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Is this dissociation, depersonalization, or is there a better term?

Is this dissociation, depersonalization, or is there a better term?



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I am attempting to find the term that describes a bizarre and terrifying experience I recently had. As background: I was the subject of a severe violent assaulted at age 12, now 30 years ago. I have very little recollection of the event, just bits and pieces. I still have recurring nightmares of this event that my husband finally videotaped because I never remember them. They show me in extreme distress, and it is very difficult for him to wake me from them.

I recently had a prolonged (hours-long) night-time episode in which I was in and out of awareness. I am still unable to remember large pieces of that episode. But apparently I became so violent that my husband began to restrain me to prevent me from injuring myself. I have periods of remembering him sitting on me and holding me down, and not understanding why, but feeling like I was in grave danger and that he was trying to hurt or even kill me. But I don't remember anything between those moments of awareness.

What are clinical terms that describe this sort of drifting in and out of what we assume was a prolonged traumatic flashback?


Fact Sheet III – Trauma Related Dissociation: An Introduction

Dissociation is a process in which a person disconnects from their thoughts, feelings, memories, behaviors, physical sensations, or sense of identity. Dissociation is common among people seeking mental health treatment.

Most health professionals believe dissociation is a way the mind copes with too much stress. Many people with a dissociative disorder have had a traumatic event during childhood, although dissociation can also occur with other types of trauma. This is called Trauma-Related Dissociation.

Trauma-Related Dissociation is sometimes described as a ‘mental escape’ when physical escape is not possible, or when a person is so emotionally overwhelmed that they cannot cope any longer. Sometimes dissociation is like ‘switching off’. Some survivors describe it as a way of saying ‘this isn’t happening to me’.

These reactions are usually temporary but, in cases of severe or repeated trauma, dissociation may last longer. This can be frightening and difficult to explain to others.

Dissociation affects people in different ways. The different types of symptoms are described below.

Depersonalization

Depersonalization refers to being disconnected from yourself or your body. Some people feel parts of their body are not real, disappear or change. Others feel numb, or much smaller than they really are. Some people have an ‘out of body’ experience – as if they are above or behind their body.

Depersonalization happens when people are distressed and is more common among people who were mistreated as children. Depersonalization helps a person cope by detaching.

Derealization

Derealization is a sense of the external world not being real or being changed in some way. People might say that the world looks fake, flat, or far away. Sometimes people say the world looks as if they are watching a movie or as if they are in a dream or play acting on a stage. Sounds can also be distorted. Like depersonalization, this is a relatively common experience.

Derealization can help a person cope with trauma, by making the trauma seem less ‘real’. This creates a ‘mental distance’ to help them survive.

Dissociative Amnesia

Amnesia is the inability to recall important personal information. We all forget things sometimes (like not being able to remember where we put our keys), but amnesia involves serious memory problems for major events or parts of your life that most people can remember.

Lots of things can cause amnesia including substance abuse, head injury or disease. Dissociative Amnesia is a special term given to amnesia caused by not being able to fully integrate traumatic information, emotions, or memories.

The symptoms of Dissociative Amnesia vary, and can include:

  • memory gaps lasting from minutes to years
  • forgetting part or all of a traumatic event
  • forgetting things that remind you of trauma and
  • having a ‘foggy’ memory of a trauma, or feeling like it ‘didn’t happen to you’.

People with Dissociative Amnesia can have amnesia in current life, even after the trauma has passed. Examples include:

  • not being able to recall a conversation or meeting with someone
  • forgetting part of a day
  • completing an important task (such as writing an essay or doing a job interview), but not remembering it
  • Finding things that must belong to you, but having no memory of how you got them or
  • Finding notes or drawings that you must have done, although you do not remember doing them.

Dissociative Amnesia is quite different to ‘normal forgetting’ and people with Dissociative Amnesia usually find it frightening and disorientating. They may be embarrassed and try to hide it from others. Sometimes people with Dissociative Amnesia feel ‘vague’ and ‘spaced out’. They may worry that they are ‘dumb’ or have brain damage.

However, people with Dissociative Amnesia are not less intelligent. Nor is the amnesia caused by lack of concentration. Dissociative Amnesia makes sense for survival. If a person cannot escape an ongoing trauma, being able to dissociate from the memory may help them to go to work or school or do other tasks of life.

However, when Dissociative Amnesia continues months or years after the trauma is over, it causes distress and disruption and needs treatment.

Identity confusion and identity alteration

Identity confusion is a term used when a person feels confused about ‘who they really are’. Their beliefs, opinions, tastes and thoughts may fluctuate a lot. While some identity confusion can be a normal part of life, particularly while growing up, traumatized people can experience this in a severe way, well into adult life.

Identity alteration is the sense of having a part or parts which feel very different from yourself. There may be a sense that some feelings, behaviors and memories do not belong to you. These may feel as if they come from or belong to someone else. An altered sense of identity can cause people to feel confused or unsure about ‘who they really are’.

Examples of identity alteration include:

  • having a sense of being more than one person
  • feeling that you have ‘someone else’ inside
  • hearing voices inside
  • feeling that someone or something else ‘takes over’ or
  • confusion about your age or where you are.

Some people with identity alteration have obvious symptoms such as using different voice tones, language, or facial expressions. However, for most people the changes are subtle and hidden from others. In fact, people with dissociated identities often feel ashamed and distressed by their symptoms and try even harder to hide symptoms from others.

A person with identity alteration does not have ‘different people inside them’. It is more accurate to say that they have different ‘parts’ which make up the whole, single person. However, these parts are not integrated or accepted into a single ‘self’. This lack of integration causes the confusion and amnesia, and the sense of being controlled by someone or something else.

Dissociative disturbances of movement and sensation

Sometimes trauma-related dissociation causes physical symptoms which cannot be explained by a physical disease or disorder. These symptoms can include:

  • Unexplained loss of function after a trauma:
    • loss of senses such as sight, hearing, speech
    • loss of movement or feeling in a part of the body, including paralysis or complete numbness or
    • loss of skills such as temporary inability to remember how to drive a car or cook food.
    • involuntary movements or impulses that do not feel they are yours
    • unexplained pain or other sensations or
    • seizures which are not caused by a physical disorder like epilepsy.

    Because these symptoms feel outside of the survivor’s control, they can cause fear and confusion. Often, they are misdiagnosed and people with such forms of dissociation may have a lot of medical treatment that does not help them. However once correctly diagnosed these symptoms can be treated by psychological methods. It is also important to realise that all these disorders can be improved or even resolved with effective treatments. For more information see Fact Sheet IV: What are the Dissociative Disorders? and Fact Sheet V: Getting Treatment for Complex Trauma and Dissociation.

    Boon, S., Steele, K. & Van der Hart, O. (2011). Coping with Trauma-related Dissociation: Skills Training for Patients and Therapists, WW Norton and Co, New York.

    Brand, B.L., Sar, V. Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A. & Middleton, W. (2016). Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harvard Review of Psychiatry, 24(4): 257–270. doi: 10.1097/HRP.0000000000000100.

    Brand, B.L., Lanius, R., Vermetten, E., Loewenstein, R.J. & Spiegel, D. (2012). Where Are We Going? An Update on Assessment, Treatment, and Neurobiological Research in Dissociative Disorders as We Move Toward the DSM-5, Journal of Trauma & Dissociation, 13:1, 9-31, DOI: 10.1080/15299732.2011.620687

    Courtois, C.A. & Ford J.D. (2013) Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach, Guilford Press, New York, p 9 – 27

    Dell, P.F. (2009) The Phenomena of Pathological Dissociation. In P.F. Dell & J.A. O’Neil (Eds.) Dissociation and the Dissociative Disorders: DSM V and Beyond, Routledge, New York.

    Dorahy, M.J., Brand, B.L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., Lewis-Fernández, R. & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian & New Zealand Journal of Psychiatry, 48(5), 402–417, DOI: 10.1177/0004867414527523

    Dorahy, M.J., Middleton, W., Seager, L., Williams, M. & Chambers, R. (2016). Child abuse and neglect in complex dissociative disorder, abuse-related chronic PTSD, and mixed psychiatric samples, Journal of Trauma & Dissociation, 17:2, 223-236, DOI: 10.1080/15299732.2015.1077916

    Frewen, P. & Lanius, R. (2015). Healing the Traumatized Self: Consciousness, Neuroscience, Treatment. W.W. Norton & Co, New York.

    Hunter, E. C., Sierra, M., & David, A. S. (2004). The epidemiology of depersonalisation and derealisation. A systematic review. Social Psychiatry and Psychiatric Epidemiology, 39(1), 9–18. doi:10.1007/s00127-004-0701-4

    International Society for the Study of Trauma and Dissociation (2011): Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, Journal of Trauma & Dissociation, 12:2, 115-187, doi:10.1080/15299732.2011.537247

    Lyssenko, L., Schmahl, C. Bockhacker, L., Vonderlin, R., Bohus, M. & Kleindienst, N. (2017). Dissociation in Psychiatric Disorders: A Meta-Analysis of Studies Using the Dissociative Experiences Scale. The American Journal of Psychiatry, 175. appiajp201717010025. 10.1176/appi.ajp.2017.17010025.

    Nijenhuis. E.R.S. (2009). Somatoform Dissociation and Somatoform Dissociative Disorders. In P.F. Dell & J.A. O’Neil (Eds.). Dissociation and the Dissociative Disorders: DSM V and Beyond, Routledge, New York.

    Nijenhuis. E.R.S. (2004). Somatoform Dissociation: Phenomena, Measurement and Theoretical Issues, W. W. Norton and Co, New York

    Ó Laoide, A., Egan, J. & Osborn, K. (2018). What was once essential, may become detrimental: The mediating role of depersonalization in the relationship between childhood emotional maltreatment and psychological distress in adults, Journal of Trauma & Dissociation,19:5, 514-534, DOI:

    Spiegel, D., Lewis-Fernández, R., Lanius, R., Vermetten, E., Simeon, D., & Friedman, M. (2013). Dissociative disorders in DSM-5. Annual Review of Clinical Psychology, 9, 299-326. http://dx.doi.org/10.1146/annurev-clinpsy-050212-185531

    Steele, K., Boon, S. & Van der Hart, O. (2017). Treating Trauma-Related Dissociation: A Practical Integrative Approach, W.W. Norton & Co, New York.

    To download a PDF of this Fact Sheet click here.

    About ISSTD

    The International Society for the Study of Trauma and Dissociation is an international non-profit, professional association organized to develop and promote comprehensive, clinically-effective and empirically-based resources and responses to trauma and dissociation and to address its relevance to other theoretical constructs.


    Control

    If we think about dissociation as a hardwired protective strategy, we may be able to find its benefits. There is a helpful parallel in a familiar process that is more accepted as a positive in our time: It has been only recently that we shifted the perception about our emotions we used to believe that they were bad for us and now we know that all of them have a protective function.

    Generally speaking, we humans count with a set of protective means to survive, and when we gain control over them, they become instruments for a better life, of mental health, and of wellbeing. In the same fashion, if we learn how to use the dissociative ability of our brain and gain control over it, we could use it to become mentally healthier and consciously avoid some pains. If you think about it, people take drugs and alcohol to dissociate from pain and problems dissociation offers a healthier solution than self-medicating.

    Jeffrey Seinfeld, author and deep object relations thinker, scholar, and theorist told me once that

    “the line between psychosis and mysticism is very thin the difference between the two is whether you can keep control or lose it.”

    In the same way, the line between healthy dissociation and pathological one is having control over it, or better yet, having the awareness that you could use to our advantage. Even in the case of dissociative memories, where we are not clearly in control of what to remember and what to forget, forgetting can be healthy, adaptive, and advantageous. It’s all about how we instruct our brain on what is important and what could be ignored.


    Glance Stealing and Dissociation: A Long-term Psychotherapy Case ☆

    Depersonalization is one of the symptoms of dissociative disorder, which usually occurs in adolescence. It is a chronic condition of detachment from self and surrounding. The main purpose of this research is to analyze a long-term psychotherapy case in order to explore the transformation of the client's problems during the process and the progress of therapy. This research adopts the method of narrative analysis of the qualitative research. The client is a 20-year-old male junior student in college. The symptoms of panic, depersonalization, and derealization coexist. The client has received psychotherapy once a week from 2008 to 2010 for 57 therapy sessions in total. The recordings of the therapy sessions are transcribed and coded for the analysis of the client's transformation during the process of psychotherapy. The results of this research show that the level of the client's anxiety was lowered after psychotherapy. He was given a chance to express and integrate the negative feelings in the relationships. He had lessened the discussion on symptoms and shifted the focus to interpersonal relationships.


    What Is Dissociation?

    Dissociation refers to being disconnected from the present moment. It is a subconscious way of coping with and avoiding a traumatic situation or negative thoughts.

    While about half of people may have experienced an event of dissociation in their lifetime, only about 2% are actually diagnosed with what is known as a dissociative disorder.

    Dissociation usually happens in response to a traumatic life event such as that which is faced while being in the military or experiencing abuse. In this way, dissociation is usually associated with trauma and post-traumatic stress disorder (PTSD). However, dissociation can also happen in the context of anxiety symptoms and anxiety disorders.

    Often, dissociation that happens due to extreme stress or panic is recognized but attributed to other causes such as health issues. A person with panic disorder may seek medical attention for these symptoms and feel powerless to stop them.

    Overall, dissociation interferes with the treatment of all types of disorders and makes it hard to pay attention to the present moment. It can also slow or prevent healthy trauma processing and coping. Because of this, it's important to address dissociation through treatment and learning ways to cope.


    The Matrix Has You: On Dissociation and Feelings of Detachment

    I had my first panic attack about a year and a half ago, and it was the scariest moment of my life. Knowledge from undergraduate courses in abnormal psychology helped me to recognize what was going on fairly quickly. However, that recognition afforded me little comfort. I&rsquod heard all about the most common symptoms of panic attacks: accelerated heart rate, sweating, trembling, hyperventilation. I had all of these &ndash but that wasn&rsquot what was troubling me most. It was the feeling of detachment, the feeling of pulling away from the world around me, that really frightened me.

    As I stood in the Walmart parking lot, a smothering feeling of unreality clouded my mind. Thoughts raced through my head: what is going on? Am I going crazy? Am I dying? Is this a nightmare? That was my first experience with dissociation.

    If you&rsquore not familiar with the term, dissociation describes a state of detachment from reality that is fairly common in both panic disorder and PTSD. Dissociation can occur normally: you&rsquove probably experienced it during states of boredom when you &ldquozone out&rdquo. At the pathological level, dissociative symptoms come in two main flavors &mdash derealization and depersonalization.

    Derealizationis the feeling that your surroundings are &ldquooff&rdquo. You may feel like the environment is lacking emotional depth or that it&rsquos covered in a veil (like someone put plastic wrap over your eyes). From my experience, it feels like I&rsquom stuck in a virtual reality simulator &ndash I know I&rsquom me, I know my thoughts and actions are my own, but my surroundings don&rsquot seem to be real. (I imagine it&rsquos a bit like what Neo feels when he goes back into the Matrix after being freed.)

    Depersonalization, in contrast, is sort of the opposite feeling. You may feel like you&rsquore in a dream or like you&rsquore watching yourself from outside your body. I would say it feels more like being a video game character &ndash I&rsquom conscious of what&rsquos happening around me, I have my own thoughts, but it seems like someone else is controlling what I&rsquom doing. Everything seems automated or predetermined.

    For several months, a feeling of detachment was one of my main triggers &ndash so every time I woke up feeling groggy or had a beer, I would worry about panicking. (Quick note &ndash alcohol can induce an acute state of dissociation.)

    Recently, I&rsquove started to dissociate without the accompanying panic. The good news: I can have a beer without having a panic attack. The bad news: I have days on end of feeling like I&rsquom not fully present. Since I&rsquom constantly feeling a bit detached, I have memory disturbances from time to time I can&rsquot remember how I got somewhere or whether I washed my hands before eating.

    I also have trouble concentrating on what other people are saying. The longer someone talks without letting me interject, the harder it becomes to stay in the present and focus. There have been weeks where I couldn&rsquot let anyone talk to me for more than a minute or two because it exacerbated the derealization &ndash I felt like I was just watching a movie of someone talking.

    How can you deal with dissociative symptoms?It can be very difficult to live with depersonalization and derealization when they become chronic. The first few months I felt these symptoms, I was terrified there was something really wrong with me. When your perception of the outside world is compromised, you feel like you&rsquore going crazy or you&rsquore losing your grip on reality. Fortunately, these symptoms are not life threatening and will eventually go away.

    In order to get relief from these troubling symptoms, you may want to try grounding techniques. Grounding is a common technique that is used in anxiety disorders, and is all about staying in the present and accepting reality. Here are some easy exercises that you can try:

    • Appeal to your senses. Take a moment and list out two things that you can see, hear, taste, smell, and feel.
    • Appeal to your rationality. Re-orient yourself in the present by asking yourself some basic questions like &ldquoWhere am I?&rdquo, &ldquoWhat is the date today?&rdquo, &ldquoWhat season is it?&rdquo.
    • Tense your muscles. If you&rsquove ever done a progressive muscle relaxation, then you&rsquoll be familiar with this concept. Start with flexing your toes, think about how that feels, and then relax them. Try this with different muscle groups.
    • Take a warm shower. For some reason, I&rsquove found that the best way to overcome my derealization is having a long, hot shower. The feeling of the hot water on your skin kind of forces you to stay in the present and accept that your surroundings are real.

    I&rsquove found grounding techniques to be quite helpful for quick relief from depersonalization and derealization. It&rsquos not rocket science &mdash it&rsquos just about reminding your brain that you do exist and the world around you is real (assuming we&rsquore not actually in the Matrix).

    Justin spends most of his time in Montreal studying psychology and biotechnology. When he has a break from school, he likes cooking, pretending to go to the gym, writing horror stories, and watching a lot of supernatural dramas. He hopes one day to become a professor and expert on anxiety disorders. He writes a blog called Anxiety Really Sucks! and can be followed on Twitter @justinrmatheson.


    Dissociating Parts of the Personality

    “Parts” developed to do a particular task. You can read all about them in an article I wrote: Dissociated Parts and Alters. A younger part could exist to make sure you have fun, while another could stay loud to make sure you succeed professionally. If they don’t agree with each other, your brain will compartmentalize them and they will be considered dissociated.

    Costs and Benefits: Integrating parts into the whole makes life more efficient (the whole is bigger than the sum of the parts) but having parts is also important to reach a balanced experience. If you are aware of your parts, you can decide which one will be in the driving seat at any moment since you will be the copilot. Or you can choose one to guide while you drive. If you have nice and clear communication with your parts, you may be a more integrated person, and life could be more fulfilling.


    Three Problems with Dissociation

    In the minds of clinicians and researchers, the term ‘dissociation’ conjures up a variety of intriguing and controversial phenomena it should therefore come as no surprise that some have complained that the term is vague and imprecise (Cardeña, 1994 Frankel, 1994 Spitzer, Barnow, Freyberger & Grabe, 2006). Complaints notwithstanding, there is little disagreement that dissociation has been, and will remain, an important part of human psychology (Erdelyi, 2005), particularly as a reaction to trauma. Moreover, dissociation challenges the assumption, and the very nature of, unity in human experience. Consequently, dissociation deserves serious attention from scientists, clinicians, and theoreticians – both for its own sake and for advancing our understanding of fundamental structures of human psychology.

    The aim of this paper is to bring into view three problems that any adequate understanding of dissociation will need to address. In order to articulate these problems, I will draw from relevant figures and moments in the history of dissociation. I refer to the three problems as the motleyness problem, ontological problem, and normative problem, respectively. My main point is that if we do not have adequate answers to these problems then our conception of dissociation, especially a rich phenomenological articulation, will remain vague and imprecise. I will conclude with some thoughts about how to proceed.

    I. The Motleyness Problem

    In psychology, the term ‘dissociation’ has come to encompass a wide range of different phenomena, including daydreaming, depersonalization, derealization, dissociative amnesia and dissociative fragmentation—and this is far from an exhaustive list. While all are considered forms of dissociation, each is characterized by a distinctive presentation and phenomenal character. For example, the phenomenology of depersonalization, such as an ‘out-of-body’ experience, is quite different than the phenomenology of identity fragmentation in dissociative identity disorder (DID). In this section, I will briefly sketch the development of how the term ‘dissociation’ became the label of so many distinct phenomena, and how this generates a problem—the motleyness problem—that an account of dissociation needs to address.

    The vast majority of dissociation researchers and clinicians credit the French psychologist-philosopher Pierre Janet for the discovery of dissociation—although dissociative phenomena certainly existed prior to Janet’s discovery, notably theorized in terms of animal magnetism and spirit possession. [1]Janet (1907) identified dissociation as the major feature of cases of somnambulism and hysteria, with the assertion that the model of somnambulism was the basis for more complex cases of hysteria. Somnambulism in the late 19 th century went beyond mere sleepwalking to include states where a person would speak and act as though they were conscious, yet not recall what occurred during that time (the person would be amnestic to what occurred while in the somnambulic state). Janet (1907) understood somnambulism to involve the “dissociation of an idea, that has emancipated itself from the ensemble of consciousness”(p. 173).For Janet, the hallmark of somnambulism was this division of consciousness, and the formation of two separate conscious streams: the conscious and subconscious. The subconscious stream formed around an idéefixe, or ‘fixed idea’, which was often the result of an extremely stressful or traumatic event. This fixed idea would not be integrated into the ‘normal’ consciousness and persist in various levels of complexity. Thus, for Janet, dissociation is a failure of integration, with the result being the formation of these subconscious ideas.

    While Janet established the role played by dissociation in the pathologies of somnambulism and hysteria, on the other side of the Atlantic, the American physician Morton Princeexpanded the scope of dissociation along both pathological and nonpathological lines. In his 1906 book, Dissociation of a Personality, he described ‘Miss Beauchamp’ as developing four personalities, building upon the complexities of the divisions in personality. Elsewhere, Prince (1929) described forms of ‘absentmindedness’ or ‘abstraction’, which could be roughly approximated to forms of ‘spacing out’ or a kind of ‘loss of present awareness’, as forms of nonpathological dissociation. Prince’s work began to expand what was considered dissociation beyond what Janet initially intended. [2]

    The late 20 th century brought about a revitalized interest in dissociative phenomena in the form of multiple personality, experiments in hypnosis, and an increasing interest in altered states of consciousness. During this time, the conception of dissociation shifted from structural divisions of consciousness (from the time of Janet and Prince) to include phenomenal or experiential separations and disconnections. The move to include phenomenal disconnections was one of the factors that lead to the theorizing of the continuum model of dissociation, which resulted in a wide variety of nonpathological altered states of consciousness, such as daydreaming, trance-states, ‘spacing-out’, and fantasizing to be included as forms of dissociation. For some critics, this expansion of the range of dissociative phenomena was seen as problematic. Detractors such as Onno van der Hart and Martin Dorahy (2009) describe this diffusion as “conceptual drift” that renders dissociation as “ill-defined” with “almost any psychologically derived breakdown in integrated functioning” to be considered dissociation (p. 19). They also point out that a broad, inclusive definition of dissociation incorporates phenomena which exhibit no clear developmental pathway, adding to the complexity and ambiguity. Even those that support the more inclusive definition agree that the term is imprecise term and could benefit from conceptual clarity (Cardeña, 1994 Frankel, 1994 Spitzer, Barnow, Freyberger & Grabe, 2006). It is with reference to these concerns and objections that we can speak of a “motleyness problem.” Therefore, a satisfying account of the range of dissociation would help make sense of, and delimit, the range of phenomena that are grouped under this heading.

    II. The Ontological Problem

    With the motleyness problem pertaining to the number of different phenomena called dissociation, a related challenge for dissociation theory is to identify whatis being dissociated. The term ‘dissociation’ suggests some kind of division or sundering—but what exactly is the thing that is being divided? I shall refer to this as the ontologicalproblemof dissociation, since it relates to the mode of unity, and hence the mode of being that makes dissociation a possibility in human psychology. Sorting out what is being dissociated is important not only for conceptual clarity, but also in practical application, especially insofar as the therapeutic goal is to integrate or unify dissociated parts.

    The classical dissociationists Janet and Prince conceived of both consciousness and personality as the underlying unity that was susceptible to dissociative division. Janet (1907) also referred to the emancipation of the “system of ideas and functions” which itself is ambiguous, but was likely more of a functional description of the dissociated parts he was observing (p. 332). A central assumption of these ontologies is the focus on privileging internal, psychological structures, and the divisions that occur to these psychological structures.

    One of the most explicit representations of the heterogeneity of ontological commitments in dissociation theory can be found in the account of dissociation and dissociative disorders found in the Diagnostic and Statistical Manual of Mental Disorders, fifth-edition (DSM-V). The DSM-V defines dissociation as “the splitting off of clusters of mental contents from conscious awareness” (p. 820) and the “disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior (p. 291). Here, we see the DSM-V present a variety of ontological commitments forwhatis being dissociated. Moreover, terms such as ‘consciousness’, ‘identity’ and ‘body representation’—to name a few—are difficult to define, have rich philosophical and psychological histories in their own right, and remain ambiguous, driving home the challenge to a cohesive and consistent account of dissociation. Implied in the DSM-V’s description is the assumption that there exists a normal integration, which raises the question of how to determine what this normal integration of ‘consciousness’, ‘memory’, ‘emotion’ (and other terms on this lengthy list) actually looks like.Given this, a reasonable goal for a model of dissociation should be to provide an account of how these different dissociated parts come together. On this point the DSM-V’s account is quite lacking.

    III. The Normative Problem

    According to Janet, any division in consciousness or personality should be considered pathological so-called normal people do not exhibit these divisions. Moreover, these divisions are seen by Janet as the result of traumatic experiences. However, as mentioned earlier, Prince’s project involved theorizing nonpathological forms of dissociation, a trend that continues today (Butler, 2006). This presents us with our third challenge: to distinguish normal from the pathological forms of dissociation, particularly in the context of trauma.

    The current debate—really an updated version of Janet and Prince’s positions—is whether dissociation should be classified along a dimensional continuum, incorporating phenomena ranging from normal/everyday experiences such as daydreaming as well as pathological forms, or whether it should be understood as a categorical, strictly pathological phenomenon. Probably most significant in the narrower categorical camp is the theory of structuraldissociation(Steele, van der Hart, & Nijenhuis, 2009). This model depicts two parts of the personality, which includes the apparently normal part (ANP) and the emotional part (EP). A key part of this model is it has a single etiology—traumatic experiences. Structural dissociation theorists argue that only the pathological division of the personality in an ANP and EP should be called dissociation, and the others that are mapped onto the continuum (e.g., daydreaming, ‘spacing-out’, etc.) would be better labeled as ‘alterations in consciousness’.

    Of course, the DSM-V provides the general criterion “symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” to determine pathology in all dissociative phenomena. However, we must keep in mind that just because these dissociative experiences are defined in the DSM-V, this does not mean that they are necessarily pathological. The DSM-V excludes the diagnosis of DID if the ‘symptoms’ are “part of a broadly accepted cultural or religious practice” (p. 292). This provides evaluative latitude for determine pathological dissociation in the context of cultural practices. In fact, dissociation may take on an adaptive or therapeutic role, especially in response to trauma, as a way of “not knowing” harmful information (Barlow & Freyd, 2009).Even if the DSM’s strategy of determining pathology is useful, distinguishing what might be adaptive or therapeutic from pathological is important. Moreover, the stigma that may accompany the designation of pathology, especially in the context of an adaptive response, is also a concern. The take-home message is that a theory of dissociation has to have the resources to adequately delineate among the normative and pathological, along with the nuanced distinction of the adaptive/therapeutic role.

    IV. Concluding Remarks and Looking Ahead

    The aim of this paper has been to articulate three problems that have been generated by the history of engagement with dissociative phenomena, and by its contemporary analysis. Taken collectively, these three problems help frame a challenge that a minimally adequate accounting of dissociation should meet. First, such an account should define the class of phenomena that are understood as dissociative and shed light on the unity that belongs to that class. Second, such an account should be clear about what thing or things exhibit division when dissociation is at work. Finally, such an account should help clinicians to make sense of the distinction among normal, pathological, and therapeutic instances of dissociation.

    There exists an extensive body of theoretical and scientific literature that address dissociation, and this work may help to address these problems. But to date there is no clear consensus about how the three challenges can or should be met. Perhaps there may be value in looking beyond the current models and ontological commitments to find a reasonable solution to capturing the phenomenological richness and complexity of dissociation.

    Acknowledgements: I would like to thank Professor Wayne Martin and Doctors Jon Cleveland and Tyson Bailey for their extremely helpful comments. Special thanks to Doctors Steve Gold and Amy Ellis for the endless conversations about dissociation.

    [1] In the interest of space, I will focus on Janet as the starting point for dissociation. Although, we must keep in mind the relevance of prior work, especially in the fields of animal magnetism and spirit possession. Janet (1925), for example, credited the French magnetist Amand-Marie-Jacques de Chastenet, Marquis de Puységur’s description of somnambulism as a precursor to his own theory of dissociation.
    [2] Prince was not the only one to think along these lines. Other notable figures that also contributed to the expansion of dissociation included William James and Frederic Myers.

    References
    American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 th ed.). Arlington, VA: American Psychiatric Publishing.

    Barlow, M.R. & Freyd, J.J. (2009). Adaptive dissociation: Information processing and response to betrayal. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 3-26). New York: Routledge.

    Butler, L.D. (2006). Normative dissociation. Psychiatric Clinics of North America. 29, 45-62.

    Cardeña, E.T. (1994). The domain of dissociation. In S.J. Lynn & J.W Rhue (Eds.) Dissociation: Clinical and theoretical perspectives. pp 15-31. New York: Guilford Press.

    Erdelyi, M.H. (2005). Dissociation, defense, and the unconscious. In D. Speigel (Ed.) Dissociation, Culture, Mind, and Body. Washington DC: American Psychiatric Association.

    Frankel, F.H. (1994). Dissociation in hysteria and hypnosis: A concept aggrandized. In S.J. Lynn & J.W Rhue (Eds.) Dissociation: Clinical and theoretical perspectives. pp 80-93. New York: Guilford Press.

    Janet, P. (1907). The major symptoms of hysteria: Fifteen lectures given to the medical school of Harvard University. New York, NY: MacMillan.

    Janet, P. (1925). Psychological healing, volume 1(Trans. E. Paul & C. Paul). New York: MacMillan (Originally published as Les medications psychologiques(2 volumes) in 1919).

    Prince, M. (1906). The dissociation of a personality: A biographical study in abnormal psychology.New York: Longmans, Green, and Co.

    Prince, M. (1929). Clinical and experimental studies in personality. Cambridge, MA: Sci-Art.

    Spitzer, C., Barnow, S., Freyberger, H.J. & Grabe, H.J. (2006). Recent developments in the theory of dissociation. World Psychiatry, 5(2), 82-86.

    Steele, K., van der Hart, O., & Nijenhuis, E. R. S. (2009). The theory of trauma-related structural dissociation of the personality. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 239-258). New York: Routledge.

    van der Hart, O. & Dorahy, M.J. (2009). History of the concept of dissociation. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 3-26). New York: Routledge.

    Bryan T. Reuther, PsyD, is currently an Assistant Professor of Human Services at Indian River State College in Fort Pierce, Florida, where he teaches in both the Human Services and Psychology Departments. He received his Master of Science and Doctorate degrees, both in clinical psychology, from Nova Southeastern University located in Fort Lauderdale, FL, where specializing in trauma psychology. He also holds a Bachelor of Arts degree in Psychology and Criminal Justice from the University of Central Florida. He has published papers in the Journal of Theoretical and Philosophical Psychologyand the American Psychological Association’s Handbook of Trauma. His research interests include understanding the existential significance of trauma, psychotherapy integration, and the philosophical underpinnings of psychological theories.


    What are dissociation and depersonalization?

    Depersonalization and disassociation refer to a dreamlike state when a person feels disconnected from their surroundings. Things may seem ‘less real’ than they should be.

    These types of sensations vary in severity and can result from a range of conditions, including post-traumatic stress disorder and the use of recreational drugs.

    The person may feel as if they are watching themselves from a distance. Some take on a different identity. The person is able to do a “reality check.” They are aware that they their sensations are unusual.

    Depersonalization is an aspect of dissociation.

    • Dissociation is a general term that refers to a detachment from many things.
    • Depersonalization is specifically a sense of detachment from oneself and one’s identity.
    • Derealization is when things or people around seem unreal.

    Share on Pinterest PTSD or past trauma can lead to depersonalization, when people feel detached from themselves.

    The exact cause of dissociation is unclear, but it often affects people who have experienced a life-threatening or traumatic event, such as extreme violence, war, a kidnapping, or childhood abuse.

    In these cases, it is a natural reaction to feelings about experiences that the individual cannot control. It is a way of detaching from the horror of past experiences.

    According to Mind, a mental health charity based in the United Kingdom, dissociation can be a strategy for calming down, to help a person cope in times of stress.

    Neurologically, it may involve an imbalance in brain chemicals.

    A number of factors can make a person more likely to experience dissociation and depersonalization.

    Recreational drugs

    Some recreational drugs affect the chemicals in the brain. These can trigger feelings of depersonalization.

    Ketamine: People use this dissociative anesthetic as a recreational drug. They take it because they seek an “out-of-body” experience.

    Cannabis use: People have experienced dissociation and depersonalization with cannabis use and withdrawal.

    Alcohol and hallucinogens: These may trigger depersonalization in some people

    People have reported perceptual disturbances such as depersonalization when withdrawing from benzodiazepines.

    As a symptom of another condition

    Many people who experience depersonalization also have another mental health condition.

    Some kinds of dissociation can occur with the following conditions:

    Dissociation and depersonalization disorders

    According to the National Alliance on Mental Illness (NAMI), dissociative disorders that feature dissociation or depersonalization are:

    • Dissociative amnesia: People forget information about themselves or things that have happened to them.
    • Depersonalization-derealization disorder: This can involve out-of-body experiences, a feeling of being unreal, and an inability to recognize one’s image in a mirror. There may also be changes in bodily sensation and a reduced ability to act on an emotional level.
    • Dissociative identity disorder: A person becomes confused about who they are and feel like a stranger to themselves. They may behave differently at different times or write in different handwriting. This is sometimes known as multiple personality disorder.

    In some cultures, people seek to attain depersonalization through religious or meditative practices. This is not a disorder.


    Treatment

    Treatments for BPD such as dialectical behavioral therapy (DBT) often include components that help reduce dissociation. Treatment for dissociation is usually based on building skills to help you reconnect with yourself, the present moment, and your current surroundings.

    Grounding is one skill that can be used to reduce dissociation. Grounding exercises involve using external stimuli and your five senses (sight, hearing, touch, smell, and taste) to reconnect with the present. For example, a visual grounding exercise will have you observe small details in the environment around you until you are feeling more connected.

    Some people respond better to grounding exercises that use sensation to bring them back to reality, such as holding an ice cube for a few moments, chewing a piece of minty gum, or smelling a lemon.