Dissociation is a common response to trauma and a symptom of mental health disorders, such as post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). It involves a sense of detachment and a fragmentation of the self, where a person may feel separated from their own thoughts, feelings, or actions. Many people assume that all dissociation is related to dissociative identity disorder (DID), but there are actually four types of dissociation that can manifest in different ways. In this article, we will take a closer look at these four types of dissociation and discuss how to recognize them.
Dissociative Amnesia
Dissociative amnesia is the most common type of dissociation. It involves the inability to remember certain aspects of one's self or personal history. This can include forgetting one's name, where they are from, or important events in their life. It can also involve forgetting specific traumatic events that have occurred, such as an assault or abuse. People experiencing dissociative amnesia may seem confused or disoriented when asked about their memories, and may simply respond with "I don't remember." This type of dissociation is often seen as a protective measure to cope with traumatic experiences (Staniloiu & Markowitsch, 2014).
Research has shown that dissociative amnesia is associated with alterations in brain activity, particularly in regions involved in memory processing and emotional regulation. A study by Kikuchi et al. (2010) found that individuals with dissociative amnesia showed reduced activity in the hippocampus and amygdala, areas crucial for memory formation and emotional processing.
Dissociative Fugue
Dissociative fugue is a more extreme form of dissociative amnesia. It involves a sudden and unexpected loss of memory and identity, often accompanied by a physical or geographical escape from one's current environment. During a fugue state, a person may travel far from their home without any recollection of who they are or how they got there. They may also assume a new identity and behave as if they have no memory of their past life. This type of dissociation is rare but can be triggered by extreme stress or trauma (Coons, 1999).
A case study by Igwe (2013) described a patient who experienced dissociative fugue after a traumatic event, traveling to a different city and assuming a new identity for several months before being discovered. This case highlights the profound impact that dissociative fugue can have on an individual's life and the importance of proper diagnosis and treatment.
Dissociative Identity Disorder (DID)
Perhaps the most well-known type of dissociation, dissociative identity disorder (DID) involves the presence of multiple distinct identities or personalities within one individual. This can manifest as a person switching between different identities, each with their own memories, behaviors, and characteristics. DID is often linked to a history of severe and chronic childhood trauma, such as physical, emotional, or sexual abuse. It is a complex and potentially debilitating disorder that requires specialized treatment (Dorahy et al., 2014).
Neuroimaging studies have provided insights into the neural basis of DID. Reinders et al. (2014) used functional magnetic resonance imaging (fMRI) to examine brain activity in individuals with DID and found distinct patterns of neural activation associated with different identity states. This research supports the idea that DID involves genuine alterations in brain function and is not simply a product of suggestion or role-playing.
Depersonalization/Derealization Disorder
Depersonalization/derealization disorder involves feeling detached from one's own body or self, as if viewing oneself from the outside in. People experiencing this type of dissociation may feel as though they are in a dreamlike state or watching their life through a gauzy veil. They may also feel disconnected from their thoughts, emotions, and physical sensations. While depersonalization/derealization can be a symptom of other disorders, it can also occur independently as a result of stress or trauma (Sierra & David, 2011).
A study by Simeon et al. (2000) found that individuals with depersonalization disorder showed abnormalities in sensory integration and emotional processing, suggesting that this form of dissociation may be related to disruptions in the brain's ability to integrate different types of information.
How to Recognize Dissociation
Dissociation can be challenging to recognize because it often involves internal experiences rather than outward behavior. However, there are some signs to look out for:
Memory lapses or gaps in recollection
Feeling detached or disconnected from oneself or the world
Feeling as though one is observing their life from the outside in
Feeling like one is watching a movie of their life rather than living it
Losing time or finding oneself in a new place without any memory of how they got there
Switching between different personalities or identities
Feeling numb or emotionally detached
Experiencing physical symptoms without any medical explanation
It's important to note that everyone experiences dissociation differently and that not all dissociation is necessarily indicative of a disorder. Some level of dissociation can be considered normal and adaptive for coping with stress and trauma. However, if you or someone you know is experiencing frequent or severe dissociative episodes, it may be a sign of a deeper issue that requires professional help.
Assessment and Diagnosis
Proper assessment and diagnosis of dissociative disorders are crucial for effective treatment. Clinicians use various tools and techniques to evaluate dissociative symptoms, including structured interviews, self-report measures, and psychological tests. The Dissociative Experiences Scale (DES) is a widely used screening tool that assesses the frequency and severity of dissociative experiences (Carlson & Putnam, 1993).
Treatment Approaches for the 4 Types of Dissociation
Treatment for dissociative disorders typically involves a combination of psychotherapy and, in some cases, medication. Cognitive-behavioral therapy (CBT) has shown promise in treating dissociative symptoms by helping individuals identify and challenge maladaptive thought patterns and behaviors (Brand et al., 2012). Eye Movement Desensitization and Reprocessing (EMDR) therapy has also been found to be effective in treating trauma-related dissociation (Shapiro, 2018).
For individuals with DID, phase-oriented treatment is often recommended. This approach involves stabilization, trauma processing, and integration of dissociated identity states (International Society for the Study of Trauma and Dissociation, 2011).
Conclusion
Dissociation is a complex and multifaceted phenomenon that can manifest in different ways. Whether it's the inability to remember important aspects of one's life, feeling detached from oneself or the world, or switching between different identities, dissociation is often a response to trauma and stress. While it can be challenging to recognize, being aware of the different types of dissociation and their potential signs can help us better understand and support those who may be experiencing this phenomenon. If you or someone you know is struggling with dissociation, don't hesitate to seek professional help for support and treatment.
References
Brand, B. L., Lanius, R., Vermetten, E., Loewenstein, R. J., & Spiegel, D. (2012). Where are we going? An update on assessment, treatment, and neurobiological research in dissociative disorders as we move toward the DSM-5. Journal of Trauma & Dissociation, 13(1), 9-31. https://doi.org/10.1080/15299732.2011.620687
Carlson, E. B., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation: Progress in the Dissociative Disorders, 6(1), 16-27.
Coons, P. M. (1999). Psychogenic or dissociative fugue: A clinical investigation of five cases. Psychological Reports, 84(3), 881-886. https://doi.org/10.2466/pr0.1999.84.3.881
Dorahy, M. J., Brand, B. L., Sar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., ... & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian & New Zealand Journal of Psychiatry, 48(5), 402-417. https://doi.org/10.1177/0004867414527523
Igwe, M. N. (2013). Dissociative fugue symptoms in a 28-year-old male Nigerian medical student: A case report. Journal of Medical Case Reports, 7(1), 143. https://doi.org/10.1186/1752-1947-7-143
International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187. https://doi.org/10.1080/15299732.2011.537247
Kikuchi, H., Fujii, T., Abe, N., Suzuki, M., Takagi, M., Mugikura, S., ... & Mori, E. (2010). Memory repression: Brain mechanisms underlying dissociative amnesia. Journal of Cognitive Neuroscience, 22(3), 602-613. https://doi.org/10.1162/jocn.2009.21212
Reinders, A. A., Willemsen, A. T., Vos, H. P., den Boer, J. A., & Nijenhuis, E. R. (2012). Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS One, 7(6), e39279. https://doi.org/10.1371/journal.pone.0039279
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
Sierra, M., & David, A. S. (2011). Depersonalization: A selective impairment of self-awareness. Consciousness and Cognition, 20(1), 99-108. https://doi.org/10.1016/j.concog.2010.10.018
Simeon, D., Guralnik, O., Hazlett, E. A., Spiegel-Cohen, J., Hollander, E., & Buchsbaum, M. S. (2000). Feeling unreal: A PET study of depersonalization disorder. American Journal of Psychiatry, 157(11), 1782-1788. https://doi.org/10.1176/appi.ajp.157.11.1782
Staniloiu, A., & Markowitsch, H. J. (2014). Dissociative amnesia. The Lancet Psychiatry, 1(3), 226-241. https://doi.org/10.1016/S2215-0366(14)70279-2
Comments