An often overlooked area of trauma impacts by mental health providers are dissociative symptoms and dissociative disorders. Dissociation is the mind’s last alternative to escape from a situation where there is no escape. A person may unconsciously adapt to a traumatic experience by believing they are somebody else or that an event is happening to somebody else.
Dissociation is the disconnection between things usually associated with each other. Dissociative phenomena occur naturally on some level and can be adaptive or maladaptive in nature. Because dissociative experiences are not integrated into the usual sense of self, they can lead to discontinuities in conscious awareness.
The cause of dissociation stems from a combination of environmental and biological factors. Different forms of trauma (repetitive childhood physical and/or sexual abuse is very common) are associated with the development of dissociative disorders. Although less common, a dissociative disorder can develop without repetitive childhood physical or sexual abuse. Significant psychological or emotional abuse and severe neglect may create a dissociative response. Chronic distress due to fear, confusion, and disruption to attachment from primary caregivers can also play a role in dissociation during childhood.
If dissociation continues to be used into adulthood, however, when the original danger no longer exists, it can be maladaptive and significantly impact activities of daily living. The dissociative adult may automatically disconnect from situations that are perceived as dangerous or threatening, without taking time to determine whether there is any real danger.
There are five main dissociative experiences in which the dissociation of psychological processes changes the way a person experiences life:
- Amnesia refers to the inability to recall important personal information that is so extensive that it cannot be due to ordinary forgetfulness. Amnesias are often important events that are forgotten, such as abuse or a troubling incident, lasting from minutes to years. Other amnesias, sometimes referred to as micro-amnesias, are more commonly reported to me by clients who have amnesia as a symptom of their dissociative disorder. These micro-amnesias create the experience of engaging in a discussion and the discussion is not remembered, or the content of a conversation is forgotten from one moment to the next. I have had clients who do not remember a phone call with me, or a therapy session, or whether they even came to their appointment.
- Depersonalization is the experience of seemingly being detached from, or “not in” one’s body. A profound alienation from the body such as a sense of not recognizing yourself in the mirror or not recognizing a body part are common. In my experience people can find it hard to articulate the experience. I have heard it described as, “I know I am in my body, but I do not feel connected to it.”
- Derealization is the sense of the world not being real. I have heard it described as, “It’s like I’m watching my life sort of like a movie.” In other descriptions people say the world seems unreal, foggy, distant, or as if seen through a barrier at a distance. Many people report experiencing these two dissociative phenomena in combination.
- Identity confusion is a sense of confusion about self. These individuals have difficulty maintaining consistency in choices because their preferences, values, and opinions are unclear or change drastically at different times. For example, this can result in a person making a decision to use drugs when at other times it would be repugnant to them.
- Identity alteration is the sense of being markedly different from another part of oneself. A person may shift into an alternate personality, become confused, and not know who they are talking to or where they are. The person may experience distortions in time, situation, and place such as believing they are years younger than they actually are, believing they live in a different city, or not realizing a family member has died. Other observable changes include using a different voice tone, facial expressions, range of language, or an accent. Though sufferers of this condition may or may not be able to confirm the experience of identity alteration, they usually can confirm becoming confused about their behaviors, speech patterns, demeanor, body language, feelings, or perceptions.
Although not one of the five main dissociative features identified above, the inability to tolerate and regulate strong emotion is a primary difficulty for an individual with a dissociative disorder. Individuals with a dissociative disorder often struggle with concentration, memory, and perceptions.
To complicate matters further, dissociative disorders can create a certain level of vulnerability towards other maladaptive coping such as addiction to drugs and alcohol.