DISSOCIATION

Dissociation is an unconscious defense mechanism where a person is able to disconnect him/herself from extremely painful events in order to protect him/herself. Dissociation runs on a continuum – low level of dissociation is when a person “goes on autopilot” while driving a very familiar route whereas a high level of dissociation leads a person to experience the world as foggy, distant, and surreal. Dissociation can manifest cognitively, emotionally, and physically.

Cognitive Dissociation is when there is a disruption or discontinuity in consciousness, thoughts, and memory. For example, when a person loses their train of thought, spaces out, forgets where their keys are or what someone told them a few minutes ago.

Emotional Dissociation is when a person feels taken over by an emotion that does not make sense at that time. For example, suddenly feeling unbearably sad for no apparent reason and then having that sadness suddenly disappear.

Physical Dissociation is being taken over by a sensation or finding oneself carrying out an action as if a force outside of oneself is controlling it. For example, when a person finds him/herself doing something that he/she would not normally do but is unable to stop him/herself or suddenly feeling a physical sensation for no apparent reason and then having that sensation suddenly disappear.

Dissociation can disrupt a person’s memory, identity, perception, consciousness, or physical movement. It may happen gradually or chronically and is often associated with or caused by a trauma. Dissociation is much more likely to occur when the person has experienced a high level of trauma and/or when there are multiple instances of trauma rather than a single event.4

At its extremes, Dissociation can result in Dissociative Disorders such as Dissociative Amnesia, Dissociative Identity Disorder, Depersonalization/Derealization Disorder, and Dissociative Disorder Not Otherwise Specified.[1]

  • Dissociative Amnesia: The inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.
  • Dissociative Identity Disorder: Characterized by the presence of two or more distinct identities or personality states.
  • Depersonalization/Derealization Disorder: The presence of persistent or recurrent experiences of depersonalization, derealization, or both. Depersonalization is the persistent or recurrent feeling of detachment or estrangement from one’s self. While Derealization is the feeling of unreality or of being detached from one’s environment.
  • Dissociative Disorder Not Otherwise Specified: Conditions wherein symptoms are characteristic of Dissociation but was unable to meet the full diagnostic criteria for any of the Dissociative Disorders.

Canadian Statistics

  • One in three girls and one in six boys are sexually abused in North America.[2]
  • In 2014, one-third (33%) of Canadians aged 15 and older experienced some form of child maltreatment (e.g. physical abuse, sexual abuse, witnessing violence by a parent or guardian against another adult) before the age of 15.[3]
    • Physical abuse – 26%
    • Sexual abuse – 8%
    • Witnessed violence by a parent/guardian against another adult in the home – 10%
  • Sixty-five percent of victims of childhood physical and/or sexual abuse reported having been abused 1 to 6 times. Twenty percent reported having been abused 7 to 21 times. Fifteen percent reported having been abused at least 22 times.3
  • Physical abuse was often perpetrated by a parent or a step-parent (61%), while sexual abuse was often perpetrated by someone outside of the family (61%) – a stranger, teacher, tutor, or professor.3
  • Forty percent of Aboriginal people reported having experienced childhood physical and/or sexual abuse.3
  • Among people aged 15 and older who identified as gay, lesbian, or bisexual, 48% reported having experienced childhood physical and/or sexual abuse.3
  • Ten percent of adults who were victims of childhood abuse reported mental or psychological limitations and were more likely to report poor physical health.3
  • In 2015, there were over 86,000 victims of violence (including harassment, homicide, physical and sexual violence) committed by a spouse, parent, child, sibling, or other family members.3
  • In 2015, there were almost 92,000 victims of intimate partner violence (including harassment, homicide, physical and sexual violence).3
  • Prevalence of Dissociative Disorders:4
    • Dissociative Identity Disorder                         – 1.5%
    • Dissociative Amnesia – 1.8%
    • Derealization/Depersonalization Disorder – 2%
  • Of adults who receive mental health services, 50% of women and 25% of men have experienced childhood sexual abuse.3

Behaviours associated with Dissociative Disorders:

  • Inability to recall important personal information that is not due to normal forgetfulness1
  • Experiencing blackouts or lapses in memory1
  • Acts differently in one situation compared to another, as if they are like two different people1
  • Hears voices, sounds, or conversations inside the mind1
  • Often finds unexplained objects among their possessions and they cannot recall where it came from or how it got there[4]
  • Discovers unexplained injuries on one’s own body5

Feelings associated with Dissociative Disorders:1

  • Depersonalization (feelings of detachment from one’s own thoughts, feelings, sensations, body, or actions)
  • Derealization (feelings of detachment to one’s surroundings or environment)
  • Confusion
  • Depressed mood
  • Helplessness
  • Hopelessness

Thoughts associated with Dissociative Disorders:5

  • “I know I must have feelings but I do not feel them. Am I normal?”
  • “My thoughts do not feel like they are my own.”
  • “I feel like I do not have control over my own mind and body.”
  • “I think I am going crazy whenever other people tell me about something I did but I cannot remember ever doing it.”

Dissociative Disorders and the Body:1

The following physical symptoms are often associated with this condition:

  • Seizure-like episodes
  • Headaches/Migraines
  • Asthma/breathing problems
  • Irritable bowel syndrome
  • Unexplainable pain
  • Itchiness

Dissociation and the Brain:

When you face a real or perceived threat, it triggers an automatic survival-mode response from the Autonomic Nervous System (ANS). The ANS has two branches, the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS) and is responsible for keeping us safe by regulating bodily functions that are not in our control, such as our heart rate, digestion, increasing/decreasing blood flow, dilation of the pupils, etc.[5] When we are in physically escapable and threatening situations, the SNS branch of the ANS has two ways or responding to the situation: to move us into a state of “fighting” the threat or “fleeing” from the threat.5 For instance, if you are in an argument with your child, you may choose to argue (“fight”) or walk away while the child is in a time-out (“flee”). To produce the fight-or-flight response, the hypothalamus activates the sympathetic nervous system and the adrenal-cortical system.[6]

However, if the traumatic and dangerous situation cannot be controlled or physically escaped from (when the person cannot select “fight” or “flee”), the brain selects the “freeze” response, which is controlled by the PNS (and more specifically, by the Dorsal Vagus nerve within the PNS). A “freeze” state occurs when a person faints or stays conscious but is able to disconnect from themselves – this is a form of survival and protection. For instance, someone who is being sexually abused report being able to “float toward the ceiling” because he/she is not able to escape the assault. Overall, people are able to disconnect from their emotions, cognitions, memory, attention, awareness, sensations, and their sense of self when faced with inescapable events that are threatening or dangerous. The hypothalamus activates the PNS when it is perceived that the SNS will not accomplish the goal through the “fight or flight response.”

Research on Dissociation suggests a link between dissociative symptoms and lowered activity in brain regions associated with emotional processing and memory (amygdala, hippocampus, parahippocampal gyrus, and middle/superior temporal gyrus), attention and awareness (insula), filtering sensations (thalamus), processing of information about self (precuneus), and cognitive control (lateral prefrontal cortices). This suggests that these functions may be altered during Dissociation. Lowered activity in these areas have been associated with states of detachment (e.g., numbing), reduced emotional awareness, traits of alexithymia (difficulties in identifying and describing feelings), and reduced emotion regulation.[7]

Does Psychology Work?

  • Mindfulness Therapy: Researchers show that MT is effective in treating psychological disorders such as depression and anxiety.[8] There is also evidence that incorporating mindfulness in clinical practice is effective in reducing Dissociation.[9]
  • Eye Movement Desensitization and Reprocessing (EMDR): Researchers show that trauma-focused EMDR is an effective treatment for adults who suffer from PTSD[10] with dissociative subtype[11] and were survivors of childhood abuse. It was also able to significantly reduce severity of PTSD symptoms, Depression, Anxiety, and Dissociation. Researchers also show that EMDR counteracts activation patterns in brain regions related to Dissociation.[12]
  • Ego State Therapy (EST): EST utilizes family and group therapy techniques to resolve the conflicts between the different parts of self (called ego states). EST can be used to treat Dissociation.[13] Every individual has several parts of self (like a “family of selves”). For instance, when you are hungry and tired at the same time, you will feel the push and pull of these two states – both parts are needed but you can only choose one at a time. When you consistently select one state over another, conflicts begin to form and the system is off balance. EST helps to rebalance the system by accepting and valuing all parts of self.

Tips on how to Manage Dissociation![14],[15]

Here are some grounding techniques to overcome Dissociation and bring yourself back to the present moment and in touch with your body:

  • Use physical sensations and focus on what sight, touch, hearing, smell, and taste you are sensing in the present moment. Remembering a traumatic or painful memory often triggers a person to go inside of their mind and in the past, where it does not feel safe. By stimulating the senses, the person comes back to the present where “nothing bad is happening.”
  • State facts out loud such as your age, birthplace, name, and address. This will help make sense of your reality and remind you of who you are.
  • Remember to breathe. When a person is confronted with trauma, the first thing that changes is his or her breathing. Holding the breath for 4 seconds and slowly exhaling for 6-8 seconds will bring you back to a more neutral state and distract you from the past event.
  • Find solace in laughter from a funny movie or video or from a friend or loved one. This will help ground you to your body and connect you to others who can help.

Dissociation is a normal human experience. We all have the capacity to dissociate or “zone out.” Sometimes, people zone out because they get absorbed in a movie and other times people are able to “zone out” when they have experienced the same thing over and over (such as when you are driving a familiar route for weeks – in this case, your mind can think of your “to do’ list and also be on autopilot while driving). On the other hand, people can also face traumatic and inescapable experiences that lead to more chronic and problematic Dissociation. Although Dissociation from the event, at the time that the event occurred, aided in you being able to protect yourself from feeling the full impact of the event, the long-term consequences of Dissociation can be devastating. Unfortunately, prolonged and chronic Dissociation can disrupt a person’s life and prevent him/her from overcoming the experience. It can also lead you to have a “meaningless” life where you do not “feel alive” when you cannot feel your emotions. For some, it feels like you are a stranger in your own mind and body. Clinicians at Hopewell Psychological can help you safely connect back to yourself and process the traumatic event. We tailor our therapy to your specific needs and offer a supportive, trusting, non-judgmental, and collaborative setting.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] Sadock, Benjamin James; Sadock, Virginia Alcott; & Ruiz, Pedro. “Kaplan & Sadock’s Synopsis of Psychiatry.” Philadelphia: Wolters Kluwer. 2015. Print.

[2] “Childhood Sexual Abuse: A mental health issue.” Canadian Mental Health Association. 2013. Web. May 2017.

[3] “Family violence in Canada: A statistical profile, 2015.” Statistics Canada. 2017. Web. May 2017.

[4] American Psychiatric Association. “DSM-5.” Washington: American Psychiatric Publishing. 2013. Print.

[5] Miller, J. G., Kahle, S., Lopez, M., & Hastings, P. D. “Compassionate love buffers stress-reactive mothers from fight-or-flight parenting.” Developmental Psychology. 51. 1. (2015). Pp. 36-43. DOI: http://dx.doi.org/10.1037/a0038236

[6] Suresh, A., Latha, S. S., Nair, P., & Radhika, N. “Prediction of fight or flight response using artificial neural networks.” American Journal of Applied Sciences. 11. 6. (2014). Pp. 912-920. DOI:10.3844/ajassp.2014.912.920

[7] Krause-Utz, Annegret; Frost, Rachel; Winter, Dorina; & Elzinga, Bernet M. “Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder.” Current Psychiatry Reports. 19.1 (2017). doi: 10.1007/s11920-017-0757-y.

[8] Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M-A., Paquin, K., & Hofmann, S. G. “Mindfulness-based therapy: A comprehensive meta-analysis.” Clinical Psychology Review. 33. (2017). Pp. 763-771. DOI: http://dx.doi.org/10.1016/j.cpr.2013.05.005

[9] Sharma, T., Sinha, V. K., & Sayeed, N. “Role of mindfulness in dissociative disorders among adolescents.” Indian Journal of Psychiatry. 58. 3. (2016). Pp. 326-328. DOI: 10.4103/0019-5545.192013.

[10] Chen, Ling; Zhang, Guiqing; Hu, Min; & Liang, Zia. “Eye Movement Desensitization and Reprocessing Versus Cognitive-Behavioral Therapy for Adult Posttraumatic Stress Disorder: Systematic Review and Meta-Analysis.” Journal of Nervous & Mental Disease. 203.6 (2015): 443-451. doi: 10.1097/NMD.0000000000000306.

[11] Van Minnen, A., van der Vleugel, B.M., van den Berg, D. P. G., de Bont, P. A. J. M., de Roos, C., van der Gaag, M., & de Jongh, A. “Effectiveness of trauma-focused treatment for patients with psychosis with and without the dissociative subtype of post-traumatic stress disorder.” The British Journal of Psychiatry. 209.4 (2016): 347-348. DOI: 10.1192/bjp.bp.116.185579.

[12] Herkt, Deborah; Tumani, Visal; Gron, Georg; Kammer, Thomas; Hofmann, Arne; & Abler, Birgit. “Facilitating Access to Emotions: Neural Signature of EMDR Stimulation.” PLoS ONE. 9.8 (2014). E106350. https://doi.org/10.1371/journal.pone.0106350.

[13] Watkins, H. H. “Ego-State Therapy: An overview.” American Journal of Clinical Hypnosis. 35. 4. (1993). Pp. 232-240. DOI: http://dx.doi.org/10.1080/00029157.1993.10403014.

[14] Polley, Sherry. “Using Grounding Techniques when Dissociating.” Healthy Place. 2015. Web. May 2017.

[15] Amaral, Richard. “3 Strategies to Prevent ‘Zoning Out’.” Psychology for Growth. 2013. Web. May 2017.

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