What is dissociation ?

What is dissociation ?

Written by Andrew Moskowitz

Dissociation is officially defined in the psychiatric diagnostic manuals where dissociative disorders are discussed. According to the American Psychiatric Association DSM-5 (Diagnostic and Statistical Manual, 5th Ed.; APA, 2013), dissociation is: ‘a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior’ (p. 291). According to the ICD-10 (International Classification of Diseases, 10th Ed.; WHO, 1992), dissociation is a ‘partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements’ (p. 151). And the ICD-11, which will be published in 2019, refers to dissociation as the ‘involuntary disruption or discontinuity in the normal integration of memories, thoughts, identity, affects, sensations, perceptions, behavior, or control over bodily movements’.

As can be seen, all of these definitions refer to dissociation as something not happening that normally should happen – namely, psychological integration. But they differ in the words used to describe this failure – a ‘disruption’, ‘discontinuity’ or ‘loss’ (partial or complete). While they also differ somewhat in the words used to describe the functions or domains where this disruption or loss can occur, the areas of memory, identity, sensations or perceptions and body movements, motor control or behavior are all emphasized.

So, what does all this mean? Healthy psychological functioning requires the integration of a wide range of mental functions, including sensations, perceptions, thoughts, emotions, etc., in the context of an individual’s memories of the past and hopes/plans/goals for the future. With dissociation, this does not occur.

A common dissociative symptom is dissociative amnesia – the (apparent) lack of a memory, usually of a stressful or traumatic nature. The lack of memory is only apparent, however, because of the nature of dissociation – the memory can usually be accessed when the person is in another personality state or part, under hypnosis, in dreams or during traumatic flashback experiences. Typically, the traumatic nature of the experience led to it being dissociated ­­– because the person was unable to come to terms with it. In this way it differs from amnesia due to brain injury or alcohol inebriation, where – most of the time – no memory is ever formed.

Other dissociative symptoms occur for the same reason – the disruption or lack of integration is believed to serve a psychological purpose. Severe dissociation is often manifested in identity disturbances, particularly the formation of different parts of the personality. Different parts of the personality develop to deal with aspects of the trauma, or with the goal of functioning in daily life.

While amnesia and dissociated identity are dissociative symptoms that occur only in dissociative or post-traumatic disorders, other dissociative symptoms occur in other disorders, and even in individuals with no psychiatric diagnosis. For example, experiences of depersonalization and derealization are common in anxiety disorders, and almost everyone sometimes feels – typically transiently – as though they are not themselves (de-person-alization), or that they are in the middle of a movie or a dream (de-real-ization). When these experiences occur on a chronic basis, however, they are considered a depersonalization/derealization disorder.

In addition, some forms of dissociation – such as absorption – may commonly occur outside of dissociative disorders and be considered essentially normal. Absorption involves a narrowing of consciousness in which only part of the current context is attended to. For example, a person intensely reading a book and not noticing other things going on around them, even someone calling their name, would be considered absorption.

In both depersonalization/derealization and absorption, the failure of integration involves some aspects of the environmental context. Other forms of dissociation can involve somatic or physical sensations that are present – such as unexplained physical pain – or absent – such as anaesthesia – not being able to feel pain.

While everyone agrees that dissociative amnesia and dissociative divisions of identity/personality are dissociation, there is disagreement about whether the term dissociation should refer to common alterations of consciousness such as absorption, or all forms of depersonalization/derealization. Questions like this, including whether there is such a thing as ‘normal’ dissociation, are discussed on the ESTD website under 'history of trauma and dissociation'.