Psychologist Melbourne: Dissociation

What is Dissociation?

Dissociation is when you disconnect from your thoughts, feelings, memories or sense of self. It can be mild and everyday (daydreaming) to severe and life disrupting (feeling disconnected from your body or losing hours of time). Mild dissociation is common and harmless, severe dissociation can be a sign of mental health conditions like schizophrenia, PTSD, autism or trauma. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has the diagnostic criteria for dissociative disorders, the go to resource for mental health professionals.

Types of Dissociative Disorders

Dissociative disorders are a group of mental health conditions where a person disconnects from their thoughts, feelings and experiences. The American Psychiatric Association recognises several types of dissociative disorders:

Understanding the different types of dissociative disorders is key to understanding the challenges associated with each.

Symptoms of Dissociation: Dissociative Symptoms

The symptoms of dissociation can be many and varied and may include:

Causes of Dissociation: Childhood Trauma

When faced with a threatening or distressing situation we can become either hyper-aroused (high energy) or hypo-aroused (low energy). In many cases hypo-arousal leads to symptoms of dissociation. This means that in response to stress, especially after a traumatic event, our mind may “shut down” to some extent and we may feel numb, forgetful or disconnected from reality or ourselves. This altered state is a psychological buffer especially when we can’t physically escape the situation or change the stressor. Dissociation is a common and helpful coping mechanism in response to trauma (e.g. if you have a car accident you may feel numb or the situation may feel surreal later at the hospital). But it becomes a clinical condition when the dissociative response is triggered too easily or in response to less significant stressors or when the response is severe and life-impacting. People who have experienced significant trauma, neglect or lack of emotional attunement may be more prone to developing a dissociative disorder.

Understanding Dissociation and Diagnosing Dissociative Identity Disorder

While we can usually identify hyper-arousal and distress, identifying dissociation can be harder to spot and more tricky to diagnose. Talking to a psychologist can help you understand if you have any dissociative symptoms.

The DSM-5 is the standard reference that mental health professionals use to diagnose dissociative disorders. Diagnosing a dissociative disorder is usually done through clinical interviews and standardised assessment tools such as the Multidimensional Inventory of Dissociation 60-item version (MID-60), a questionnaire developed in Australia.

Treatment

Treatment for dissociation often involves a combination of approaches. Treatment usually involves learning to identify when you are in stressful or triggering situations and then using grounding techniques and distress tolerance strategies. DBT, CBT and mindfulness therapies can be very useful. It may also be helpful to work on the situations in your life that are causing stress to see if you can reduce or eliminate them.

For people with a dissociative disorder trauma focused therapies like Eye Movement Desensitisation and Reprocessing (EMDR), Schema Therapy and Internal Family Systems (IFS) may be suitable. These therapies aim to integrate the individual’s sense of self and process traumatic memories that may be underlying the dissociation. Trauma focused therapies are particularly relevant for people who are dissociating as a response to post-traumatic stress disorder (PTSD) where dissociation is a defence against distressing experiences.

CBT for Dissociative Disorders

CBT can be very useful for dissociative disorders. This therapy helps individuals understand and change the negative thoughts and behaviours that are causing their dissociative symptoms. With a mental health professional you can:

CBT can be very useful for dissociative disorders caused by childhood trauma, emotional abuse or PTSD.

Living with Dissociation

Living with dissociation can be hard, it can affect many areas of your daily life. People with dissociative disorders may experience:

However with the right treatment and support people with dissociative disorders can manage their symptoms and improve their life. You need to work with a mental health professional who specialises in dissociative disorders to create a treatment plan that includes therapy, medication and lifestyle changes.

In addition to professional help you can also:

By seeking help and support people with dissociative disorders can manage their symptoms and improve their mental health.

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