Dissociation, Dissociative Disorders, and Dissociative Identity Disorder
Dissociation can take many forms with varying but often very serious impacts upon people. Dissociation is understood to be the result of trauma, often complex and experienced in childhood, meaning that it is something experienced by many survivors or ritual or organised abuse and people who have experienced other forms of abuse in childhood
Mairsinn has experience of working with people affected by various forms of dissociation and in 2024 extended our remit to specifically work to increase awareness of and reduce the suffering of people affected by all forms of dissociation resulting from abuse. Support and information can be found on our forums pages, and there is further information on dissociation, dissociative disorders, and dissociative identity disorder below
Mairsinn has experience of working with people affected by various forms of dissociation and in 2024 extended our remit to specifically work to increase awareness of and reduce the suffering of people affected by all forms of dissociation resulting from abuse. Support and information can be found on our forums pages, and there is further information on dissociation, dissociative disorders, and dissociative identity disorder below
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Further Info
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Dissociation
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DID
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Dissociative Amnesia
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Depersonalisation Disorder
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You can find out more about the most common forms of dissociation by reading through the above tabs
Dissociation is a separation or disconnection between thoughts, feelings, memory, identity and behaviours and a separation between the mind and body (American Psychiatric Association, 2013). It is the mind’s way of putting unbearable experiences and memories into different compartments. For example, a survivor may remember a traumatic event but have no feelings attached to the memory or they may display negative behaviour but have no memory or understanding of the behaviour. These different parts of the survivors experiences are of course connected, but they learn to survive by becoming unaware of the connections.
Dissociation is often associated with childhood trauma (Hulette, et al, 2008; Hulette, et al., 2011). It is thought by some to be a survival mechanism, and one that is often overlooked in traumatised children (Wilkinson & DeJong, 2021). A child who is being abused by an adult cannot fight back and cannot physically run away, but they can escape in their mind. Dissociation may serve as a natural defence mechanism to cope with unbearable overwhelming trauma (Schauer & Elbert, 2010) but it can hinder the processing of memory, emotion, and sensations (Lanius, 2015). Memories may then be stored as fragments which can return in flashbacks.
Studies have shown empirical evidence of a link between severe long-term trauma in childhood and dissociation (Vonderlin, 2018). Some researchers argue that there may be a cognitive predisposition and social factors which contribute to the way some people who are prone to dissociation, perceive stress and express their feelings (Giesbrecht, 2008). Dissociation is still not fully understood by mental health professionals though there is some evidence that this is slowly changing.
Traumatised children are usually not aware that they dissociate and often cannot put into words what is happening to them. From their perspective, their experiences are normal. Dissociation leads to a range of behaviours which can often be misunderstood as daydreaming, not listening, lying, fantasising, or having problems with concentration. Dissociation is the brain keeping them safe by momentarily removing them from the perceived threat in their day-to-day life. These perceived threats can feel real but as they continue long after the threat is gone, they can hamper learning and functioning.
Traumatised children who do not get help usually continue to dissociate into adulthood even when they are no longer in danger. Their brains simply cannot turn the coping strategy off. Because memories might be fragmented into lots of little pieces through dissociation, survivors can often have a flashback to a memory, a feeling, a behaviour or a physical pain with no understanding of why or what triggered it. This can feel disorienting and confusing as all they know is that they feel as though they are in immediate danger. People who are in ongoing danger situations throughout childhood will develop more and more sophisticated ways to dissociate and this may lead to dissociative identity disorder.
Dissociation is often associated with childhood trauma (Hulette, et al, 2008; Hulette, et al., 2011). It is thought by some to be a survival mechanism, and one that is often overlooked in traumatised children (Wilkinson & DeJong, 2021). A child who is being abused by an adult cannot fight back and cannot physically run away, but they can escape in their mind. Dissociation may serve as a natural defence mechanism to cope with unbearable overwhelming trauma (Schauer & Elbert, 2010) but it can hinder the processing of memory, emotion, and sensations (Lanius, 2015). Memories may then be stored as fragments which can return in flashbacks.
Studies have shown empirical evidence of a link between severe long-term trauma in childhood and dissociation (Vonderlin, 2018). Some researchers argue that there may be a cognitive predisposition and social factors which contribute to the way some people who are prone to dissociation, perceive stress and express their feelings (Giesbrecht, 2008). Dissociation is still not fully understood by mental health professionals though there is some evidence that this is slowly changing.
Traumatised children are usually not aware that they dissociate and often cannot put into words what is happening to them. From their perspective, their experiences are normal. Dissociation leads to a range of behaviours which can often be misunderstood as daydreaming, not listening, lying, fantasising, or having problems with concentration. Dissociation is the brain keeping them safe by momentarily removing them from the perceived threat in their day-to-day life. These perceived threats can feel real but as they continue long after the threat is gone, they can hamper learning and functioning.
Traumatised children who do not get help usually continue to dissociate into adulthood even when they are no longer in danger. Their brains simply cannot turn the coping strategy off. Because memories might be fragmented into lots of little pieces through dissociation, survivors can often have a flashback to a memory, a feeling, a behaviour or a physical pain with no understanding of why or what triggered it. This can feel disorienting and confusing as all they know is that they feel as though they are in immediate danger. People who are in ongoing danger situations throughout childhood will develop more and more sophisticated ways to dissociate and this may lead to dissociative identity disorder.
Dissociative identity disorder (DID) is a rare disorder associated with moderate to severe mental health symptoms. It has previously been known as Multiple Personality Disorder or split personality. According to Brand et al (2019) around 1.5% of the worldwide population has been diagnosed with dissociative identity disorder. Dissociative identity disorder is typically caused by severe childhood trauma and abuse (Lynn et al., 2014)
The DID person, per the International Society for the Study of Trauma and Dissociation, is described as a person who experiences separate identities that function independently and are autonomous of each other. The International Society describes alternate identities or "alters" as independent identities with distinct behaviours and memories distinct from others and may even differ in language and expressions used. Signs of a switch to an altered state include trance-like behaviour, eye blinking, eye-rolling, and changes in posture.
Dissociative Disorders are classically characterized as disrupting normal consciousness, memory, identity, and behaviour. The disorders are classically broken down into "positive " and "negative " symptoms -positive symptoms are often associated with "new personalities, derealization," and negative symptoms are symptoms such as autism and paralysis. (Spiegel et al,2011).
Dissociative identity disorder is part of the larger dissociative disorders’ spectrum; however, it has more specific criteria outlined by the Diagnostic And Statistical Manual Edition-5. The Diagnostic and Statistical Manual (DSM-5) criteria for DID include at least two or more distinct personalities. Each personality varies in behaviour, sense of consciousness, memory, and perception of the outside world. Persons with DID experience amnesia, distinct gaps in memory, and recollections of daily and traumatic events. They cannot be directly related to substance use or part of cultural norms or practices. Importantly, these symptoms cause a notable lack of daily functioning (Brand et al (2016).
The DID person, per the International Society for the Study of Trauma and Dissociation, is described as a person who experiences separate identities that function independently and are autonomous of each other. The International Society describes alternate identities or "alters" as independent identities with distinct behaviours and memories distinct from others and may even differ in language and expressions used. Signs of a switch to an altered state include trance-like behaviour, eye blinking, eye-rolling, and changes in posture.
Dissociative Disorders are classically characterized as disrupting normal consciousness, memory, identity, and behaviour. The disorders are classically broken down into "positive " and "negative " symptoms -positive symptoms are often associated with "new personalities, derealization," and negative symptoms are symptoms such as autism and paralysis. (Spiegel et al,2011).
Dissociative identity disorder is part of the larger dissociative disorders’ spectrum; however, it has more specific criteria outlined by the Diagnostic And Statistical Manual Edition-5. The Diagnostic and Statistical Manual (DSM-5) criteria for DID include at least two or more distinct personalities. Each personality varies in behaviour, sense of consciousness, memory, and perception of the outside world. Persons with DID experience amnesia, distinct gaps in memory, and recollections of daily and traumatic events. They cannot be directly related to substance use or part of cultural norms or practices. Importantly, these symptoms cause a notable lack of daily functioning (Brand et al (2016).
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013, p. 298), dissociative amnesia is (a) “an inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting”; (b) “that causes significant distress in social, occupational or other important area of functioning”; (c) “not attributable to psychological effects of substance (e.g., alcohol or drugs), neurological, or medical condition”; and equally (d) “not better explained by other psychological disturbances such as (among others) posttraumatic stress disorder, neurocognitive disorders, traumatic brain injury and factitious disorder.”
The diagnostic criteria for dissociative amnesia include “an inability to recall important autobiographical information, usually of a traumatic or stressful nature” and “is not attributable to the physiological effects of a substance…or a neurological or other medical condition” (APA, 2013, p. 298). In other words, dissociative amnesia is psychologically caused, not physically caused. Key to this dissociative amnesia definition is the storage of the traumatic memory, followed by “a period of time when there is an inability to recall” due to a psychological cause (trauma), and it is “potentially reversible” and recalled later (p. 298).
The diagnostic criteria for dissociative amnesia include “an inability to recall important autobiographical information, usually of a traumatic or stressful nature” and “is not attributable to the physiological effects of a substance…or a neurological or other medical condition” (APA, 2013, p. 298). In other words, dissociative amnesia is psychologically caused, not physically caused. Key to this dissociative amnesia definition is the storage of the traumatic memory, followed by “a period of time when there is an inability to recall” due to a psychological cause (trauma), and it is “potentially reversible” and recalled later (p. 298).
Depersonalisation or derealisation disorder (DPD) is a state of mind in which a person feels disconnected from their body, senses and environment (Phillips & Sierra, 2003). There can be a sense of unreality about the world and a feeling of out-of-body experiences. It is generally believed to be the brain’s defensive mechanism designed to protect a person in extreme anxiety or traumatic situations (Stein and Simeon, 2009). Where symptoms are chronic, it is considered a type of dissociative disorder (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) (American Psychiatric Association, 2013).
The exact cause of DPD is not known but trauma and childhood anxiety are thought to be common factors (Lee et al., 2012). People experience persistent and frequent feelings of detachment from their physical self as well as emotional numbness and symptoms can include detachment from surroundings and an inability to respond emotionally(Sierra and David, 2011). DPD can be accompanied by anxiety, depression or schizophrenia, and difficulties in concentration and memory (Lambert et al., 2001a), which can affect quality of life and interfere with daily activities and social relationships.
The exact cause of DPD is not known but trauma and childhood anxiety are thought to be common factors (Lee et al., 2012). People experience persistent and frequent feelings of detachment from their physical self as well as emotional numbness and symptoms can include detachment from surroundings and an inability to respond emotionally(Sierra and David, 2011). DPD can be accompanied by anxiety, depression or schizophrenia, and difficulties in concentration and memory (Lambert et al., 2001a), which can affect quality of life and interfere with daily activities and social relationships.
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