In a world where our minds constantly process and store information, there are times when it becomes overwhelmed. For some individuals, this overload can lead to what is known as a dissociative disorder; an instinctive defense mechanism that allows the mind to protect itself. But what is the science behind this phenomenon?
Dissociative disorders are characterized by a dissociation, or detachment, from reality. This can manifest as a disruption in a person's memory, identity, or perception of the environment. Although the exact cause of dissociative disorders is still being studied, experts believe it is often triggered by traumatic experiences or severe stress.
The mind's ability to dissociate acts as a safeguard, allowing individuals to compartmentalize distressing or overwhelming memories. It's a survival instinct that protects the individual from emotional turmoil that they may not be ready to confront. However, while dissociation can be helpful in the short term, it can also lead to significant challenges in daily life.
Understanding dissociative disorders
Like most things, dissociation occurs on a spectrum. The way I consider dissociation is on a spectrum from adaptive (helpful) to seemingly maladaptive (unhelpful or sometimes even harmful). Everyone experiences dissociation to some extent. Most folks have had the experience of "highway hypnosis" where miles and minutes have passed without awareness to what has taken place. Other times, we've driven our entire route home from work only to think "Whoa, I was zoned out that entire time!" That is dissociation, albeit, in a mild form. Dissociative disorders are mental health conditions that are characterized by a disconnection or detachment from reality. This can manifest as a disruption in a person's feelings, memory, behavior, identity, or perception of the environment. There are several types of dissociative disorders, including dissociative amnesia, depersonalization/derealization disorder, and dissociative identity disorder (DID).
I want to take a moment to express that folks who experience dissociative disorders are very much folks with the same basic wants and needs as everyone else. While the symptoms of dissociative disorders and DID can be distressing for those experiencing them or for folks close to them, the people who experience these symptoms are very much human. My guess is that you likely already know someone in your life who knows (or doesn't) that they experience a version of a dissociative disorder or DID and simply don't know.
Types of dissociative disorders and common symptoms
Dissociative amnesia is a type of dissociative disorder that involves significant gaps in a person's memory. These gaps can be related to a specific event or period of time, and the person may not be able to recall important personal information, such as their name or where they live. They may have an inability to recall important life events, like obtaining their driver's license, their college graduation, or wedding ceremony. This can also show up as more general "lost time", where a person has difficulty accounting for a few hours of a day or a few days of a week.
Depersonalization/Derealization Disorder is a single diagnosis within the Diagnostic and Statistical Manual 5-TR (DSM-5-TR), however, I believe it's important to outline the differences that are unique to each experience.
Derealization is a type of dissociation that involves feeling detached or disconnected from one's surroundings and environment. Individuals with this disorder may feel like they are in a dreamlike state. Other descriptions can include as feeling as if you are watching yourself but looking at another person, like living in fog, like living in a video game or simulation, or living in a dreamworld where actions do not have consequences. Derealization can also include a feeling of emotional disconnection from events and people.
Depersonalization is a type of dissociation that involves feeling disconnected from oneself, thoughts, and/or one's body. Individuals with this disorder may feel like they are watching themselves from outside their body, even floating above their own body, or feeling like they are not in control of their own body. It is not uncommon to hear that those experiencing this disorder have a sense of going through the motions or robot-like. Depersonalization can also include a feeling of numbness toward your own memories or the world around you, additionally, this may include feeling a disconnection from emotion or memory, feeling as if they are not your own. Some people experience the sensation of looking into a mirror and not recognizing themself or looking at a part of their body (an arm, a leg, a hand, etc.) and feeling as if they've never seen it before.
Dissociative identity disorder (DID), formerly known as multiple personality disorder, is a dissociative disorder characterized by the presence of two or more distinct personality states. These personality states, often called alters, may have their own unique memories, behaviors, and emotions. These personality states can vary in age, gender, gender expression, culture, religion, sexual orientation, and species.
Dissociative Disorder Not Otherwise Specified (DDNOS) is a previous name for a diagnosis that is no longer in use. Instead, Other Specified Dissociative Disorder (OSDD) or Unspecified Dissociative Disorder (UDD) are used.
OSDD is characterized by disruption to memory, identity, consciousness, or perception of your environment. This can also look like disorientation or losing awareness of one's identity or your surroundings. "Dissociative trance" is another symptom that may be experienced with OSDD. Have you ever been performing a simple task, like washing the dishes, and zoned out and become lost in your thoughts? Maybe later you found dishes in a place where they shouldn't have been? This is dissociative trance. While a very normal experience to experience it occasionally, those with OSDD can experience dissociative trance in a more intense manner. Those with OSDD may even become unresponsive to those in the external environment while in dissociative trance. Those with OSDD may experience their external world as blurry or feel frozen, paralyzed, or stuck while in dissociative trance. Those with OSDD may additionally experience times when their identity comes into question, is rejected, or when they detach from who they are.
Unspecified Dissociative Disorder (UDD) is used when folks present with symptoms of dissociation that fit many, but not all, of the criteria necessary for one of the other diagnoses mentioned in this article. This is often used as a working diagnosis, meaning that it may not be final diagnosis and other diagnoses are being considered.
Dissociative identity disorder frequently begins in childhood, but may not be recognized for years, or the person may go through a pattern of recognizing and forgetting. It is not uncommon for those who experience DID to experience frequent doubt about their experience. The experience of dissociative identity disorder can be variable depending on how much cohesion and awareness there is within the DID system. For some people who experience DID, there are high levels of system awareness with access to information about all personal states, as well as the memories and experiences they hold. For others with DID, there is low to no system awareness and every experience in between. The symptoms of dissociative disorder can vary depending on the type of dissociative disorder a person has. Common symptoms may include memory loss, feeling detached from oneself, feeling like one's surroundings are not real, and experiencing a sense of being outside of one's body. Individuals with DID may also experience gaps in their memory or have difficulty recalling important personal information.
Diagnosing dissociative disorder can be challenging because symptoms can be similar to those of other mental health conditions. A mental health professional will typically conduct a thorough evaluation to rule out other conditions and determine the most appropriate treatment.
Treatment for dissociative disorder may include therapy, medication, or a combination of both. Therapy may involve talk therapy, ego state therapy (Developmental Needs Meeting Strategy, Internal Family Systems (IFS), Inner Child, etc.), Brainspotting therapy, or eye movement desensitization and reprocessing (EMDR) therapy. Medications, such as antidepressants or anti-anxiety medications, may also be prescribed to help manage symptoms.
Causes of dissociative disorder
The exact cause of dissociative disorder is still being studied, but experts believe it is often triggered by traumatic experiences or severe stress. Trauma can be any event that is shocking or distressing that causes one's nervous system to be overwhelmed. It is thought that dissociation may be a way for the mind to compartmentalize these distressing or overwhelming memories and protect the individual from emotional turmoil that they may not be ready to confront. It has been considered that the personality states present in dissociative identity disorder (DID), have encapsulated a trauma that was unable to be worked through, either on one's own or with a parent or caregiver, at the time of occurrence. This is a highly adaptive and skillful way the brain works to protect us and keep us alive during a challenging time.
The mind's ability to dissociate acts as a safeguard, allowing individuals to compartmentalize distressing or overwhelming memories. It is a survival instinct that protects the individual from emotional harm. Dissociation can occur in response to trauma or stress, but it can also be a symptom of other mental health conditions, such as post-traumatic stress disorder (PTSD) or borderline personality disorder (BPD).
Diagnosis and treatment options for dissociative disorder
Coping with dissociative disorder can be challenging, but there are strategies that can help. These may include grounding practices, mindfulness practices, such as meditation or deep breathing exercises, as well as self-care activities, such as exercise, healthy eating, and getting enough sleep. It's also important for individuals with dissociative disorder to have a strong support system, whether that be family, friends, or a mental health professional. Support systems for individuals with dissociative disorder can come in many forms. Family and friends can provide emotional support and encouragement, while support groups can offer a sense of community and understanding. Mental health professionals can provide therapy and medication management, as well as guidance on coping strategies and self-care activities.
Coping strategies for individuals with dissociative disorder
Dissociative disorders can be challenging conditions to live with, but with the right treatment and support, individuals can find hope and change. I encourage anyone experiencing a dissociative disorder to reach out and find a community of folks who understand what you're experience. There are many places this can be done; you can search in your community for support groups, you can find support groups online, through Discord, etc.
If you believe you're experiencing symptoms of dissociative identity disorder (DID), in order to better understand yourself, using an app like Simply Plural can help you to track symptoms, communicate within the system, and share information with family or friends.
It's important to remember that there are no "right" or "wrong" goals when it comes to treatment. For some folks with DID, managing symptoms of dissociative amnesia and decreasing the impact to function in daily life is the primary goal, for others a focus on blending personality states is the goal. Your path is your own and you have a right to choose regardless of your diagnosis. Through therapy, medication, and self-care, individuals with dissociative disorders can learn to manage their symptoms and lead fulfilling lives.
Conclusion: Hope for individuals with dissociative disorder
If you are someone who experiences a dissociative disorder and feel like it is impactful to your life, help is available. It's important for those struggling with dissociative disorder to seek help from a mental health professional who is comfortable and confident in working with dissociation and dissociative disorders. It is a great idea to ask a potential therapist if they have experience working with and treating those who have dissociative disorders, how they do it, and how successful they have been.
Find resources at: www.isst-d.org and please reach out if you have any questions or concerns by sending an e-mail to kaci@thepinecenter.com
The Pine Center offers treatment for dissociative disorders and therapy for dissociative identity disorder (DID) for all of North Carolina virtually and in-person in Charlotte.
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