What is dissociation?
Often, when I work with a new client who is considering EMDR in their healing journey, I assess them for dissociation during our first couple of sessions. While some people are familiar with the term, some are not, and many are curious to learn more.
So, first, what exactly is dissociation? I have seen it mixed up sometimes in the general pop psychology world. People may refer to it as dis-association, reporting that it is a behavior used when they just want to disconnect from the world. However, the proper psychological term is dissociation, and it can be defined as a mental process that involves a disconnection from thoughts, feelings, memories, self, the present moment, or even our identity.
There are various ways that one may experience dissociation, and it can be helpful to explore which aspects of dissociation you experience the most before engaging in further trauma therapy.
Absorption
The most common form of dissociation I see in my work with clients is absorption. Clients experiencing the absorption level of dissociation may notice symptoms such as listening to someone talk and then realizing they have no clue what was just said or becoming so absorbed in a TV show or movie that they may not understand what is happening around them. Sometimes, I even call this aspect of dissociation “comfy eyes,” as your eyes can seem almost like they get stuck staring at a particular area, and your mind may go blank.
2. Depersonalization/Derealization or DP/DR
DP/DR is a separate diagnosis in the DSM-5 and can be assigned to individuals who persistently experience feelings of detachment, either bodily or cognitively, from themselves or their environment. While it can occur solely as a diagnosis, depersonalization, and derealization can also appear briefly in response to trauma, anxiety, specific drugs, or medications.
Depersonalization occurs when someone feels a general detachment from emotions, body, and self. They could experience specific symptoms such as not recognizing themselves in the mirror, feeling like a spectator of their life, or feeling above or outside of their body.
Derealization occurs when someone feels detached from their surroundings and may feel that life in general is “not real.” Environments or people they once knew may feel unreal or unfamiliar.
3. Amnesia
Dissociative amnesia is another DSM-5-specified dissociative disorder. Amnesia involves the inability to remember important life events, information, or experiences that would not be typically lost with normal forgetting. For example, someone experiencing amnesia may show up in a place and have no recollection of how they got there, or they may notice large chunks of time that they cannot recall. Again, like DP/DR, amnesia can be diagnosed or just experienced as aspects of ones experience.
4. Fantasy-prone
Fantasy-prone dissociative behaviors can occur when someone engages deeply and long-term with fantasy and imagery. It is often common for children to create and engage with fantasy worlds of imagery in their minds. While fantasy can be helpful in creative pursuits, it can also lead to maladaptive coping if one begins to use fantasy as escapism from reality in a harmful or disruptive way that disrupts further healing and emotional development.
5. Influence of Ego-states
Ego-states can be indicated when childhood trauma disrupts the natural process of personality integration. Infants operate based on a loose collection of different “parts” that handle their various needs, such as exploration, attachment, and feeding. Without the occurrence of early childhood trauma, these states integrate naturally into one whole personality by around ages 6-9. However, if a child has experienced abuse, neglect, or any other traumas, this process can be disrupted. These various states of self are left unable to merge due to the focus on survival of trauma.
Why do I dissociate?
Dissociation is your brain's built-in coping mechanism for managing stress, boredom, trauma, etc. When things become “too much” for your internal system to take in (which can be a different level of tolerance for each of us), dissociation can act as a mental “eject” button that can sort of distance us mentally and in other cases even physically from the experience. Dissociation can also occur due to certain medications, alcohol use, and everyday activities such as getting lost in a book or zoning out while driving.
Why is it essential that I get assessed for dissociation before engaging in trauma reprocessing?
Jumping into trauma reprocessing without an understanding of your own level of dissociation can cause emotional flooding and overwhelm and generally make the process more distressing than it may need to be. Dissociative barriers in our brains are there for a reason: they often keep strong emotions out of our direct awareness so we can cope and continue with daily living. When engaging in trauma reprocessing, dissociative barriers can come down, leaving you with feelings, memories, or thoughts that may be stronger than what you had initially anticipated. It is vital to know, going into trauma work, what levels of dissociation you may experience so there can be resourcing, a plan, and coping skills set up before throwing you right into all of those uncomfortable feelings. I promise, with this work, going slower is faster! We do not want to retraumatize your system by moving too quickly.
What is the DES? And can I be diagnosed with a dissociative disorder if I score highly on the DES?
The DES (Dissociative Experiences Scale) is a screening tool that I, and other trauma practitioners, may use to assess and open up a conversation about how you experience dissociative symptoms. It can give us helpful information about how you may experience dissociation but does not allow me or another provider to make a definitive diagnosis. For example, a client scores highly on the DES. All this is telling me is that we may need to pump the brakes per se on jumping right into trauma reprocessing and spend some time assessing dissociative symptoms further, building more resources and coping skills, and maybe engaging in further ego-state or “parts work” before continuing with EMDR.
A diagnosis of a dissociative disorder can take time as symptoms need to be thoroughly assessed, and other outstanding factors, such as current trauma, substance use, other mental health disorders, medication side effects, etc, are ruled out. Additionally, a strong therapeutic relationship, while always crucial in trauma work, may also need to be present before the full range of symptoms show up in session.
I hope this blog was helpful in building your understanding of dissociation! Please feel free to reach out with any further questions, or to schedule a consultation use my contact page here.
