Think back to a time when you found yourself daydreaming or staring into space without any awareness of the people or things around you. Can you remember anything about your surroundings? What about who was around you, what was going on, and where you were? If not, perhaps you can relate to the strange and rare experience of dissociating.
Dissociation has been defined as a separation from reality or an unconsciousness that disrupts memory, identify, or sense of self for a temporary period of time. It is a more severe and complicated form of daydreaming and tends to occur under stress, fear, or anxiety. For many people, dissociation occurs on a spectrum in which there are mild forms and severe forms requiring medication and therapy. In the DSM-IV-TR (the 4th edition of the DSM. We will discuss dissociative disorder from DSM-V at a later time), dissociative disorder is defined as a “dissociative trance involving narrowing of awareness of immediate surroundings or stereotyped behaviors or movements that are experienced as being beyond one’s control.” There are 4 kinds of dissociative disorders which include:
- Dissociative Identity Disorder (formerly known as multiple personality disorder): Consider the movie the “Three Faces of Eve.”
- Dissociative amnesia: Includes experiences in which dissociation occurs, making it difficult to recall information prior to the dissociating occurring. For example, someone who has been severely sexually abused might have trouble recalling when it happened and who did it. The “amnesia” is due to the severity of the circumstance or the severity of the trauma and not normal forgetfulness. It’s almost as if the brain protects itself by “disconnecting” from the traumatic experience. For many youngsters, it can be difficult for them to cope with the reality of having been sexually or severely physically abused. So once they see a therapist and the therapist attempts to discuss the trauma, the child might truly forget important details and answer the therapist with “I don’t know,” or “I don’t remember.” In some cases, the “forgetfulness” is intentional, but in many other cases, it is not. It is simply a neurological response to a traumatic experience.
- Dissociative fugue: Occurs when an individual experiences “amnesia” in such a way that they become an entirely different person (in appearance, tone of voice, attitude, and sometimes living conditions). The disorder causes the person to travel away from their home environment or place of work. In some cases, the disorder has caused an individual to leave their long-term relationships or marriages and homes for a life on the road or a totally new life in a different state or country. The disorder does not include a conscious awareness of these changes. The person completely forgets their current life and those in it and “creates” a new one. A new identity, new goals, new passions, new interests, etc. are created.
- Depersonalization disorder: Includes a feeling of unreality or feelings of living in a fantasy or “pretend place.” This disorder can make an individual feel as if they are an outside observer of their life, not a full participant. If you can think back to how it feels while you are dreaming or close to awaking from a dream, you can imagine how this disorder affects the sufferer.
- Dissociative NOS (not otherwise specified): This type of dissociation includes many of the symptoms (or similar symptoms) of all of the above disorders but does not fit 100% into either of the categories. For example, someone who is walking through a busy city street might begin to dissociate and once the dissociation is over, forgets why they were walking in the first place. But the experience might not occur during stress or anxiety and a traumatic history may or may not be present. Symptoms may also come and go or be acute and mild. When an individual is clearly showing a separation from reality which interferes with daily functioning but does not clearly exhibit ALL of the symptoms of the dissociative disorders, a diagnosis of Dissociative Disorder, NOS is given.
Believe it or not, some cultures refer to dissociating as “possession” or “possession trance.” Possession trance is a term more frequently used in Asia and India and refers to a transient alternation whereby one’s normal identification is replaced by a spirit, ghost, or other similar entity. Of course, this is a culture bound theory and does not apply to dissociative identity disorder in the U.S. But it is something to think about and something worth considering. In a dissociative experience, the individual becomes completely unlike themselves and can appear different in physical appearance, tone and rate of voice, dress, and attitude. In many cases, the individual who is experiencing the dissociative experience may appear to be in an amnestic state in which nothing is remembered once the person “comes out of” the “trance” or dissociative experience.
Dissociative disorders are difficult to identify and are often mistaken for psychotic disorders. In other cases, dissociative disorder is diagnosed when an individual’s symptoms do not fit neatly into the category of a psychotic disorder and psychotic disorder, NOS also does not fit. Differentiating the correct diagnosis can take time and extensive evaluation in therapy. If you believe that you or someone you know is experiencing dissociative symptoms, I encourage you to research the condition and seek a mental health professional (who has experience with this diagnosis) to evaluate and teach you more.
I wish you well
Basu, S., Subhash, C. G., & Sayeed, A. (2002). Trance and possession like symptoms in a case of cns lesion: A case report. Indian Journal of Psychiatry 44(2), 65-67. (link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953657/).
NAMI. (2014). Mental Illness: Dissociative Disorders. Retrieved November 20, 2014, from http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/By_Illness/Dissociative_Disorders.htm.
Sharon, I., and Bienenfeld, D. (2014). Dissociative Disorders. MedScape. Retrieved November 15, 2014 from, http://emedicine.medscape.com/article/294508-overview.