To Devin: Hi Devin! I was the anon about dissociation and physical symptoms. I was wondering if you could elaborate more, since you said you had a lot to say? I don't have any super specific questions, just really trying to get a better understanding.
First off: everybody please read this becuase it took a very long time to type up and⦠no thatās about the only reason tbh.Ā
I kinda wanted to avoid writing a very long post on something so vague but here we go!
Well there probably isnāt a completely ideal place to start, but the definitions of dissociation is as good as any. Ā
One of the non-medical definitions for dissociation is simply:
the disconnection or separation of something from something else or the state of being disconnected.
The psychiatric definition, as given in the DSM 5 is:
The splitting off of clusters of mental contents from conscious awareness.Ā Dissociation is a mechanism central to dissociative disorders. The term is also used toĀ describe the separation of an idea from its emotional significance and affect, as seen inĀ the inappropriate affect in schizophrenia. Often a result of psychic trauma, dissociationĀ may allow the individual to maintain allegiance to two contradictory truths while remainingĀ unconscious of the contradiction. An extreme manifestation of dissociation isĀ dissociative identity disorder, in which a person may exhibit several independent personalities,Ā each unaware of the others.
(As a side note,Ā āindependent personalitiesā is actually incorrect? Why the latest version of the DSM has that phrasing I have no clue. It should beĀ āindependent identitiesā not personalities. Thatās a HUUUUGE misnomer and shame on the APA for not changing that)
While it may not be completely accurate, I like to think of dissociation in three groups. One is just the bare dictionary definition. I call it the basic, or simple dissociation. Ā Another is dissociative symptoms, which is dissociative acts, emotions, etc, that are symptoms of a psychiatric disorder such as schizophrenia or BPD. And the third is dissociative disorders, which is a disorder that falls under the dissociative disorders category, oddly enough.
So recap on terms Iāll use:
Basic dissociation - the dictionary definition
Dissociative symptoms - Ā acts, feelings, or emotions that are symptoms or criteria for a psychiatric disorder (such as BPD, schizophrenia, depression, PTSD).Ā
Dissociative disorders - Ā a psychiatric, usually trauma based, disorder under the dissociative disorder category in the DSM.Ā
While these may not be completely and technically accurate, itās what personally helps me when I think about the huge range of dissociation.Ā
When it comes to the basic dictionary meaning of dissociation; we do it and use it all the time. If you have a group of friends and you cut ties with them; youāve dissociated with them. Getting a divorce is a legal dissociation with your (ex)spouse. A company stops doing deals with another group due to a conflict of interest; they have now disassociated with each other. I personally use the word a lot in my writing as such and I am sure many of you have used it too, or at least a close synonym.Ā
There are a lot of dissociative symptoms that can be experienced in the breadth of mental illness. However I want everybody to note that itās the dosage that makes the poison. Iām sure youāve all zoned out at one time or another, either during class, watching a movie, reading, sitting down doing nothing, etc. That is actually dissociation. BUT most of the population does that, especially when tired or stressed. And even a good third of the population has experienced depersonalisation or derealisation at least once in their life.Ā
When such things happen on a regular basis and become a chronic issue is when they turn from a relatively harmless natural reaction, to an illness or symptom of something larger.Ā
For example, many disorders often have types of dissociation symptoms as either effects of a disorder, or criteria for it. Dissociation under extreme stress is actually the 9th criteria for Borderline Personality Disorder. But I think that is jumping ahead of ourselves.Ā
Then of course there are Dissociative Disorders hallmarked by the fact it causes a disruption or discontinuity with memory, identity, emotion, perceptions, motor control, behaviour and more. Basically it messes up how you would normally interact with yourself, your thoughts and your environment on a hugely drastic scale. Iām talking about so large scale that it affects everything in your life. Ussually a DD is a result of trauma, though very very rarely it may not. Remember that dissociation is a coping method and most commonly used (negatively) in responce to traumatic stimuli.Ā
More on dissociation from a psychiatric view in general!
So here is a brief run down of various dissociative symptoms:
Feeling disconnected from yourself physically (numbing of pain or sensations)
Feeling disconnected from yourself emotionally (numbing of emotions such as not feeling very sad in event of a death)
Sudden, unexpected shifts in mood without reason
feelings that the world is not real
memory issues such has inability to remember things
inability to focus/zoning out
lapses in memory such as unaccounted time
compulsions to act in certain ways (especially ways you may not normally)
confusion about oneās identity, who they are; behaving in ways that counter their normal behaviour/personality
Dissociation can be classed into two types: positive and negative. Now, itās REALLY important to note that positive doesnāt mean good, nor negative mean bad.
Positive dissociation are intrusions of oneās awareness or behaviour such as; depersonalization, derealisation, or identity changes.Ā
Negative dissociation are losses of control or inability to access memory such as amnesia or fugue states.Ā
Two really important dissociative states thatās important to know is depersonalization and derealisation. Simply put depressionalisation is feeling like you are not real, or feeling detached from yourself, body, or mind. Derealization is feeling like reality is not real or that the environment you are in is not real.Ā
But I think itās important to define them further.Ā
Depersonalization- Itās often described as being anĀ āout of body experienceā or as if you are notĀ āinā your body. Sometimes itās felt as being completely alienated from oneās body, like looking in the mirror and not being able to recognise yourself. Itās also often described as feeling like the body is a puppet, and not your own.Ā
Derealization - Often time itās described as the world looking fake, far away, or foggy. Or it looks like you are watching a movie, but not in it.
Iām not quite ready to go onto dissociative disorders themselves yet. Instead we are going to take a look at the range of psychiatric disorders that have dissociative symptoms in them. Ā
Note Iāve garnered these simply by CTRL+F and searching forĀ ādissociationā and ādissociativeā in the DSM 5 instead of going and reading the whole book. (Iām skipping the Dissociative Disorder Section for obvs reasons)
Post Traumatic Stress Disorder
Conversion Disorder (Functional Neurological Symptom Disorder)
(Quite a few drug and substance abuse/addiction disorders)
Borderline Personality Disorder
And while not specifically mentioned in the DSM these also can have dissociative symptoms:
Bipolar Disorder (any non unipolar included)
Major Depressive Disorder (and any unipolar included)
Obsessive Compulsive Disorder
Obsessive Compulsive Personality Disorder
Basically all anxiety disorders
Pretty much all eating disorders
Insomnia and other sleep disorders
Neurological and non-psychiatric diseases that dissociation is a cognitive symptom of:
Amyotropic Lateral Sclerosis
Neuroborreliosis (Lyme disease)
Epilepsy (especially Temporal Lobe Epilepsy)
Other things that can cause dissociation:
Migraines or really bad headaches
tricyclic antidepressiants
being really sick or malnourished
intoxication (legal/illegal drugs and alcohol)
withdrawal from addiction
military training geared on suppressing empathy to make it easier to kill other people
As you can see, there are a lot of things can cause feelings of dissociation! And itās very much not limited to just psychiatric issues either. Seriously, you can zone out and be dissociating for no reason and so long as itās not chronic, itās healthy and normal. For the most part people will experience them in situations of stress or sleep deprivation.
Now that we have those out of the way I think we are ready to jump into Dissociative Disorders themselves. As of the DSM 5 (published May of 2013) there are three main types (and oneĀ āother specified DDā and oneĀ āUnspecified DDā)
Dissociative Identity Disorder (formally known as Multiple Personality Disorder) is probably the one everybody knows about. It is the subject of many stories and film, especially horror.Ā
It is the most severe and long lasting of all the types of DDās and is hallmarked by the presence of two or more distinctive identities orĀ āpersonality statesā and often take control of an individual (generally called the host) which often causes an inability to recall personal information that can not be defined by justĀ āforgetfulnessā.
Generally there are an average of 2-4 alters orĀ āheadmatesā but itās also common to see 13-15 different alters emerge over time especially during the course of treatment. Most of the time the host is not aware of these alters, and if they are itās VERY VERY rare for hem to be aware of all of them.Ā
Alters split from the core identity generally in responce to extreme trauma (starting under the age of⦠6 I believe. itās nearly impossible to start splitting older than that if youāve never done so before). Various alters may take control of the host during different situations as most were formed for particular situations. In DID, itās common to have alters of various ages, genders, sexualities, and even⦠degrees of helpfulness. Infact often there are alters that are actually very harmful to the host as they may be reckless, purposely hurt themselves, be abusive to others, etc.Ā
Because of the vary conversational nature of DID and not helped by its extreme rareness⦠this isnāt much known on this disorder. Much of what is heard or known is either incorrect or blatant lies. And⦠unfortunately itās a very⦠popular illness to fake or roleplay for fun or attention especially on the internet. *squints angrily at tumblr*Ā
Dissociative Amnesia actually used to be two different disorders but was combined in the DSM 5! But anyways, DA is an inability to recall important information about yourself caused by trauma or stress. It is unlike normal forgetfulness due to itās chronic or severe nature, such asā¦. forgetting people you know or your name. This amnesia can NOT be caused by a substance, head injury, or a different psychiatric disorder such as PTSD or a neurocognative disorder.Ā
DA can last for several days or several years. It is classified by four categories:
Localised amnesia ā for a time, the person has no memory of the traumatic event at all. For example, following an assault, a person with localised amnesia may not recall any details for a few days.
Selective amnesia ā the person has patchy or incomplete memories of the traumatic event.
Generalised amnesia ā the person has trouble remembering the details of their entire life.
Systematised amnesia ā the person may have a very particular and specific memory loss; for example, they may have no recollection of one relative.
As of the DSM 5, what was formally known as Dissociative Fugue (or psychogentic fugue) is now a subtype of DA. A fugue state is when a person suddenly does not know who they are or have any memory of their past. Generally they have no idea they are having a loss of memory and will invent a new persona. One of the hallmarks of a fugue state is purposeful travel. Somebody with DF may travel long distances from home, thousands of miles even, and the fugue state may last hours or months. When somebody comes out of a DF state they generally have no memory of the new identity they had made for themselves and had been using.Ā
Depersonalization/Derealization Disorder used to be two different disorders but was also recently classed together in the DSM 5 due to their similarity and the fact they were often comorbid. Basically this is just really chronic depressionalization and/or derealization.Ā
Uh, there probably is still more I could say but I am really tired of typing the word dissociation and I totally forgot where I was going with this.Ā
Of course, please note that I am very much not an expert in dissociative disorders and itās something Iāve not read a lot of literature on so I could be wrong on a lot of things.
So⦠if you have any specific questions, Iāll be happy to elaborate.Ā
āāāāāāāāāĀ
Thank you for that Devin that was amazing and a really good rundown of what disassociation is.I disassociate when my gender dysphoria is really bad. My ptsd can also trigger it. Iām also open to any questions about it - Adrienne