Often during addiction treatment, guests will face many emotions and thoughts that they haven’t in years. One of the greatest gifts of sobriety is your clarity of mind, but being lucid can also feel like a curse if you are overwhelmed with facing the repressed feelings that are resurfacing now that you’re sober. One defense mechanism or reaction you may have is called dissociation. This is a state that can be triggered, or result from conversations that are emotionally straining. Today we’re going to explore dissociation, dissociative states, dissociative disorder, and depersonalization.
What is Dissociation?
Dissociation is a state that causes a lack of connection to a person’s thoughts, memory, sense of identity and mental process. A dissociative state is marked by “losing touch” with awareness of your immediate surroundings.
Dissociation is often associated with childhood trauma, and are closely linked; “Among people with dissociative identity disorder in the United States, Canada and Europe, about 90 percent had been the victims of childhood abuse and neglect” (Wang). Dissociation is also extremely common for trauma survivors who have post-traumatic stress disorder (PTSD), these survivors can often develop a dissociative disorder as a form of coping.
How Common is Dissociation?
Dissociation is fairly common, as there are varying severities of a dissociative state. Daydreaming is a mild state of dissociation, while there is a more apparent dissociative state that is marked by episodes where the affected undergo a complete loss of touch with reality. Almost a third of people describe experiencing dissociation, although only 4% of those people describe being in that state at any significant frequency. According to Mental Health America, 7% of the population has suffered from a dissociative disorder at some point in time (“Dissociation and Dissociative Disorders”). Dissociation is extremely common among people who have experienced some type of trauma, including: physical, emotional or sexual abuse, war, extreme violence, natural disasters, and childhood trauma.
What Does Dissociation Effect?
Dissociation disrupts four major areas of functioning, including:
- sense of self/ identity
- awareness of self and surroundings
Dissociative disorders can be more specific than just entering a dissociative state frequently. Dissociative disorders involve issues with memory, perception, emotion, behavior and sense of self. There are a few types of dissociative disorders that a person can suffer from. Some dissociative disorders include:
- dissociative amnesia
- dissociative identity disorder (formerly known as multiple personality disorder)
- depersonalization/ derealization disorder
Dissociative amnesia can be experienced in two subtypes, including psychogenic amnesia and psychogenic fugue. Psychogenic amnesia is “the inability to recall personally significant memories” (“Dissociation and Dissociative Disorders”). Psychogenic fugue is the “memory loss characteristic of amnesia, loss of one’s identity, and fleeing from one’s home environment” (“Dissociation and Dissociative Disorders”).
“the person has two or more distinct personalities that alternate with one another”(“Dissociation and Dissociative Disorders”). “The Sidran Institute notes that a person with dissociative identity disorder ‘feels as if she has within her two or more entities, each with its own way of thinking and remembering about herself and her life. It is important to keep in mind that although these alternate states may feel or appear to be very different, they are all manifestations of a single, whole person’ ” (Wang).
“Depersonalization – experiences of unreality or detachment from one’s mind, self or body. People may feel as if they are outside their bodies and watching events happening to them.
Derealization – experiences of unreality or detachment from one’s surroundings. People may feel as if things and people in the world around them are not real” (Wang).
Why Does Dissociation Happen?
Dissociation is usually a trauma-response, which can be a mental, emotional or physical response after exposure to a person, place, or thing that is reminiscent of the trauma that was experienced. Dissociation is a coping skill for trauma survivors, it allows the person to continue functioning at a moment of severe traumatization. Situations that are threatening or non-threatening, directly related or seemingly unrelated to the original trauma, can trigger a dissociative state all the same. Dissociation can occur during or after a traumatic event. Dissociation happens usually as an automatic response, and is typically a state entered subconsciously or in other words the person enters a dissociative state without their knowledge. Dissociation happens usually without planning or awareness.
Some things that can cause dissociation include:
- traumatic events
- triggering events
- difficult relationships
Signs and Symptoms
Dissociation can cause changes in bodily sensations and cause an inability to react emotionally. Usually dissociation marks a feeling of disconnection between you and your own body.
Some common signs and symptoms of being in a dissociate state can be:
- spacing out
- glazed, blank look/ staring
- mind going blank
- mind wandering
- a sense of the world not being real
- watching yourself from seemingly outside of your body
- detachment from self or identity
- out of body experience
- disconnection from your surroundings
- lack of sensation
- flat affect, monotone voice
- 5 Senses
- Focused sight
- Ice cubes
- Behavioral Therapies
- post-traumatic stress disorder
- obsessive-compulsive disorder
- phobic disorder
The duration of these symptoms can represent the difference between a dissociative episode and a dissociative disorder. Experiencing these symptoms could be fleeting, recurrent, or even constant.
How Can I Get Out of a Dissociative State?
There are a few exercises and targeted therapies that help people come out of dissociative states.
Here are some examples of exercises that will help bring someone out of a dissociative state:
If someone is in a dissociative state, ask them to describe what each of their senses are experiencing. For example, what can you hear right now? What can you feel around you? What can you see? What can you smell right now? What can you taste?
There are many ways to practice grounding exercises. Some grounding exercises that we find most helpful include giving the person in a dissociative state something to taste or feel. Ways you can do this is by giving them a candy and asking them to describe the taste and sensation. Another way to do this is put an object in their hands and ask them to describe the way it feels.
Focused sight techniques include asking the person in a dissociative state to look at something in the room and focus on it. Ask them to describe everything about it, ask them questions about it to try and bring their attention back to the present moment.
Have the person in a dissociative state hold ice cubes (or a frozen apple, orange, or frozen bag of vegetables, etc) in their hands. The cold temperature will bring them back to the moment by causing an unavoidable sensation in the present moment.
Targeted Therapies for Dissociation
Some targeted therapies can be extremely helpful in treating dissociation or dissociative disorders. Practicing targeted therapies over a period of time can also help people learn how to overcome dissociative states long term.
These targeted therapies include:
EMDR is eye movement desensitization and reprocessing therapy. It “was originally designed to alleviate the distress associated with traumatic memories” (Shapiro). The goal of EMDR therapy is to explore the trauma or adverse life experiences to bring about an adaptive resolution. Therapists will usually use hand movements to create eye movement in the guest, keeping them relatively in-tune with the present moment. EMDR can also use hand-tapping and audio stimulation.
Studies of EMDR show its effectiveness in guests with a trauma history, “Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions” (Shapiro).
Talk therapy, to uncover traumas and process through them with a therapist. Psychotherapy is a wide umbrella term for many different talk therapies. Psychotherapy is usually done in a one-on-one setting, but results can also be achieved in a group setting.
Behavioral therapy is a subcategory of psychotherapy. Cognitive behavioral therapy and dialectical behavioral therapy are the two most effective behavioral therapies to treat dissociation.
Other Disorders that can Involve Dissociation
Many people who experience dissociation or depersonalization have a co-occuring disorder or condition. Some kinds of dissociation can occur alongside the following conditions:
When it comes to dissociation and dissociative disorders, a criticism lies in the medical community surrounding many mis-diagnosis. If you can relate to anything you’ve read in this article, we think it’s best to seek a medical professional who specializes in dissociative disorders and/or trauma, to get an accurate diagnosis. At Royal Life Centers, upon your arrival to our facilities, guests will undergo an assessment and evaluation to uncover any co-occuring disorders— to develop the most effective course of treatment. Our assessments and evaluations include assessing guests for dissociative tendencies and dissociative disorders. A comprehensive addiction treatment program like ours will provide intensive therapies to work through any unresolved emotions and events that could be contributing to a tendency to dissociate. Our treatment programs focus on wellness of the mind, body, and spirit for a full recovery experience.
If you or someone you know is struggling with an addiction, please reach out to our addiction specialists at (877)-RECOVERY or (877)-732-6837. Our team of addiction specialists make themselves available 24 hours a day, 7 days a week, to provide guidance and support. Because We Care.
“Dissociation and Dissociative Disorders.” Mental Health America, Mental Health America, 14 Oct. 2013, www.mentalhealthamerica.net/conditions/dissociation-and-dissociative-disorders
Shapiro , Francine. “What Is EMDR?” EMDR Institute , EMDR Institute, Inc., www.emdr.com/what-is-emdr/
Wang, Philip. “What Are Dissociative Disorders?” What Are Dissociative Disorders?, American Psychiatric Association (APA), Aug. 2018, www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders
Washington University. “Dissociation Information.” WA State CBT, Washington University, 2012, depts.washington.edu/hcsats/PDF/TF-%20CBT/pages/7%20Trauma%20Focused%20CBT/Dissociation-Information.pdf