Dissociation and Dissociative Disorders
The term ‘dissociation’ refers to a set of feelings and sensations whereby people feel disconnected from themselves and/or the world around them. We can all feel disconnected at times, for example when we drive a route we know well we might go into ‘automatic pilot’ and not recall some of the route, or daydreaming in maths class.
However, for some people, dissociating from thoughts, feelings and experiences is a protective mechanism. This can occur during traumatic experiences, whereby the individual ‘shuts off’ from what is happening because it is too overwhelming. Whilst this can be a useful strategy at the time of the trauma, if it continues into everyday life when the trauma is no longer around, it can become problematic. Other mental health problems can include features of dissociation, for example psychosis, bipolar disorder and borderline personality disorder.
There are five main types of dissociation:
- Amnesia: where individuals cannot remember important personal information, or recall events or experiences.
- Depersonalisation: this is where you, yourself do not feel real, or parts of your body do not feel as though they belong to you. This can include out-of-body experiences.
- Derealisation: where the world around you does not seem real. It might seem hazy, or objects might change in size, shape or colour.
- Identity Confusion: feeling as though you don’t know who you are.
- Identity Alteration: whereby an individual changes who they are in a way that changes their behaviour and is noticeable to others.
Dissociative Disorders occur when dissociative experiences become more severe and occur regularly.
The main types are:
- Dissociative Amnesia: These include periods of forgetting personal information or periods of time that you cannot account for. These experiences cannot be explained by ordinary forgetfulness.
- Depersonalisation Disorder: Strong feelings of detachment from your own body or feel as though your body is not real.
- Dissociative Fugue: Fugue states may only last a few days but can last longer. People in a fugue state may lose a sense of their identity and assume a new one. When your memory returns, this can be highly distressing and confusing.
- Dissociative Identity Disorder (DID): This is a highly complex dissociative disorder whereby the individual experiences severe changes in personality. These shifts in personality might be experienced as completely separate identities. Each ‘self-state’ might have a different way of thinking and experiencing the world. Sometimes people are aware of the other personalities, sometimes they are totally unaware.
How can I tell if I dissociate?
Dissociation covers a wide range of symptoms, which are individual to everyone and will range in severity. Some people describe a general sense of ‘not feeling present,’ whereas others may not be able to account for large periods of time.
People who have a Dissociative Disorder may experience:
- Gaps in their memory (that are not accounted for by other factors such as tiredness, dementia etc)
- Finding themselves in strange places and not recall how they got there
- Out-of-body experiences
- Feelings of being unreal or as though parts of their body do not belong to them
- Feeling as though they are looking at the world from inside a bubble
- Forgetting appointments, conversations, places, people.
- Acting like different people
- Feeling detached from emotions, or a sense of feeling numb
- Internal voices and dialogue
- Being told about events that they do not remember
- Having possessions that they do not recall buying
Other problems can include:
- Mood swings
- Hearing voices that other people can not hear
- Sleeping difficulties
- Eating disorders
- Substance misuse
When is dissociation a problem?
Occasional, mild dissociation is an everyday part of life. As mentioned above, we have all daydreamed at some point. However, Dissociative Disorders can impact on your ability to function at work, school, in relationships and can put people at risk of harm. For example, some people can come out of a dissociative state and not know where they are, others have harmed themselves without realising because they were not aware of what they were doing. Many people can function quite well with dissociative experiences and do not need support. However, dissociation can be frightening, isolating and impact greatly on all areas of life. What is important is how you feel about the experiences and whether it is distressing to you. If it is, there is support available and treatments that can help.
It is possible to live with dissociation and dissociative disorders. However, for some people they can result in harmful situations and pervasive difficulties. A thorough assessment will be necessary to properly explore the symptoms, experiences, diagnose any disorders and come to an understanding of why the dissociation is occurring. For some people, an understanding of what is happening and why can be enough, other people may want support to live with and overcome their dissociative experiences.
The aim of treatment for any dissociative experiences is to increase connections between thoughts, feelings, physical sensations and the world around you. There is no medical treatment for dissociation, however medication can help some of the associated difficulties such as depression. Talking therapies would be the treatment of choice here, and depending on the type of dissociation, typical treatment available on the NHS may not be long enough to be effective for severe dissociative disorders. There are no NICE guidelines for the treatment of DID, therefore the best treatment guidelines come from the International Society for the Study of Trauma and Dissociation (ISSTD).
Whatever the difficulties, talking therapies can help. The type of talking therapy will depend on the specific difficulties and what your goals are. The options for therapy can be discussed with you during the assessment period.