Dissociation

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What is Dissociation?

Dissociation is a process where a person disconnects from their thoughts, feelings, memories or sense of identity. Dissociation is a natural phenomena which can happen to anyone under significantly stressful circumstances. According to Polyvagal Theory it is a function of the evolutionarily older, Dorsal Vagal path of the parasympathetic nervous system, which enables us to disconnect or ‘freeze’ from experiences that pose high threat to our body or psyche. The route out of dissociation is emotional safety, finding nurturing circumstances and relationships that can soothe the nervous system and where needs be, process any past emotional trauma and associated emotional dysregulation that may still be driving dissociation .

Acute and chronically traumatic events will often have some degree of dissociation during the event itself or in the following hours, days or weeks. Events seem ‘unreal’ or the person feels detached from what’s going on around them as if watching a movie. In most cases, the dissociation resolves as the nervous system returns to safety, however, for many, dissociation can be an enduring process, active to varying degrees, over many years. For some, the experience of dissociation will be enduring and severe enough to receive a diagnosis of a dissociative disorder. Dissociative disorders usually require specialised psychotherapy so that the person can learn over time how to self manage stress, and to come to terms with any past traumas that may still be unresolved.

Types of Dissociation

 

Depersonalisation can lead you to

  • feel as thought you are watching yourself in a movie or as an outside observer
  • feel disconnected from parts of your body or emotions
  • feel ungrounded
  • feel as if you are far away from your surroundings

Derealisation may lead you to

  • experience the world as unreal or as if you are in a computer game or simulation
  • see objects changing in shape, size or colour
  • see the world as ‘lifeless’ or ‘foggy’
  • feel as if other people are robots (even though you know they are not).

Dissociative Amnesia is a survival tactic driven by the nervous system in response to intolerable stress. If a person cannot escape an ongoing trauma, being able to dissociate from the memory, and dilemmas it brings up, can help a person continue to function in life.

With Dissociative Amnesia you may:

  • have memory gaps lasting from minutes to years;
  • forget part or all of a traumatic event;
  • forget things that remind you of trauma; and
  • having only a foggy memory or sense impression of a trauma

Identity confusion/ alteration is a term used when a person feels confused about who they are because their beliefs, opinions, tastes and thoughts may fluctuate a lot. While some identity confusion can be a normal part of life, especially while growing up, childhood trauma can create more enduring struggles in this area. These differing ‘parts’ or ‘facets’ of a person can feel as if they don’t fit together well and psychotherapy often works to integrate these differing ways of coping and being in the world.

Examples of identity alteration include:

  • having a sense of being more than one person;
  • feeling confused about why you behave or feel so differently across different situations;
  • hearing voices inside;
  • feeling that someone or something else ‘takes over’ you at times
  • confusion about your age or where you are.

While some people with identity alteration have obvious symptoms such as using different voice tones, language, or facial expressions, most people with these struggles are experiencing more subtle shifts which are often easier to hide from others.

Symptoms of Dissociation

  • Feeling emotionally disconnected 
  • Problems with handling intense emotions
  • Sudden and unexpected shifts in mood 
  • Depression or anxiety problems, or both
  • Feeling as though the world is distorted or not real 
  • Memory problems that aren’t linked to physical injury or medical conditions
  • Other cognitive (thought-related) problems such as concentration problems
  • Significant memory lapses such as forgetting important personal information
  • Feeling compelled to behave in a certain way
  • Identity confusion – for example, behaving in a way that the person would normally find offensive

    What Causes Dissociation? 

    The prevailing view within mental health is that the underlying cause of dissociative disorders is chronic trauma in childhood. Examples of trauma include repeated physical or sexual abuse, emotional abuse or neglect. Unpredictable, frightening or controlling family environments may also cause the child to ‘disconnect’ from reality during times of stress. The severity of a dissociative disorder in adulthood is largely linked to the severity of childhood trauma.

    Traumatic events that occur during adulthood may also cause dissociative disorders. Such events may include war, torture or going through a natural disaster.

      Therapy for Dissociation

      Therapy interventions should always be chosen following a thorough assessment. Depending on the type and severity of dissociation, there are times where the support of a psychiatrist may be necessary, especially if certain emotions can mean you are at risk of self harm or other risky behaviours. 

      Psychotherapy can help you to understand more about the possible origins of your dissociation. Schema Therapy is a particularly helpful therapy approach for this kind of problem area and seeks to help you understand all the ways in which dissociation is at work in your life. This involves an exploration of past experiences as well as how it shows up in the present day and impacts how you go about your life. Building a clear picture in this way can help with self awareness and familiarity with some of what is driving your dissociation. Schema Therapy is an emotionally based therapy and will be helpful at accessing some of the emotions that drive the need to dissociate when you are ready to work with these.

      NeurOptimal Neurofeedback can be a helpful support to therapy for dissociation because it directly trains the brain to harness its ability to self regulate. Many clients who use Neurofeedback with dissociation tend to report that it helps gently lift the dissociation over time and that thispaves the pay for working with any deeper emotions that may need to be processed. The brain continues to learn and change over our lifetime and it is this neuroplasticity that neurofeedback helps with. Our brain and nervous system are designed to rise to challenges and then to let go again so it is this grounded flexibility that it tends to recapture for people.

      Breathwork uses different breathing techniques to help regulate the nervous system. We know that the vagus nerve, the seat of our parasympathetic nervous system and our ability to return to calm after stress has nerve endings throughout our respiratory system and that breathing in certain ways changes activates parasympathetic activity. Breathing is also free and accessible all the time so it is a very handy way to regulate the nervous system and emotions 24/7.

      Brainspotting is a therapy technique that targets how the brain processes emotions and memories. Using eye position to find activated ‘brain spots’ for emotions, sensation or sensations in the body means that the brain can be harnessed to balance the source of anxiety in the deeper brain areas.