Dissociation can feel very scary, especially when we don’t know what it is we’re experiencing. By learning more about it, we can begin to understand what we’re going through and develop ways to manage it.
WHAT IS DISSOCIATION?
The dictionary definition of dissociation is ‘the splitting off of a group of mental processes from the main body of consciousness.’ Another definition is ‘the action of separating yourself, or considering yourself to be separate from something or someone’.
Reading a definition doesn’t always help us to picture it, though. It can be hard to put an abstract concept into words.
We’ve probably heard the term ‘association’ at some point. If we’re associated with someone or something, we usually talk about being linked to them. If one of our associates does something we don’t agree with, then we might choose to ‘dissociate’ from them. We could also describe this as ‘separating ourselves from them’.
In a mental health context, when we dissociate we feel separate or disconnected from ourselves and the world around us. We might not be aware of our actions and could find that we chunks of time that we can’t remember; also known as ‘blanks’. We don’t know where we were, what did, who we saw, or what we said. This can be really scary.
SYMPTOMS OF DISSOCIATION
Feeling disconnected isn’t the only symptom associated with dissociation.
We might struggle to process intense emotions. Mood swings can be common. Sometimes it can lead to depression or anxiety. Our memory is often affected, as are other areas of our cognition such as concentration. We might feel compelled to behave a certain way, struggle with our identity, and be confused about who we are which can further affect our behaviour. Some of us will struggle to remember personal things. We could feel confused, spacey, dazed, foggy-headed, lost, and ‘un-anchored’. The world might not feel real. We could experience ‘confused, dazed wandering’ also known as ‘dissociative fugue’.
Dissociation can part of an existing mental health diagnosis such as depression, anxiety, an eating disorder, obsessive compulsive disorder or post-traumatic stress disorder. But we could be diagnosed with a dissociative disorder in its own right.
There are a few different types of dissociative disorder, but each of them features dissociation at their core. As well as the diagnoses listed below, we could also experience dissociation as part of an ‘unspecified dissociative disorder’ or an ‘other specified dissociative disorder’.
If we live with dissociative amnesia, we will have no memory of certain events or past experiences. We might also struggle to remember information about ourselves. In some instances, we might forget some of the skills we’ve learned.
‘Bewildered wandering’ or ‘purposeful travel’ can be a symptom of dissociative amnesia. For example, we might find that we’ve walked to a friend’s house but not be able to remember leaving our house, walking to their house, or the reason for visiting this friend.
We might have memory blanks that last days, weeks, months, or even years. Sometimes we’ll be aware of these memory blanks. But there might be times when we have no idea that we’ve forgotten certain things until someone talks about a memory that we have no recollection of.
Dissociative amnesia isn’t the same as forgetfulness or ‘not knowing where the time has gone’. We all have times when we’re super-engrossed in our work and haven’t noticed it getting dark around us. ‘Where has the time gone?!’ is a phrase many of us utter now and again. But neither of these situations mean that we’ve been dissociating.
DISSOCIATIVE IDENTITY DISORDER (DID)
Another name for Dissociative Identity Disorder (DID) is ‘multiple personality disorder’.
If we live with it, then we might struggle to pin down our identity or form a picture of who we are. We might write in different styles, talk about ourselves as if we’re a group (eg. ‘we went to the park’ as opposed to ‘I went to the park), behave out of character, feel as though there are multiple people within us, or feel like a stranger to ourselves.
For a diagnosis, we need to have at least two distinct ‘personality states’.
Depersonalisation describes a state where we feel totally detached from ourselves. We could feel as though we’re ‘floating’ above ourselves, watching ourselves do things. Time might feel strange and we might not be able to connect with things we’re feeling emotionally or physically.
Derealisation is a state where we feel detached from our surroundings. The world around us can feel foggy, distorted, and ‘dreamlike’
LIVING WITH DISSOCIATION
Dissociation can bring up all sorts of different emotions.
Sometimes it’s scary. It’s not nice to feel as though we’re not in control of our body or mind. Being unable to remember things is tough, especially when others can remember them. Sometimes our lack of memory can feel embarrassing or shameful.
There are times when we get frustrated or angry. Dissociation isn’t necessarily within our control and can take up a lot of our time. If we’ve planned or day and then dissociate for six hours, then we’re probably not going to be able to fit everything in. Sometimes we almost want to shake ourselves.
Dissociation can impact all areas of our life. It could crop up when we’re working, relaxing, looking after our kids, walking down the street, or doing the weekly shop. It can create problems within our relationships. For some of us, it can be incredibly disabling.
WHAT CAUSES DISSOCIATION?
We still have a lot to learn about dissociation. At the moment, our understanding is that it’s a way for our mind to cope with too much stress. It’s often linked with trauma, for example, a car crash, abuse, war, kidnapping, medical procedure, assault, bereavement, or anything else that resulted in us fearing for our safety and/or being seriously injured or violated. A traumatic experience doesn’t have to have affected us directly. We may have witnessed it, learned that it’s happened to a close family member or friend, or we might be repeatedly exposed to details of traumatic events (for example, if we’re a counsellor). Substance misuse can also cause dissociation.
Dissociating can be a way to switch off or detach ourselves from an awful event. It can be a coping strategy to help us get through traumatic situations. To a point, it can help us to protect ourselves from the full impact of a bad experience. The problem is that if we continue to dissociate once we’ve reached a place of safety, then it can be distressing and interfere with our life.
It’s important to remember that not everyone who goes through a traumatic event will develop a mental health problem or a dissociative response. There are lots of factors that can affect how we respond to things including any previous traumas we’ve had, other life stressors, genetics, how much support we have, our neurology, and any existing mental health conditions we live with.
We might have heard the term ‘trigger’. It’s a term we often use when talking about things like flashbacks or panic attacks but can also be used for dissociation.
If we think about a standard anxiety-provoking event and view our stress levels as a curve on a graph, it might look like a hill. We start off totally chilled. Then, if we encounter a ‘trigger’, our stress levels can begin to rise. As they rise, we start to feel the physical symptoms of anxiety. This is a normal, human response, and helps us to perform to the best of our ability. At the top of the curve, we’re at peak performance. Adrenaline is flooding our body and we’re feeling stressed, but it feels manageable. For most people, once the ‘trigger’ has passed our stress levels will drop again.
When we’re ‘triggered’, we fly past the manageable peak of this curve. Our stress levels keep climbing until we reach the ‘I don’t think I can cope’ zone. At this point, our brain shuts off. We can’t take any more. So we disconnect and dissociate.
THINGS THAT CAN HELP WHEN WE DISSOCIATE
There are a range of things we can do to help with dissociation.
Grounding can be really helpful when we dissociate. It’s a way of keeping ourselves connected to ourselves and our environment.
There are loads of different grounding techniques. They include things like naming one thing for each ‘sense’ something you can see, hear, touch, smell and taste. We could try to find something in the room for each letter of the alphabet or each colour of the rainbow. Using fidget toys can give us something tactile to focus on. We might find it helpful to write affirmations or facts about ourselves and then read them when we start to struggle.
If we’re someone who dissociates on public transport or when in public places, we might want to speak to a friend or family member about it. They could accompany us when we go out if that would help us to feel safer.
For some of us, dissociation will affect our ability to drive. If we start to dissociate when rushing down the motorway at 70mph, it’s not safe. In the UK, if we have a medical condition that affects our ability to drive then we need to tell the DVLA.
WIDER THINGS THAT CAN HELP
There are some things we can do ‘in the background’ to try and reduce how often we dissociate.
If we don’t meet our basic needs, we probably won’t feel our best. Making sure we get our basic self-care sorted can provide a strong foundation. This includes things like getting into a sleep routine, drinking enough water, and eating a varied diet.
Keeping a log of times when we slip into dissociation can help us to identify patterns or triggers that commonly occur. We can use this information to make adjustments to our lives and hopefully start to reduce the number of times we dissociate.
Dissociation is linked to stress, so anything that can help us relax and ‘de-stress’ can help. This could include things like making sure we take our breaks at work, listening to calming music, practising mindfulness or meditation and having a calm space that we can retreat to on an evening.
TREATMENT OPTIONS FOR DISSOCIATION
Talking therapies can help us to work through the underlying causes of our dissociation. We might need specific trauma therapy or trauma-informed care. Therapy can also help us to learn new skills and techniques to manage our dissociation.
Sometimes medication is an option. There aren’t any specific dissociation medications but sometimes antidepressants might be appropriate.
GETTING SUPPORT WITH DISSOCIATION
We don’t have to live with dissociation alone. Our GP would be happy to speak to us about it, or we could contact our local mental health team if that’s an option in our area. If we feel really unsafe, we could ring 111 or in emergencies, go to A&E or 999. We deserve help and support.
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