Dissociation is a special case of a ‘defence mechanism’
………. described as a “disorder of not being in the present” by Dr Peter Levine, a leading researcher and practitioner in this field.
There are a range of dissociative responses to consider. These are described as:
Dissociative identity: a mental process of disconnecting from one’s thoughts, feelings, memories or a sense of identity. It may look like daydreaming, spacing out, or eyes glazing over. Sometimes individuals act differently, or using a different tone of voice or different gestures. There can be sudden switches between emotions, or reactions to an event, such as appearing frightened and timid, then becoming bombastic and violent.
Many people with a dissociative disorder have had a traumatic event during childhood. The dissociation is but one way to avoid dealing with such an incident – it is a coping strategy.
Dissociative identity disorder (DID) is the diagnosed condition and it used to be called multiple personality disorder. Someone diagnosed with DID may feel uncertain about their identity and who they are. They may feel the presence of other identities, each with their own names, voices, personal histories and mannerisms. The main symptoms of DID are:
- memory gaps about everyday events and personal information.
- having several distinct identities.
Dissociative amnesia: this disorder can show in several ways. There may be periods where information about myself or events in my past life are not recalled. It’s even possible to forget a learned talent or skill. The symptoms can include disconnectedness from myself and the world around me; forgetting about certain time periods (hours, days or even longer), losing recollection of events and personal information. Particularly relevant is a tendency to feel little or no physical pain. The result can be uncertainties about who I am or even an awareness of my distinctly different identities. These gaps in memory are much more severe than normal forgetfulness and it is important to consult doctors less the condition arise from another medical condition.
Some people with dissociative amnesia find themselves in a strange place without knowing how they got there. They may have travelled there on purpose, or wandered off in a confused state. These blank episodes may last minutes, hours or days. In rare cases, they can last months or years.
Depersonalisation is where I have the feeling of being outside myself and observing my actions, feelings or thoughts from a distance.
Derealisation is where I feel the world around me is unreal. People and things around me may seem “lifeless” or “foggy”.
I can have both depersonalisation and derealisation. It may last only a few moments or it can come and go over many years.
it is a condition that is managed, rather than cured. Professional treatment can help with management by reducing distressing symptoms
Causes of dissociative disorder
The causes of dissociative conditions are not well understood. They may be related to a previous traumatic experience, or a tendency to develop more physical symptoms when stressed or distressed. Someone with a dissociative condition may have experienced physical, sexual or emotional abuse during childhood. Some people dissociate after experiencing war, kidnapping or even an invasive medical procedure.
If we can remove and process that threat, and some people manage this for a long time, then the dissociative behaviour may not re-appear but the condition can be return in times of stress as a learned coping skill. This might work as long as it does not get in the way of everyday life. However, dissociation does tend to get in the way; other people notice our change in behaviour and can be unsettled by it.
Dissociation can range from a conscious decision to postpone dealing with feelings to a complete loss of touch with the present. When something utterly overwhelming happens, some people detach from their emotions in order to function, perhaps even to survive.
Switching off from reality is a normal defence mechanism that helps the person cope during a traumatic time. It’s a form of denial, as if saying “this is not happening to me”.
The condition can become a problem when the environment is no longer traumatic – I still act and live as if it the past threat feel current; the triggering incident has not dealt with. Professional help is there to process such features.
Responding to forms of Dissociation
Dissociation can be seen as a special and rather mysterious condition; generally a ‘bad’ thing as it can be involve disturbing experiences. However, dissociation can make sense once we reflect on how it may have ‘looked after’ us sometime in the past. It can prove a ‘better’ strategy to facing overwhelming stress or trying to run away from a situation. When it is not possible to escape by physical actions, then a retreat into our mind, and a detachment from a situation make sense. Dissociation may persist and displace negative feelings in the moment. This could be a helpful action in the short term – see my clip about the impala.
That said, too much dissociating can slow or prevent recovery from the impact of trauma. It is a condition that disrupts usually integrated functions of consciousness, perception, memory, identity, and affect. Persistent blanking out can interfere with everyday performance. ‘Zoning out’ is one reported symptom, falling at the mild end of the spectrum. Some symptoms of dissociation can be part of other conditions, e.g. anxiety.
Once the purpose of a dissociative response becomes clear, we can respond to this feature more constructively. So, in summary, how does dissociation present?
with well-known mental health problems such as depression, anxiety including suicidal thoughts and actions.
with a sense of detachment from ourselves; seeing ourselves at a distance; as if in a movie.
with an unclear sense of identity (“who am I”).
with significant problems in relationships at home or work and other important areas of our life.
A presence of multiple people talking. This internal dialogue is normal for all, but it is unsettling when it is rowdy.
So, dissociation is disruptive. How?
- by persistent disruption of our ability to remember events. This is more troubling than the simple forgetfulness most of us experience from time to time.
- when wandering that leads to confusion; we wonder how we got where we are.
- by our awareness of two or more very different ‘identities’ appearing at unpredictable times.
- when feeling detached from others around us, sometimes regarding those others as not genuine.
Such reactions visibly impact on our consciousness, our identity, our memory and on our actions.
The NHS has a specific page on this topic available to you.
One aim of therapy is to increase choice and to manage experiences so there is a beginning, middle and end that feels more under control.
Identifying small, safe experiments connected to dissociation may be is best developed with some professional guidance but I can comment on some practical steps that work with those ‘relatives’ of dissociation; namely,
De-realisation and de-personalisation.
If dissociation can be a withdrawal inside or somewhere else, it can be related to difficulty with sensory awareness – where perceptions of our senses might change. Familiar things might start to feel unfamiliar, or I may experience an altered sense of reality. It is this altered sense of reality that carries the label “derealisation”.
Derealisation: symptoms include feeling alienated from others or being unfamiliar with your surroundings — for example, like you’re living in a movie or a dream. If it can feel like you are watching yourself in a movie, then you can take advantage of that fact. It is a process that is used for good in therapy when visualisation is used in an organised and purposeful fashion.
Symptoms of depersonalization include:
- Feelings that you’re an outside observer of your thoughts, feelings, your body or parts of your body — for example, as if you were floating in air above yourself
- Feeling like a robot or that you’re not in control of your speech or movements
- The sense that your body, legs or arms appear distorted, enlarged or shrunken, or that your head is wrapped in cotton
- Emotional or physical numbness of your senses or responses to the world around you
- A sense that your memories lack emotion, and that they may or may not be your own memories
There is a good chance of recovery. Dissociative symptoms can feel better managed. Separate parts of your identity can be helped to merge and become one sense of self.
SOME SAFE EXPERIMENTS
- Using your senses in any way you can to bring yourself back to reality. Describe what you just notice, just feel, just see, NOW.
- Pinching the skin on the back of your hand.
- Holding something that’s cold or really warm (but not too extreme, for obvious reasons!).
- Focus on the sensation of temperature around you.
- Counting or naming items in the room.
- Breathing slowly. [Where have you heard that before!].
- Listening to sounds around you.
- Walking barefoot, where it is safe to do so.
- Wrapping yourself in a blanket and feeling it around you. There are on the market, today, ‘heavy’ blankets and these seem to help with sleep and relaxation
- touching something or sniffing something with a strong smell.
SOME MORE EXPERIMENTS
- Safe space visualisation work.
- Dim the lights or reduce other stimuli.
- Use sensory items to enhance smell, touch and texture
- Lower the voice of self and others.
- Raise frequency of speech; prosody.
- Move: inside/outside and just notice the changes.
- Touch other objects or, if appropriate, allow others to use physical touch where it is OK to do so.
In face of threat, we respond with Flight/Fight, but – as babies and toddlers we cannot escape that way. Instead, we seek to attach to a carer. That works until there is is a problem – when the attachment is to some-one unable to be there for us consistently – for whatever reason.
Instead, then, we have to re-negotiate the ruptures created in our relationship patterns.
Even these serious ruptures – when there is an absence of some-one else to provide consistent support and care – can be faced.
HOW? By re-telling and re-building your own story tale. Therapy can be a gift to explore ways to hold together your memories and experiences in a different way.
This process can best begin from the ‘bottom up’ – with our sensations and what sense I can make of them.
I mention the phenomenon, here, as it needs to see the light of day. It is a feature I meet fairly regularly. It is treatable: with guidance from an experienced and well-trained therapist. I emphasise this as it is possible for other people to re-trigger unhelpful dissociative responses. Everyday conversations may, quite unintentionally, lead us to want to escape. There are everyday words that can trigger such an escape. It is not possible to predict what those words might be. Skillful listening is needed to scan language that might prove helpful and unhelpful.
Therapy is an organised and focused activity during which experiences of dissociation can be discussed in order to develop and learn new coping techniques. It is highly likely that one or more trauma will arise and therapy exists to re-integrate any trauma, however large or small, into our sense of self.
Through the process, a sense of being ‘one’ once again – not two or more – can emerge.