Dissociation Isn't Always About Trauma

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The term “dissociation” has received a lot of public and professional attention in recent years. This is likely due to the increased interest in psychological trauma, and, unfortunately, movies like "Split," ostensibly about someone with dissociative identity disorder (DID), but portrayed more as a psychopath.

Despite the rise of the awareness of dissociation, I can’t help but notice that the general understanding remains relatively narrow; it's usually presented as splitting into another identity or PTSD flashbacks. In reality, dissociation is part of everyday life—but it indeed can be pathological.

The definition of dissociation, from a clinical standpoint, is twofold:

1. An alteration in consciousness or identity. Basically, there is a literal disconnect from their experience of self, encounters, and/or the environment.
2. A separation of an idea or experience from it's emotional significance.

Everyday Dissociations

Considering the first definition, if you’ve ever been on a long car ride and all of a sudden it seems you arrived at the destination in no time, you’ve experienced dissociation. Now, if you’re sitting down, notice the feeling of the floor under your feet and your body against the chair. You probably weren’t aware of those contacts until I drew your attention to them because, you guessed it, you were not conscious of them.

Dissociations like these are just part of everyday life. They are often adaptable, like when there’s a lot of background noise and you’re able to “tune it out” to concentrate better.

As for the second definition, psychologist Nancy McWilliams (2011) explained that dissociative experiences are "a common first-line adaptation to deal with destabilizing situations like emotional intensity" and are considered normal experiences. If you have ever encountered what you consider an emotionally charged situation, like an EMT rescuing someone from an accident, but felt oddly calm, you have encountered the second definition. It is like a momentary emotional callous to help get through a situation where panic would be detrimental.

3 Types of Problematic Dissociation

While dissociations like the above are innocuous, everyday experiences, the other end of the dissociation continuum includes more pernicious encounters, often associated with trauma, depression, and personality disturbances, including the following:

1. Dissociative amnesia

In this form of dissociation, there are missing recollections of specific times/incidents. The amnesia can be for specific parts of the traumatic event, like the most frightening or painful, for example, or an entire timeframe leading up to, and following the event(s). Some, like children who have endured chronic abuse, neglect, and loss, or people living in war-torn regions, may literally not recall more than vague details of their childhood or the war period.

This psychological trick seems to be meant to protect the person from constantly enduring the replaying of the trauma, as if they weren’t there. Unfortunately, it’s a double-edged sword, because, as one can imagine, not recalling one’s childhood or another period of their life can wreak existential havoc.

It can also be a problem if there’s a crime witness issue. A viewer of a heinous crime might tell investigators they can’t remember what happened, for instance, only to be viewed as refusing to cooperate or somehow being an accomplice of the offender.

The Cleveland Clinic (2023) noted that the dissociated memories often resurface, but might be very painful, leading to depression or anxiety that requires its own intervention. Of course, it is possible that the intensity of the memories might lend themselves to being repressed to an amnesic state once again. Interestingly, dissociated memories can be retrieved, according to trauma expert Steven Gold, Ph.D. (2016), or, if not, the existential complications with sense of self or matters of life meaning can be worked through in therapy.

2. Dissociative identity disorder

Historically called “multiple personality disorder,” people who suffer from DID invariably have very early histories of intense abuse and neglect. Thus, as their personality/identity is developing, they evolve compartmentalized alter identities. In effect, the core person's identity is fragmented or dissociated to deal with particular situations.

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Mitra and Jain (2023) summarize four components that seem necessary for DID to evolve:

Several prominent psychologists, such as Kluft, have broken down the theory behind DID-in-sum. The theory describes predisposing factors for dissociation, which include an ability to dissociate, overwhelming traumatic experiences that distort reality, creation of alters with specific names and identities, and lack of external stability, which leads to the child's self-soothing to tolerate these stressors.

To put it into some perspective, many of us, if physically threatened, for example, will change to an aggressive demeanor and seem like a different person. And we remember the incident. Chances are, we’re not always conscious of our ability to become so defensive unless it is required. Now, imagine having dissociative amnesia for parts of childhood, but having evolved hypertrophied versions of normal survival/defensive reactions within.

Regardless of whether one can recall their problematic childhood, defenses are naturally programmed into them. Thus, when faced with a situation resonating with the subconscious (our “operating system,” always running in the background to keep things going, but we’re not really aware of it) as threatening, these overly developed defenses may show themselves, rendering a “different identity.”

Provided these reactions are really part of the person’s traumatic past, which is “forgotten,” it makes sense they tend not to recall being in an altered identity. Thus, those with DID often end up presenting for treatment not because they realize they are dissociating, but because they keep losing track of time or ending up in situations or places they don’t recall arranging/going to.

Therapy for DID is best summed up by the International Society for the Study of Trauma and Dissociation (2011) as, "Helping the identities to be aware of one another as legitimate parts of the self and to negotiate and resolve their conflicts is at the very core of the therapeutic process."

As one might imagine, this can be a complex process, as therapists must first gain the trust of the individual and the other identities. This creates a safe environment for them to be vulnerable, explore their roles and learn how to more effectively protect the core than splitting off at each vulnerability and creating upheaval in the core's life. (For an inside-out look at DID, and what successful treatment can look like, readers are directed to All of Me by Kim Noble.)

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3. Depersonalization/derealization

Here, people may have out-of-body experiences or feel as though everything around them is surreal. Examples include seeing or hearing things as drastically larger or smaller/quieter or louder, or even feeling as if moving through water.

One patient told me it is like floating in and out of Salvador Dali paintings. While correlated to trauma, this condition can occur without “traditional” traumas like severe violence or neglect.

For instance, it is not unusual that people who panic might feel depersonalized, likely a defense to remove one from the unpleasant sensations going on during the panic attack. In addition, I’ve worked with depressed people who develop feelings of periodically living outside of the body or in “dreamlike” states with strange changes in sensory abilities which seem to be a protective effort from the misery of the mood. They then may self-injure to pull themselves out of such numbed or depersonalized sensations.

Some personality disturbances like borderline, schizoid, and schizotypal also experience this state, likely to escape the volatility of the inner world of the borderline person, and perhaps to cope with the stresses of feeling so unable to relate to other/the world in the latter two. This is also commonly induced by cannabis use, as explained in this article by psychologist Elena Buzzobova. People with schizophrenia also sometimes report dissociative experiences (e.g. Buetinger et al., 2020; Farrelly et al., 2024).

Treatment depends on the overall experience. For example, people presenting with depersonalization/derealization in the context of depression or panic will likely have a decrease in symptoms as the depression or panic improves. For others, learning to manage stress can reduce the intensity, and learning to attend to ground oneself in bodily sensations or other stimuli.

Disclaimer: The material provided in this post is for informational purposes only and is not intended to diagnose, treat, or prevent any illness in readers or people they know. The information should not replace personalized care or intervention from an individual's provider or formal supervision if you're a practitioner or student.