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Dissociation

Dissociation is a separation from reality that may involve a variety of behaviors including the development of alternate identities and amnesia. It is similar to psychosis in that involves detachment from reality. However, the primary difference between dissociation and psychosis is that people who are dissociating are typically aware of their detachment from reality while people having psychotic episodes might not be. Daily activities such as daydreaming are minor instances of dissociation, but when dissociation is a long-term defense mechanism or a person feels incapable of avoiding dissociation, it may become a psychological problem.

Symptoms of 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 (known as dissociative identity disorder, 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. Dissociated people sometimes cannot speak, and other times may not hear what is said to them for brief periods. Daydreaming is a very common, mild form of dissociation.

What Causes Dissociation?
Substance abuse can cause temporary dissociation, as can some brain injuries and illnesses. Trauma, particularly child abuse, seems to play a role in dissociation. Posttraumatic stress can lead to dissociation. In some cases, the precise cause of dissociation cannot be found.

Impact of Dissociation on Everyday Life

Serious forms of dissociation can be persistent and are far more intense than occasional daydreaming, and thus interfere with one's ability to:

  • Stay in touch with reality
  • Form lasting relationships
  • Complete important tasks
  • Care for oneself
  • Feel pleasure (including sexual pleasure)
  • 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.

 

Psychological Issues Associated with Dissociation

Severe dissociation is usually a sign of past trauma, such as physical abuse or sexual abuse. It may occur as part of severe anxiety, certain personality disorders, or dissociative identity disorder (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

Psychotherapy is the most common method of treatment for dissociative problems. 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 a client may be avoiding. When dissociation is caused by trauma, clinicians frequently focus on treating the underlying anxiety and depression that resulted from the trauma. Trauma relief therapies and other techniques aimed at transforming the emotional response to the traumatic event can be extremely beneficial. 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.

 

Dissociative Disorders
There are currently five recognized dissociative disorders listed in the Diagnostic and Statistical Manual (DSM-IV):

  • Dissociative identity disorder – Previously referred to as multiple personality disorder, this illness involves the development of one or more alternative personalities and may be a reaction to severe trauma.
  • Depersonalization disorder – A disorder characterized by feelings of detachment from reality. The patient, however, realizes her detachment and recognizes the detachment as an emotion, not as reality.
  • Dissociative fugue – Usually accompanied by a separation from familiar surroundings, this disorder involves difficulty recalling the past and may lead to the formation of an entirely new identity.
  • Dissociative amnesia – Similar to a dissociative fugue, this loss of memory typically results from a traumatic event.
  • Dissociative disorder not otherwise specified – This diagnosis is used for dissociation that does not meet the diagnostic criteria of other forms of dissociation but interferes with daily functioning. Periodic daydreaming, for example, would not warrant this diagnosis.

Dissociating 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 is not 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 eye movement desensitization and reprocessing (EMDR), 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.

References:

  1. American Psychological Association. APA Concise Dictionary of Psychology. Washington, DC: American Psychological Association, 2009. Print.
  2. International Society for the Study of Trauma and Dissociation. (n.d.). Dissociative disorders. International Society for the Study of Trauma and Dissociation. Retrieved from http://www.isst-d.org/education/faq-dissociation.htm

 

 

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Last updated: 01-07-2014

     

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