Mild dissociation is normal. It allows us to separate mind and body, without it we would be unable to experience ‘being in’ a book or a film for example, imagination or visualising ourselves doing something that is not actually happening in reality. It is also part of the mechanism by which we remember experiences. Mild separation of mind and body is a defence that helps us cope with everyday stress when we may focus on something else whilst ‘denying’ that something stressful is going on. At times of great stress or one off trauma (such as a train crash) our brains switch to the ‘flight/fight’ response and severe dissociation is normal. It’s not unusual to hear how people got themselves safe by imagining a different scenario or hearing sounds, like music or talking, that didn’t occur (auditory hallucinations) but were useful during the trauma.
When there has been a history of prolonged trauma in childhood, especially when there has been child sexual abuse ‘flight/fight’ and the dissociative defence is over used. Over time permanent changes in brain chemistry mean the Flight/Fight response can become ‘hard wired’ so the individual responds to normal everyday experiences by dissociating. Survivors call it ‘numbing’, ‘zoning out’, ‘checking out,’ 'disappearing' and so on. Most Survivors don’t notice until they grow up or get safe but they may have often been told they live in a ‘dream world’ or ‘on another planet’.
Survivors who experience dissociative distress usually meet the diagnostic criteria for Post-Traumatic Stress Disorder (PTSD). They are likely to experience flashbacks or aberrations (re-experiencing the trauma repeatedly) which causes extreme distress triggering dissociation.
There is a spectrum from normal to severe disassociation, Post Traumatic Stress Disorder (PTSD) manifests towards the extreme end followed by complex PTSD, DDNOS and Dissociative Identity Disorder at the extreme end of the spectrum.
There are five aspects to disassociation.......
It’s not unusual to forget every day stuff like where I put the keys, a birthday, or anniversary-who hasn’t experienced ‘highway hypnosis,’ missed their turning or had no idea how they got somewhere. Mild amnesia is a normal response to stress, which protects us from being overwhelmed. When dissociative amnesia is induced by trauma it becomes more sinister as the memories remain not only unprocessed but associated with ‘fear’. Unfortunately the concept of ‘time’ is a cortex function, not only is a dissociated person unable to keep track of time but when re-sufficing memories flashbacks seem endless. State dependant learning (I can only do x when I’m in the mood) plays a major role in memory retrieval so what is stored in a particular state can only be retrieved in the same state- this is how triggers and flashbacks work. Sometimes current trauma cannot be processed due to dormant trauma, which is likely to be triggered at times of personal stress and public trauma such as 9/11 or the Jimmy Savile Enquiry. As traumatic memories are not accessible in normal functioning Survivors ‘forget’ they were abused.
Severe Amnesia becomes a disorder when someone can’t remember important personal information, such as their name or where they live. They may experience a ‘Fugue State’ where someone travels to a new location during a temporary loss of identity and may assume a different identity and a new life. For Multiples this happens when an alter has taken executive control of the body and is unlikely to be as dramatic as creating a new life.
At times of high stress it is not uncommon to feel detached from oneself, indeed as counsellors there are times the ability to observe self is a distinct advantage. Detaching from emotion is a great way to control anxiety and perform under stress. Being in ‘two minds’, role play, observing, aspects of grief and acting are all aspects of depersonalisation. When this is deliberate or spontaneous but rare, brief and associated with stress, illness or danger depersonalisation is normal. However, when the ‘sense of self’ is disturbed, splitting off feelings, emotions and/or the body (as in depression when sufferers describe ‘watching themselves from a distance’) depersonalisation can interfere with function.
Severe Depersonalisation becomes a disorder when not feeling ‘like myself today’ escalates to a feeling that the body is unreal, changing or dissolving. This includes out-of-body experiences, such as seeing yourself as if watching a movie which is often a feature of depression.
Commonly occurs with depersonalisation and is induced by the same stress. In a derealised state the individual feels weird, with derealisation the environment and those around them feel unreal. Probably the most common form of this is when meeting someone you know you know but you just can’t remember who they are. Until you can put a name to the face it feels weird because intellectually you know you know this person but you can’t connect the emotional memory so you don’t know how you feel about them. Derealisation is a loss of emotional awareness towards a person, place or thing previously invested with it- a coping mechanism brought on by danger, stress, tiredness, hypnosis, drugs or alcohol.
Severe Derealisation episodes are often accompanied by a 'buzzing', or 'white noise' as the perception of other people or things change, colours intensify or dull, solid things become flexible, once inoffensive objects trigger traumatic memories and take on a life of their own changing size and shape. When this is severe and long lasting as it may be for Survivors, abusers or someone who reminds them of their abuser may be seen as an ‘alien’ or an impostor. Familiar places suddenly don’t feel ‘right’ and there is a split between intellectual understanding and reality. Everything seams surreal and as the Survivor struggles to integrate now and ago time they think they’ve gone mad.
It is quite normal to accidentally take the ‘mother’ persona to work, the ‘work’ persona home, the ‘counsellor’ persona out with friends or forget to take the ‘lover’ to bed. Our society is obsessed with roles and how people are expected to behave.
Severe Identity Confusion leads to feeling as if there is an internal struggle to define self. the brain forms our identity from previous experiences, if there are big holes in it due to dissociative amnesia Survivors struggle with their identity. When many roles put on them or they are expected to form multiple-attachments, such as when they are taken in to care, they may become predisposed to DID. Sexual confusion is common among Survivors who sometimes decide that if they were not the sex they were abuse would not have happened. Both promiscuity and frigidity are long term effects of CSA as survivors try to work out what sex they are.
This is when there is a shift in your role or identity that changes your behaviour in ways that others could notice. For instance, you may be very different at work from when you are at home. In its mildest form is similar to identity confusion but the individual actually switches roles. In the moderate form people may behave as if they were two or more people usually when stressed or under the influence of drugs or alcohol. The normally mild individual starts fights or the usually flamboyant life and sole type become shy and withdrawn. These are usually ‘fragments’ of the personality normally repressed, not wholly developed alters. Once again state-dependant learning and memory is a factor.
Severe Identity Alteration is when a systems of alters who have a separate identity from the presenting person (CEA) have executive control of the body known as being 'out.'
What are the Dissociative Disorders?
Dissociative disorders occur when people have persistent and repeated episodes of dissociation. These usually cause distressing internal chaos and may interfere with work, school, social, or home life.
This features strong feelings that you are detached from your body, or that your body is unreal.
An inability to remember significant personal information or particular periods of time, which can’t be explained by ordinary forgetfulness.
When a person takes on a new identity. They may ‘wake up’ in another town with another name and have no recollection of who they were before.
Dissociative Disorder Not Otherwise Specified (DDNOS)
In DDNOS, each of the five types of dissociation may occur, but the pattern of mix and severity does not fit any of the other dissociative disorders.
Dissociative Identity Disorder (DID/MPD) or Multiplicity
This is the most complex dissociative disorder formerly known as multiple personality disorder (MPD). This has given rise to the idea that this is a personality disorder, although there's actually only one personality and it is usually extremely organised. Its defining feature is severe identity alteration known as 'alters,' when there is more than one they are known as a 'system.' Alters may take the executive power over the body and while each has a distinctive age appropriate pattern of thinking and relating to the world the underlying character traits don’t change. Severe amnesia means that one identity may have no awareness of what happens when another identify is in control. Identity confusion is usually moderate to severe. It also includes severe depersonalisation and derealisation.
DID is a bit of a mouthful so at I et al where we specialise in working with systems they have chosen to be known as 'Multiples' and refer to people not DID as 'singletons.'
What Are the Effects of Dissociative Disorders?
People with dissociative disorders may be troubled by other problems at the same time. These may include depression, mood swings, anxiety and panic attacks, suicidal tendencies, self-harm, headaches, hearing voices, sleep disorders, phobias, alcohol and drug abuse, eating disorders and obsessive-compulsive behaviour which may be directly connected to dissociation.
The effects of dissociative disorder may include:
Gaps in memory finding yourself in a strange place without knowing how you got there
loss of feeling in parts of your body
distorted views of your body
forgetting important personal information
inability to recognise your image in a mirror
a sense of detachment from your emotions
the impression of watching yourself
feelings of being unreal
internal voices and dialogue
feeling detached from the world
feeling that a customary environment is unfamiliar
a sense that what is happening is unreal
forgetting a learned talent or skill
a sense that people you know are strangers
a perception of objects changing shape, colour or size
feeling you don’t know who you are
acting like different people, including child-like behaviour
being unsure of the boundaries between yourself and others
feeling like a stranger to yourself
being confused about your sexuality or gender
feeling like there are different people inside you
referring to yourself as ‘we’
being told by others that you have behaved out of character
finding items in your possession that you don’t remember buying or receiving
writing in different handwriting
having knowledge of a subject you don’t recall studying
This list is NOT exhaustive
Dissociative amnesia is extreme, not only can multiples not recall traumatic events they are unable to stay in ‘now time’ as they switch between different states known as ‘alters’ – since the internal clock is in the hippocampus, which is switched off, multiples can’t tell the time. Alters are sometimes associated with a particular ‘forgotten’ event (Age fixing event) so they may remain fixated at the age they were at the time of the trauma. Consequently the individual exists as a ‘system’ made up of a number of alters of varying ages and indeed sex.
Next we explain trauma bonding, the essential building block for dissociative disorders.