Understanding Dissociative Disorders

Dissociation and its Impact on Day-to-Day Life

Unfortunately, there is no one-size-fits-all when it comes to dissociation. Dissociative experiences are variable and subjective which makes describing symptoms very difficult. Friends or family may be aware of the person’s inner suffering, but fail to recognize how much the person uses dissociation to cope. Confusion about the diagnosis, inaccurate media portrayal, and lack of professional training often leads to a delay in accurate diagnosis, which can cause life difficulties, depression, mood swings and self-destructive behaviors. Fortunately, both the DSM5 and the International Society for the Study of Trauma and Dissociation (ISSTD) identify a number of identifiable and diagnostic traits. The following explains these traits and offers some personal reflections.

What is Dissociation?

Dissociation is a common defense to stressful or traumatic situations and is different to daydreaming, as the latter leads to a disconnection from the world and from things usually associated with each other. It causes a break in how our minds handle information, meaning that dissociated experiences cannot integrate into our sense of self and may become lost from our awareness.

Even when we remain aware, we may feel disconnected from our thoughts, feelings, memories, and surroundings. It can affect our sense of identity and disrupt our perception of time. An example would be thinking about an event that was originally very upsetting, yet we experience no feelings while talking or thinking about it. Clinicians refer to this as emotional numbing, which is common to both post-traumatic stress disorder and dissociative disorders.

More severe forms of dissociation may affect us subjectively as thoughts, feelings, and actions and that don’t belong to us. These may seem ‘made,’ and as though they come out of nowhere. Or we may carry out an action as if being controlled by a force other than ourselves. It may feel like our minds and/or bodies have been ‘taken over’ by emotions that don’t seem appropriate to our activities or make sense.

As a personal example, I may feel suddenly excited, without obvious reason and inappropriate to the context, and then the excitement can leave in much the same manner as it came. The same applies with sadness – coming out

What Are The Five Main Types of Dissociation?

a. Depersonalization

Depersonalization is the sense of our inner self being detached from the body. Sometimes while feeling dissociated, we may look in the mirror and feel like we don’t recognize who we’re seeing, or feel disconnected from our body in a way that feels numb, or in my case, like my body is a cloud.

b. Derealization

Derealization is the sense of the world around us not being real. For me, it feels like I’m watching the world through an old-fashioned television set with poor sound. Others describe derealization as the world looking phony, foggy, or far away, or as though they’re detached.

c. Amnesia

Amnesia refers to memory loss beyond the realms of ordinary forgetfulness. Some people with dissociative disorders may have amnesia of the classic fugue variety, where they travel long distances before becoming alert and disoriented. At other times, amnesias are associated with important events that are forgotten, such as abuse, a troubling incident, or a block of time. Most commonly, we experience multiple micro-amnesias where discussions are not remembered. This can cause a scramble for clues as to what was, or still is, being discussed, while trying not to disclose the lack of continuity. Amnesia affects our perception of our own pasts, including our childhood, plus our moment-to-moment living. It causes a discontinuity in our sense of self, and can cause problematic relationships with others.

d. Identity Confusion

Identity confusion causes an insurity about who we are or what we can do. For example, I learned to fly light aircraft before realizing I had a dissociative disorder. While I never lost the ability to pilot an aircraft, I did notice that I could feel very different between or even within flights. My sense of self and emotions could swing from confident, to cautious, and then terrified.

e. Identity Alteration

Identity alteration refers to a more profound sense of alteration. As an example, I have absolutely no recollection of jumping up during a therapy session and informing my therapist that her sessions were, “dumb and stupid.” Later, while rubbing my forehead and disclosing that a voice inside my head wouldn’t stop complaining about therapy, she reported what had happened. That was quite a shock. However, it doesn’t have to be this extreme. There are more subtle forms of identity alteration, which may involve changes in voice tones, use and range of language, and minute changes in facial expressions. Additionally, these changes may accompany alterations in our view of the world. As another personal example, I was telling my therapist something unpleasant when the emotions of a terrified toddler swamped my body and I had to physically move myself from her line of sight. Going into and coming out of states such as these can sometimes feel smooth, or barely noticeable, but are most-often jarring. When I’m aware it’s happening, or become aware once it’s over, it can also feel extremely embarrassing. Fortunately, I have a patient and informed therapist who is taking time to help me become aware of the changes and sits with my feelings of shame.

What Are The Causes of Dissociation?

The exactly causes of dissociation are unclear, but it often affects people who have experienced an event that threatens their life, safety, or well-being. Trauma can include experiencing a direct encounter with a danger or threat, as well as witnessing the suffering or endangerment of another person.

Dissociative disorders most often form in children exposed to long-term physical, sexual or emotional abuse. Remember that our experiences with abuse are subjective: what one person experiences as traumatic abuse, another might not. Comparing our individual experiences and responses with what others have experienced is counter-productive to our healing. If it felt abusive, then trust that your mind and body need to heal.

Dissociative disorders usually develop as a reaction to these traumas and help to keep difficult memories at bay. They help the sufferer to get on with their lives in a way that might not otherwise be successful. Symptoms, ranging from sporadic amnesia to what might seem like fully-formed alternate parts or identities, vary depending on the type of dissociative disorder a person has. Times of stress can worsen symptoms, making them more obvious to those who pay attention.

  • A combination of environmental and biological factors, though the genetic tendency to dissociate is estimated to be zero.
  • Repetitive childhood physical and/or sexual abuse
  • Severe neglect or emotional abuse, even when there has been no overt physical or sexual abuse 
  • Families in which the parents are frightening, unpredictable, are dissociative themselves, or make highly contradictory communications.

Note: it’s important to understand that dissociation in the context of chronic, severe childhood trauma is considered adaptive because it can reduce distress created by trauma.

  • Experiencing ongoing trauma in childhood significantly increases the likelihood of developing dissociative disorders in adulthood.
  • The development of dissociative disorders in adulthood appears to be related to the intensity of dissociation during the actual traumatic event(s); severe dissociation during the traumatic experience increases the likelihood of generalization of such mechanisms following the event(s)

Note: When dissociation learned in childhood continues into adulthood, and the original danger no longer exists, it may be considered maladaptive.

What is Affect Regulation & Dysregulation?

The term affect regulation, refers to our ability to tolerate and regulate intense emotional experiences. Affect dysregulation refers to the opposite, or our difficulties tolerating emotional experiences.

This problem results (in part) from:

  • having had little opportunity to learn to soothe oneself or modulate feelings
  • not being taught these skills by an adult.

Problems in affect regulation are compounded by:

  • the sudden intrusion of traumatic memories
  • overwhelming emotions that accompany these memories.

The inability to manage intense feelings may:

  • trigger a change in self-state from one prevailing mood to another. 
  • cause depersonalization, derealization, amnesia and identity confusion. 
  • change the ability of the person to tolerate a particular emotion, such as feeling 
  • cause an overwhelmed mind to escape from fear when there is no escape, a person may unconsciously adapt by believing, incorrectly, that they are somebody else.

Common Misdiagnoses

Many people with a detected or undetected dissociative disorder experience depression. While prescribed antidepressants can relieve the feelings of depression, antidepressants neither reduce nor improve symptoms of dissociation. Some people may be misdiagnosed as having psychotic disorders and are treated with antipsychotic medication

a. Alcohol or drug abuse

People with diagnosed or undetected dissociative disorders may self-medicate with alcohol or drugs. In my experience, the sensation of being ‘drunk’ helps normalize my feelings of dissociation. Sometimes the alcohol lowers my resistance and allows my parts to speak, while at other times I use it to quieten them. I know this is unhealthy and have to work through it with my therapist. 

b. Anxiety disorders

People with diagnosed and undetected dissociative disorders often experience generalized anxiety, panic attacks, obsessive compulsive symptoms. Treating anxiety alone does not help dissociative symptoms.

c. Attention deficit (hyperactivity) disorder

People with dissociative disorders commonly experience problems with attention and their memory, particularly when sufferers experience amnesia. Medication for ADHD may help with poor attention, but will not help dissociation and amnesia.

d. Bipolar disorder

Mood swings are common in people who have a dissociative disorder. It was these symptoms that my sons questioned first, actually going as far to say, ‘Mom, you’re so bipolar – go see a doctor.’ Professionals are often mistaken too, defaulting to considering bipolar disorder as the reason for a person’s mood swings. Lack of training and knowledge about dissociative disorders can find a person taking anti-psychotic drugs which may cause long-term problems.

e. When nobody knows

Common clues that a person might have a dissociative disorder include experiencing many different symptoms that come and go. I was in treatment for years and was diagnosed with histoplasmosis, asthma, lyme disease, partial seizures, non-epileptic seizures, depression, anxiety, sleep apnea, and so on. It was only once I found an experienced trauma therapist that all the dots made any sense.

f. Other coexisting diagnoses

  • Eating disorders
  • Impulse control disorders
  • Obsessive-compulsive disorder
  • Sleep disorders

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