WHAT IS DISSOCIATION?

THE CONNECTION BETWEEN DISSOCIATION & MINDFULNESS

Understanding Dissociation

There is a lot of confusion about what dissociation is. The mental health field has only more recently come to gain a greater understanding of what dissociation means for the brain.

In mental health, dissociation refers to the brain disconnecting, or having a lack of awareness, from one’s thoughts, feelings, actions, body sensations, or sense of self. It is the brain checking out of what is happening in the present moment.

Historically, it has been misdiagnosed badly. Until 1992, ‘Dissociative reaction or state’ was listed under ‘Hysteria’ by the World Health Organization. (Owen, 2022) Further back, it was chalked up as demonic possession. We now know it is a normal function of the human brain, and thus we can work towards becoming more comfortable with the idea of it.

We can all relate to dissociation in its simplest form. It is in our human nature to dissociate to a certain degree. Our brains love to rely on procedural memory in the day-to-day repetition and mundane.

Can you imagine how overstimulated we would be if we attended to everything happening around us at all times? What an important function our brains are equipped with to discern between what needs our attention and what does not.

Therefore, it is understood that dissociation is not always pathological but can be normal and adaptive. It is considered a skill of the brain rather than a flawed function.

Dissociation And Trauma

In the wake of trauma, dissociating can be a powerful survival response for the brain when other responses, such as fight or flight, may not be an option. (Owen, 2022) You might have heard other people describe this phenomenon as having an “out-of-body experience” or “going somewhere else” when they encounter a traumatic event.

The International Society for the Study of Trauma and Dissociation (2020) identifies this as trauma-related dissociation. This serves as a “mental escape” when physical escape cannot be achieved, or when the level of emotional overwhelm is incapable of coping with. This is your backup hard drive when the system fails. The brain taps into this to mitigate pain. This fascinating response is basic human functioning… this is survival.

In his well-known book, The Body Keeps the Score, van der Kolk (2015) describes dissociation as “the essence of trauma”.

According to experts, dissociation becomes problematic when it remains a coping mechanism after the trauma has passed. When trauma remains unresolved, these memory fragments become reference points for the brain in scanning for threats in situations and environments in the present (and future). This can explain hypervigilance and other post-traumatic stress adaptations.

Suppose an individual becomes triggered by something in their present world that reminds them of the unresolved trauma or signals their nervous system that there is a threat. In this case, the brain can learn to chronically shift into a dissociative state to avoid pain.

While it is natural for the brain to help us avoid or reduce pain, it is not always productive in processing emotions or traumatic events and memories. We need to feel the experience to deal with it and heal, so our brain and body need to be able to connect to our emotional experiences to do so.

More specific symptoms of trauma-related dissociation can include depersonalization, derealization, dissociative amnesia, and identity confusion/alteration. These are more rare but can be experienced.

Depersonalization is the experience of having an “out-of-body experience”, when a person feels detached from their body. Derealization is the experience of feeling like things are not “real”, or when real life seems more like a movie or a dream. Dissociative amnesia is having trouble with remembering events that one was present for. Any of these can be very disorienting for an individual.

Identity confusion is just what it sounds like – difficulty knowing one’s core sense of self that is not easily swayed. Lastly, identity alteration is the experience of feeling as if one is not a single and whole person, but instead separated differing ‘parts’. (ISSTD, 2020) This can make it difficult to experience autonomy over one's life and understandably result in a confusing or alarming experience.

Lastly, some trauma-related dissociation can manifest into physical symptoms, such as loss of sight, hearing, speech, movement or feeling in a body part, involuntary movements, or unexplained pain. (ISSTD, 2020) Pseudo seizures have also been seen in survivors of trauma which cannot be explained by a medical diagnosis.

Those who have endured childhood trauma or complex trauma can potentially be at a higher risk for trauma-related dissociation. For children who are not yet equipped to cope in other ways and are not offered safety or support by an adult, dissociation can become a default protective response early on before a core sense of self is fully developed.

Finding Hope in Healing

If you believe you are experiencing trauma-related dissociation, it might be a good time to talk with a therapist or mental health provider about your experiences to learn about pathways to healing.

There are multiple evidence-based therapy modalities for moving through trauma, including EMDR, IFS, Somatic Experiencing, ART, and CPT. Some therapists specialize in the areas of structural dissociation and dissociative disorders. Requesting a consultation is one suggested approach to finding the right therapist to join you in your journey. This is a good opportunity to ask about specific trainings and modalities a clinician practices with, and a time to explore any further referrals that may be helpful. For those beginning therapy, it might be advised by a therapist to start with building coping and emotional regulation skills before moving into trauma work. 

The practice of mindfulness also offers promise in targeting dissociation. Mindfulness taps into the associative process by bringing attention and focus to the present moment, and to the self. Sensing, naming, and identifying what is going on inside is the first step to recovery. (van der Kolk, 2015) It is powerful for emotional regulation, promotes personal choice, and allows you to show up and participate in your life and goals.

You can start introducing mindfulness into your routine by practicing two “anchor points” to start and end your day. This moment is meant to anchor you into your day and your body by just noticing what is happening, without judgment. Name what you notice with your five senses. You could practice this exercise while taking a shower, drinking coffee, or even brushing your teeth.

It is important to know that full or “good enough” healing is possible, and neuroscience supports the ability for brain functions to resume typical functioning following traumatic events. An individual can take back their rightfully deserved power to feel in control of an existence they experience and live in alignment with who they are – not who their trauma says they are.

“Until you make the unconscious conscious, it will direct your life and you will call it fate.” – C.G. Jung

References 

Chefetz, R. A. (2015). Intensive psychotherapy for persistent dissociative processes: The fear of feeling real. W W Norton & Co.

Fact sheet III - trauma related dissociation: An introduction (2020) ISSTD. International Society for the Study of Trauma and Dissociation. Available at: https://www.isst-d.org/public-resources-home/fact-sheet-iii-trauma-related-dissociation-an-introduction/ (Accessed: February 22, 2023).

Owen, MC, LAC, L. (2022) “Trauma and Dissociation: A Clinical Approach,” Arizona Trauma Institute. Arizona Trauma Institute, Arizona: aztrauma.org, 1 February.

van der Kolk, M.D., B. (2015) The body keeps the score: Mind, brain, and body in the transformation of trauma. New York, NY: Penguin Books.