Dissociative Disorders

Dissociation

Definition

Types of Dissociation

• Normal Dissociation
• Depersonalization
• Derealization
• Fugue Episodes
• Amnesic Episodes
• Somatoform
• Dissociative Disorders Not Otherwise Specified (DDNOS)
• Dissociative Identity Disorder (DID)

Causes

• Distorted Early Parenting (extreme disorganized attachment)
• Sexual Abuse
• Emotional Abuse
• Physical Abuse
• Witnessing Violence (in particular, intrafamilial violence)
• Medical Distress

Dissociation is a defense or coping mechanism that people use when they are overwhelmed by an experience (being in a severe car accident, experiencing an earthquake, being severely or repeatedly abused) or an emotional response (extreme fright, anger, grief). With dissociation the child or adult may cut off awareness of what is happening (memory), awareness of physical pain, awareness of emotion, awareness of one's own needs or own body, or awareness of different aspects of the self. While dissociation can be helpful at the time of being overwhelmed, it can create considerable problems. Repeated disconnection from experiences, emotions, body sensations, or need states results in a disrupted sense of self.

Dissociation may affect a person subjectively in the form of “made” thoughts, feelings, and actions. These are thoughts or emotions seemingly coming out of nowhere, or finding oneself carrying out an action as if it were controlled by a force other than oneself (Dell, 2001). Typically, a person feels “taken over” by an emotion that does not seem to makes sense at the time. Feeling suddenly, unbearably sad, without an apparent reason, and then having the sadness leave in much the same manner as it came, is an example. Or someone may find himself or herself doing something that they would not normally do but unable to stop themselves, almost as if they are being compelled to do it. This is sometimes described as the experience of being a “passenger” in one’s body, rather than the driver.

There are five main ways in which the dissociation of psychological processes changes the way a person experiences living: depersonalization, derealization, amnesia, identity confusion, and identity alteration.

What is depersonalization?

Depersonalization is the sense of being detached from, or “not in” one’s body. This is what is often referred to as an “out-of-body” experience. However, some people report rather profound alienation from their bodies, a sense that they do not recognize themselves in the mirror, recognize their face, or simply feel not “connected” to their bodies in ways which are challenging to articulate. ^[1]

What is derealization?

Derealization is the sense of the world not being real. Some people say the world looks phony, foggy, far away, or as if seen through a veil. Some people describe seeing the world as if they are detached, or as if they were watching a movie (Steinberg, 1995).

What is dissociative amnesia?

Amnesia refers to the inability to recall important personal information that is so extensive that it is not due to ordinary forgetfulness. Most of the amnesias typical of dissociative disorders are not of the classic fugue variety, where people travel long distances, and suddenly become alert, disoriented as to where they are and how they got there. Rather, the amnesias are often an important event that is forgotten, such as a wedding, or birthday party that was attended, or a block of time, from minutes to years. More typically, there are micro-amnesias where the discussion engaged in is not remembered, or the content of a conversation is forgotten from one moment to the next. Some people report that these kinds of experiences often leave them scrambling to figure out what was being discussed. Meanwhile, they try not to let the person with whom they are talking realize they haven’t a clue as to what was just said ^[2]

What are identity confusion and identity alteration?

Identity confusion is a sense of confusion about who a person is. An example of identity confusion is when a person sometimes feels a thrill while engaged in an activity (e.g., reckless driving, drug use) which at other times would be repugnant. Identity alteration is the sense of being markedly different from another part of oneself. This can be unnerving to the individual and to the people around him or her. In addition to these observable changes, an individual may experience distortions in time, place, and situation. For example, someone with identity alteration may suddenly feel five years old, think they are in their childhood home and expect a deceased person whom they fear to appear at any moment ^[3].

More frequently, subtler forms of identity alteration can be observed when a person uses different voice tones, range of language, or facial expressions. These may be associated with a change in the individual’s world view. For example, when talking about fear, a person may initially feel young, vulnerable, and frightened, followed by a sudden shift to feeling hostile and callous. The person may express confusion about their feelings and perceptions, or may have difficulty remembering what they have just said, even though they do not claim to be a different person or have a different name. Sometimes an individual is able to confirm the experience of identity alteration, but often the part of the self that is doing something is not aware of the existence of dissociated self-states. If identity alteration is suspected, it may be confirmed by observation of amnesia for behavior and distinct changes in affect, speech patterns, demeanor and body language, and relationship to other people. Therapy can gently help the individual become aware of these changes, the starting point for treatment of dissociation ^[4].

What is the cause of dissociation and dissociative disorders?

Research tends to show that dissociation stems from a combination of environmental and biological factors. The likelihood that a tendency to dissociate is inherited genetically is estimated to be zero ^[5].

Most commonly, repetitive childhood physical and/or sexual abuse and other forms of trauma are associated with the development of dissociative disorders (e.g., Putnam, 1985). In the context of chronic, severe childhood trauma, dissociation can be considered adaptive because it reduces the overwhelming distress created by trauma. However, if dissociation continues to be used in adulthood, when the original danger no longer exists, it can be maladaptive. 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. This leaves the person “spaced out” in many situations in ordinary life, and unable to protect themselves in conditions of real danger.

Dissociation may also occur when there has been severe neglect or emotional abuse, even when there has been no overt physical or sexual abuse ^[6]. Children may also become dissociative in families in which the parents are frightening, unpredictable, are dissociative themselves, or make highly contradictory communications ^[7].

The development of dissociative disorders in adulthood appears to be related to the intensity of dissociation during the actual traumatic event(s); severe dissociation during the traumatic experience increases the likelihood of generalization of such mechanisms following the event(s). The experience of ongoing trauma in childhood significantly increases the likelihood of developing dissociative disorders in adulthood ^[8].

References

1. ↑ Frey, 2001; Guralnik, Schmeidler, & Simeon, 2000; Maldonado et al., 2002; Simeon et al., 2001; Spiegel & Cardeña; Steinberg, 1995
2. ↑ Maldonado et al., 2002; Steinberg et al., 1993; Steinberg, 1995
3. ↑ Fine, 1999; Maldonado et al., 2002; Spiegel & Cardeña, 1991; Steinberg, 1995
4. ↑ Fine, 1999; Maldonado et al., 2002; Spiegel & Cardeña, 1991; Steinberg, 1995
5. ↑ Simeon et al., 2001
6. ↑ Anderson & Alexander, 1996; West, Adam, Spreng, & Rose, 2001
7. ↑ Blizard, 2001; Liotti, 1992, 1999a, b
8. ↑ International Society for the Study of Dissociation, 2002; Kisiel & Lyons, 2001; Martinez-Taboas & Guillermo, 2000; Nash, Hulsey, Sexton, Harralson & Lambert, 1993; Siegel, 2003; Simeon et al., 2001; Simeon, Guralnik, & Schmeidler, 2001; Spiegel & Cardeña, 1991