A Brief Introduction to Dissociation
“It is by no means certain that our individual personality is the single inhabitant of these our corporeal frames…We all do things both awake and asleep which surprise us. Perhaps we have co-tenants in this house we live in.” ~ Oliver Wendell Holmes
There are few constructs in psychology that are as misunderstood as those relating to dissociation. There are times when many of us have experienced the sensation of being away from ourselves – so engaged in a book or movie that we lose track of time, or driving somewhere and having no memory of the journey. This is a very basic understanding of the concept however does explain the basic element of removal from self that underlies an awareness of dissociation. In a therapeutic sense, dissociation is a common defence or reaction to a traumatic situation (Steinberg, 2008). It is a natural bodily response to life threatening situations or trauma.
When faced with a threat and the inability to protect ourselves, the nervous system automatically switches into dissociative mode. It is a mechanism that allows the mind to separate or compartmentalise certain memories or thoughts from normal consciousness. These memories are not erased but rather buried and may resurface at a later time.
A dissociative disorder involves a disturbance of “the normally integrated mental processes involved in memory, consciousness, identify and perception” (Ottmanns & Emery, 2010, p196). It is more pervasive than a mere lapse in attention, as when daydreaming. Haddock (2001) describes this as dysfunctional dissociation and it is active when “an individual is not aware of or able to control [their] dissociative responses; the responses occur in inappropriate situations and the intensity and duration of the dissociation is disruptive to [the person’s] life” (p2).
Dissociative disorders are now acknowledged as fairly common effects of severe trauma in early childhood, most typically extreme and repeated physical, emotional and sexual abuse. Personal identity is still developing during childhood so a child is more adept at stepping outside themselves or dissociate from what is happening. Children that learn to dissociate early in life and on a continual basis may utilise this coping mechanism in response to other stressful situations in their life whilst adults may develop dissociative disorders in response to severe trauma such as the experience of war, natural disasters, kidnapping, torture and invasive medical procedures (Mayo, 2009).
The Diagnostic and Statistical Manual of Mental Disorders IV (American Psychiatric Association, 2000) identifies four (4) categories of dissociative disorders and one for atypical dissociative disorders – dissociative amnesia (DA), dissociative identity disorder (DID), dissociative fugue, depersonalisation disorder and dissociative disorder not otherwise specified (DDNOS).
a) Dissociative amnesia (DA) is characterised by an inability to recall personal information that is more extensive than simple forgetfulness. The loss cannot be attributed to substance abuse, head trauma or cognitive disorders such as Alzheimer’s.
b) Dissociative identity disorder (DID) formally known as multiple personality disorder, is characterised by the existence of two or more distinct identities, with at least two of these identities taking control over the person’s behaviour. There is some degree of amnesia between identity states with the original identity unlikely to have any recollection of subsequent identities.
c) Dissociative fugue is characterised by the sudden and unexpected travel away from home associated with an inability to recall previous identity.
d) Depersonalisation disorder is a recurrent sensation of being detached from self – being ‘in a dream’.
e) Dissociative disorder not otherwise specified (DDNOS) is an inclusive category for classifying dissociative symptoms that do not meet the criteria of the other four dissociative disorders.
Historically, dissociative disorders where classified as forms of hysteria, more prevalent in women then men. Sigmund Freud regarded dissociation to be a normal means through which the ego defended itself against unacceptable unconscious thoughts – an expression of unconscious conflict. Pierre Janet, one of Freud’s contemporaries, had differing thoughts and considered dissociation as abnormal – detachment from conscious awareness occurred only as a part of psychopathology (Oltmanns & Emery, 2010).
The two continually criticised each other with Freud believing that Janet underestimated the power of the unconscious, whilst conversely Janet thought Freud placed too much emphasis on the unconscious. Freud’s view remained quite prevalent throughout much of the twentieth century. Only now in the twenty-first century are Janet’s concepts remerging. It is this continuing uncertainty pertaining to what constitutes dissociation that breeds reluctance among mental health professionals to offer a complete diagnosis.
Two risk factors have been identified as putting individuals at a higher risk of developing dissociative disorders. The first is a person’s hypnotisability – as children the ability to be hypnotised is quite high, and starts to decrease around the age of ten. People who are more easily hypnotised and therefore more easily able to dissociate, may be at a higher risk of developing a dissociative disorder.
Secondly (as previously indicated) the existence of significant trauma or stress increases the chance of the natural defence mechanism of dissociation to enable itself. The interplay of the two factors is significant – if an easily hypnotised individual experiences a severe trauma then they may find it easier to dissociate and move away from self as a means of coping (University of Western Australia, n.d.).
For many years treatment of dissociative disorders has focused on uncovering the trauma and recounting it, with psychotherapy as the primary treatment option. As with any mental health concern, a blanket approach can not be offered nor deemed appropriate. The same can be said for dissociative disorders – each concern must be dealt with on an individual basis centred on the client’s presentation. The following information has been adapted from the Mayo Clinic and provides an overview of popular treatment alternatives.
a) Creative art therapy – this includes art, dance/movement, drama, music and writing. The concepts associated with art therapy allow clients to tap into the creative side of self in order to assimilate self and experience.
b) Cognitive therapy – involves identifying negative, unhealthy beliefs and behaviours and replacing them with healthy positive ones. Therapy, particularly in the case of dissociative identity disorder, is long term.
c) Medication – there are no medications specifically for the treatment of dissociative disorders though a medical practitioner may provide a prescription to treat symptoms relating to the disorder (such as antidepressants for depression-related symptoms).
The true prevalence of dissociative disorders is difficult to establish, with symptoms often well hidden. There is also a degree of sensationalism associated with dissociative disorders. The media has added further to the practice by only emphasising the most shocking and lurid details.
Dissociation is still considered quite a rare occurrence, although many individuals will often go undiagnosed or misdiagnosed for many years, thus delaying effective treatment. It is vital as practitioners, that acknowledgement is given to the existence of dissociation whilst remaining vigilant to the impact diagnosis can have on a client’s experience.
By Anda Davies, CertVI WPTA, DipProfCouns, BSSc, MA
References:
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (4th ed.). Washington, USA: American Psychiatric Association.
- Haddock, D. (2001). The dissociative identity disorder sourcebook. USA: McGraw-Hill.
- Mayo Clinic. (2009). Dissociative disorders. Retrieved October 22, 2009, from http://www.mayoclinic.com/health/dissociative-disorders/DS00574.
- Oltmanns, T., and Emery, R., E. (2010). Abnormal psychology. (6th ed.). Upper Saddle River, New Jersey: Prentice Hall.
- Steinberg, M. (2008). In-depth: Understanding dissociative disorders. Retrieved October 22, 2009, from http://pstchcentral.com/lib/soo8/in-depth-understanding-dissociative-disorders/all/1/.
- University of Western Australia (UWA). (n.d.). Dissociative disorders: Amnesia, fugue, depersonalisation and dissociative identity disorder. Retrieved October 22, 2009, from http://psychology.uwa.edu.au/_data/page/31721/Dissociative.pdf.
