​What is dissociation?

Your sense of self and of reality both rely on your thoughts, feelings, memories, experiences and perceptions. Dissociation happens when these factors don't match up. When they are disconnected, your sense of self and your experience of reality will change. The mind and body disconnect and you may feel as though you are looking at a complete stranger when looking at yourself. This is a detachment from reality, not a loss of reality, which may characterise other mental health issues such as psychosis. 

Dissociation describes a range of feelings, from mild detachment from your environment, to severe detachment from physical and emotional experience. 

Dissociation is often considered a coping or defence mechanism, a way of tolerating stress, boredom or conflict. For some people, dissociation is a form of extreme escapism. These cases tend to be on the less severe end of the spectrum; on the other end lie dissociative disorders, many of which are characterised by alterations in personal identity. 


Types of dissociative disorders

Dissociative disorders occur when an individual experiences repeated dissociative episodes.


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 largely experienced as autonomous, unexpected intrusions into an individual's usual functioning. As a result, they can be deeply unsettling. Other symptoms and signs of dissociation include:

  • feeling unable to recognise yourself in photographs and/or the mirror
  • feeling detached from your emotions, feeling numb
  • having distorted views of your body
  • having an internal dialogue
  • forgetting a talent or skill or, conversely, having knowledge of something that you don't remember studying/learning



What causes dissociation and dissociative disorders?

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, without taking the time to assess whether this is in fact the case. 

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


How can counselling help with dissociation and dissociative disorders?

Counselling and psychotherapy could help unearth the reason behind your dissociative behaviour. A counsellor 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.

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Last updated on 21 October 2015