Dissociation is not very well understood, and most people think it’s very rare. In reality, mild dissociation is so common that most of us have experienced it! Part of the trouble understanding and talking about dissociation is that the language is clinical and unfamiliar. It’s not particularly easy to spell or pronounce. (many folks throw an extra ‘a’ in diss -a- ociation, but it’s quite long enough with the 5 syllables it already has) Dissociation is the disconnection between things that are normally connected. It’s easiest to think of as being unplugged on some level.
Most of us have experienced a small degree of dissociation. One common example is called highway hypnosis, which is where you may drive say, home from work, and arrive not able to recall any details of the trip. You’ve been driving on autopilot probably thinking about other things. Another example is daydreaming, or getting ‘lost’ in a good book. These are common experiences, and do not indicate a problem of any kind. Dissociation only becomes a disorder when it is severe, distressing or disabling.
Dissociation is not psychosis, although like any symptoms of mental illness, someone can experience both of them. A hallmark of psychosis is the addition of new information, such as seeing or hearing things that other people can’t, whereas dissociation is generally related to a loss of information instead.
Dissociation is a symptom of a number of different mental illnesses, such as Post Traumatic Stress Disorder, and Borderline Personality Disorder. There is also an entire category of disorders where dissociation is the primary issue, just like the category of anxiety disorders groups different mental illnesses where anxiety is the underlying feature. One of these is called Dissociative Identity Disorder.
Dissociation can happen in may different areas. It depends which area has been unplugged as to which symptoms a person experiences. People who suffer from chronic dissociation may struggle with symptoms such as:
Emotional numbing – where someone cannot connect to their own feelings, feeling flat, empty or numb instead.
Amnesia – ‘zoning out’/blackouts/lost time, when dissociation occurs in the area of memory, for example suddenly discovering that it is Thursday, and having no memory of Wednesday.
Time speeding up or slowing down.
Losing sensations – not being able to feel your own body, or feel sensations such as heat, cold, pain, hunger. Dissociation can unplug someone from their own senses, reducing or even removing altogether their sight or sense of hearing or ability to feel pain for example.
De-realisation – this describes someone’s experience when they are unplugged from the world around them, it may feel like being in a dream, or that they are living in a film. Nothing feels ‘real’. This may not sound so bad but it can be very distressing to experience.
Depersonalisation – describes being unplugged from yourself, where someone may feel unreal, like being a robot or living in a dream. They may not recognise their own reflection in a mirror, and may have out of body experiences where they seem to be watching themselves. Losing a sense of yourself like this can be intensely distressing unless the person is also experiencing emotional numbing.
Other common symptoms include flashbacks, sleep disturbance, psychosomatic pain or body memories, and identity disturbances.
Many people experience one or more of these symptoms on occasion without having a mental illness. People who have a dissociative disorder may experience dissociation in only one or up to all of these areas. Some people struggle with chronic symptoms all the time, while others experience episodes. There’s a wide range of ways dissociation can present and different kinds of difficulties it can cause people. It can be difficult to describe dissociative experiences before you know the terminology. In my case, even reading about it wasn’t enough, it took quite some time for me to realise that the confusing experiences I was having were dissociative.
It can be difficult to imagine what severe dissociation might feel like, but if you have ever stayed awake for a night or two, perhaps studying, then you have some idea. You may have felt confused, foggy, your sense of time might have been different, perhaps the room appeared fuzzy or spun around you, you may not have felt your feet upon the floor. Going into shock following an accident of some kind also resembles a dissociative experience. If you’ve ever been injured you may have felt really cold or numb or had odd tingles or pins and needles in your body. You may have experienced tunnel vision, time may have slowed right down or skipped in little bursts so you felt like you were in the backyard one moment and the ambulance the next. You may have felt dizzy or like you were falling, even if you were already lying down. Everything may have seemed very surreal and strange, as if you were in a dream. You may have become quite confused and reacted inappropriately. Perhaps you started giggling despite having a broken leg. Perhaps you were injured in traffic collision but all you could worry about for awhile was the groceries getting warm on the back seat. Remembering experiences like these can help you better understand the struggles of people who experience severe dissociation.
For someone dealing with severe dissociation, the very first priority must be safety. It is very important not to ignore the risks that severe dissociation poses. Driving a vehicle or even walking near traffic can be very dangerous during a severe dissociative episode. People struggling with chronic dissociation have to adapt their choice of activities to the level of symptoms they experience each day to make sure they stay safe. For example, when dissociative, I tend to burn myself accidentally while cooking.
If memory is affected, using extensive memory aids can greatly assist in maintaining safety and accomplishing goals. I use ‘to do’ lists a lot and set reminders on my phone for appointments an hour before. The kinds of tasks I write on my to do lists vary depending on how well I am that day. On bad days they are very simple things such as brushing my teeth and eating breakfast!
Dissociation can be rooted in trauma or grief. If this is the case for you, it’s important to spend some time working through those experiences instead of just trying to manage symptoms. This doesn’t have to be done in therapy or to mean that you are awash with painful feelings all the time. Finding a balance between expressing and honoring the events of the past and being able to connect with the present can reduce dissociation. Sometimes dissociation worsens when a person feels that the world is not a safe place to be connected to. Working to restore a sense of safety and control can help to reduce symptoms.
Grounding techniques can be very helpful to manage dissociation, and I encourage people to work on developing their own grounding kit. Some people who struggle with severe dissociation are vulnerable to issues with self harm. Sometimes this is as a kind of grounding technique, in other cases people use self harm to trigger dissociative episodes when they feel overwhelmed and want to disconnect. Building self awareness is an important part of managing dissociation, as you learn what triggers or feeds your dissociation and what makes you feel safe, connected and grounded you will be able to tailor your own individual recovery. The more individual the approach to managing dissociation is, the more likely it is to work. It is absolutely possible to go on to have a meaningful, connected, vibrant life, even if you are like me and find that dissociation is something that continues to need managing on a day by day basis.
For a brochure about managing dissociation, click here.