Disclaimer: The following article is for informal educational purposes only. I am not a licensed medical or mental health professional. I am simply a trauma survivor and coach who has done a helluva lot of reading and research. I do not recommend self-diagnosing a dissociative disorder. If you suspect you may have a dissociative disorder, please reach out to a psychiatric professional for an appropriate evaluation. Many symptoms of dissociative disorders can have their origins in a variety of other diagnoses such as AD/HD, ASD, or even traumatic brain injury. These symptoms can only be properly evaluated by a trained professional.
One of my most popular posts on Quora answered the question What does it look like when a child dissociates? where I shared an experience of watching one of my adopted children dissociate and reflected on my own childhood experience of dissociation. You can find that here. It’s well worth a read - especially for the community engagement in the comments section where there are many stories of other people’s lived experiences as well.
Dissociation seems to be widely misunderstood and certainly not discussed nearly enough. Culturally we’ve begun to use this term “trauma informed” a bit too loosely without truly understanding how to notice and respond to people who experience dissociation. I want to give a big shout out to Jamie Marich's book published this year - Dissociation Made Simple - for presenting the textured and deeply personal experiences of people with lived experience of deep dissociation.
That said, dissociation is not always from trauma. There is a spectrum of sorts which moves from typical dissociation that most people can experience throughout the day, to structural dissociation* which is experienced by a much smaller number of individuals and indicates quite a bit of distress occuring in early childhood. Let’s take a walk along that spectrum:
Feel free to download this graphic for your own purposes here (please share but do not alter):
Dissociation simply means dis-associating. When in a dissociative state, we are disconnected from our immediate surroundings and associating in our minds with some other state. This can be a child escaping into their fantastical imaginary world, an adult mentally disconnecting from an abusive partner, or an individual having an ayahuasca experience. All of these are examples of people dis-associating from their present experience.
Typical (Every Day) Examples of Dissociation
Young children are experts at everyday dissociation. My son has spent years of his life, plastic sword in hand, leaping and thrusting at imaginary enemies along the outskirts of the woods on our property. If I were to ask him what he’s up to he will tell me “I’m playing an imagination game”. In other words, he is actively ignoring his actual surroundings in exchange for an encounter in his imagination. He is dissociating and I’m thrilled about it. I love seeing him get lost in his mind going on fantastical adventures!
As adults we may experience this type of dissociation while driving a car and suddenly we realize we missed the exit because we were lost in deep, focused thought on something besides our car’s trajectory. Getting lost in a good book, playing a video game, being in the "zone" while creating or competing, or scrolling through your phone are other ways we may dissociate ourselves every day.
These forms of typical dissociation create no reason for alarm. It may be a bit healthier at times to be more mindful of our surroundings, but nobody considers this type of dissociation to be disordered behavior.
It is important to recognize that when dissociation is a result of trauma, the goal is to provide as much safety as possible. If you have experienced dissociation from a young age, you have developed a super power that kept you safe in frightening circumstances. I honor the bada$$ in you who survived!
The following types of dissociation may be indicative of the presence of a dissociative disorder and present as symptoms of these disorders:
Depersonalization - People with depersonalization often describe themselves as outside of their own bodies, as if they are watching themselves from a different vantage point. This often occurs when a person is undergoing a difficult/traumatic experience and desperately needs to feel that “this isn’t happening to me.” The person with depersonalization may feel robotic or unfeeling. This could occur for someone undergoing a difficult surgery, a childhood abuse situation, or the driver in a car accident. It is not always a result of abusive trauma. I have even heard of depersonalization arising from a bad drug trip.
Derealization - Similar to depersonalization, this occurs when an individual desperately needs to believe that what is happening around them is not real. This feels like the people around you and their surroundings are somehow made up - as if the individual is living in a constant dream state, on the other side of a wall, in a fog, or a strangely distant world.
Somatic Numbing - This involves dissociating from the sensations in your body. People who experience this may not be able to express feeling physical pain until it becomes quite intense, or may not be able to sense when they are hungry, hot, or cold. This would not be due to a medical condition, but rather a psychological state of disconnection from their body’s normal nervous system messaging system.
Psychic Numbing - Much like somatic numbing, psychic numbing disconnects the mind from the feeling of emotions in the body. Someone who experiences this may say they feel like they are a head attached to a body with no connection between the two. They may not experience emotional states like tears or the excitement when a love interest is near, or nervous “butterflies” in the stomach.
Dissociative Trance - This is when a person seems completely unaware of their surroundings and may not even respond at all to such things as loud noises, physical contact, extremes of temperature, etc. This is not related to spiritual trance-like states.
Memory Gaps - Many people may not be able to remember certain things. They have become dissociated from their past experiences. Some people report having little to no memory of many years of their childhood. Sometimes the memory gaps take the form of not being able to remember important life events such as a graduation or the birth of a child. This inability to recall autobiographical information may also be referred to as dissociative amnesia. And sometimes these gaps may occur in daily activities - with a person going about their day and having no memory of things like getting home from work or putting on the clothes they are wearing. This would be distinguished from the typical dissociation at the start of this discussion by the level of impairment this creates in a person’s daily life.
Flashbacks - A flashback is the experience of vivid and intrusive memories entering the mind. These are generally disturbing memories that represent events that contain unresolved fear/terror. A flashback indicates that these memories have not been properly integrated into - and thus remain dissociated from - the mind’s complex memory filing system.
Emotional Flashbacks - Similar to a flashback, these are vivid, intrusive and disturbing experiences of the emotional content of a memory without access to the memory of the actual experience. These are unintegrated implicit memory material that comes from the mid-brain area. Essentially, the mind is replaying the emotional and/or sensory aspects of a memory without any context from the actual disturbing event. Some people report feeling suddenly full of rage, extremely melancholy or crying for “no reason”.
*Structural Dissociation - This type of dissociation is found in people with profound levels of dissociation. In order to protect itself from terrifying experiences during the earliest years of development, the mind skips the developmental stage of integrating the various self-states that emerge as a young child begins to learn about the world. These self states, instead of integrating into a more cohesive whole, construct dissociative barriers between each other so that they often have no awareness of one another. The fragmented self states and the erection of these dissociative walls is referred to as structural dissociation.
DSM-5 Dissociative Disorder Classifications:
The DSM-5 - The Diagnostic and Statistical Manual used by mental health practitioners to diagnose disruptive behavior patterns - does define several different “disorders” of dissociation. (I’m not a huge fan of the word disorder but this is how it is defined in the DSM-5). They are considered to be disorders because their presence is significantly disruptive to the individual’s daily functioning. Atypical dissociation is generally an inability to integrate aspects of self such as memory, behavior, motor functioning or even consciousness. These disorders have layers of unintegrated functioning.
When diagnosing these disorders, professionals must consider a list of differential diagnoses. These are conditions that may have similar or overlapping symptoms/markers. For dissociative disorders, these include substance abuse disorders, anxiety and/or depressive disorders, psychotic disorders, or medical injury to the brain, among others. It is possible to have “co-morbid” - co-existing - conditions that are diagnosed in addition to the dissociative disorder.
Again, I must stress that these descriptions are a lay person’s understanding and have been simplified for ease of understanding. Please speak with a licensed professional for questions about diagnosis and treatment - and for further clarification.
Also, I feel obligated to note that the usefulness of diagnosis is a deeply personal subject. Many find relief and understanding in having a name for their symptoms which can also help them gain appropriate care. Others may find diagnosis deeply stigma-creating and othering. Love it or hate it, the DSM-5 currently carries a lot of weight in receiving treatment in the US.
Those disorders given diagnostic labels in the DSM-5 are:
Dissociative Identity Disorder (DID) - Once called Multiple Personality Disorder, this condition is marked by the presence of structural dissociation. An individual with DID has a mind fragmented into at least two - generally more - self states which are divided by dissociative barriers. An individual with DID may wake up in the morning in an unfamiliar bed and have no idea how they got there. Or they may come across a beautiful painting on their desk and have no recollection of creating it - or even believe they have the ability to have painted it.
Otherwise Specified Dissociative Disorder (OSDD) - This has replaced what was formerly known as Dissociative Disorder Not Otherwise Specified (DD-NOS). OSDD closely resembles DID, with the main difference being the lack of amnesiac episodes in day to day life caused by “switching” of self-states. In OSDD there is the presence of multiple self-states as in DID, but these self-states are generally co-conscious and less easily differentiated. This can create a particularly disconcerting amount of chaos in the mind as the pwOSDD tries to sort out all of the internal “voices” clamoring for attention at once.
Depersonalization/Derealization Disorder - This can be the presence of depersonalization, derealization or both. The pwD/DD can accurately describe reality but may see reality through a distorted lens (for example, is not hallucinating, paranoid or delusional).
Dissociative Amnesia - A person with Dissociative Amnesia is not able to recall either specific events or a general period of life. For childhood trauma survivors, they may have no memory of a specific number of years in childhood that correspond with on-going abuse. This is much more significant than “usual” forgetting that happens with the passing of time or old age.
Unspecified Dissociative Disorder - This diagnosis was parced out from the former DD-NOS diagnosis (with OSDD as the other part of this parcing). Basically UDD is the diagnosis given when there are a collection of symptoms of dissociative disorders that don’t fit any of the other diagnostic categories specifically. This may also be diagnosed if the clinician does not want to pinpoint a specific diagnosis - generally in situations where a diagnosis is required but more information is needed.
I hope this information has been helpful to give you a general overview of what can be very confusing information. If you feel you may have a dissociative disorder, please don’t despair - you are not alone and there is help! First I encourage you to see a qualified professional for a proper diagnosis. Then, I would love to talk with you about working 1:1 or in a Mindful Resilience group to develop embodied mindfulness skills that will prepare you for trauma work with a qualified practitioner. You are so very worth it!
The following directories may also have helpful resources for you:
Find an EMDR practitioner: https://www.emdria.org/find-an-emdr-therapist/
Find a Trauma Informed Stabilization Treatment (TIST) practitioner (you might see a familiar name here!): https://janinafisher.com/search/
Find a Dialectical Behavior Therapy (DBT) practitioner: https://www.dbtproviders.com/
Find a practitioner for DID: https://www.psychologytoday.com/us/therapists/dissociative-disorders
Bibliography (really useful sources to learn more!):
Daniel Siegel, M. D. (2018, May 21). A framework for cultivating integration. PsychAlive. Retrieved March 22, 2023, from https://www.psychalive.org/framework-cultivating-integration/
Fisher, J. (2017). Healing the fragmented selves of trauma survivors: Overcoming internal self-alienation. Routledge.
Fisher, J. (2021). Transforming the living legacy of trauma: A workbook for survivors and Therapists. PESI Publishing & Media.
Marich, Jamie. Dissociation Made Simple: A Stigma-Free Guide to Embracing Your Dissociative Mind and Navigating Daily Life. North Atlantic Books, 2023.
Traumadissociation.com. (1970, January 1). Dissociative Disorders. Trauma Dissociation. Retrieved March 22, 2023, from http://traumadissociation.com/
Siegel, D. J. (2011). Mindsight: The New Science of Personal Transformation. Bantam Books.
*structural dissociation is merely one theory to explain why/how dissociation happens - in actuality, dissociation feels complex and involves body, mind and spirit to many with lived experience
**most images from wix media library
***image of two people in woods seated in chairs from lauren mudrock photography
Comentários