In the middle of a conversation about weekend plans with her husband, Margaret stood up, waved her finger, and angrily yelled at him. Instead of reacting at the moment as he had done in the past, her husband stayed still. About three minutes later, Margaret returned to her seat, appeared calm again, and picked back up on talking about the weekend.
If this was the first him Margaret’s husband experienced the event, he might have acted differently. But this time, they were in counseling and their therapist had witnessed the entire thing. After Margaret sat down, the therapist asked her if she remembered standing up and yelling at her husband. Margaret gave everyone a blank stare and just said, “No.”
During a dissociative episode, a person experiences a disconnection or detachment from the present moment. It can occur for a split second or last hours depending on the nature of the dissociation. It is a way of escaping reality when the present moment triggers some past trauma. A person who dissociates can do this voluntarily and involuntarily depending on the nature of the current moment. Stress worsens the dissociating as does unresolved past trauma.
What are the symptoms of dissociation? As listed in the DSM-5, there are three types of dissociative disorders: dissociative amnesia, dissociative identity disorder, and depersonalization/depersonalization disorder. All of these are variations of a dissociative disorder, which has the following signs:
- A disruption or discontinuation of normal consciousness: out of body experience,
- Loss of memory for periods of time, events, and people,
- Hazy identity,
- Emotional stress in relationships and work which are disproportional,
- Inaccurate perception of reality,
- Detachment from self, emotions and/or surroundings,
- Other conditions such as depression, anxiety, and suicidality.
What is dissociative amnesia? Margaret’s inability to recall what happened moments ago was an example of her memory loss. This type of thing frequently happened to her. She did not have dementia, a medical condition, and was not under in influence of medication or drugs. Instead, when conversations turned contentious, she dissociated and then had no recollection of the event. This was very frustrating to her husband, who would never forget the incident. Margaret’s childhood trauma of physical abuse from her alcoholic father explained her current situation. As a child, Margaret would dissociate during the beatings so she would not have to feel the pain with too much intensity. Anytime her husband would raise his voice, Margaret was triggered and subconsciously dissociated. To avoid additional pain, she would forget the event happened without even knowing it.
What is dissociative identity disorder? Also known popularly as multiple personality disorder, this disorder is characterized by “switching” to other identities. Usually, there is one dominant personality that is present but alters (or other personalities) appear when triggered by trauma, stress, abuse, or neglect. Each identity can have unique personality traits, different histories, physical mannerisms, handwriting, and interests. When a person experiences severe trauma, their survival mechanism is to pretend that the abuse is happening to another person, thus the formation of an alternate personality. This usually begins in childhood, but more personalities may develop throughout a lifetime. The personalities can be therapeutically integrated, or they can remain separate. It is very common for people with this disorder to also have dissociative amnesia, depersonalization, and derealization.
What is a depersonalization-derealization disorder? During one of Margaret’s sessions alone, she recounted some childhood abuse that she remembered. But when she spoke about it, it was as if she was talking about a movie and not herself. She could observe everyone there but there was no feeling or significant thoughts. She was detached – also known as depersonalization. As she spoke of the event, she said it was happening in slow motion, almost like it happened in a dream, and everything seemed like it wasn’t real. This is derealization. A person can experience either one or both for a few minutes or longer.
Once Margaret was diagnosed correctly, she was able to recover and no longer dissociated. Proper diagnosis is essential as this disorder is often confused with others such as Borderline Personality Disorder, Acute Stress Disorder, and even Post-Traumatic Stress Disorder. Seek out an experienced professional to ensure that a correct diagnosis is given.