Welcome to day 28 in the 31-day writing challenge on mental health. Today, I will be discussing dissociation. I used to have a diagnosis of dissociative identity disorder, but dissociation is also common in post-traumatic stress disorder and borderline personality disorder.
Dissociation refers to a detachment from reality: disconnection from one’s surroundings, one’s own body, one’s mental processes or one’s identity. there are five different domains of dissiociation:
- Depersonalization: a disconnection from one’s own body or mental processes. People who experience depersonalization feel “unreal”.
- Derealization: a disconnection from one’s environment. The world around people who are derealized seems unreal or vague, as if looking through a glass wall.
- Amnesia or memory loss. People who experience dissociative amnesia can be triggered by things that remind them of an unpleasant memory, but they do not remember the unpleasant event. Amnesia can also refer to “time loss”, where the person does not know what happened during a specific time period. Identity amnesia refers to a person not remembering who they are.
- Identity confusion. This refers to being unsure of who one is. I have always believed that everyone has a level of identity confusion, but when I did a structured interview for dissociation, it appeared as though this isn’t really normal.
- Identity alteration or “switching”. This refers to a person becooming “someone else”. This ccan be apparent on the outside, like by the person having a change in non-verbal communication that is unlike them. It can also be apparent on the inside, where the person just feels as though they’re “someone else”.
Dissociation is different from psychosis in that people who dissociate are still aware of reality. Most people with dissociative experiences do not experience delusions or hallucinations, though a PTSD flashback coupled with dissociation can look like it. At least in my case, I’ve appeared quite disorganized and out of my mind when in a flashback.
Dissociation to a certain extent is normal. Most people on occasion get “lost” in a book or movie, for example. When dissociation is more severe, you may have a dissociative disorder. There are several different dissociative disorders.
- Depersonalization/derealization disorder is characterized primarily by depersonalization and/or derealization. This disorder can only be diagnosed if the depersonalization/derealization is not due to another mental disorder, such as a panic disorder.
- Dissociative amnesia is primarily characterized, as the name suggests, by amnesia.
- Dissociative fugue. This is a subtype of dissociative amnesia where the affected person travels away from their home or work and has amnesia for their entire life prior to travelling away. They also often adopt a new identity.
- Dissociative identity disorder is characterized by both amnesia and dissociative phenomena affecting identity, ie. identity confusion and alteration. DID is considered to be the most severe dissociative disorder.
Depersonalization and derealization can, as I said, be part of another mental disorder, such as panic disorder. There is also a subtype of PTSD which is characterized by depersonalization and derealization. Other causes of depersonalization and derealization include stress and certain substances, such as marijuana.
The other dissociative disorders are believed to be trauma-based. Treatment involves psychotherapy. The psychotherapeutic treatment of DID consists of three phases:
- Stabilization. In this phase of treatment, a person learns coping skills to deal with flashbacks, keep themself safe and stay grounded.
- Processing the trauma that caused DID.
- Integration. This can refer to merging of the alters, but also to rehabilitation.
In 2011, Onno van der Hart, Kathy Steele and Suzette Boon published a manual for skills training in the first phase of DID treatment called Coping with Trauma-Related Dissociation.