry, 5(2), 82-86.