Dissociation

Dissociation is a "failure in the normal automatic integration of memories, perceptions, identity, and consciousness". ^[1]

Dissociation is often considered to exist on a spectrum or continuum, ranging from normal (normative dissociation) to pathological dissociation. ^[2][3][4]

An example of severe dissociation is when 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 Posttraumatic Stress Disorder. ^[5] The International Society for the Study of Trauma and Dissociation describes dissociation as "a psychological process commonly found in persons seeking mental health treatment". ^[5] Dissociative experiences are among the diagnostic criteria for acute stress disorder (ASD) and Posttraumatic Stress Disorder (PTSD) as well as borderline personality disorder, and are the core feature of dissociative disorders. ^[3]

Normative Dissociation[edit]

Normative dissociation does not disrupt everyday activities^[1], is brief, and is not caused by trauma. ^[2]

For example, people may drive somewhere and then realize that they do not remember many aspects of the drive, ^[1] being totally absorbed in a particular activity, daydreaming or fantasy, meditation and voluntary identity alteration (e.g., a religious trance). Most people will experience normative dissociation regularly in their lives. ^[2]

Pathological Dissociation[edit]

Pathological dissociation is categorized by symptoms that "manifest from a division of the personality, e.g. identity alteration, Dissociative Amnesia." ^[6] People with a dissociative disorder experience pathological dissociation; they may totally forget a series of normal behaviors occupying minutes or hours and may sense missing a period of time in their experience.^[1]

Dissociation thus disrupts the continuity of self and the recollection of life events. Severe dissociative pathologies, in contrast, may be chronic, severe, and debilitating; are typically associated with tremendously difficult life experiences or histories; and are relatively rare ^[2] in comparison to normative dissociative experiences.

This form of dissociation has been recognized as linked to abuse for many, many years.

"Dissociation is the predominant defense present in multiple personality disorder, (now known as Dissociative Identity Disorder) Posttraumatic stress disorder, and schizoid disorder (see Schizophrenia). It is also found in many less pronounced disorders, often masked by anxiety or depression. The presence of dissociation is a highly reliable indicator of previous mental, physical, and/or sexual abuse. In some cases dissociation is a reaction to early abandonment, severe sustained pain, near-death experiences, and/or prolonged neglect. These overwhelming experiences, usually, but not always, in childhood, threaten the cognitive and emotional stability and physical security, if not the life, of the individual."^[7]

Symptoms include:

• A feeling the world or the body is not real or belongs to someone else
• Looking at the world as though looking through a fog
• Losing time
• Not recognizing family members
• Not recognizing oneself in a mirror
• A familiar place feels strange
• The ability to ignore pain^[8]

The DES is a self-assessment tool designed to measure the level of dissociation. It measures both normative and pathological dissociation, but scores only answers to questions about pathological dissociation.

Difference between Normal and Abnormal Dissociation[edit]

People dissociate in response to trauma or other overwhelming situations such as intense pain or anxiety.” Sure all people dissociate, but that is not the same as pathological dissociation as researchers van der Hart, Nijenhuis and Steele are working to define.

“The essential manifestation of pathological dissociation is a partial or complete disruption of the normal integration of a person’s psychological functioning …. Specifically, dissociation can unexpectedly disrupt, alter, or intrude upon a person’s consciousness and experience of body, world, self,mind, agency, intentionally, thinking, believing, knowing, recognizing,remembering, feeling, wanting, speaking, acting, seeing, hearing, smelling,tasting, touching, and so on. . . . [These disruptions . . . are typically experienced by the person as startling, autonomous intrusions into his or her usual ways of responding or functioning. The most common dissociative intrusions include hearing voices, depersonalization, derealization, “made” thoughts,“made” urges, “made” desires,“ made” emotions, and “made” actions.”

Other authors are content with saying that dissociation exists on a spectrum, but this is less accurate. The see dissociation where at one level it is normal and experienced by almost everyone, now and then, to the other end which is the alters in those with Dissociative Identity Disorder. Somewhere in between is what is called pathological dissociation which occurs when dissociated parts are “unable to integrate or synthesize experience, and dissociated material.” Those with acute stress disorder , Posttraumatic stress disorder, conversion disorder, or somatization disorder will have dissociative symptoms.

References[edit]

1. ^ ^{a b c d} Merck Manual Professional: Overview of Dissociative Disorders. retrieved on 26 May, 2013
2. ^ ^{a b c d} Butler, Lisa D. "Normative dissociation." Psychiatric Clinics of North America 29.1 (2006): 45-62.
3. ^ ^{a b} Spitzer, Carsten, et al. "Recent developments in the theory of dissociation." World Psychiatry 5.2 (2006): 82. Retrieved May 26, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525127/
4. ^ Barlow, M. Rose, and Jennifer J. Freyd. "Adaptive dissociation: Information processing and response to betrayal." Dissociation and the dissociative disorders: DSM-V and beyond (2009): 93-105.
5. ^ ^{a b} Dissociation FAQs. retrieved on 26 May, 2013
6. ^ Dell, Paul F., and John A. O'Neil, eds. Dissociation and the dissociative disorders: DSM-V and beyond. Routledge, 2009.
7. ^ Inquiry, attunement, and involvement in the psychotherapy of dissociation. Erskine, Richard G. Transactional Analysis Journal, Vol 23(4), Oct 1993, 184-190.
8. ^ "Dissociative Experiences Scale". Retrieved 2013-05-09.