Dissociation: Types, Assessment, and Treatment

What does it mean to dissociate?  Is it daydreaming, losing focus, mind drifting, having an out-of-body experience, or not feeling in control?  Dissociation is a symptom and disorder present in the world of mental health due to the heavy impact it demonstrates on the mind, body, and behaviors.  Dissociation is rooted in trauma and described as an unhealed emotional, physical, psychological, sexual, or even spiritual wound*.  When these wounds are left untreated, the trauma manifests into a range of internal distress and dysregulation.  Dissociation means to sever or separate from any given moment when the environment or trigger is too overwhelming, uncomfortable, or unpleasant.  Dissociation occurs to offer temporary relief from a trigger and protect one’s mental/emotional state from worsening and meet one’s needs.  Dissociation is not always categorized as a “bad thing” and is also part of everyday experiences.  When was the last time you drove, ended up safely at your destination, but couldn’t fully recall the car ride?  When were you last involved in a conversation and zoned out only to tune back in when everyone had moved to a different topic?  These moments can be described as “escapism” and are normal when infrequent and not disruptive to everyday life.  Dissociation may impact the quality of life when unconsciously used as a defense or coping mechanism.

It is estimated that about 10% of the adult population experiences dissociation as a disorder which leads to the spread of awareness, understanding, and debunking of myths being an integral part of the process.  There are several categories of dissociative disorders, including dissociative amnesia, depersonalization/ derealization disorder, dissociative identity disorder (DID), trauma and stress-related disorders, and unspecified dissociative disorder.

  • Dissociative amnesia is the most common type of dissociative disorder.  It is experiencing memory loss by blocking out information related to a stressful or traumatic situation—dissociative amnesia results in the person being unable to recall memories, personal information, or long periods.
  • Depersonalization/derealization disorder is defined as feeling disconnected from the world or numb.  A feeling as if one is in a dream, having the perspective that you are watching yourself from outside your body, or feeling as if occurrences in life are not real.  These symptoms often occur in response to a traumatic life event, accident, illness/injury, or assault.
  • Dissociative Identity Disorder (DID), previously referred to as multiple personality disorder, is one of the most controversial disorders in the field of mental health.  This disorder develops as a coping mechanism in response to severe childhood trauma where the mind splits feelings, characteristics, and personality traits into separate parts/alter.  These parts go by names, ages, descriptions, etc., and each piece serves a purpose to the person.  This disorder is on a spectrum that ranges in degrees of severity and intensity.  People with this condition often experience “switches” in personality traits and genders and hear internal dialogue with other parts.  They may also experience an inability to remember personal information, experience feelings of detachment, loss of time, cannot recall certain behaviors, and often experience amnesia from early childhood through early adolescence.
  • Trauma and stressor-related disorders categorize dissociation as a symptom that may manifest in flashbacks, feelings of detachment, or feelings of unreality, avoidance, etc.  Often symptoms of PTSD are centered around a traumatic event as opposed to dissociation centered around developmental or childhood trauma over some time.
  • Other specified/unspecific dissociative disorder is defined as someone who did not meet the full criteria for the above dissociative disorders.  There is either the individual’s reason did not meet the criteria, or a person will not give a reason.

It is helpful to complete assessments, such as a Structured Clinical Interview for Dissociative Disorders (SCID-D), Dissociative Disorders Interview Schedule (DDIS), Multidimensional Interview of Dissociation (MID), and Dissociation Experience Scale (DES-II) to best screen for the presence and intensity of dissociation.  These screening tools review experiences throughout life and the manners in which dissociation may present within specific behaviors.

A range of mindfulness skills and grounding techniques may help one feel more present and connected to their body.  Mindfulness is a method of increased awareness of the mind, body, and mental state.  The art of practicing mindfulness is closely associated with grounding techniques to ground one in the present moment by acknowledging a negative thought pattern or related trigger/trauma.  One will then intentionally focus on centering the mind and divert attention to another area to experience temporarily emotional relief.  Mindfulness includes breathing techniques, mental grounding, physical grounding, soothing grounding, meditation, body scans, muscle movement, visualization, and healthy coping skills.  These exercises can last a few seconds to hours to distract the mind or body.  One may also engage in a positive internal dialogue to curate a state of security.  The goal is that mindfulness and grounding techniques replace maladaptive habits that have manifested from dissociation, such as avoidance, detachment, unsafe sex, self-harm, addiction, and suicidal thoughts.

The journey towards healing inner childhood wounds and reducing dissociation takes time, deep trauma work, resources, and commitment to the process.  With the proper stabilization, symptom education, processing of trauma, and treatment plan, one can work towards integration and an overall healthier relationship with self.  Remember, everyone dissociates!  It does not necessarily indicate trauma or a need for mental health treatment.  Dissociation can also be a result of experiencing intense emotions, boredom, sensory overload, discomfort, social interactions, or even drug or alcohol use.  When you begin to experience dissociation, it is a sign to be more in tune with your environment and the internal/external trigger.  Here are a few ways to check in with yourself at that moment: Am I in an environment where I feel accepted and safe?  Are the people around me part of my support system?  What emotion am I feeling at this moment?  What just happened that may have disrupted my state of being?  How can I get to a mental place where I feel more grounded and secure?  Awareness will bring us one step closer to acknowledging any disconnects in the mental state and ultimately bring us closer to healthy cohesion within mind and body.  Suppose you experience dissociation regularly, impacting your overall quality of life (work, school, interpersonal relationships, emotional/mental state, etc.).  If so, it may be helpful to speak with a mental health professional to explore a path toward healing.

References

https://www.netce.com/coursecontent.php?courseid=2188

https://www.gatewaytosolutions.org/are-you-feeling-out-of-control-emotional-dysregulation/

https://www.gatewaytosolutions.org/the-truth-about-sexual-abuse-prevalence-and-risks-part-i/

https://www.gatewaytosolutions.org/mindfulness-and-psychotherapy/

https://www.gatewaytosolutions.org/five-easy-steps-to-start-therapy-at-gateway-to-solutions/

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