DISSOCIATION

What is Dissociation?

In general, dissociation is a defense mechanism that everyone uses every day. In its most common form, mild dissociation includes day dreaming, “zoning out,” or doing things on “autopilot.” For example, when you find yourself staring out the window thinking about what you are going to do after your class, driving a car and not recalling the details of how you got from one point to the next, or getting so caught up in a movie you don’t hear someone whispering behind you – these are all examples of normal dissociation. Dissociation is a form of self-hypnosis. Everyone experiences dissociation.

You may dissociate more when you are tired or bored. Think about times when you have been in a boring meeting or a class with a teacher who talks with a monotone voice and doesn’t use ways to engage your interest. What do you do? Maybe you start to doodle, you day dream about something that is more interesting or you think about a problem that is on your mind. Dissociation gives you an ability to do more than one thing at a time. While you may be half hearing what is happening in the boring class or meeting, your mind is wandering off somewhere else.

Dissociation is a wonderful aspect of creativity and imagination. Think about the times when you were able to be the most creative. Sometimes creative folks need to enter into the “twilight zone” of dissociative states to really get their imagination going. Therapy is often best done in dissociative type states. When working with teens, I often encourage them to use a distraction while dealing with difficult issues to help them examine their feelings. It can be very helpful!

Sometimes the ability to dissociate from your emotions is harmful to you and potentially to others. If you live in a fog most of the time, things around you feel surreal. This experience is called derealization. Its almost like you are walking through a movie but it isn’t actually a movie – its your life. You don’t feel present and connected to what is going on around you. This feeling in fact can be very distressing for some people. For others, people try to induce this feeling through the use of drugs and alcohol, to avoid their feelings.

Dissociation is a common symptom of depression and anxiety. A fact that many therapists don’t understand. Many people have sought therapy out for a depressive or anxiety related disorder only to find that therapy and medication don’t do enough. The problem often is because the client’s dissociation is ignored or unrecognized by a clinician. Thus whenever the depression and anxiety is experienced, you may “check out” – leaving the very reasons you become depressed or anxious unintegrated! It is a huge problem because many clinicians have no idea how important a good understanding of dissociation is in the treatment of more common clinical problems!

Trauma survivors and abuse survivors often rely too heavily on dissociation as a defense mechanism. Dissociation is a crucial survival mechanism that protects you during a crisis and afterwards. It helps you stay on task so you can protect yourself. If you are able to function without fully experiencing the emotional impact of an event, you can accomplish tasks until it is safer to deal with your emotions. For example, lets say a man comes up to you, points a gun at you and demands your money and jewelry. If you were to feel the terror of having your life threatened, you may not be able to fight him off, run away from him or comply with his demands. In another example, if you were a child who was physically abused, dissociation may have allowed you to endure a highly traumatic experience without having to fully experience it. Abuse survivors often report that they “go away in my mind” or “stop feeling the pain.” Without the ability to dissociate, you would feel the full extent of trauma as it happens and afterwards, which could be completely devastating for you. The ability to dissociate is a critical part of people’s survival responses.

Think about the level of dissociation it takes to remain in a dangerous situation. Lets say that you are in a war. You have been captured by the enemy and put into a prison. The enemy soldiers are cruel towards you. Perhaps they don’t feed you properly, keep you in isolation for long periods of time and physically assault you. In order to survive being held captive, it is important for you to be able to enter a type of dissociative state to cope with the abuse you endure. But, there can come a point when you dissociate so much that you don’t take your opportunities to escape when you have the chance, a common phenomenon that occurs in many captive situations of all types.

Think of a more common captivity situation, like child abuse or domestic violence. Victims of abuse are in a captive state psychologically. They dissociate to cope with being abused. Dissociation during sexual abuse is a classic example. Many people who have been sexually abused as children report leaving their bodies and watching the abuse from above themselves. This is a more extreme form of dissociation than simple daydreaming. This is the mind’s ability to cope with horror at its best. Instead of having to be emotionally experiencing sexual abuse, the mind helps your soul escape. Your experience of being is not in your body, but on the ceiling somewhere witnessing abuse that is happening to you.

There are varying levels of dissociation:

· Everyday Dissociation we all experience that is healthy in general

o day dreaming

o spacing out

o fantasy

· Traumatic Dissociation that comes from trauma and is not integrated in the psyche

o numbness

o deadened emotions

o leaving one’s body

· Severe Traumatic Dissociation comes from major trauma that is not integrated in the psyche

o derealization – constant experience of dissociation

o depersonalization – not feeling the sense of “Me” or feeling your body as belonging to yourself

o forming separate identities or self-states

§ fully formed identities

§ partially formed identities with specific roles

§ emotion states that are fragments

In its most extreme form, dissociation can actually cause a sense of fragmentation or various self-identities within one person. This happens to children who endure horrifying torture and extreme forms of abuse. Instead of leaving one’s body, an entire separate identity is created to handle the abuse the child has to endure. It isn’t uncommon for children who develop different self-states to form several personalities to take on various roles. The more personality states created, the more abuse has occurred. This form of dissociation only happens in childhood, when children are most vulnerable, and endures through adulthood unless therapy is sought out. Therapy can help people with multiple identities to either learn to manage the fractured pieces of themselves more effectively and improve their overall quality of life, or to integrate the fractures into one sense of Self.

For dissociation that interferes in your quality of life, therapy can be extremely helpful. Traumatic dissociation happens when you are overwhelmed by a traumatic event or a series of traumatic events. It is self-protective. The problem is that in order to put the past to rest, the painful feelings of the past trauma have to be re-integrated into your sense of self, and a new sense of the integrated trauma needs to be internalized. Therapy helps trauma and abuse survivors integrate traumatic material, improve your sense of well-being, help you learn to manage difficult emotions that arise when unintegrated trauma gets triggered, and helps prevent past trauma from interfering in your present life.

I follow the ISST-D guidelines for diagnosing and treating Dissociative Disorders. For someone who has either Dissociative Identity Disorder or Dissociative Disorder, NOS, I use the following steps. This is a general idea of what you can expect in treatment with me, not an exact layout of my treatment plan. First, I help establish a sense of safety within therapy. This takes a lot of time as building a sense of trust and emotionally safety for someone who has been tortured significantly is difficult to do. I try to establish a safe enough working relationship with a client and we negotiate through the boundaries of therapy. During this time we may work on getting to know one another, establishing the ground rules for therapy and work on practical issues dealing with Dissociation. This is a time for skill building and practicing new skills, mapping the system, and taking time to get to know different alters in a system. For some people who have a lot of fragmentation or who are not used to allowing outsiders to meet their alters, this may sound strange and confusing. It is only by establishing a relationship with different alters that I can help become a member of a healing internal team.

This period of time is stabilization and restructuring time. Sometimes an system may be set up in such a way that worked during a time when you were being abused. If you are out of the abusive situation, your system needs to adapt to a different way of being. This takes time and is the main focus of treatment. Then, only when you are ready do we do trauma work. Trauma work is slow and usually structured. We may decide to work on a specific memory during a session and have a couple of other sessions for regrounding. Not all material will be re-integrated. It isn’t possible, but enough of it can be worked through to help rebuild a more cohesive sense of self and life experience. The majority of therapy work is done during the first phase – working with the system, not in the trauma phase. The third phase is integration or learning to function as “one.” For most therapists, integration is the end goal of treatment; however you may or may not want this. This is a personal choice. If you do opt for integration, the final phase of therapy is adjusting to life as an integrated Self.

Sadistic abuse or extreme abuse is often a term used to describe ritual abuse and mind control, but it can also be used to refer to anyone who has endured abuse that was extreme and sadistic in nature. A sadist is someone who enjoys inflicting pain on others. He/she often finds sexual pleasure in witnessing the pain his/her victim endures at his/her own hands. Often rapists will take some sadistic pleasure in the act of rape. A sadist is one who demands his victim be present psychologically and emotionally during the abuse they inflict. They will speak words of hate, blame their victim for their abuse, call them debasing names and use particularly humiliating ways of abusing their victims. Some sadists enjoy the power of giving and taking life. They want total possession and control over their victims, even to the point of killing and reviving them. For other sadists, the mere act of inflicting horror and fear is enough for them.

Victims of sadistic perpetrators often hold a deeper sense of horror and terror than their non-sadistically abused counterparts. They often feel the hate that their perpetrator has instilled in them. They develop a sense of intense fear, terror, and difficulties with intimacy. Because their perpetrators demanded their psychological presence to inflict their abuse, these victims will often avoid intimacy at all cost, even if they crave being close to others. They find having close friends, lovers and family members intolerable. They may be quick to leave therapy as the therapy progresses because they cannot tolerate the relationship and interdependence that gets created in a therapeutic or other intimate relationship. Work with sadistic abuse survivors must go especially slow are carefully. They require long-term treatment because they have internalized the intense self-hate and fear of developing a close relationship with anyone. Because their lives have often been threatened, even coming to therapy can seem dangerous, even if their perpetrators have been imprisoned, live in another state or country, or are deceased.

Many sadistic abuse survivors may be misdiagnosed as having borderline personality disorder, histrionic personality disorder, bipolar disorder, schizophrenia and ADHD. They often suffer from intense mood swings, severe trauma symptoms, depression, intense anxiety, panic attacks, agoraphobia (fear of being around crowds or in some cases, being afraid to leave the house), obsessive compulsive disorders, phobias, hear voices that are usually dissociative and not psychotic in nature and may appear to be paranoid. They frequently have trouble forming intimate relationships, may vacillate between having intense relationships and avoiding relationships altogether, experience sexual difficulties, a variety of physical problems which may or may not have a true medical cause in nature, and dissociate a lot. Their self-esteem often is extremely low. They may have many thoughts that are self-hating in nature and frequently have addictions and/or self-harming behaviors.

Since it is true that we all have reactions to traumatic events, how do you know if you need the help of a therapist? The easy answer to this question is to seek out a therapist if you are feeling like the impact of trauma is interfering in your life. There are some ways to know if you need therapy. Ask yourself the following questions:

* Do you wonder if therapy might benefit you?
* Do you want someone to talk with?
* Do you cry a lot, feel hopeless, worthless?
* Do you avoid your feelings?
* Do you frequently feel afraid or scared?
* Do you have trouble leaving your house or being in large crowds? Do you have easily overwhelmed in grocery stores or other larger stores? Do you ever feel like you have to leave because it is too overwhelming? Have you ever left a store because it was so overwhelming? Do you avoid crowds and/or large stores?
* Do you become really sad, anxious, angry, enraged, or emotional to the point that it seems excessive to you or to others?
* Do you use sex, drugs, alcohol, relationships, exercise, eating, etc. to avoid pain?
* Are you addicted to anything? If you are not sure, who doesn’t know you personally and is going to just focus on your problems, not theirs?
* Do you have low self-esteem or feel bad about yourself?
* Are you having problems in your relationship(s)?
* Do you feel depressed, anxious or worry a lot?
* Have you been raped or sexually assaulted? Do you avoid talking about it or is it “haunting” you?
* Are you a victim of a violent crime? Do you avoid talking about it or is it “haunting” you?
* Are you a survivor or childhood physical or sexual abuse, neglect or emotional abuse? Do you think it is still affecting you? Do other people tell you that it might be impacting you even when you don’t think so?
* Am you jealous of people giving your boyfriend/girlfriend/significant other attention even if you know they are just friends?
* Has someone you loved recently died or died a long time ago but you haven’t been able to grieve? Do you need a place to talk about this?
* Do you feel sad, and anxious?
* Do you have trouble keeping things together?
* Do you have a pattern of problems in your relationships?
* Do you avoid having relationships because you don’t want to get hurt or am afraid you will hurt someone?
* Am you afraid of men or women because you have been hurt in the past?
* Do you avoid sex?
* Do you have sex to avoid intimacy or forming a relationship with someone else?
* Do you lie?
* Do you have uncontrollable outbursts of anger?
* Do you have rage?
* Do you have panic attacks or anxiety attacks?
* Do you do things that you know are wrong but just can’t seem to stop them and don’t know why?
* Do you feel like you need help but are afraid to ask for it?
* Do other people suggest that therapy may be helpful to you?
* Would you like to get support from someone who has no other agenda than just to be there for YOU for a change?
* Are you having thoughts or fantasies about dying or want to kill yourself?
* Do you ever cut, scratch, burn or hurt yourself intentionally?
* Do you think about doing things to hurt yourself but don’t act on it?
* Do you wish you could die, but wouldn’t take your own life? Do you think about suicide, whether you would do or not?
* Have you been abused as a child or an adult?
* Have you ever hurt another person or an animal?
* Have you ever abused someone like you were abused?

· Have you ever had sexual contact with a child or teen?

* Do you get so angry that you want to hurt someone? Do you feel out of control?
* Do you steal?
* Do you often feel as though you are not fully present, like you are in a fog or everything around you feels surreal?
* Does time pass and you don’t know what happened when it passed?
* Do you ever feel like, or wonder that maybe there is someone else inside my head or do you have other identities?
* Do you still have imaginary friends that are real to me even though you am older than 10?

If you answered yes to any of these questions, you could benefit from therapy. Some of the questions assess trauma responses that are mild but disruptive to your life and other of the questions ask about more serious problems. If you answered “yes” to the disruptive questions, it is still a good idea to seek out help. The list contains a variety of trauma reactions from varying levels of traumatic responses. So, for example, you may have problems with anxiety and depression, relationship problems, and feel generally out of control, but seem to be somehow holding it together. You would find therapy very helpful and enjoyable because you would see results fast.