A Divided Mind: The many faces of dissociation
By Alina Dillahunt
Dissociation is a condition that can cause someone to lose memory of events, feel like an outsider watching their own life, become another person without remembering it, and can greatly affect their day-to-day functioning . However, many afflicted with dissociation suffer years of symptoms before entering treatment, often because their dissociation was protective against the emotions involved with a traumatic memory, or they were unaware of symptoms due to loss of memory . Other times, the person is aware of the abnormal experience, but unsure of how to describe it to others or unaware that there is a formal condition for the phenomenon they are experiencing .
Over half of all U. S. adults experience symptoms of dissociation at least once in their lifetime, and overall it affects 2% of the population . It often is a response to trauma, like combat experience or abuse, but can vary in severity and accumulation of symptoms . Suicidal attempts and non-suicidal self-injury are associated with dissociative symptoms; thus, it is important to be vigilant, know what dissociation can look like, and provide treatment early as these behaviors can be fatal . The Diagnostic and Statistical Manual of Mental Disorders (DSM), has defined a category of disorders called “dissociative disorders” that include dissociative identity disorder, dissociative amnesia/fugue, and depersonalization disorder .
However, dissociation can occur in a wider scope of people than those who meet a formal dissociative disorder diagnosis, including those with various other mental disorders or those who have experienced abuse or trauma . Dissociation symptoms include amnesia, derealization (feeling of disconnectedness from surroundings), depersonalization (detachment from oneself) and identity confusion . All of these symptoms are connected in that the person is exhibiting a detachment from their memory, identity, or perception of self or environment. This is why dissociation is often considered a “fractured” or “divided” mind and the clinician’s strategy for rehabilitation is to work to reintegrate the conscious and unconscious mind .
The most prevalent dissociative condition is dissociative identity disorder, in which a person alternates between multiple identities often with multiple voices in their head and gaps in memory .
Similarly, memory loss is the main symptom of dissociative amnesia; this is often characterized by sudden onset or a particular traumatic event .
The final formal dissociative disorder is depersonalization disorder, with a typical early onset around 16 years of age, this disorder involves feeling like events or experiences are “unreal” and the main symptom is a feeling of detachment in the environment and within one’s identity construction .
It is important to note while dissociative disorders may be rare, the experience of dissociation is not. Dissociation can be experienced among a non-clinical population as well, such as those who experience symptoms under extreme stress, and, as mentioned before, sudden onset of dissociative symptoms after trauma . Many who experience trauma have an accumulation of dissociative symptoms that were acquired as a defense mechanism for detaching from the trauma or experience so as to not feel the full impact. If this dissociation continues past the trauma, there may be more obstacles in working through the trauma . These survivors of trauma may then develop and meet criteria for a dissociative disorder. Nevertheless, many people experience dissociative symptoms that can be targeted in therapy but do not meet formal criteria for a disorder .
An example is dissociative trances, which are experiences of complete unawareness and unresponsiveness to environmental stimuli that can occur in trauma victims, those with borderline personality disorder, generalized anxiety disorder, and/or those under extreme stress . Additionally, those who have experienced childhood abuse may have undergone intense thought reform, where one’s identity is disturbed due to prolonged persuasion .
Once dissociation is suspected in a patient, the clinician can investigate the severity of the dissociation experience by using the Dissociative Experience Scale; where patients rate their experiences on 28 measures of dissociation . Dissociation can be treated through psychotherapies like cognitive behavioral therapy, and treatment can be helped through the use of antidepressants .
There are also novel treatments gaining support such as Eye Movement Desensitization and Reprocessing, where a patient recalls a traumatic event while following the clinician’s finger movements with their eyes . The concurrent eye movement allows processing of the event without the full effect of the emotions and allows the event to be reprocessed in a healthier way. Dissociation is experienced by many, so it is important to recognize the symptoms, encourage treatment, and support victims of trauma and abuse.
- NAMI. (n.d.). Retrieved March 21, 2018, from https://www.nami.org/learn-more/mental-health-conditions/dissociative-disorders
- Peterson, G. (1991). Children coping with trauma: Diagnosis of “dissociation identity disorder.”Dissociation, 4(3), 152-164.
- NIMH » Home. (n.d.). Retrieved December 13, 2017, from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
- Calati, R., Bensassi, I., & Courtet, P. (2017). The link between dissociation and both suicide attempts and non-suicidal self-injury: meta-analyses. Psychiatry research, 251, 103-114.
- Şar, V. (2014). The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry. Clinical Psychopharmacology and Neuroscience, 12(3), 171–179. http://doi.org/10.9758/cpn.2014.12.3.1712.
- Van IJzendoorn, M. H., & Schuengel, C. (1996). The measurement of dissociation in normal and clinical populations: Meta-analytic validation of the Dissociative Experiences Scale (DES). Clinical Psychology Review, 16(5), 365-382.
- Courtois, C. A., & Ford, J. D. (Eds.). (2009). Treating complex traumatic stress disorders: An evidence-based guide. Guilford Press.
- Shapiro, F., & Solomon, R. M. (1995). Eye movement desensitization and reprocessing. John Wiley & Sons, Inc.