Dissociation: A Comprehensive Guide
Dissociation is a complex psychological process that can be difficult to understand, particularly for those who have not experienced it first-hand.
Essentially, it is a mental process where a person disconnects from their thoughts, feelings, memories, or sense of identity. Though it can sometimes serve as a coping mechanism in response to extreme stress or trauma, it can also contribute to a range of psychological disorders if left unaddressed.
At its core, dissociation is a form of detachment from reality. This detachment can manifest in various ways, including a sense of being outside one's body, experiencing the world as unreal or dreamlike, or not being able to remember significant periods of time. Dissociation is not a singular experience, but a spectrum, ranging from daydreaming (a mild form of dissociation) to conditions like Dissociative Identity Disorder (DID).
Dissociation and Trauma
Dissociation often occurs in response to overwhelming experiences, especially those that are traumatic. The human brain has remarkable adaptive abilities, and dissociation can be seen as a protective response to prevent the mind from fully experiencing something that is too painful or traumatic to process.
Imagine you're faced with a stressful or traumatic situation that your brain perceives as threatening. Instead of staying engaged, your brain "flips the switch" to dissociation, distancing you from the full intensity of the experience. This disconnection can provide temporary relief or protection from the distress associated with the traumatic experience. However, recurrent or prolonged dissociation can interfere with mental health, daily functioning, and quality of life.
The Neurobiology of Dissociation
Dissociation is believed to be linked to the way the brain responds to extreme stress.
During a traumatic event, the brain's alarm system, primarily the amygdala, is activated. If the threat level is too high, the brain may decide to disconnect or dissociate to protect the individual from experiencing extreme emotional pain.
Simultaneously, the prefrontal cortex, the brain's control centre for executive functions like decision-making, cognition, and memory, may decrease its activity. This decrease could contribute to memory gaps or time loss that often accompany dissociation.
When dissociation is recurrent or severe, it may result in dissociative disorders. These include Dissociative Identity Disorder (DID), Dissociative Amnesia (DA), Depersonalization/Derealization Disorder (DPDR), and other specified dissociative disorders (OSDD).
Each of these disorders has unique symptoms, but they all involve some form of dissociation. For instance, DID, previously known as multiple personality disorder, involves the presence of two or more distinct identities or personality states. DPDR is characterized by persistent or recurrent episodes of depersonalization, derealization, or both.
Treatment Approaches for Dissociation
Various therapeutic interventions can help individuals who experience dissociation. Cognitive-Behavioral Therapy (CBT) helps individuals understand their thoughts and feelings and how they influence their behavior. It also teaches coping strategies to handle stress or trauma triggers.
Eye Movement Desensitization and Reprocessing (EMDR) is another effective therapy often used for trauma-related disorders. EMDR enables people to heal from the symptoms and emotional distress resulting from traumatic life experiences.
Dialectical Behavior Therapy (DBT), a form of cognitive-behavioral therapy, can also be effective. DBT focuses on mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, which can be particularly beneficial for those struggling with dissociation.
Working with a trauma-informed therapist can make a significant difference. A therapist well-versed in trauma can provide a safe and understanding space to explore painful memories and experiences, helping the individual to integrate these experiences and reduce the need for dissociation.
Understanding dissociation is crucial, both for individuals experiencing it and for those around them. It's an adaptive survival mechanism that can become a debilitating condition if it becomes chronic or severe. With awareness, understanding, and appropriate therapeutic intervention, however, it's possible to manage dissociation and lead a healthier, more integrated life.
Here is a list of reputable resources used in developing the current understanding of dissociation and its treatment, which include studies, review articles, and books that are considered to be valuable sources in this field:
~ Dissociation and the Dissociative Disorders: DSM-V and Beyond by Paul F. Dell, John A. O'Neil (Routledge, 2009)
~ Brand, B. L., Classen, C. C., McNary, S. W., & Zaveri, P. (2009). A review of dissociative disorders treatment studies. Journal of Nervous and Mental Disease, 197(9), 646-654.
~ Chefetz, R. A. (2015). Intensive Psychotherapy for Persistent Dissociative Processes: The Fear of Feeling Real (Norton Series on Interpersonal Neurobiology). WW Norton & Company.
~ Spiegel, D., Loewenstein, R. J., Lewis-Fernández, R., Sar, V., Simeon, D., Vermetten, E., Cardeña, E., Brown, R. J., & Dell, P. F. (2011). Dissociative disorders in DSM-5. Depression and anxiety, 28(9), 824-852.
~ Brand, B. L., & Loewenstein, R. J. (2010). Dissociative disorders: An overview of assessment, phenomenology, and treatment. Psychiatric times, 27(10), 62-69.
~ Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. Guilford Press.
~ Linehan, M. M. (2014). DBT skills training manual. Guilford Publications.
The effectiveness and suitability of different therapeutic approaches will depend on the individual's specific symptoms, their personal history, and their current situation. It is always recommended to seek advice from a qualified healthcare professional for individual medical advice.