What is dissociation?
Dissociation is a word that is used to describe the
disconnection or lack of connection between things
usually associated with each other. Dissociated experiences
are not integrated into the usual sense of self, resulting
in discontinuities in conscious awareness (Anderson & Alexander,
1996; Frey, 2001; International Society for the Study
of Dissociation, 2002; Maldonado, Butler, & Spiegel,
2002; Pascuzzi & Weber, 1997; Rauschenberger & Lynn,
1995; Simeon et al., 2001; Spiegel & Cardeña, 1991;
Steinberg et al., 1990, 1993). In severe forms of dissociation,
disconnection occurs in the usually integrated functions
of consciousness, memory, identity, or perception.
For example, someone may think about an event that
was tremendously upsetting yet have no feelings about
it. Clinically, this is termed emotional numbing, one
of the hallmarks of post-traumatic stress disorder.
Dissociation is a psychological process commonly found
in persons seeking mental health treatment (Maldonado
et al., 2002).
Dissociation may affect a person subjectively in the
form of “made” thoughts, feelings, and
actions. These are thoughts or emotions seemingly coming
out of nowhere, or finding oneself carrying out an
action as if it were controlled by a force other than
oneself (Dell, 2001). Typically, a person feels “taken
over” by an emotion that does not seem to makes
sense at the time. Feeling suddenly, unbearably sad,
without an apparent reason, and then having the sadness
leave in much the same manner as it came, is an example.
Or someone may find himself or herself doing something
that they would not normally do but unable to stop
themselves, almost as if they are being compelled to
do it. This is sometimes described as the experience
of being a “passenger” in one’s body,
rather than the driver.
There are five main ways in which the dissociation
of psychological processes changes the way a person
experiences living: depersonalization, derealization,
amnesia, identity confusion, and identity alteration.
These are the main areas of investigation in the Structured
Clinical Interview for Dissociative Disorders (SCID-D)
(Steinberg, 1994a; Steinberg, Rounsaville, & Cicchetti,
1990). A dissociative disorder is suggested by the
robust presence of any of the five features.
What is depersonalization?
Depersonalization is the sense of being detached from,
or “not in” one’s body. This is what
is often referred to as an “out-of-body” experience.
However, some people report rather profound alienation
from their bodies, a sense that they do not recognize
themselves in the mirror, recognize their face, or
simply feel not “connected” to their bodies
in ways which are challenging to articulate (Frey,
2001; Guralnik, Schmeidler, & Simeon, 2000; Maldonado
et al., 2002; Simeon et al., 2001; Spiegel & Cardeña;
Steinberg, 1995).
What is derealization?
Derealization is the sense of the world not being
real. Some people say the world looks phony, foggy,
far away, or as if seen through a veil. Some people
describe seeing the world as if they are detached,
or as if they were watching a movie (Steinberg, 1995).
What is dissociative amnesia?
Amnesia refers to the inability to recall important
personal information that is so extensive that it is
not due to ordinary forgetfulness. Most of the amnesias
typical of dissociative disorders are not of the classic
fugue variety, where people travel long distances,
and suddenly become alert, disoriented as to where
they are and how they got there. Rather, the amnesias
are often an important event that is forgotten, such
as a wedding, or birthday party that was attended,
or a block of time, from minutes to years. More typically,
there are micro-amnesias where the discussion engaged
in is not remembered, or the content of a conversation
is forgotten from one moment to the next. Some people
report that these kinds of experiences often leave
them scrambling to figure out what was being discussed.
Meanwhile, they try not to let the person with whom
they are talking realize they haven’t a clue
as to what was just said (Maldonado et al., 2002; Steinberg
et al., 1993; Steinberg, 1995)
What are identity confusion and identity alteration?
Identity confusion is a sense of confusion about who
a person is. An example of identity confusion is when
a person sometimes feels a thrill while engaged in
an activity (e.g., reckless driving, drug use) which
at other times would be repugnant. Identity alteration
is the sense of being markedly different from another
part of oneself. This can be unnerving to clinicians.
A person may shift into an alternate personality, become
confused, and demand of the clinician, “Who the
dickens are you, and what am I doing here?” In
addition to these observable changes, the person may
experience distortions in time, place, and situation.
For example, in the course of an initial discovery
of the experience of identity alteration, a person
might incorrectly believe they were five years old,
in their childhood home and not the therapist’s
office, and expecting a deceased person whom they fear
to appear at any moment (e.g., Fine, 1999; Maldonado
et al., 2002; Spiegel & Cardeña, 1991; Steinberg,
1995).
More frequently, subtler forms of identity alteration
can be observed when a person uses different voice
tones, range of language, or facial expressions. These
may be associated with a change in the patient’s
world view. For example, during a discussion about
fear, a client may initially feel young, vulnerable,
and frightened, followed by a sudden shift to feeling
hostile and callous. The person may express confusion
about their feelings and perceptions, or may have difficulty
remembering what they have just said, even though they
do not claim to be a different person or have a different
name. The patient may be able to confirm the experience
of identity alteration, but often the part of the self
that presents for therapy is not aware of the existence
of dissociated self-states. If identity alteration
is suspected, it may be confirmed by observation of
amnesia for behavior and distinct changes in affect,
speech patterns, demeanor and body language, and relationship
to the therapist. The therapist can gently help the
patient become aware of these changes (e.g., Fine,
1999; Maldonado et al., 2002; Spiegel & Cardeña,
1991; Steinberg, 1995).