Dissociation

Dissociation is a feeling of being out of one’s body, which may take several forms:

• Floating above oneself, as if watching from the outside

• Total numbness

• Taking on a different identity temporarily, with no memory of one’s real identity (sometimes called multiple personalities)

• Imagining oneself to be in another place or time and totally losing touch with one’s actual surroundings

Dissociation may also include periods of impulsive behavior not remembered later, in which a person carries out tasks, travels, speaks, and so forth, but all as if in a trance or a dream. These episodes are called dissociate fugues, a DSM diagnosis. Dissociated people sometimes cannot speak, and other times may not hear what is said to them for brief periods. Daydreaming is a very mild form of dissociation.

• Impact of Dissociation on Everyday Life
• Associated Psychological Issues with Dissociation
• Therapy for Dissociation
• DSM Criteria for Dissociative Amnesia
• DSM Criteria for Depersonalization Disorder
• DSM Criteria for Dissociative Fugue
• DSM Criteria for Dissociative Identity Disorder
• Woman Associating during Sexual Encounters - Case Example

Impact of Dissociation on Everyday Life

More serious forms can be persistent and are far more intense, and thus interfere with:

• ability to stay in touch with reality
• form lasting relationships
• complete important tasks
• care for oneself
• feel pleasure (including sexually)
• communicate clearly
• take responsibility for one’s actions and needs.

Sometimes, people completely forget dissociative episodes, and sometimes they remember them later. During some dissociative episodes, the dissociating person may be unaware of what is happening to them – the environment, and the fact of their dissociation – and other times they may be aware, though numb and very detached.

Associated Psychological Issues with Dissociation

Severe dissociation is usually a sign of past trauma, such as physical or sexual abuse. It may occur as part of severe anxiety, certain personality disorders, or dissociative identity disorder, which was once called multiple personality disorder, and is quite rare. Dissociation is a way of coping with intense feelings of distress, including terror and rage, which usually stem from trauma.

Therapy for Dissociation

Dissociation describes the disruption of a person’s psychological of conscious functioning. Daydreaming is a form of dissociation, but in psychological terms, dissociation refers to a mental or emotional detachment and is often the result of a trauma such as a death or abuse. People dissociate as a method of coping with an experience that is too painful or overwhelming for them to handle in an adaptive way. Common forms of dissociation are amnesia, identity disorders, depression, post-traumatic stress or anxiety. Psychotherapy is the most common method of treatment for dissociative problems, and focuses on acknowledging and experiencing the painful emotions that are being avoided. For clients who are not able to re-experience the traumatic events, trauma relief therapies and other techniques aimed at transforming the emotional response to the event can be extremely beneficial. 

DSM Criteria for Dissociative Amnesia:

• The predominant disturbance is one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.

• The disturbance does not occur exclusively during the course of Dissociative Identity Disorder, Dissociative Fugue, Posttraumatic Stress Disorder, Acute Stress Disorder, or Somatization Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a neurological or other general medical condition (e.g., Amnestic Disorder Due to Head Trauma).

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

DSM Criteria for Depersonalization Disorder:

• Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream).

• During the depersonalization experience, remains intact.

• The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or another Dissociative Disorder, and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).

DSM Criteria for Dissociative Fugue:

• The predominant disturbance is sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past.

• Confusion about personal identity or assumption of a new identity (partial or complete).

• The disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

DSM Criteria for Dissociative Identity Disorder:

• The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).

• At least two of these identities or personality states recurrently take control of the person's behavior.

• Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

• The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures).

NOTE: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

Woman Associating during Sexual Encounters - Case Example

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 isn’t sure how to get over it. Her therapist helps her identify some irrational and some rational fears and ways to protect herself from the rational ones. She also refers pat to a support group with a good reputation where she can talk about her experience and her emotions. Pat is finally referred for EMDR (eye movement desensitization & reprocessing) a proven technique for overcoming trauma. Meanwhile, in therapy, she is able to confront and work through feelings of helplessness, rage, and grief, and begins to learn communication skills for use with potential sexual partners, as well as ways to choose appropriate partners, which has always been difficult for her. The experience of talking about her abuse with her therapist, who uses gentle redirection and encouragement to keep Pat fully present (as opposed to dissociating) during their sessions, helps Pat learn how to do this on her own.

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