Dissociation

The meaning of dissociation is found in the word itself: dis-association.  Dissociation occurs when a person’s mind dis-associates with his or her body.  This is not the technical definition of the term, but it’s where I start when I explain it to patients.  (The Diagnostic and Statistical Manual of Mental Disorders defines dissociation thus: A disruption in the usually integrated function of consciousness, memory, identity, or perception of the environment).  When a person dissociates, his body stays in one place while his mind sort of goes somewhere else. 

Dissociation is not necessarily pathological.  In fact, everyone dissociates.  Have you ever driven an oft-travelled route - perhaps heading to work or driving home – and arrived at your destination to find that you have no recollection of the actual journey (perhaps because you were daydreaming or otherwise absorbed in your thoughts)?  That’s dissociation.  Another example of dissociation is the experience of “flow:” we become totally absorbed in some task or activity such that we are completely unaware of our surroundings, to include the passage of time.  When we look at the clock, we are surprised to find that several hours have passed in what seemed like only minutes. 

So in certain forms, dissociation is a normal and quite common experience.  In extreme forms, however, dissociation can become disruptive and therefore problematic.  Probably the most severe manifestation of dissociation is in Dissociative Identity Disorder.  (Some of you might know it as Multiple Personality Disorder).  The identity or self of any given person is made up of various parts or components.  For example, there is a part of me who is compassionate and benevolent and another part of me who is petty and vindictive.  There is a part of me who is responsible and a part of me that is reckless.  I will think, feel, and even behave differently depending on which part of my “self” is activated at any given time.  Even though my identity consists of many different parts I am still only one person.  There is an overall cohesiveness among the different parts of myself.  There is some sort of “observing ego” that stands back from it all, that intimately knows each individual “part” of my identity, and that holds all the pieces together.  A person with Dissociative Identity Disorder (DID) does not have this “observing ego.”  The various parts of a person with DID are completely separate and unaware of one another.  They do not share memories and they do not share information.  One part has no awareness of what another part does, even though they all reside in the same physical body. 

Fortunately, Dissociative Identity Order is extremely rare.  In fact, there has historically been quite a bit of debate about whether it exists at all.  I have only ever worked with one person who was diagnosed with DID and I suspect the diagnosis was incorrect.

I have, however, worked with many patients who struggle with other forms of dissociation.  I’ve had several patients who recalled experiences in which they were outside of their bodies, seeing themselves but having no control over what they were doing.  One person saw herself go into a store, buy a bottle of pills, and take the entire bottle.  She said she was screaming at herself to stop but was powerless to prevent her own suicide attempt. Another person was involved in a serious industrial accident.  He described being outside of his body, watching himself curl up on the ground and scream with pain.  He told himself to get up but to no avail. 

Other patients have no recollection of what happened during dissociative episodes.  They simply report “losing time.”  One woman regained awareness to find herself in an unfamiliar city with no idea how she’d gotten there.  She’d somehow driven 75 miles without meaning to.  Another patient became anxious while driving and decided to pull off the road to calm himself down.  He remembers looking at the clock as he pulled off.  The next thing he remembers is looking at the clock again and seeing that over an hour has passed.  He has no idea what he did during that hour.

Dissociation fascinates me.  How can someone’s mind wander away from his body?  I imagine it is a scary thing to know that your body has been doing things without your knowledge (or consent).  I’ll talk about what causes dissociation and how to treat it in future posts.