A Deep Dive into Dissociation

Alexa Kightlinger

As a researcher, I’ve always been interested in how memory can be altered, particularly how stress or fear plays a part in it. As I’ve discussed in previous articles, episodic memory may not always be rooted in truth. Eyewitness accounts can be altered by various factors that play into how much attention we pay to a situation. While it’s easy to understand how the amount of attention we pay to a scene or whether we are tired may impact the details we remember, not much is known about how dissociation impacts our memory. As we will discuss, dissociation is often caused by individuals experiencing traumatic events. It’s amazing what the body will do to protect the brain from negative memories. It is my hope that this article shines a light on just one small aspect of what those who experience trauma may face. 

Dissociation is a complex psychological concept where the individual experiences a disconnect from reality. As a key feature of dissociative disorders, dissociation is often brought on as a result of chronic developmental stress as patients diagnosed with this disorder report higher frequencies of childhood abuse or neglect (Șar, 2014). As it is with most disorders, dissociation falls along a continuum, with dissociative identity disorder (DID) on the most severe end. Those who suffer from dissociative disorders may experience disruptions in one or more mental functions, affecting areas of one’s memory, identity, or consciousness. The DSM-5 (2013) breaks dissociative disorders into five categories.

(1) Dissociative Identity Disorder

Diagnostic Criteria

A: The possession of two or more distinct personality states which results in the disruption of identity.

B: Recurring gaps in recalling everyday experiences.

C: Stress in social, occupational, or other social areas of functioning.

D: Disturbances that are not a normal part of cultural or religious practice. 

E: Symptoms that can not be attributed to physiological effects of substances or other medical conditions.

(2) Dissociative Amnesia

Diagnostic Criteria

A: Inability to recall important autobiographical information.

B: Stress in social, occupational, or other social areas of functioning.

C: Symptoms that can not be attributed to physiological effects of substances or other medical conditions.

D: Disturbances that can not be explained by DID, PTSD, acute stress disorder, somatic symptom disorder, or major / mule neurocognitive disorder.

(3) Depersonalization/Derealization Disorder

Diagnostic Criteria

A: Presence of persistent depersonalization and/or derealization events.

B: Reality testing remains intact during depersonalization and/or derealization events.

C: Stress in social, occupational, or other social areas of functioning.

D: Symptoms that can not be attributed to physiological effects of substances or other medical conditions.

E: Disturbances can not be explained by other mental disorders such as schizophrenia.

(4) Other Specified Dissociative Disorder

While similar to other categories, other specific dissociative disorders are used in situations where the clinicians find that the presentation of the disorder does not meet the full diagnostic criteria for any specific dissociative disorder.

(5) Unspecified Dissociative Disorder.

The unspecified dissociative disorder is used when the clinician chooses not to specify reasonings that criteria are not met; similar to situations in which there is not enough information to make a specific diagnosis, like in an emergency room setting. 

Out of Body Experiences 

As mentioned before, dissociation is frequently reported among individuals who experience high levels of stress and trauma at a young age. It often develops to help individuals cope with the trauma or stress by disconnecting them from distressing thoughts or emotions. Many report having an “out of body” experience where they are almost like an observer of the event that is occurring. These usually occur when individuals are placed in near death situations and are commonly associated with psychiatric disorders, brain dysfunction, and pharmacological agents   (Madgal et al., 2021). While few cases have been reported alongside a DID diagnosis, a 15-year-old male patient who described experiencing this strange phenomenon was later diagnosed with DID and dissociative fugue (Madgal et al., 2021). Doing so allows the individual to develop an emotional numbness. While this does help prevent individuals from becoming overwhelmed by emotions, prolonged dissociation may lead to cognitive challenges or confusion with maintaining a sense of self. In some cases, dissociation may even become a natural response when individuals are placed in non-threatening situations.

Treatment

Dissociative disorders are often difficult to diagnose, leading many cases to go undiagnosed or misdiagnosed. It is estimated that approximately 7% of the population may have suffered from a dissociative disorder at one time in their life (Mental Health America, 2025). While no medication has been found to specifically treat dissociation, many are prescribed antidepressants, which address the anxiety and mood symptoms that are comorbid with this disorder (Gentile et al., 2013). Psychiatrists must approach dissociative disorders with caution since medications such as benzodiazepines can reduce anxiety, but worsen dissociation. For individuals with DID, some have found success in the following:

• Selective serotonin reuptake inhibitors 

• Tricyclic antidepressants

• Monoamine oxidase inhibitors 

• Beta-blockers

• Clonidine

• Anticonvulsants

• Benzodiazepines

*Note that while one medication may have worked for one person, it is important for clinicians to approach each case separately.

In addition to medication, specialized therapy is another choice individuals choose to pursue. Facilities, such as what is offered at The Chicago Psychoanalytic Institute Treatment Center, offer a safe environment to facilitate emotional healing. By focusing on aspects of exploring underlying trauma, emotional awareness, developing coping mechanisms, and improving interpersonal relationships, clients can work towards healing (Chicago Psychoanalytic Institute, 2024). Several techniques may be taught to help someone suffering from a dissociative disorder heal.

Subramanyam et al., (2020) outlines a few treatment methods clinicians may employ to help their client heal from trauma. 

• Psychoeducation: Focuses on normalizing the individual's symptoms and relating them to the dysfunction they experience in daily life. This helps shift focus away from victimization and allows them to understand themselves by giving meaning to their symptoms.

• Grounding Skills: By helping the patient detach from emotional pain, patients are taught to shift their attention from negative emotions to external cues in the present. 

• Cognitive Awareness: The patients ask cognitively oriented questions such as “Where am I?” or "What day is it?”

• Sensory Awareness: Similar to grounding skills, patients are taught how to use their senses to anchor them to the present moment.

• Distress Tolerance: This teaches the patient to tolerate negative emotions by increasing their capacity to handle painful emotions when the situation cannot be changed immediately. This helps eliminate negative behaviors like substance abuse. 

Impact

Dissociation not only affects the individual but also their close friends and family. Memory lapses can make conversation difficult when the individual suffers from dissociation and can not remember important information, leading to disruptions in family routines or minimizing time families originally had for leisure (Mohammad et al., 2023). This can also cause frustration and anger if friends and family members are not understanding or supportive of what their loved one is dealing with. Severity can also lead to an increased load of responsibilities as severe dissociation can interfere with daily life. Caregivers may be tasked with reminding individuals of daily tasks/important events or helping them with emotional regulation during stressful times. Additionally, the lack of awareness of how dissociation can impact all involved contributes to misunderstandings and stigmatization. For more severe disorders such as DID, the media has misrepresented them as violent and dangerous, leading others to view them as the curator of violence, rather than the victim of it.

Conclusion

I hope this article has provided more information not just on what dissociation is, but the effect it has on others. Furthering our understanding of dissociation helps promote awareness of this mental health challenge. Regardless of whether we are personally affected by this or not, educating ourselves helps bridge the gap between the unknown and fosters an air of understanding and empathy towards those who experience dissociation as part of their everyday lives.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed). Pearson.

Dissociation and Dissociative Disorders. (n.d.). Mental Health America. https://mhanational.org/conditions/dissociation-and-dissociative-disorders

Dissociation: Understanding Its Complexities and Healing - Chicago Psychoanalytic Institute. (2024, December 6). Chicago Psychoanalytic Institute Treatment Center. https://chicagoanalysis.org/blog/conditions-and-diagnoses/dissociation-treatment/

Gentile, J. P., Dillon, K. S., & Gillig, P. M. (2013). Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innovations in Clinical Neuroscience, 10(2), 22. https://pmc.ncbi.nlm.nih.gov/articles/PMC3615506/

Mohammad, Y., Kumar, R., Sinha, N., & Kumar, P. (2023). A study of stressors, family environment, coping patterns, and family burden in persons with dissociative disorder. Industrial Psychiatry Journal, 32(2): 317-322. https://doi.org/10.4103/ipj.ipj4223 

Mudgal, V., Dhakad, R., Mathur, R., & Sardesai, U. (2021). Astral projection: A strange out-of-body experience in dissociative disorders. Cureus, 13(8), 17037. https://doi.org/10.7759/cureus.17037.

Şar, V. (2014). The many faces of dissociation: Opportunities for innovative research in psychiatry. Clinical Psychopharmacology and Neuroscience, 12(3), 171–179. https://doi.org/10.9758/cpn.2014.12.3.171