What is Dissociation?

By Ruddy
I often say that I am dissociated, but this is actually an umbrella term that covers a wide range of experiences and sensations. According to the DSM-IV, there are six main types of dissociative experiences and/ or disorders. In the following article I will explain some of these terms by describing how I personally experience them.
The first is amnesia, which is basically forgetfulness. This means that I very frequently have absolutely no idea of pretty important things like where I am, who I am, what year it is, how old I am, and what I’m supposed to be doing. This can be really alarming and frightening, and can put me in danger. It can also be really alarming for other people.
The second is depersonalisation. If you have ever had a sudden trauma like being in a car accident, you may have experienced this. It is an out of body sensation, feeling disconnected from your physical self and your whole sense of self. I experience this in many different ways. I may be floating, sometimes inside my body, sometimes outside of it. I may be observing myself from afar. I may not recognise my face and be puzzled when I look down and see my body. I may not be able to feel my body (which is dangerous, eg when cooking). I may not be able to move very well, seeing as it’s not my body. I may just simply feel on another planet.
The third is derealisation. This and depersonalisation get a bit blurred for me. Derealisation means that the outside world goes weird. Again this can happen in many ways. One way to describe it is the Alice in Wonderland effect. I feel tiny and the world is huge and intimidating. The walls are closing in on me. The floor is rippling and moving. The floor is slanting upwards or moving around. If I look at people who I am close to, I might be able to recognise who they are but they seem somehow unfamiliar and very far away and I stare at their faces wondering who they actually are. Noises might be distorted or muffled, sensations numbed, and speaking is a strange experience, trying to project into such a bizarre and distant world.
The fourth is fugue. This is essentially one of the consequences of other types of dissociation and lost time. Imagine that you are sitting comfortably in your house. The next second you find yourself curled up in a wooded area by the verge of a busy main road in the middle of the night. This is fugue. There is a big gap between now and the last thing you remember, you’ve found yourself somewhere and have no idea how you got there, and you also have amnesia so you don’t know who you are or where you are. This experience, until you work out what’s going on and sort things out, can be very short, or it can last months or years. It goes without saying that this can be extremely frightening and dangerous.
The fifth is Dissociative Disorder Not Otherwise Specified, or DDNOS, which is diagnosed in 40% of dissociative cases (O’Neil et al (2008)). This diagnosis is another umbrella term. The most common presentation of DDNOS involves either people where there are not two or more distinct personality states evident, or where the person does not have amnesia for important personal information (Spring, R., Multiple Parts (2013)). For example, the person experiences themselves as lots of different “me’s” and watches their other selves from afar. DDNOS is a controversial diagnosis because the line between it and DID is not clear and there are many issues with the process of diagnosis. It is a difficult diagnosis to have because it does not have the recognition that DID has and can leave the person feeling even more confused and isolated.
The sixth, and the furthest along the dissociative spectrum, is Dissociative Identity Disorder, or DID.  Here, all of the dissociative symptoms above are present, and the dissociation has occurred to the extent that the person’s personality has actually fractured. According to the DSM-IV, having DID means that you have two or more personality states and have amnesia between them. Sometimes the term polyfragmented is used, which I understand to mean 100+ parts, or multiple systems (separate groups of parts). Life with DID is extremely confusing and fragmented. Non-DID life is linear, which means that you can remember your day from the moment you got up until now in a straight line with no gaps. My experience of life is completely different. My life is shared between hundreds of people, and that means my time too. I cannot remember a whole day without lots of gaps, and my experience of time is here there and everywhere, like a jigsaw taken apart or an exploded party popper. My experience of living is also very different. There are few moments in my life where I am not experiencing some kind of dissociation. That means that there are few moments when I am fully connected and in step with the outside world.
Finally, there are other aspects of dissociative experiences which are not given a label. Some of these can be explained by the intensity of my inside world which is often much more real than the outside world, for example, voices and chatter, screaming, sensations from inside my brain, and so on. Some can be explained by body memories, flashbacks, and hallucinations, such as crawling skin, seeing things on the outside, and feeling things on my body. This, and multiple parts, can also explain things like feeling much shorter or taller, older or younger, weaker or stronger, in agonising pain or unable to feel pain, and more or less well. Dissociation has lots of day to day effects, like clumsiness, loss of balance, and poor short term memory. There are lots of other dissociative experiences but I can’t think of them right now – I’m too dissociated!