What Does Dissociation Actually Mean?

What is dissociation? For one it is something that all human beings do. Ever find yourself in a class or meeting that you thought, “Oh this is so boring,” and then allowed yourself to drift away and daydream? This is dissociation. We are disconnecting or dissociating our attention away from something. Further in this article is the dissociative experiences scale to screen dissociation for you.

Used as a Coping Strategy

We use daydreaming or drifting away to avoid the unpleasantness of a situation. Sometimes we do so to protect our feelings in that situation, to avoid an unpleasant experience or get distracted as the new thing is far more interesting than the situation. This is very much a normal experience and we all can relate to times we have done this.

Dissociation is a Normal Human Response

Dissociation is very normal. It is very common to see dissociation in children. They are imaginative and creative and their play is dissociative naturally. They can separate the human child and then suddenly become a super hero or an animal and they imagine themselves as flying through the air or swimming in the ocean. They aren’t doing either but it is imaginary and healthy.

That reduces into adolescence and much lower in adulthood. Teens and adults may daydream still and let their attention drift away in a meeting or doing repetitive tasks that require little attention to complete. Adults while driving routes that they are very familiar with don’t have memory of the trip.

Is there Dissociation that isn’t Healthy?

Yes. To understand why let’s look at a common way that unhealthy dissociation develops. Children are vulnerable by nature. They cannot fight off or flee faster than an adult. So when a child is exposed to a negative experience (physical, emotional abuse or witness to violence of others for example), they may dissociate in order to avoid awareness of the experience. In that way they endure so to speak and block out the worst of the experience.

If the negative experiences are ongoing, children become very effective at dissociating. They aren’t integrating their ongoing experiences into the totality of their lives leading to fractionation. The results of that dissociation is often misunderstood and misdiagnosed and poorly treated.

Typical range of problematic dissociation in children include:

• • Amnesia of times and blocks of time

• • Disturbance in understanding of the self

• • Trance-like states

• • Rapid shifts in mood and behavior

• • Shifts in knowledge, abilities, memory and skills (can ride a bicycle one moment and suddenly seem to forget)

• • Auditory and visual hallucinations

• • Vivid imaginary friends

The unfortunate problem is that many kids are misdiagnosed with psychosis, bipolar, ADHD, and/or learning disabilities resulting in more trauma than help due to use of medications, labeling, etc.

Then we grow up

The maladaptive dissociation doesn’t dissipate as these children grow up. If anything, the child perfects the dissociation and fractionation continues as amnesia of blocks of time increase. Too often children exposed to negative childhood experiences keep being exposed.

Different Maladaptive Dissociative Techniques

To start any discussion of issues with maladaptive dissociation, helps to understand that I do not see these as disorders that we have. I support the dis-ease model not the disease model. In other words, most of the so called disorders in mental health are mainly maladaptive coping strategies that have worked to address something. Generally they worked in the past and no longer serve today or the cost far outweighs any benefit now.

Dissociative Amnesia

This again is spectrum from very mild forgetting about what we had for breakfast as we didn’t bring mindfulness to the experience to the so called run away bride who “comes to” miles away without memory of getting there. It is very typical to lose time in hours or chunks of time such as the 3rd grade for example when exposed to childhood trauma.

Typical amnesia can be experiences such as arriving in a well known place traveling on a well known path without memory of the trip. Or drifting off while doing a mundane task such as housework, yardwork, or something that you are trying to pay attention but drift off such as reading or some tedious work task. Then later coming out of this trance like state and have no memory of what you were doing. Time distortion is very common where we lose minutes or longer.

When the amnesia is a problem is when the forgetting or lost time creates a more disjointed whole where more time is lost than remembered. What many clients tell me is of fractionation of time so severe that every or most days feels chopped up, disjointed and confusing as they are unable to track many minutes and hours in a day. They have no memory of the time when trying to piece their day back together.

Now during those times of amnesia people aren’t like a turned off robot waiting to be rebooted such as in science fiction. They are functioning and to someone on the outside they may seem robotic in their actions, rather unresponsive or curt or strangers because they aren’t acting typically for them. Then after emerging from the amnesia they have no memory of that time.

Run Away Bride or Groom

This is the typical amnesia or fugue state that is listed in the Diagnostic and Statistical Manual of Mental Health Disorders currently in the 5th edition (DSM-V). Why it is often termed the run away bride is that is one stressful situation in which the brides have left before the wedding and “come to” miles to states away several days later. Grooms have done the same so this isn’t a female only issue.

This is often an extreme reaction to stress and very rare. Once a male client would start to drive to a destination and then suddenly come to miles away at a particular parking lot. Since the company vehicle had GPS he was able to see what happened. Another woman found herself caring for an elderly parent who was her abuser while fighting her ex for visitation of her children and came to completely after several weeks in which she traveled across the country. In both cases, they didn’t have any memory of the time.

Depersonalization and Derealization

These are two ways as described in the DSM-V to dissociate. In both cases these are thinking that the world or ourselves doesn’t feel quite real. This is a normal experience in some situations. For example a parent dies and after the funeral the childhood home no longer feels quite right and may even feel foreign. Or we have a surgery or lost a limb and something has changed within our bodies and we may feel somewhat weird in our own bodies.

Depersonalization is the feeling of being outside of oneself and not connected to thoughts, feelings and experiences. Derealization is the detachment to the world outside self so that the outside world feels somewhat foreign.

When it can be a problem is severity and persistence. Often (and this is speaking in generalities) people who experience childhood and even adulthood sexual abuse or assault may experience sensations of not being in themselves. Witnessing or experiencing abuse in childhood could lead to disconnecting from the world. That doesn’t mean if someone who experiences long term depersonalization/derealization periods is only someone who experienced childhood abuse. Though common not the only reason. Another reason could be long term chronic health problems.

Both are common and half of adults report having at least one period of either depersonalization and/or derealization. Persistent problems of either is very uncommon with estimates of 2% of the population having severe enough and persistent periods to be problematic to the level of intervention. That said many people with childhood abuse often report many instances of both experiences and often describe these periods as “feeling like I’m crazy.”

Dissociative Identity Disorder

This is often the most poorly understood and inaccurately portrayed by media and movies I dare say in mental health. Hollywood often inaccurately portrays dissociative identity disorder or DID as some crazed person with evil intentions who is violent, aggressive and disruptive to society. Disruptions are most generally in the person’s life who has developed DID but generally they aren’t violent or aggressive.

Yes, developed. Again this isn’t some disorder in which someone in a grocery store sneezed on us and now we have DID. Let’s do an experiment.

First take a couple of deep breaths and bring attention to your body and mind. Now, I’m going to give you a list one at a time of situations. Pay attention to your mind and body as you picture yourself as you would act, talk, appear and be in the situations. Note how you typically act in the situation.

List of situations. Read each and then imagine how you act, feel and think in that situation before going to the next:

1. • Spending the day with your children (or nieces/nephews)

• • While at work and interacting with coworkers and/or customers

• • In a one-on-one meeting at work with your boss

• • In a staff meeting with coworkers

• • Hanging out with your best friend

• • Hanging out with a group of good friends

• • Making love to a partner (not unwanted sexual experience).

With very few exceptions, most of us will behave quite differently with our children than our boss or lover. Rightly so. We have different faces for the experiences and that doesn’t make us fake but adaptable in various situations with differing social rules.

For people who develop DID this happens most often with the experience of ongoing childhood trauma or big negative experiences over years. I have seen both. In order to cope with negative experiences, the child dissociates and acts a part so to speak. In other words a part of them is now engaging with the situation and the main personality or part is unaware of what is happening. Different therapy modalities have different models to describe these shifting personalities. The key is that there are shifts in personality mostly with amnesia so significant that it is noticeable to other people.

This amnesia can look like missing large gaps of time such as years in childhood, forgetting how to do tasks that they generally know how to do and/or finding tasks completed without knowledge of doing them. They may also report auditory or visual hallucinations. Others report that the person seems so different from argumentative, child-like or overly sexual when the person is rather reserved.

It isn’t common to develop full blown and actual DID. What is common with trauma especially in childhood is the presence of amnesia, loss of time and disruption to having a distinct timeline, and reports from loved ones of strange or unusual behavior.

Hollywood perceptions tend to have only one aspect correct about DID and that is disruption. But it isn’t disruption to society. Primarily it is disruptive and confusing to the person experiencing the part dissociation so to speak and often to the loved ones of the person.

Fixing Maladaptive Dissociation

First and foremost this is a typical experience. Think of a recent time that you “blanked out” a so called boring time such as a staff meeting, long drive or while watching a show.

To begin to stop the more maladaptive forms of dissociation is a process. There isn’t a one size fits all but from professional experience I use a three step process in therapy. Though referred to as steps these are done by degrees integrating and then building on.

1. 1. Develop awareness: This is both awareness of self as in our thoughts, feelings and body and outside of ourselves. With trauma, sometimes we cut off awareness to certain body parts or it can look like total unawareness of our thoughts and/or inability to name and identify emotions. This can be true for all of us and not just those experiencing dissociation. Often awareness is the first step in any self-improvement task.
   2. Learn emotional regulation skills through rational self counseling skills. These are skills built sequentially to build understanding of our brain, emotions and how to intervene in ways that help us to meet our goals for therapy. Basically it is learning how to be our own therapist.
   3. Address the trauma that is underlying maladaptive dissociative coping strategies. Trauma can affect us in two broad categories: emotionally charged memories and the lessons learned from trauma experiences. Emotionally charged memories can look like nightmares, day-mares, avoiding certain stimuli, overly sensitive and over reactive responses to known and sometimes unknown stimuli. Lessons are what we come to believe about ourselves from our experiences and the negative lessons could be “no good”, “worthless”, “useless”, “world is unsafe”, “people are unsafe from me”, “I’m broken” “I’m to blame” or “I’m not to blame” and a host of beliefs in which we find ourselves inferior or broken or helpless.

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To learn more about Awareness check the course Building Your Awareness Skills.

Learn how to resolve trauma and develop rational self counseling skills check the course The Trauma Resolution Solution.