'It Was All a Dream:' Dissociation from Trauma
What Is Dissociation?
Dissociation is an experience where a person disconnects from their mind and body. More formally, it’s defined as “a disruption of consciousness, memory, identity, and/or perception of either your environment or yourself.” This could look as simple as a daydream or as serious as amnesia. There is a spectrum of dissociative experiences and their causes are as variable as the symptoms. With PTSD and trauma, dissociation can stem from overwhelming thoughts, memories, or emotions. It’s a way to protect yourself from the pain and hurt of the experience.
Dissociation can be very alarming. It can be an experience that some people don’t even know is happening. A way to gauge if dissociation is something you've been struggling with is combing through the Dissociative Experiences Scale. Do you resonate with any of those experiences? Some examples of experiences that could be considered dissociative include:
driving or riding in a car, subway, bus, etc. and not remembering all or part of the trip
talking with someone and suddenly realizing you didn't hear all or some of what the other persons are saying
feeling like you are standing next to yourself or watching yourself as if you were looking at another person
not recognizing familiar people like friends or family
looking in a mirror and not recognizing yourself
sometimes remembering a past event so vividly that you feel like you're there
sitting and staring into space not being aware of the passage of time
feeling like you're looking through the world as a fog with people or objects appearing far or unclear
finding writings, drawings, or items that you have written or purchased but not remembering where it came from
being able to ignore pain
not being sure if an experience happened to you or if you dreamed it
feeling like your body doesn't belong to you
Types and Causes
Mental health occurs on a spectrum and so do its symptoms too. Dissociation can be as impactful as a simple daydream or it can be life-changing and frightening. Three types of different dissociations include:
depersonalization-derealization: This condition involves feeling detached from one's own body and thoughts. People may feel that they are observing their own life as an outsider or feel disconnected from their surroundings.
dissociative identity: Previously known as multiple personality disorder, this condition is marked by having two or more persistent personality states.
dissociative amnesia: This condition is characterized by forgetting personal information and memories of events (Tull, 2021).
Depersonalization-derealization is the most common form of dissociation for people who struggle with PTSD. Depersonalization is when one doesn't feel like the self is real. Derealization is when one doesn't feel like the world is real. Some causes for dissociation can be from a substance use disorder, trauma and PTSD, or as symptoms of migraines, epilepsy, phobias, acute stress disorders, and more.
What Should I Do If I Have a Dissociative Episode?
First and foremost, I'm sorry if you have had to experience something like dissociation. It's an extremely unnerving experience that is oftentimes unexpected. I would suggest if this happens to reach out to a trusted professional or hotline. NAMI's hotline is 1-800-950-NAMI or SAMHSA at 1-800-662-4357. It's also important to connect with a licensed therapist or provider for ongoing help. It's also important to know that EMDR treatment is contradicted for people who still struggle with dissociation. For EMDR treatment to be effective, conscious focusing is necessary. No need to worry though, it's a key phase in EMDR to teach stabilization skills to avoid dissociation during EMDR therapy.
If you continually struggle with dissociation where low-level coping skills may help on top of the extra support already in place, grounding exercises are a go-to. Grounding exercises are a surefire way to bring you back into the present moment if you feel yourself drifting away from the here and now. Here are some grounding techniques:
Temperature. Shocking your system back to equilibrium is my favorite way to connect to the present moment. Using an ice pack, holding ice, taking a cold shower, or splashing cold water on your face should be helpful in breaking a dissociative episode.
Use your senses. Engaging in the 5-4-3-2-1 technique includes pointing out and paying attention to 5 things you see right now, 4 things you are touching/feeling, 3 things you hear, 2 things you smell, and 1 thing you taste. It's a great method for using the senses to focus on the present.
Intense exercise. Do short bursts of running, jumping jacks, going for a walk, jumping around, dancing, or other forms of exercise. Paying attention to how your body feels in these moments is easier when you're engaging in intense exercise.
Deep breathing. Slowly inhale and exhale. Engage in box breathing or belly breathing - any kind of breathing that slows your nervous system. Focusing on your breath with technique allows us to shift away from the dysregulation and into our bodies.
Progressive muscle relaxation. PMR is a technique where you focus on a body part at a time. For example, start with your feet and tense them up and tighten them as much as possible for 15 seconds. Then release and focus on this feeling. Move up your body until you reach the end.
Practicing grounding exercises before you start to feel bad is key. Try to catch your dissociative episodes as early as possible for intervention. Remember that dissociation is a survival technique. Ensuring and trusting that you are safe from trauma takes time. Learning to cope and self-soothe is a step in that direction.
Tull, M. (2021). What is Dissociation? Retrieved from https://www.verywellmind.com/dissociation-2797292