Introduction - Understanding Dissociation

Normal Dissociation

Dissociation is a normal capacity all human beings have. In its most basic definition, dissociation is an alteration in an individual’s conscious awareness. Conscious awareness refers to the ability to experience thought, feeling, physical sensation, behavioral action and memory as an integrated whole. In other words, you can create a narrative of an event with all of those aspects from your memory. We have all experienced dissociation in mild forms and those forms might enable us to relax a certain way, focus a certain way or respond to stress and traumatic events a certain way. Let’s consider a few of these normal dissociative responses.

Relaxation or Play

You have probably seen someone who is relaxed, reading a book and appears to be completely immersed in that book. They do not hear the kitchen timer go off, signaling dinner is ready. They do not hear you call them to dinner. They are not fully attuned to their present environment. Their attention is narrowly focused on the intricacies of what they are reading. You have also probably seen a child playing a video game at the local store, completely unaware of the passersby, unaware that three other children stand behind them watching, unaware of the sounds of a child crying one aisle over and quite unaware their mother has been calling them to leave the store. Nothing is in present focus except for the elements of the video game. Our young friend has dissociated certain elements of their conscious awareness and their ability to interact with their environment. The dissociative response is both normal and healthy.

Stress

Let's assume John and Sue are hosting a wedding party. The task list is long. The duties are varied and time is running away faster than the duties can be performed. Both are scarcely aware of the other's presence as they execute their tasks in an automatic, almost robotic level of functioning. Emotions are not present, just movement and functioning. John is so focused on getting the indoor grill prepared, he is sure he didn't hear Sue ask him to watch the water in the pot on the stove. He similarly didn't see the pot boil over or respond to the issue until the smell of burned vegetables permeated the air. Even though Sue heard John tell her he would watch the pot, John didn't remember being asked the question at all. John's connection to his environment was incomplete. He had dissociated certain elements of his conscious awareness. So had Sue. For either one, their dissociative response to stress is a healthy psychological adaptation for the present stress they are facing.

Traumatic Stress

Don and his son are traveling down the highway on their way to the ballgame. As Don starts to go through the green light, he barely hears the screech of tires on the pavement as a car running a red light hits his car in the intersection. For Don, the seconds it took for the other car to reach his were long, almost feeling as if time was suspended and things were moving in slow motion. When his car came to a stopping point, he was disoriented, injured and immediately reached for his son. He remembered smelling smoke from the engine and felt his actions to release his son's seatbelt were slow. He felt he couldn't move fast enough. The next thing he remembers, he is on the side of the road, holding his son. He doesn't know how he got there or how his son got there. Sounds are muffled. Things seemed blurred, out of focus, still slow moving. He asked his son how they got to the side of the road. His son said "Dad, you ran with me, you carried me running away from the car. Don't you remember?" Dissociation enabled Don to intensify his state of physical response while segregating or compartmentalizing the emotions that might have hindered his responsiveness or ability to assist himself and his son. Don remembered some aspects of what his son was referring to, but not all aspects and not until much later. Don's conscious awareness of his surroundings, his sense of time, his behavioral actions, his emotions and his memory have all been altered, disconnected from one another. Under normal, non-traumatic circumstances, Don would have full awareness of his physical presence, his thoughts, his behavior, his actions and his memory. All of those things that make up our normal state of conscious awareness would be linked in the present moment. He completely remembered driving down the highway before the accident, the joke he and his son were sharing and the scenery that was before him. He was completely, consciously aware of those moments, but was at a loss for the traumatic moments.

Three weeks later, in the grocery parking lot, Don hears the screech of tires on the pavement. He hears the sound of crunching metal, physically feels the spin of a car, sees all of the scenes from his accident three weeks earlier in a span of seconds but there is no accident today, only the sound of screeching tires triggered his memory as if it were being re-lived today. His flashback of three weeks ago fell forward into his today without warning and its full physical, mental and emotional response from three weeks earlier was just as present today even though it was not real today in the grocery store parking lot. His flashback was a response to the trigger, the sound of screeching tires. His flashback is also a dissociative response to his traumatic encounter earlier.

Dissociation can present one or more adaptations to a traumatic incident like a car accident:

• Sense of separation from one's body; physical numbing
• Sense of separation from one's self; emotional numbing
• Sense of something feeling unreal; disconnected yet connected;
• Sense of hypervigilance, a hyper-aroused state of being;
• Altered perception of the environment; being connected to the environment;
• Altered perception of time or the passage of time;
• Altered sense of response such as "auto-pilot or robotic";
• Experiencing a memory from the past as if it were being relived in the present moment.

Any one of these adaptations are normal human responses to overwhelming trauma that cannot be processed cohesively. Consciousness is segregated or disconnected in service of self or another in order to master or survive the present circumstance. The example of Don's car accident is something you may identify with. As a nation and as individuals, we also identify with the Post Traumatic Stress Disorder (PTSD) our combat troops serving our country face in healing from the tragedy of war, having witnessed devastation in both civilian and military venues.

The Role of Repetition

If we add an element of repetition to an overwhelming exposure to trauma, the results begin to take on a different light. Thankfully, Don doesn’t experience a car accident every day. In our society, however, there are children of all ages who suffer traumatic abuse. Their abuse may be physical, emotional or sexual in nature and in most cases is a combination of all three. They are powerless in their environment to control or even master their circumstances and their circumstances are often perpetrated by those to whom their care was entrusted. Like Don and those in our other examples, they have the capacity to dissociate, to segregate thoughts from emotions, actions and physical sensation. The more frequent the abuse, the more recurrent the dissociation and the more patterned the dissociation becomes. Dissociation allows the child to segregate what is too overwhelming to process. The trauma becomes encapsulated behind borders, compartmentalized so the child can return to apparently normal functioning like going to school, as if nothing had happened. The trauma is segregated from their full, conscious awareness. Dissociation in this instance is a healthy adaptation to survive. Over time and with repetition, the healthy adaptation to survive (dissociation) becomes habitual and expressive of distinct patterns of behavioral interaction with the environment. Traumatic dissociation in essence becomes a tool of situational empowerment and can carry forward into adulthood even when the threat or need to master survival (abusive situation) no longer exists. The child’s healthy adaptation has become an automated, yet segregated response to environmental stimuli. The child’s now automated response mechanisms of consciousness (thought, behavior, emotions and memory) with habitual patterns of interacting with the environment can become distinct personality states, each uniquely responsible for interacting with the environment on the basis of the experiences they survived or functions they performed.

Dissociative Identity Disorder (DID)

Dissociative Identity Disorder (formerly known as Multiple Personality Disorder) is the existence of two or more personality states, each of which have a unique and autonomous interaction with the environment. The personality states, often called alters or parts of the personality have their own thoughts, emotions, behaviors and memory functions just as you do. The difference is two or more states operate from one person’s mind and are able to assume executive control of ones thoughts and actions. One person operates with segregated capacities of the mind and each separation has its own degree of situational empowerment in the current environment. Individuals with DID often experience memory loss when another part of the personality has executive control in the present environment. They may also experience hearing voices inside reflective of the interior dialogues between different personality or identity states. The traditional challenges of Complex PTSD are also generally present for individuals with DID. Other challenges or co-existing diagnoses may also exist within the personality system and its expression in the environment. Each instance of DID is unique to the individual within the context of their experience and their adaptations to that experience.

Dissociative Identity Disorder (DID) is not as rare as was once reported. Research has suggested an estimated 1% of the population lives with DID. If you consider that the U.S. Census Bureau projected a national population of 301,621,157 by July, 2007, then an estimated 3,016,211 people are living with DID. Earlier, we referenced that dissociation occurs on a spectrum. A sub-spectrum within the diagnosis of DID exists as well. Individuals with DID are found in all walks of life, all socio-economic classes, all races, all creeds and each has a unique capacity for working with their environment. Each person’s experience with DID is as unique as that person’s fingerprint. In as much as no two individuals experience the exact same thing the same way, so too, are the instances of DID different from one diagnosed with DID to another.

It is also important to know that for those who are diagnosed or have been recently diagnosed with DID or DDNOS, it is perfectly normal to experience both fear and denial. The resolution of those feelings about your diagnosis is one of the many gifts of the healing process.

DDNOS

DDNOS (Dissociative Disorder Not Otherwise Specified) refers to the existence of dissociative symptoms that are similar to those found in DID but the symptoms may not be as rigidly elaborated or compartmentalized. For many, the barriers between different personality states are not as clearly delineated and the parts of the personality do not interact with the environment as independently as individuals with DID might experience. Additionally, the instance of memory loss is less frequent or absent with DDNOS than one might experience with DID.

Hope in Healing

Dissociative Identity Disorder (DID) and Dissociative Disorder Not Otherwise Specified (DDNOS) can be cured with effective treatment. Effective treatment generally consists of a solid foundation of weekly psychotherapy sessions, supported by other treatment modalities identified by the therapist as meaningful to the recovery frame. Medications may or may not be involved for symptom management but are not curative in and of themselves. Many resources cite a treatment program of 3-5 years on average. Other resources cite longer periods. The period of time varies by a host of individual and therapeutic factors. The time frame is unique to each individual but the end result is both timeless and priceless.

If you or someone you know has been recently diagnosed with DID or DDNOS, please be aware that therapy is not about reliving past abuses and recovery isn't about reclaiming all memories. Healing from DID/DDNOS involves learning new strategies and skills for dealing with traumatic emotions both in the past and the present. It's about accessing the meaning one's past has in their present and in their future as they define it. It's about learning to thrive.