Amnesia

Dissociative amnesia is the most common dissociative disorder. You cannot remember specific incidents or experiences that happened at a particular time, or remember important personal information. Those with dissociative amnesia are normally aware of their memory loss.

Depersonalisation disorder

Depersonalisation is the sense of not being 'in' your body. You have out-of-body experiences, where you may see yourself as if you are watching a film. You may feel that your body is unreal or morphing in some way and feel a profound alienation from your body.

Derealisation disorder

Your surroundings seem fake, you perceive that objects change shape and size and you feel very disconnected from other people. 

Dissociative fugue

You may assume a new identity and life, though to people around you your behaviour may seem absolutely normal. Dissociative fugue usually lasts only a few days, but can last longer. This is a very complex disorder, which can provoke feelings of depression, guilt, shame, fear and confusion when the fugue has passed and you return to 'normal' life. 

Dissociative identity disorder

This is also known as multiple personality disorder. You may struggle to define yourself and feel uncertain about who you are. Your identity or the role you play may dramatically change, depending on your environment. For example, you may be polar opposites when at work from when you are at home. You may shift between these personalities, each of which has a distinctive way of relating to the world, their own thoughts and behaviours. 

Dissociative disorders are sometimes triggered by trauma, either a one-off or repeated event, but sometimes have no identifiable trigger whatsoever. 

Trauma in the form of childhood abuse – whether physical, psychological or sexual – in particular chronic abuse, has been related to high levels of dissociative symptoms, such as having erased the event from memory.

In childhood, dissociation from such trauma is viewed as adaptive, as it is a form of self-protection. If this dissociation continues into adulthood, it can be inhibitive, as the individual might automatically dissociate from situations they perceive to be dangerous or stressful. Sometimes these stressors may seem minor, but the impact of previous trauma triggers a dissociative episode (1). 

Welldoing therapist Zoe Hassid explains: "Dissociation as an adaptive mechanism may enable survival through traumatic relational interactions that objectify, violate, shame, or psychically annihilate. But from being a means of escape, it can become a prison. The mechanism will likely continue to kick in whenever a relational interaction seems reminiscent of the original trauma. As far as the body and unconscious (or right brain) are concerned, it’s not safe, even if consciously we may now live in a different time, place and relationship."

Depression, bipolar disorder, schizophrenia, borderline personality disorder, chronic pain and self-harm can all cause dissociation. Having a dissociative disorder can contribute to other mental health problems, including OCD, phobias, substance abuse, sleep disorders, anxiety, panic attacks and depression.

Dan Siegel's theory of the Window of Tolerance is a useful framework within which to understand trauma and trauma adaptations like dissociation.

Your window of tolerance is your functioning state. Within this window, you are able to comfortably experience and manage your psychological and emotional states throughout the day. Some people's windows are wider than others, meaning that some people are comfortably able to experience a broader range of emotional states and still feel comfortable, grounded and able to cope.

Either side of the window of tolerance lie the zones of hyperarousal and hypoarousal. Hyperarousal is caused by over-activation of the Sympathetic Nervous System, meaning you might feel anxious, have a raised heart rate, discomfort in your chest, shallow breathing. Hypoarousal you may feel numb, disconnected, frozen, shut down, as in dissociation. Both these states indicate that you have left your window of tolerance.

In therapy, especially if you are a trauma survivor, you can work to expand your window of tolerance. An important part of doing this is learning how to best regulate your nervous system to bring yourself back to your optimal window.

Counselling and psychotherapy could help unearth the reason behind your dissociative behaviour. A therapist will help you get in touch with your thoughts, feelings and memories, with the aim of giving you a more complete sense of self and of the world around you. 

A counsellor or therapist can also help you learn how to better cope with situations you identify as stressful, enabling you to react in ways other than dissociating.

Counselling can also be an effective means of addressing mental health issues associated with dissociation, such as depression, anxiety, bipolar disorder, schizophrenia, and borderline personality disorder.

If you have chronic issues with dissociation, your therapy is likely to be more long-term as the work may need to be more slow. Consider telling your therapist if you have a history of dissociation so they can manage the sessions in a way that helps you leave feeling grounded and in your body.

References

Fani, N., King, T. Z., Powers, A., Hardy, R. A., Siegle, G. J., Blair, R. J., … Bradley, B. (2018). Cognitive and neural facets of dissociation in a traumatized population. Emotion. https://doi-org.uoro.idm.oclc.org/10.1037/emo0000466

Last updated on 19 August 2024