While you may be unfamiliar with the term, dissociation is more common than you might think. Perhaps you have a brief moment where you are out with friends enjoying lunch or sitting in a meeting at work, and you begin to feel out of touch with what’s happening around you. You may even draw a blank an hour later when trying to remember what was discussed at the meeting or maybe you drove home but don’t remember taking the route. Occurrences such as these are a mild and common form of dissociation experienced by most people but in the case of psychological dissociation, it’s not just a matter of daydreaming or getting lost in your thoughts, but rather a severe and chronic medical condition where the individual is detached from reality. Dissociation is defined simply as the process whereby an individual feels disconnected or begins to disconnect from their memories, emotions, thoughts, feelings, and even their identity. This detachment from reality may encompass a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. Research has related the cause to be due to neurobiological mechanisms, trauma, anxiety, psychoactive drugs, suggestibility, and hypnosis. In this next article, I will highlight our current understanding of dissociation and how it manifests in everyday life.
The French philosopher and psychologist Pierre Janet (1859-1947) is considered to be the author of the concept of dissociation although it was Sigmund Freud who conceptualized dissociation as a psychological defense. For most of the twentieth century, there was little interest in dissociation until the 1970s and 1980s when an increasing number of clinicians and researchers wrote about dissociation, particularly multiple personality disorder (now known as Dissociative Identity Disorder). More recently, attention to dissociation as a clinical feature has been growing as a symptom of Post Traumatic Stress Disorder and as neuroimaging research and population studies show its relevance. Peritraumatic dissociation is experienced during and immediately following a traumatic event in which a person no longer feels the heightened overwhelming feelings as it internally has been shut off resulting in the lack of integration of thoughts, feelings, and experiences into the stream of consciousness. In other words, our nervous system has the protective intelligence and capacity to split off and mute a part of itself that is overwhelmed and screaming in order to survive. By shutting down emotionally, the person removes themselves from any feelings or memories of the event itself. What’s left is just the physical shell of the individual. This can make them believe the trauma is happening to someone else, not them. Dissociating from something can make it harder to remember what they have gone through months or years later, or it may come back in flashes.
In mild cases, dissociation can be regarded as a coping mechanism in seeking to master, minimize or tolerate stress including boredom or conflict. At the non-clinical end of the continuum, dissociation describes daydreaming and altered states of consciousness. The more severe dissociation involves dissociative disorders in which individuals detach themselves from overwhelming fear, pain, and helplessness that may include: 1) depersonalization—a sense that the self is unreal as though one is an observer of one’s mental and bodily processes and time is distorted, 2) derealization—a sense that the world is unreal and dreamlike, 3) amnesia—a loss of memory about the event, 4) fugue—forgetting identity or assuming a new self, or 5) sense of numbness in which the emotional response is suppressed. Dissociative Identity Disorder has been the most extensively researched of all dissociative disorders and is defined by the presence of two or more distinct identities or personality states.
While dissociative disorders are often triggered by trauma, there can be other causes. Medical causes of dissociation may include a range of neurologic conditions including seizure disorders, brain tumors, post-concussion syndrome, metabolic abnormalities, migraine headache, vertigo, and Meniere’s disease. The other consideration is whether dissociation is related to intoxication or withdrawal from certain drugs or a side effect of medication. Substances with dissociative properties include ketamine, marijuana, alcohol, amphetamine, dextromethorphan, and hallucinogens like MDMA (Ecstasy) and PCP. Dissociation is a common side effect of ketamine infusions for Major Depression.
Dissociation can be much more common among those who are traumatized, yet at the same time there are many people who have suffered from trauma but who do not show dissociative symptoms. Child abuse, especially chronic abuse starting at early ages, has been related to high levels of dissociative symptoms. Girls who suffered abuse during their childhood had higher reported dissociation scores than did boys. When sexual abuse is examined, the levels of dissociation were found to increase along with the severity of the abuse.
Transient experiences of dissociation are also prevalent in the general population. Depersonalization and derealization are the third most commonly reported psychiatric symptoms, after depression and anxiety. They are common after certain types of meditation, deep hypnosis, extended mirror or crystal gazing and sensory deprivation experiences. They also form an important part of how we deal with modern life but to varying degrees in each of us.
While there is an inherent lack of present awareness with dissociation, mindfulness and meditation can alter the state of awareness to the present moment and to an individual’s present state of being. Thus, one coping skill that can improve dissociation is mindfulness due to the introduction of staying in present awareness while observing non-judgmentally and increasing the ability to regulate emotions. Helpful grounding techniques might include: smelling and applying essential oils (especially vetiver and patchouli), changing the position or location of your body, looking around the room you are in and start counting lines on the wall or tiles on the floor, or calling a friend. Psychotherapy is important in Dissociative Identity Disorder to help integrate the different identities and develop a consistent and continuous sense of self. Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are also good options for meaningful, long-term improvements in managing dissociation. Ultimately, the goal of helping individuals sit and tolerate uncomfortable feelings in their bodies either from the past or present is helpful in managing dissociation and is a skill that can be cultivated over time.