Let’s Talk About Dissociating, Part 1

Matthew Cuddeback LCSW

Dissociation is often discussed in whispers and considered an area many therapists and clients are nervous to approach. So, let’s be not afraid, let’s discuss it because it can be helpful to have some understanding of the context for the mental health issues that you may be struggling with as they often inform how they are approached in therapy. Dissociation is often a scary and isolating experience and one that can unfortunately carry stigma. Let’s break that stigma down and build up a healthier understand of this phenomenon.

Dissociation is, generally speaking, when a person disconnects mentally from a moment or experience. More and more we are considering dissociation as a spectrum of reactions, so on one end of the spectrum it may be daydreaming during a boring meeting and the other it may be losing time because you were triggered and reminded of a horrible trauma. It is important to understand this spectrum because a common misconception about dissociation is that it is always a sign of severe mental health concerns. As we discuss misconceptions it is important to address one of the biggest misconceptions regarding this topic. There is a diagnosis called Dissociative Identity Disorder, this is colloquially known as multiple personalities. When discussing dissociation this can often be on the periphery of what the client or clinician brings to the situation. This can often lead to approaching this situation very problematically. In no uncertain terms, yes, Dissociative Identity Disorder is a real thing and is often defined by dissociation. No it is not at all common, yes this is too often considered to be occurring when it is not, and no not all dissociation is due to Dissociative Identity Disorder. 

Another common misconception is that dissociation means psychosis of some sort, like schizophrenia. People often associate dissociation with psychotic disorders because we often pair these symptoms and experiences with delusions or hallucinations. Sometimes they do co-occur but often they don’t. You can experience dissociation without also hallucinating. In fact, something far more common with dissociation is trauma. So, let’s get used to the idea that sometimes dissociation can be accompanied by psychosis such as delusions or hallucination but more frequently is not accompanied by any such symptoms.

Another common misconception and perhaps one of the most damaging ones, is that it is inherently bad. It can be a very healthy and adaptive thing to experience dissociation. When we are discussing symptoms or presenting concerns it is helpful to think about how this thing is happening for a reason. Your anxiety has increased? There is a good reason for that. You have increased your drinking? There is a very solid reason for that increase. You are experiencing dissociative episodes? Yep, there is a good reason for that too! We refer to these kinds of experiences as being adaptive. Your brain is telling you there is something too painful to experience and it is telling certain parts of your brain to take a vacation and not worry about it. This can be because you experienced something tremendously painful, and your mind tells you it is not safe to reexperience it right now. However, there is a point in which these things can become maladaptive, and it becomes a problem for you. Maybe the first few months after a traumatic event you dissociate when triggered. This is a normal response to an abnormal situation. But sometimes maybe you dissociate when you are driving. Or you become more present while walking down a random street in Lakeview and you were supposed to be at work downtown an hour ago. That suggests it’s time to address the issue at hand. 

Hopefully this helps to clear out some of the confusion and reluctance to take a good look at these issues and makes it easier to feel comfortable talking about dissociation. If you found this interesting, please be sure to read Let’s Talk About Dissociating Part 2 in which we talk about how to approach these issues and work on them to feel healthier.