What is Dissociation

Dissociation is a state of being disconnected from yourself or the world around you. Everyone has experienced milder types of dissociation, such as daydreaming, zoning out, or going into automatic mode when driving or performing other tasks. More severe types of dissociation can be highly distressing and significantly impact a person’s life. Some treatments can reduce the distress and minimize dissociation’s impact on your life.

What is Dissociation?

Dissociation is when you feel disconnected from yourself or the world around you. Everyone has dissociated to some extent. On the milder side, daydreaming or going into automatic mode when driving are types of dissociation. Dissociative Identity Disorder (DID) and dissociative fugue are some of the more severe types of dissociation.

Dissociation can be caused by trauma or neglect. You may also have learned to use dissociation as a way to cope with stress or distressing experiences. You may dissociate in passing (minutes), for a short time (hours to days) or for much longer (weeks or months).

The Spectrum of Dissociation

Mild and Everyday Dissociation

At the base level, dissociation is being disconnected from the here and now. Everyone has experienced this type of dissociation, such as:

• Daydreaming
• Getting lost in a good book
• Going into automatic mode when driving
• Zoning out

Dissociation can also be used intentionally, such as:

• Disconnecting from one’s current environment to assist with calming or focusing, such as an athlete zoning out distractions to focus on a shot or a race.
• As part of a ritual related to one’s religion or culture
• Side effects of substance use, to escape from the person’s current reality

Trauma-related Dissociation without Identity Shifts

Trauma and chronic pain have been associated with forms of dissociation around coping with their reality. This can include the shutting down of sensations or emotions to cope in the moment. You may be connected to yourself, but your thought process or emotional state may be deactivated to a certain extent. This can be conceptualized as “going through the motions” or being emotionally numb. You may be able to deal with simple thoughts or emotions, but complex thoughts are not attainable. This can be considered a disconnection from the whole reality of your current state. Trauma-related dissociation can also appear as amnesia, where the trauma has caused memory loss for events or more generally.

Trauma-Related Dissociation with Identity Shifts

PTSD, Complex PTSD, and Dissociative Disorders can cause dissociation that creates identity shifts. It can be with a person experiencing different versions of themselves at different ages or with various identities that may be called by multiple names. These differences in identity are often called parts or alters. In a traumatic situation where a child may fear for their safety or life, this “dissociative switch” can be turned on to allow the person to disconnect from themselves until the threat is resolved, or at least manageable. Another way there can be dissociation with identity shifts is a dissociative fugue.

Causes of Dissociation

Short-term Dissociation

Brief experiences of dissociation are pretty common. They can happen during periods of intense stress or when you’re exhausted. It is also a normal way of coping during highly stressful or traumatic events.

Long-term Dissociation

Dissociation can become a way of coping with ongoing childhood trauma. Since your brain and personality are still developing, you may not have learned other ways of dealing with stress. This can result in the development of a dissociative disorder as an adult. Some of the severe and ongoing trauma that can result in dissociative disorders include physical abuse, sexual abuse, emotional abuse, and severe neglect. Dissociative disorders can also be caused by intense trauma in adulthood.

How Can Trauma Lead to Dissociation?

When you experience traumatic experiences where you can’t escape and go into a freeze response can lead to dissociation. People go into a freeze response when fight or flight are no longer possible. When you experience dissociation during a traumatic event, you may separate different parts of the experience so you don’t have to deal with them all. In this way, the experience becomes fragmented, and your actions, memories, feelings, thoughts, sensations, and perceptions may feel separate. You may remember what happened but not the emotions or sensations associated with it, or vice versa; you may experience the feelings or sensations but not be able to connect them with what caused them.

What is Structural Dissociation?

Structural dissociation is a model of how dissociation is an adaptive strategy for coping with a traumatic environment. Ultimately, it is a survival strategy. It involves separating and disowning parts that hold the trauma so that the person can function without awareness of being traumatized. The trauma-related parts, activated by normal life stimuli and driven by implicit trauma responses, may experience threat or danger and automatically engage in defensive behaviours such as fight, flight, freeze, submit, and cry for help even when the threat of danger is long past. 

To keep the rejected part ‘out of the way’ long after the traumatic events have occurred, individuals must rely on dissociation, denial, and/or self-hatred to enforce the disconnection. In the end, they have survived trauma by disowning the most vulnerable and hurting parts of themselves. 

Outline of the Structural Dissociation Model

The structural dissociation model was developed by van der Hart, Nijennuis, and Steele, and Janina Fisher made some adjustments to the language in the model. It hypothesizes that three types of structural dissociation develop as a result of trauma:

Primary Structural Dissociation

Primary Structural Dissociation is the most straightforward division of the personality. There are just two parts. First, the “going on with normal life” part (or apparently normal part) carries out the action systems that are crucial to daily life. The other part is called the traumatized part (or emotional part), which holds the feelings and memories of the trauma and the defensive reactions related to it, including fight, flight, freeze, submit, and cry for help. This division evolves most often as a consequence of a single traumatizing event. However, it can also be observed in childhood abuse survivors in the form of the ‘inner child’ phenomenon.

In primary structural dissociation, the “going on with normal life” part is the primary ‘stakeholder’ of the personality. It maintains executive control most of the time. It carries out adult action systems crucial to survival, such as exploration, attachment, caretaking and sexuality. The traumatized part is usually not in control. Still, it can take complete executive control during a flashback where orientation to the present is lost, and the person is in a full reliving of an earlier trauma. A traumatized part is a psychological structure that is a separate, dissociated biopsychosocial subsystem with reactivated traumatic memories that may involve feelings, various sensory perceptions or firmly held beliefs. In cases of PTSD, traumatized parts are thought to be more rudimentary than in cases of Secondary and Tertiary dissociation.

Secondary Structural Dissociation

Secondary Structural Dissociation is more complex and develops when the trauma is prolonged and repeated. It involves one “Going on with normal life” part and more than one traumatized part. These traumatized parts may be present in various forms and have different degrees of separation, autonomy, and characteristics, such as name, age, and gender.

Tertiary Structural Dissociation

Tertiary Structural Dissociation involves multiple “Going on with normal life” parts and multiple traumatized parts. This form of dissociation is characteristic of DID, where there is more than one “Going on with normal life” part, and some traumatized parts may take over executive control for uses other than simple defence.

Types of Dissociation

Dissociative Amnesia

Dissociative amnesia is when you have difficulty remembering personal information, such as:

• Have gaps in your memory where you can’t remember specific events
• Not being able to remember information about yourself or your life history
• Forget how to do something you’ve been able to do well in the past
• Find that you have items that you don’t remember ever owning

Dissociative Fugue

Dissociative fugue is when you forget who you are and how you got there. Often, people in dissociative fugue take on a new identity and forget their true identity.

Dissociative Trance

In a dissociative trance, you may be utterly unresponsive to outside, surrounding stimuli. You may perceive things around them as “surreal,” “blurred,” or moving around them. At the same time, you remain paralyzed and unable to gain control over your environment.

Derealization

Derealization is when you feel like the world around you is unreal. Some experiences of derealization include:

• See objects changing in shape, size or colour
• Feel detached or separate from the world around you
• See the world as ‘lifeless’ or ‘foggy’
• Feel like you’re seeing the world through a pane of glass
• Feel like you’re living in a dream
• Feel as if other people are robots (even though you know they aren’t)

Depersonalization

Depersonalization is when you feel like you’re looking at yourself from the outside. It can include experiences such as:

• Feel as though you are watching yourself in a film or looking at yourself from the outside
• Feel as if you are just observing your emotions
• Feel disconnected from parts of your body or your emotions
• Feel as if you are floating away
• Feel unsure of the boundaries between yourself and other people

Identity Alteration

Identity Alteration is when you feel your identity shift and change. Some examples include:

• Switch between different parts of your personality
• Speak in a different voice or voices
• Use a different name or names
• Feel as if you are losing control to ‘someone else.’
• Experience different parts of your identity at different times
• Act like different people, including children

Identity Confusion

Identity confusion occurs when one has difficulty defining one’s personality. One’s opinions, tastes, thoughts, and beliefs change frequently.

What Diagnoses Involve Dissociation?

Dissociative Identity Disorder (DID)

If you have dissociative identity disorder (DID), you will experience intense changes in your identity. You have to feel like different aspects (states) of your identity are in control of your behaviour and thoughts at other times. In DID, you may experience this separation as if different memories or sensations happened to different people. This is referred to as having different identity states. This can allow you to cope when reality is too much to cope with.

This can happen in various ways:

• Each of your identity states may have different thinking patterns and relating to the world.
• Your identity states may come across as different ages and genders.
• You may feel you have one ‘main’ part of your identity that feels most like ‘you’ (host identity).
• The different parts of your identity may have memories or experiences that conflict with each other.
• These parts of your identity may be known as alters or parts, and all the parts together as a system.
• You might not feel like you have control over when different parts of your identity take over.
• You may experience amnesia, which means you don’t remember what happens when another part of your identity is in control.

Depersonalization or Derealization Disorder

Depersonalization-derealization disorder occurs when you always or often feel that you’re seeing yourself from outside your body, or you sense that things around you are not real — or both. This can be very disturbing.

Dissociative Amnesia Disorder

The most common dissociative disorder is dissociative amnesia disorder, which is when you can’t remember important information about yourself. These memories are usually of distressing or upsetting events, like severe or long-term trauma like abuse, neglect, or violence.

These bouts of amnesia are extensive and go beyond normal forgetfulness. It is treatable, and most people can regain their memories. The types of amnesia you can experience with this disorder include:

• Localized amnesia means that you cannot recall a specific event or series of events, which creates a gap in your memory. These memory gaps often are related to stress or trauma. Those with localized amnesia usually have more than one episode of memory loss.
• Selective amnesia involves losing only some of one’s memory from a specific period. For instance, this could mean forgetting some parts of a traumatic event but not all of it. A person can have both selective and localized amnesia.
• Continuous amnesia involves a person forgetting each new event as it occurs. A specific traumatic event may trigger this continuous forgetting.
• Systematized amnesia is a loss of memories related to a specific category or individual.
• Generalized amnesia is a rare form of amnesia that occurs when an individual completely forgets their own identity and life experiences. They can forget who they are, who they spoke to, where they went, what they did, and how they felt. Some people with generalized amnesia may lose previously well-established skills. This form of amnesia often occurs in sexual assault survivors, combat veterans, and those experiencing extreme stress or conflict.
• Dissociative fugue is a severe and rare version of dissociative amnesia that affects just 0.2% of the general population. It typically manifests as sudden, unexpected travel away from a person’s home. A person with a dissociative fugue may wander about bewildered and confused. They may also have memory loss and an inability to recognize people they know. It can last for just a few hours or go on for months. During the fugue, people appear to act relatively normally. However, they suddenly find themselves in a strange new situation once it ends. For instance, in some cases, a person will start a new job, assume a new identity, and essentially begin a new life. The end of the fugue may leave them feeling shame, depression, or grief.

Other Specified Dissociative Disorder (OSDD)

Other Specified Dissociative Disorders are characterized by a loss of awareness or orientation to one’s surroundings and/or identity. The functions of consciousness, memory, identity, or perception of one’s environment are disrupted. It is a diagnosis for when your symptoms don’t fit into any other diagnosis.

Unspecified Dissociative Disorder (UDD)

Unspecified dissociative disorder is given when the person making the diagnosis doesn’t have enough information to make a full diagnosis. This is usually used in emergency situations (is the dissociation due to head trauma or another reason) or situations where more information is needed to make a diagnosis. It is a working diagnosis that will be changed as more information is gained.

PTSD and Complex PTSD

Post-traumatic stress disorder (PTSD) and Complex PTSD are a disorder that can develop in people who have experienced a traumatic event. There is a dissociative subtype of PTSD for people who develop depersonalization and derealization as part of their PTSD presentation.

What are Some of the Treatments for Dissociation?

Dialectical Behaviour Therapy (DBT)

Dialectical Behavior Therapy skills can be a valuable resource for individuals experiencing dissociation, offering evidence-based strategies for grounding themselves, managing overwhelming emotions, and fostering a sense of stability and connection. DBT is best used as part of the stabilizing phase before treating the trauma that is behind the dissociation.

Eye Movement Desensitization and Reprocessing (EMDR) Therapy

Eye movement desensitization and reprocessing (EMDR) helps a person reprocess the memory of the trauma so that it is experienced differently. EMDR uses bilateral stimulation on a target memory to process the distress and maladaptive beliefs associated with the trauma. It can integrate the fragments of trauma memories with associated memories so they don’t cause as much distress or as many disturbing symptoms.

Flash Technique

Flash Technique was developed for use with EMDR who find the recall of a traumatic memory to be too disturbing or overwhelming. It can be effective for people who dissociate when they get overwhelmed. As opposed to other trauma techniques that focus on recalling the details of trauma memories, Flash only uses very brief exposure to the target. Flash was found to reduce avoidance during recall of traumatic memories, disturbance or emotionality of traumatic memories, PTSD symptoms, symptoms of depression, and symptoms of dissociation.

Hypnotherapy

During hypnotherapy, your therapist will work with you to help you explore and understand your dissociative symptoms. The therapist can then use suggestions and other hypnotic tools to help you address the underlying causes of their dissociation. Hypnotherapy can be an effective treatment for dissociative disorders.

Parts Work, including Internal Family Systems (IFS)

Parts work therapy is precisely what it sounds like—a therapeutic approach designed to help patients deal with the different parts of themselves created through trauma, eventually bringing more of a sense of peace and wholeness to the person. It can be used alone or integrated with other approaches, such as the Flash Technique and EMDR.

Conclusion

Dissociation is a state of being disconnected from yourself or the world around you. Everyone has experienced milder types of dissociation, such as daydreaming, zoning out, or going into automatic mode when driving or performing other tasks. More severe types of dissociation can be highly distressing and significantly impact a person’s life. Some treatments can reduce the distress and minimize the impact dissociation has on your life.