Dissociation, Depersonalization, And Derealization

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Do you ever feel numb? Detached? Do you experience dissociation? Like you’re completely separate from your body or like you’re floating above it, watching yourself like you aren’t even real? 

Or does the world around you sometimes feel foggy? Dreamlike? Or like time is moving super fast or super slowly? 

These are all signs of dissociation, derealization or depersonalization. These three terms all have some overlap in symptoms. Dissociation is a common response to trauma and other overwhelming experiences, but it can also become a chronic state or a learned response to emotions. 

In this post, you’ll learn to identify the triggers and internal signs leading up to dissociation and when you have a framework to understand why dissociation happens, then you can be more gentle with yourself and learn skills to manage overwhelming situations more adaptively and flexibly and be more resilient. Let’s get better at feeling

What Exactly Is Dissociation?

I have worked with many clients who’ve experienced dissociation or depersonalization, often they have a history of trauma. 

I can remember one time a young woman who I’d been working with was sitting on the ground outside the office, she wasn’t shaking or crying, or speaking but you could tell something was very wrong.

There were some staff members there who had tried to talk to her but weren’t getting any response. Her eyes seemed like they were gazing off in the distance, seeing right through walls.

She didn’t acknowledge me or recognize me, she seemed frozen, trapped in her world. She seemed very upset but not moving.  I sat on the floor next to her, probably stayed there for 5-10 minutes, then asked her if I could hug her.

She didn’t say anything, but in the past she’d been ok with side hugs, so I put my arm around her shoulders. She barely seemed to register it.

We just sat with her, sometimes the staff members or I would ask her a question. But she was completely disconnected for a while.

We started to ask her if she could hear us, if she could see us, I asked her to feel the ground under her. She started to talk, but in a pretty disconnected way.

I asked a staff member to bring an ice cube, which she held in her hand. Gradually she started to come back. We could see her getting more emotional, she actually became a little panicky, then shaky, then crying. 

She told us she’d had a really bad flashback to some childhood abuse and that triggered her to dissociate. We sat with her and supported her for over an hour, as she started to come back to herself and be able to function. 

In therapy, we continued to process trauma and work through skills to manage those intense symptoms for about a year and over time her ability to manage her thoughts, emotions and bodily sensations really increased and the episodes became less frequent and less intense.

This is an example of a dissociative episode that is not uncommon for survivors of trauma. Dissociation can vary in severity from severe disorder to simple distraction.

Dissociation In Everyday Life

I’ve seen how on a much smaller level, I slip into the shut-down mode in certain situations. A revolving fight with your husband.

An annoying management issue at work. A difficult and unresolvable issue with health.

Can you notice that feeling you have when you check out, turn off, shut down, and withdraw emotionally?

This is dissociation on a very small scale. In some ways we all seek to dissociate a little through daydreaming, watching tv, or diving into social media. And some people walk through life just feeling numb or detached most of the time. 

This might be a common defense mechanism for many people. But, when separating from your thoughts, memories, or reality becomes involuntary or interferes with your ability to function, it becomes a disorder.

At its most severe, dissociation can cause amnesia, or the formation of alternate identities. In the DSM there are three dissociative disorders- dissociative amnesia, dissociative identity disorder (aka multiple personalities) and Depersonalization-derealization disorder. And by itself, dissociation can be a symptom of PTSD. 

So First, Let’s Understand Why We Dissociate?

Dissociation is most common for people who have experienced childhood trauma or other intense situations where they were unable to escape or overcome the danger.

It’s our body’s innate wisdom, a survival strategy for when things are overwhelming, to protect us from feeling the pain by temporarily disconnecting the mind from the body and environment.

For example, in this video a cheetah chases an impala, you can see the impala go through the nervous system stages, safety, flight (run away) fight (kick) and then after the cheetah catches her, freeze-  the impala stops moving, and shuts down.

The cheetah has her neck in his mouth. But then a hyena menaces and the cheetah takes off, the hyena takes a bite at the impala and the impala appears to be dead, doesn’t flinch, then the cheetah and the hyena fight each other for a minute and the impala hops up and sprints away. 

It seems as though, when the cheetah or the hyena had their mouths on the impala, she was still, calm, and perhaps had dissociated, wasn’t feeling the pain, was mentally separated from her body.

In inescapable situations like these, it seems like dissociation protects the impala from suffering, detaches her from pain, and in rare situations, even saves her life by keeping her aggressors from causing further damage before she can escape. 

Dissociation Is A Protective Mechanism

Dissociating is an adaptive protective mechanism when the situation is extreme and inescapable. 

We have to acknowledge that it serves a function- Bessel Van Der Kolk shares the story of his own experience with dissociation in his book “The body keeps the score” Pg. 99

And you may have read or watched “Life of Pi” where a young man essentially creates a false reality to cope with overwhelming trauma. So dissociation is a powerful method our brain uses to protect us. 

But when we overuse that coping skill for triggers, work assignments, stress, and relationship problems, it often interferes with our life. 

  • Like my client- she didn’t even know where she was
  • If every time you get in a disagreement with your spouse, you shut down and withdraw, eventually the relationship will go cold
  • If you chronically distract or avoid problems by watching too much tv, you won’t solve fixable problems and you will struggle at work or school
  • And when dissociation becomes so severe that you have split identities or slip into amnesia or fugue, then obviously this interferes with your ability to function at work, in relationships or live a happy life. 

So What Can Be Done To Heal Dissociative Disorders?

  1. Get Support from a trauma expert for working through dissociation With severe childhood trauma, or severe dissociative disorders, it’s actually probably best to be very cautious about trying to do the work by yourself, because you’re going to need someone to coach you through dissociative episodes. When you’re working through trauma, it’s easy to get overwhelmed by these survival responses and revert back into an old survival strategy like dissociation. The first thing to do is to work with someone who can help you regulate your nervous system, that’s what we do in therapy, whether it’s obvious or not, a therapist uses their own nervous system to help their client know that they are safe, they are good, they are loved, and to be present in case there’s an emergency.  Other safe people and pets can also be really helpful, but when dissociation is severe enough that you don’t know where you are or who you are, definitely seek professional support from a skilled trauma expert.
  1. Create safety. It’s pretty hard to do any of this work when you’re still in danger and your body is still thinking you need dissociation to survive, so do everything in your power to create a safe and sustainable environment for yourself. Leave toxic and manipulative relationships. Develop an internal sense of safety with positive statements, a supportive network, visualize your safe places, develop a repertoire of body- calming techniques.
  2. At its essence, dissociation is your body’s attempt to escape pain. Often you’re trying to escape something inside of you like painful memories or uncomfortable bodily sensations. You can develop the ability to face these triggers, memories and sensations with courage and calm. Grounding Skills can also help with dissociation and regulate your stress response. You can come back to your senses by literally using your senses. The 54321 grounding skill is a great place to start- 
  • Focus on five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste 
  • You can try to slow your breathing.
  • Pay attention to the pressure of your feet on the ground
  • or Engage in a physical activity, like running or yoga
  1. Learn mindfulness skills Mindfulness skills can help you accept that pain, face it, and allow it to be there without desperately needing to dissociate to deal with it. I’m not saying that dissociation is a choice, but I am saying that you can replace the need for dissociation when you increase your skills to manage emotions. 
  1. Process your trauma Old, unprocessed trauma can make even small triggers cause dissociation. After developing grounding, mindfulness, and internal safety resources, and when possible with the help of a therapist, work through your old trauma through body movement, writing, talking, and other expressive techniques. This can help decrease the intensity of the emotions around the traumatic memories and triggers.
  2. EMDR has a lot of strategies that may be helpful for dissociation: Including Bilateral Stimulation: This involves alternating stimulation of the left and right sides of the body (i.e. via sound, tapping or eye movements). This helps to re engage the dissociated part of the brain and allows the brain to reprocess old memories so they aren’t so painful.
  3. A somatic experiencing practitioner would treat dissociation by helping the individual to build the skills necessary to re-establish awareness and connection with their body. This could include helping the individual to gradually become aware of sensations in the body, learn to regulate their emotions and body sensations, and develop an ability to self-soothe and self-regulate.
  4. And an Internal Family Systems practitioner would help someone acknowledge and accept all of their parts, and possibly integrate those parts into a cohesive unit. Though integration isn’t always necessary. 

While dissociation, whether mild or severe can be really uncomfortable and get in the way of living your life, it is treatable. With the right skills and support, you really can learn to re-regulate your nervous system, face and resolve pain, and spend more time right here in the present moment, living your life and making it better and better each day. 

Click the link below to learn how to process your emotions. 

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