Yes, There’s a Spectrum of Dissociation

The dissociation spectrum ranges from daydreaming to dissociative identity disorder.

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Anyone who has traveled as a passenger in a car or sat through a long lecture has almost certainly daydreamed — a very mild form of dissociation. It’s often a pleasant, easy experience, with the mind wandering off into some story or thoughts about upcoming events. Of course, daydreaming can also involve negative thoughts, but they typically pass quickly at this stage. 

Then, there are instances in which a person’s separation from reality moves down the spectrum, potentially meriting the diagnosis of a dissociative disorder. Below, we delve into the full dissociation spectrum and explain how therapy can help with dissociative disorders. 

What is the dissociation spectrum? 

The dissociation spectrum spans from daydreaming to dissociative disorders. According to Charlie Health Primary Therapist Kathleen Douglass, MA, LCPC, the most common type of dissociation is something almost all of us do from time to time. “That’s daydreaming or getting lost in a great book. You’re still ‘here’ but mildly disconnected from reality,” she explains. 

On the other end of the spectrum are episodes that fall under the category of a mental health condition. “These episodes involve chronic detachment from reality, making it very hard for a person to consistently function in the world,” said Douglass. 

Each instance on the dissociation spectrum qualifies as a dissociative experience, but only severe episodes are part of a dissociative disorder. "Since dissociative disorders occur on a spectrum and can occur in different levels of severity, it is possible to experience dissociating without having a diagnosable disorder," said Douglass. In short, you can experience mild dissociation without a clinical diagnosis.

Signs and symptoms of dissociative disorders

Things go from simple daydreaming or mild dissociation to a diagnosable condition when someone experiences moderate to severe dissociation. According to the National Alliance on Mental Illness (NAMI), dissociative symptoms linked to a mental health condition include memory loss, feeling outside of your body, limited to no self-identity, detachment, and changes in voice, mannerisms, or temperament. 

That being said, the exact symptoms you experience if living with a dissociation disorder depend on the condition and severity. According to the American Psychiatric Association, publisher of the Diagnostic And Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are three types of dissociative disorders: Dissociative amnesia, depersonalization disorder, and dissociative identity disorder. Here's what you need to know about each specified dissociative disorder and other mental health conditions linked with dissociation. 

Dissociative amnesia

Unlike general forgetfulness, dissociative amnesia involves being unable to remember something in association with an overwhelming traumatic experience or memory, such as physical or sexual abuse and neglect. Trauma that occurs early in life is often the catalyst for dissociative amnesia. 

The most common manifestation of dissociative amnesia is localized, meaning a person is unable to recall a specific instance or time directly connected to a traumatic event. Some people, though, face selective dissociative amnesia, where they recall some details or emotions related to a trauma while having gaps in memory for other parts of the event. The rarest form of dissociative amnesia is generalized, in which a person loses recollection of their entire identity and experiences linked to traumatic events. In most of these instances, a person is unaware of these gaps in their memory and is suppressing traumatic memories. 

Depersonalization-derealization disorder

With depersonalization-derealization disorder, a person feels as if they are viewing their life from the outside — like watching a movie (depersonalization). A person living with this dissociative disorder might also experience life as if the things that are happening around them aren't real, maintaining a sense of detachment from their day-to-day life (derealization). 

People with this mental health condition tend to be aware that their observations of life are different, an awareness that can add to their stress. They also might only experience either state of dissociation for mere moments at a time. The first onset of depersonalization-derealization disorder tends to be at 16 years old, on average, and the majority of people with this condition experience their first dissociative episode before the age of 20, according to experts.

Dissociative identity disorder (DID)

DID was long referred to as multiple personality disorder and is the most severe mental disorder of these three conditions. It's characterized by a person experiencing at least two different personality states. Each identity can have its own behaviors, thoughts, memories, voice, and interests — even food preferences. The different personality states can be different ages, genders, or even perceived body types. The shift between personality states can occur involuntarily and without warning. 

A person experiencing DID might also feel like an observer of their life. Furthermore, they can forget pieces of information or events ranging from daily events to traumatic events. This can lead to severe distress in all areas of their lives and difficulties functioning throughout their lives. 

The most common associated risk of developing DID is physical or sexual abuse in childhood. People living with dissociative identity disorder are at a higher risk of self-harm and suicide.

Dissociation as a symptom of other mental health conditions

Dissociation can also be a symptom or subtype of certain mental disorders. For example, dissociation can be a subtype of post-traumatic stress disorder (PTSD). According to the National Center for PTSD, individuals with this subtype of PTSD showed increased suicidal ideation and attempts, functional impairment, and psychiatric comorbidity. They also had recurrent and early traumatic experiences before developing PTSD.   

Dissociation is also a symptom of borderline personality disorder (BPD). A person might be experiencing BPD if they have extremely strong emotions and symptoms such as dissociating when stressed, quickly shifting values, and lacking a strong sense of self. 

How therapy can help with dissociative disorders

So, how are dissociative disorders treated? While the specified dissociative disorder and its symptoms come into play, there are a few overarching techniques that can be beneficial. 

The main option is therapy. 

"Focusing on practical skills such as grounding techniques and distress tolerance practices are often recommended, though it may vary from person to person," said ​​Claire Streeter, PMHNP, ARNP, a Charlie Health Psychiatric Mental Health Nurse Practitioner. Streeter also recommends evidence-based trauma-focused therapies, such as eye-movement desensitization and reprocessing (EMDR), in treating dissociation. Douglass further suggests cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). She notes that some people also try hypnotherapy. 

Dissociative disorder treatment at Charlie Health

If you or a loved one is struggling with dissociative symptoms, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for teens and adults dealing with serious and ongoing mental health conditions, including dissociative disorders. Our expert clinicians incorporate evidence-based, trauma-focused therapies into individual counseling, family therapy, and group sessions. With this kind of holistic treatment, managing traumatic memories is possible. Fill out the form below or give us a call to start healing today.