Dissociation

What is Dissociation?

In general, dissociation is a defense mechanism that everyone uses every day. In its most common form, mild dissociation includes day dreaming, "zoning out," or doing things on "autopilot." For example, when you find yourself staring out the window thinking about what you are going to do after your class, driving a car and not recalling the details of how you got from one point to the next, or getting so caught up in a movie you don't hear someone whispering behind you - these are all examples of normal dissociation. Dissociation is a form of self-hypnosis. Everyone experiences dissociation.

Common Tool We All Share or Uncommon Adaptation to Survive? (It is both).

Dissociative Assessment Tools

http://www.rossinst.com/dissociative_experiences_scale.html

There are varying levels of dissociation:

Everyday Dissociation we all experience that is healthy in general
day dreaming

spacing out

fantasy

Traumatic Dissociation that comes from trauma and is not integrated in the psyche
numbness

deadened emotions

leaving one's body

Severe Traumatic Dissociation comes from major trauma that is not integrated in the psyche
derealization - constant experience of dissociation

depersonalization - not feeling the sense of "Me" or feeling your body as belonging to yourself

forming separate identities or self-states
fully formed identities

partially formed identities with specific roles

emotion states that are fragments

Dissociation Info

Valor Institute
Coping With Dissociation
Cuckoo Comics
Dr. Bill Tollefson
Intl. Society for the Study of Trauma and Dissociation
Many Voices
Mosaic Minds
Sidran Institute
Third of a Lifetime

Types of Dissociative Reactions
By: Elaine Ducharme, Ph.D.
It is important to recognize that there are other types of dissociative responses and/ or altered states.
Hypnoid or trance-like states appear to be an ego defense to trauma and have been identified as a powerful predictor of early DID in children and adolescents. Somnambulism or sleep walking is common in childhood and generally disappears by around age 10. However, sleepwalking that continues into adulthood often has a later age of onset and is more frequently accompanied by the presence of psychopathology. In fact, somnambulism in adults may be part of the clinical picture of DID. I have several patients who have reported unexplained messes in the house, family members finding them cleaning, drawing or writing, bathing, showering, or engaged in other behaviors of which they have no memory in the morning. One woman's husband often found her trying to make sandwiches or cookies and seeming confused as to how to proceed once the ingredients were on the counter. Upon investigation, it turned out that very young alters were out and trying to cook.

Psychogenic amnesia is an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness and is not associated with an organic mental disorder (American Psychiatric Association, 2000). Most often the missing personal information involves the individual's identity and may include name, age, marital status, occupational information and personal life history (Rapaport, 1971). Individuals with psychogenic amnesia are usually aware of the fact that they are unable to recall important personal information, though they may exhibit classic la belle indifference toward their impairment. I worked with a teenager who had been abused by an uncle while on a trip. The extended family did not believe her and the loss of the affection of so many people was devastating for her. She ran into a grandparent several months after the incident and the individual acted as if the girl did not exist. The next day the police found her lying in the snow dressed only in her pajamas. She could not recall her name, did not recognize her house, family or friends. During the course of a week, she seemed to regain very little information. During several hypnosis sessions, she was able to recall the events leading up to the amnesia. It took several weeks for her to gain total recall of the more intimate details of her life. She did recover fully.

Dissociative Fugue is characterized by sudden unexpected travel away from one's home or customary place of work, accompanied by an inability to recall one's past and confusion about personal identity or the assumption of a new identity. (American Psychiatric Association, 2000). There is often the assumption of a new identity. The travel of an individual in a fugue state may seem to be rather aimless; however, it may also include the use of public transportation. They may appear quite normal to the average observer. In contrast to individuals experiencing psychogenic amnesia, fugue victims are usually unaware of their loss of self-referential information (Rapaport, 1971). Fugue states are common in patients with DID.

Depersonalization Disorder is characterized by a persistent or recurring feeling of being detached from one's mental processes or body that is accompanied by intact reality testing.(American Psychiatric Disorder, 2000) The person may report that she/he feels unreal, as if he or she were in a dream, like a machine, dead, self-estranged or otherwise changed from his or her normal state. Depersonalization is only considered to be a diagnosable disorder when it occurs in the absence of another disorder that includes feelings of depersonalization (Putnam, 1989).

Dissociative Disorder Not Otherwise Specified is included in the DSM-IV-TR for coding disorders in which the prominent feature is a dissociative symptom, but that so not meet the criteria for any specific Dissociative Disorder.

Possession states are another form of dissociation. Primitive cultures and some fundamentalist religious groups have strong beliefs in possession states. The classic psychiatric review of possession states was done by Oesterreich (1966) who felt there were two main forms of possession: a "somnambulistic" or hysterical form and a lucid or obsessional form. In the lucid form the person is aware of him or herself but feels invaded and engaged in a struggle for control over his or her behavior. In the somnambulistic form the individual has lost all consciousness of the self and speaks with the voice of the "intruder". For more extensive review of the history of possession and treatment by exorcism the reader is directed to Oesterreich (1966) and Pattison and Wintrob (1981).

Near death and out of body experiences may also be seen as a form of dissociation. Finally, a few other unusual psychiatric syndromes are seen as forms of dissociation. Folie a deux or folie a plusieurs have a core feature of the transfer of mental symptoms, particularly paranoid delusions, from one person to another. Le Delire de negation or Cotard syndrome involves, in its extreme form, a complete denial of the existence of self. In milder forms, this may be seen as a sense of depersonalization-like change in the self or a feeling of despair or self-loathing (Enoch and Trethowan, 1979).

Trances People Live
"At last, the missing piece of the dysfunctional puzzle. It is not enough to understand or even relive our childhood traumas. Dr. Wolinsky shows us how we continue to recreate those traumas in our adult lives and how to stop creating them. Every uncomfortable emotional state, and many psychosomatic symptoms, are also states of trance. Trance is the "glue" that holds the problem in the present moment. Learning to identify the kind of trance state beneath a problem or symptom gives us the tool that finally dissolves the glue. This book offers a gold-mine of resources for those who suffer from dysfunctional patterns of behavior or for anyone who feels stuck in an undesirable emotional or addictive state. Learning to step out of the trance states that create our problems and symptoms is to learn to step into the present moment at last free of the baggage from our past."