What Is Dissociation? Psychology, Definition And Treatments
By: Nadia Khan
Updated May 11, 2020
Medically Reviewed By: Lauren Guilbeault
Do you ever have a brief moment where you are out with your friends enjoying a lunch or sitting in a meeting at work and you feel out of touch with what's happening around you? Or you draw a total blank hours later when trying to remember what was discussed at the meeting? Or you drove home but don't remember actually doing the drive itself?
Some of this may feel familiar to you and that's completely normal. Occurrences such as these are a mild and common form of dissociation experienced by most people at least once in their life. Except in these situations you probably felt out of touch because you weren't paying attention, you were bored, you were thinking of other things or your mind was wandering. In the case of psychological dissociation, it's not just a matter of daydreaming and getting lost in your own thoughts for a bit but rather it is a severe and chronic medical condition where the individual is detached from reality.
Dissociation is defined (in the simplest way) as the process whereby an individual feels disconnected or begins to disconnect from their memories, emotions, thoughts, feelings and even their identity.
It is a coping mechanism and technique often used when someone is experiencing the trauma of some sort and the only way they can escape or face the pain and horror and live through their ordeal is by separating their mental self from their physical self. In essence, the person shuts down emotionally, removing themselves from any feelings, memories, from the even itself. What's left is just the physical shell of the individual and it can make them believe the trauma is happening to someone else, not them. Dissociating from something makes it hard to remember what they have gone through months or years later or it may come back piece meal in flashes.
The process of dissociation can be a symptom for various dissociative disorders, the three main types of dissociative disorders recognized by mental health professionals and listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are; Dissociative Identify Disorder, Dissociative Amnesia and Depersonalization Disorder.
The Three Types of Dissociative Disorders
- Dissociative Identity Disorder (DID)
More commonly and formerly known as Multiple Personality Disorder, the main symptom of this disorder is the presence of several different identities within one individual. These personalities alternate and change places depending on the situation at hand. Generally each personality has its own unique characteristics and voices. DID often develops as a coping mechanism for living through violent, traumatic and distressing events. For example, a little girl who was repeatedly abused as a child and was unable to defend herself or who was left helpless to stop it, may develop the identity of a tough, aggressive persona. Or someone who could have stepped in and protected her from the abuse as a child. Similarly, this can also happen if a child is a witness to violence or abuse, powerless to do anything about it as a child they may go on to develop the identity of a protector who is not powerless.
The personalities do not shift on demand but occur involuntarily and suddenly and this can cause significant confusion and distress in the individual's life and have a great impact on the people around them. Children who were abused physically or sexually throughout their childhood are more likely to develop this disorder and they are also at increased risk for suicide and self-harm.
In order to have a diagnosis of DID, two or more unique and separate identities (different behavior, personality, memories and mannerisms) have to be present. DID is the most serious and severe of three dissociative disorders and typically someone suffering from DID will also have dissociative amnesia.
- Dissociative Amnesia
When someone suffers from Dissociative Amnesia, they have trouble remembering things about themselves. This is different than someone who just happened to forget something. With dissociative amnesia, the person may have difficulty remembering a period of time or event from their life, a specific part of the event or in some rare cases, forget their identity and life entirely.
Dissociative Amnesia also comes about as a result of a specific traumatic event or occurrence. An episode of amnesia can last anywhere from a few minutes to days. In some extreme and rare cases, amnesia can last for years. There are no warning signs to an episode and they can occur suddenly, it is not uncommon for the individual to have several episodes in their lifetime.
- Depersonalization Disorder
This disorder makes the individual feel detached from the world and the reality surrounding them. They constantly feel like they're looking in on their life from the outside. They watch themselves going to work, doing the dishes or spending time with their children but none of these feel real to them. While their physical body is carrying out the actions, emotionally they are detached and removed from the situation. The symptoms can last for a few minutes or longer and can happen at any time and come back through the course of a lifetime.
Although each type of dissociative disorder has some specific symptoms, some general signs and symptoms to watch out for which may be exhibited by someone suffering from a dissociative disorder are:
- Memory loss and an inability to remember people, places or things that took place;
- Depression, anxiety or other symptoms of a mental health issue including thoughts of self-harm or suicide;
- Feeling disconnected from your physical self and feeling like you're watching your life from the outside i.e. having an out of body experience;
- Troubles with or lack of a self-identity;
Like many mental health illnesses, the individual who is going through the mental health issue may not realize there is a problem. They may chalk up their symptoms to stress or other things going on in their life or fail to understand that something is wrong. Often, family, friends or loved ones detect the first signs of something being wrong. If this is the case, it is very important that family and loved ones approach the topic of mental health in a sensitive, gentle manner while encouraging the individual to seek help.
Diagnosis and Treatment
A self-assessment questionnaire composed of twenty-eight questions is available online to help measure the symptoms and gravity of dissociation. The score and results should not be used as an official medical diagnosis. However, the types of questions (for instance, find yourself wearing clothes you don't remember putting on, finding things in your belongings you don't remember buying etc.) may help to shed some light on what you're going through or get you to analyze and take a closer look at the symptoms you are experiencing. If you're questioning whether you may be suffering from a dissociative disorder but you're unsure of how to approach it or what to base it on, something like an online screening might be a good start. You can then take the results as a discussion point to your family doctor.
Unfortunately, there is no scientific way of diagnosing dissociation, and no blood tests, x-rays, or screenings can determine or confirm a diagnosis. The doctor you see will make their diagnosis of dissociative disorder based on the symptoms you are experiencing, your family and personal history. Physical tests like blood tests or an MRI will be carried out in order to make sure some other factor like a brain tumor or burst blood vessel etc. is not at play. Once your physical health is ruled out, the doctor will likely refer you to a mental health specialist for a complete evaluation and they will then focus on your emotional and psychological health.
Once a diagnosis has been made identifying what type of dissociative disorder (if any) is present, together you and your doctor can look at treatment options and plans. Treating and managing dissociative disorders involves psychotherapy like CBT - Cognitive Behavioral Therapy and DBT - Dialectical Behavioral Therapy as well as medications like anti-depressants. A combination of both may be used depending on the circumstance and the patient. Unfortunately, while there is no way to permanently cure a dissociative disorder, treatment and commitment to your treatment plan can help you manage the symptoms and make you feel better.
So why is it so important to get help? You may feel that aside from a few minor interruptions in your life when you experience an episode of dissociation, your life is fine, so why bother getting help? The reality is even if you feel great most of the time if you are suffering from a dissociative disorder, without treatment your symptoms may worsen and complications may arise affecting your personal, social and professional life.
You might start suffering from other mental issues such as depression or anxiety, other disorders might creep up, you may turn to drugs or alcohol in order to cope with your episodes and it may develop into an addiction. And in a worst-case scenario, a very bad episode may lead to a dangerous act like suicide or self-harm.
Whether you decide to do a self-screening or not, if you are having any doubts or starting to question your symptoms and wondering whether you may have a dissociative disorder, it is imperative that you speak to a doctor or a mental health professional as soon as possible.
You might find it difficult to approach someone for help or wonder how you can even open the door to have that conversation. Like with most things in life, the more knowledge you acquire and the more you talk about something the easier it becomes to accept and understand. If you're not comfortable talking to family or someone you know right away, there are plenty of resources online where you can get help, counseling, and information from professional therapists who are experts in their field and who will listen without judgment.
Remember that mental health issues are more common than we think and they are nothing to be embarrassed or ashamed of. In fact, the smartest thing you can do is recognize the need for help and seek treatment so that you can be armed with the right tools and knowledge to lead your best life.
If at any point you start to have thoughts of suicide or self-harm or feel completely out of control, get yourself to the nearest clinic or hospital and if that's not possible call 911.