Do you ever experience a fleeting moment when you are out having lunch with your pals or seated in a meeting at work and you feel disconnected from what is going on around you?
Or do you completely wipe out when asked about the meeting s topics hours later?
Or perhaps you drove home but don t recall making the actual trip?
You might recognize some of this, and that s just normal. These kinds of incidents are a moderate and typical type of dissociation that most people encounter at least once in their lifetime. You probably felt out of touch in these circumstances because you weren t listening, you were bored, you were daydreaming, or your mind was elsewhere. Psychological dissociation is a severe and persistent medical disorder that causes the person to be divorced from reality. It is not merely a matter of daydreaming or briefly losing yourself in your own thoughts.
WHAT IS DISSOCIATION?
A person disconnects from their ideas, feelings, memories, or sense of identity when they dissociate, which is a mental process. Dissociative amnesia, dissociative fugue, depersonalization disorder, and dissociative identity disorder are examples of dissociative disorders.
When someone experiences a traumatic incident, dissociation is frequently present during the event as well as in the hours, days, or weeks that follow. For instance, the person may feel as though they are watching the event on television or that it is "unreal" or separated from what is happening around them. Most of the time, treatment is not necessary to end the dissociation.
The common theme shared by dissociative (or conversion) disorders is a partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements. There is normally a considerable degree of conscious control over the memories and sensations that can be selected for immediate attention, and the movements that are to be selected for immediate attention, and the movements that are to be carried out.
SYMPTOMS OF DISSOCIATION
Depending on the type and intensity, dissociative disorders can cause symptoms and indicators such as
- Difficulties managing strong emotions.
- Feeling cut off from oneself.
- Issues with anxiety, depression, or both.
- Having a sense of obligation to act a specific way
- Additional cognitive (thought-related) issues, like concentration issues.
- Identity confusion, such as acting in a way that a person would typically find repulsive or objectionable.
- Feeling "derealized," or as if the reality is distorted or unreal.
- Issues with memory unrelated to physical damage or ailment.
- Memory lapses can be significant, like forgetting sensitive personal information
- Mood swings that occur suddenly and unexpectedly; for instance, suddenly feeling extremely depressed.
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WHAT CAUSES DISSOCIATION?
The majority of mental health practitioners think that persistent childhood trauma is the root cause of dissociative disorders. Continual physical or sexual abuse, emotional abuse, or neglect are a few examples of trauma. In times of stress, unpredictable or terrifying family environments can sometimes make a youngster "disconnect" from reality. It appears that the severity of the childhood trauma has a direct correlation with the severity of the dissociative illness in adults.
Adult traumatic experiences may also result in dissociative disorders. These occurrences could be a war, torture, or a natural calamity. Dissociative disorders as described are presumed to be "psychogenic" in origin, being associated closely in time with a traumatic event/s, insoluble and intolerable problems, or disturbed relationships.
TYPES OF DISSOCIATIONS
Dissociative Amnesia
When a person has dissociative amnesia, they struggle to recall details about themselves. As opposed to someone who simply forgot something, this is different. With dissociative amnesia, a person may have trouble recalling a specific time or event from their life, a portion of the experience, or in some extremely rare circumstances, completely forget their identity and life.
Another cause of dissociative amnesia is a specific traumatic event or occurrence. The duration of an amnesic episode might range from a few minutes to many days. Amnesia can linger for years in very severe and uncommon circumstances. An episode might happen quickly and has no prior indicators. The person may experience multiple episodes over the course of their lives.
Dissociative Fugue
Dissociative fugue has all the features of dissociative amnesia, plus an apparently purposeful journey away from home or place of work. The purposeful travel beyond the usual everyday range is observed during which basic self-care is maintained in terms of eating, washing, etc. and simple social interactions with strangers such as buying tickets or petrol, asking directions, ordering meals, etc. In some cases, a new identiy may be assumed, usually only for a few days but ocasionally for long periods of time and to a surprising degree of completeness. Organized travel may be to places previously known and of emotional significance. Although there is amnesia for the period of the fugue, the individual s behaviour during this time may appear completely normal to independent observers.
Dissociative Stupor
The individual s behaviour fulfils the criteria for stupor, but examination and investigation reveals no evidence of a physical cause. In addition, as in other dissociative disorders, there is positive evidence of psychogenic causation in the form of either recent stressful events or prominent interpersonal or social problems.
Stupor is diagnosed on the basis of a profund diminution or absence of voluntary movement and normal responsiveness to extend stimuli such as light, noise and touch. The individual lies or sits largely motionless for long periods of time. Speech along with spontaneous and purposeful movements are completely or almost completely absent. Although some degree of disturbance of consciousness may be present, muscle tone, posture, breathing and sometimes eye-opening and coordinated eye movements are such that it is clear that the individual is neither asleep nor unconscious.
Trance and Possession Disorders
Disorders in which there is a temporary loss of both the sense of personal identity and full awarenesss of the surroundings; in some instances the individual acts as if taken over by another personality, spirit, diety, or "force". Attention and awareness may be limited to or concentrated upon only one or two aspects of the immediate environment, and there is often limited but repeated set of movement, postures, and utterances. Only trance disorders that are involuntary or unwanted, and that intrude into ordinary activities by occuriring outside religious or other culturally accepted situations should be included under this categorization.
Dissociative Disorders of Movement and Sensation
In this category of dissociative disorders there is a loss of or interference with movements or loss of sensations, usually cutaneous. The individual therefore presents as having a physical disorder, although none can be found that would explain the persisting symptoms. The symptoms can often be seen to represent the individual s concept of physical disorder, which may be at variance with psysiological or anatomical principles.
The degree of diability resulting from all these types of symptoms may vary from occassion to occassion, depending upon the number and type of other people present, and upon the emotional state of the individual. In other words, a variable amount of attention-seeking behaviour may be present in addition to a central and unvarying core of loss of movement or sensation which is not under voluntary control.
Dissociative Motor Disorders
The commonest varieties of dissociative motor disorders are loss of ability to move the whole or part of a limb or limbs. Paralysis may be partial, with movemnets being weak or slow, or complete. Various forms and variabe degree of incoordination (ataxia) may be evident, particularly in the legs, resulting in bizarre gait or inability to stand unaided (astasia-abasia). There may also be exaggerated trembling or shaking of one or more extremities or the whole body. There may be close resemblance to almost any variety of ataxia apraxia,akinesia, aphonia, dysarthria, dyskinesia, or paralysis.
Dissociative Convulsions
Dissociative Convulsions (pseudoseizures) may mimic epileptic seizures very closely in terms of movements, but tongue biting, serious bruising due to falling, and incontinence of urine are rare in dissociative convulsions, and loss of consciousness is absent or replaced by a state of stupor or trance.
Dissociative Anaesthesia and Sensory Loss
Anaesthetic areas of skin often have boundaries which make it clear that they are associated more with the patient s ideas about bodily functions than with medical knowledge. There may also be differential loss between the sensory modalities which cannot be due to a neurological lesion. Sensory loss may be accompanied by complaints of paraesthesia. Loss of vision is rarely total in dissociative disorders, and visual disturbances are more often a loss of acuity, general blurring of vision, or "tunnel vision". In spite of complaints of visual loss, the individual s general mobility and motor performance are often surprisingly well preserved.
Dissociative Identity Disorder
The most contentious of the dissociative diseases, dissociative identity disorder (DID), is questioned and discussed by mental health specialists. The most severe type of dissociative illness was previously known as multiple personality disorder.
The syndrome frequently involves more than one personality state coexisting within the same person. While the person s behavior is affected by their various personality states, they are typically unaware of them and only notice them as memory lapses. Different body language, voice tones, outlooks on life, and recollections may be present in the other stages. When stressed, the person may adopt a different personality state. Nearly usually, a person with dissociative identity disorder also has dissociative amnesia.
HOW ARE DISSOCIATION DISORDERS DIAGNOSED?
It s crucial to get professional assistance if you think you or a loved one may have a dissociative condition. Dissociative disorders must always be diagnosed and treated by professionals.
Dissociative illnesses are complex, and their symptoms are shared by a number of other conditions, making a diagnosis challenging. For instance:
- Amnesia and other cognitive issues can be brought on by physical factors (such as brain tumors or head injuries).
- Similar symptoms to a dissociative disorder can be caused by mental diseases such obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder.
- Some drugs used recreationally, and some prescription pharmaceuticals might have side effects that resemble symptoms.
- When a dissociative illness coexists with another mental health condition, such as depression, the diagnosis may be more complicated.
IS THERE TREATMENT FOR DISSOCIATION DISORDERS?
When a diagnosis of the type of dissociative disorder (if any) present has been made, you and HopeQure’s Expert therapists can discuss treatment choices and strategies. Dialectical behavioral therapy (DBT), cognitive-behavioral therapy (CBT), and antidepressants are all used in the treatment and management of dissociative disorders. Depending on the situation and the client, a combination of both approaches may be employed.
A dissociative disorder cannot be permanently cured, but treatment and adherence to your treatment plan can help you control your symptoms and feel better.
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Reference
- American Psychiatric Association (APA). (2022). Diagnostic and statistical manual of mental disorders (5th ed.)
- National Institute of Mental Health. (2020, July 22). Dissociative disorders
- Lyons, F., & Beutel, A. E. (2010). Dissociative disorders. In B. J. Sadock & V. A. Sadock (Eds.), Kaplan & Sadock s comprehensive textbook of psychiatry (9th ed., Vol. 1, pp. 2229-2252). Lippincott Williams & Wilkins. doi: 10.1016/S0022-3914(1091340-5).