Understanding Dissociation And Its Connection To PTSD

Dissociation¹ is related to post-traumatic stress disorder (PTSD), a psychological condition. In fact, researchers have found that there is a subtype of PTSD that is characterized by symptoms of dissociation and depersonalization. Trauma is essential here.

These issues link strongly to traumatic events and experiences, especially childhood trauma.

What is dissociation?

In simple terms, dissociation is a disconnect. It involves detachment or separation of someone’s identity, memory, thoughts, emotions, actions, and even physical senses. Dissociation isn’t a disease or condition, as we have all experienced it at some point.

For example, have you ever been driving and suddenly realized you’re already at your destination? This feeling of being “spaced out” and going into autopilot is minor dissociation.

However, dissociation can also be a coping mechanism. People who go through traumatic events, especially during childhood, may experience extended periods of dissociation. Such dissociation could cause memory loss, confusion, and other symptoms.

Dissociation can sometimes become a disorder, particularly where trauma is involved. The DSM-5, a manual that provides definitions and criteria for psychological conditions, lists dissociative conditions. These include:

• Dissociative identity disorder (DID)

• Dissociative amnesia (DA)

• Depersonalization/derealization disorder (DPDRD)

Dissociation itself and dissociative conditions can be linked to PTSD.¹ There has even been a specific subtype of PTSD called the dissociative subtype (PTSD-DS). The “Dissociation and PTSD” section will describe this link in more detail.

How common is dissociation?

Dissociation is normal most of the time. It isn't a problem if you experience dissociation occasionally and are not distressed by it. However, studies estimate that the percentage of abnormal or pathological dissociation is between 9% and 18%.

Figures vary based on the different populations surveyed.

Regarding dissociative disorders, about 2.5% of people have depersonalization derealization disorder. Additionally, between 1 and 1.5% have dissociative identity disorder. Dissociation is also a relatively common symptom of other mental health disorders.

Dissociation and PTSD

PTSD is a psychological condition that usually occurs in people who have experienced one or more traumatic events. These can include abuse, accidents, war, and many other examples. As discussed above, dissociation is linked to PTSD.

Through extensive research, scientists have found that a specific type of PTSD involves dissociation and depersonalization. This form is called the dissociative subtype (DS-PTSD).

People with DS-PTSD sometimes experience symptoms of typical PTSD, such as flashbacks and hypervigilance. However, DS-PTSD mainly involves dissociation reactions. 

The cause of DS-PTSD is a “traumatic stressor” or traumatic event. For many people who experience DS-PTSD, this event is a form of childhood trauma. However, this is not the only cause.

For instance, sexual trauma in adulthood is another common factor. Soon after the traumatic event, people may experience peritraumatic dissociation, which is short-term dissociation that helps cope with the stress. This symptom is a predictor of PTSD.

DS-PTSD involves two key aspects: depersonalization and derealization.²

Depersonalization is a feeling of separation from your own body and thoughts, with a lack of control. Derealization is a change in perception, meaning everything around you feels unusual or out of the ordinary. It may even feel like you are not experiencing real life.

 While dissociation in PTSD may help with coping, it can also be detrimental to learning and development in children. In adulthood, dissociation may result in an inability to moderate emotional responses and an overestimation of danger.

Complex PTSD

Complex PTSD (CPTSD) is another type of PTSD. Because it has similarities to the dissociative subtype, the two can sometimes get confused. Most people diagnosed with CPTSD have experienced repeated, ongoing trauma rather than a one-off event.

Often, this trauma is severe. The symptoms include re-experiencing and flashbacks, avoidance, and hypervigilance. However, some specific symptoms differ from any other form of PTSD. These symptoms include poor self-regulation, emotional control, and negative self-image.

Dissociation is often associated with CPTSD. However, this does not mean that it is exactly the same as DS-PTSD. Sometimes, people can fulfill the criteria for both conditions.

It is also possible to have just one or the other because some criteria are very different. The relationship between the two forms of PTSD is complicated, but it is important to note that they are different. 

How does treatment for C-PTSD help?

If you are experiencing any form of PTSD, some treatments can help. Because CPTSD has some unique symptoms, treatment can be targeted to the condition. For instance, people with CPTSD generally have a negative self-image. Self-compassion therapy can help with this aspect. 

Types of dissociation

It is essential to separate normal dissociation from harmful “pathological” dissociation. Normal dissociation happens to everyone from time to time and is not disruptive or upsetting. However, pathological dissociation is often associated with dissociative conditions. These conditions are:

• Dissociative identity disorder (DID)

• Dissociative amnesia (DA)

• Depersonalization/derealization disorder (DPDRD)

• Dissociation subtype PTSD (DS-PTSD)

Dissociative identity disorder (DID)

DID use to be called multiple personality disorder. This condition usually involves dissociation starting at a relatively young age. Almost everyone diagnosed with DID has experienced some childhood abuse.

It is characterized by the following:

• “Alters” or unique identities that the person takes on, with different characteristics, behaviors, and even memories

• Memory issues, including memory loss or forgetfulness, which may include forgetting traumatic events

• Difficulty functioning in different settings and distress due to the symptoms

Dissociative amnesia (DA)

DA involves forgetting traumatic events, occurrences, or even information about yourself. While forgetfulness is a normal part of life, forgetting long periods or details about yourself is a sign of a disorder. DA is thought to be a coping mechanism for dealing with trauma.

There are different types of DA. These are:

• Localized amnesia: A type of DA where you can't remember a specific event or time in your life, such as a traumatic event. This is the most common type of DA.

• Selective amnesia: A type of DA where you cannot remember particular aspects of an event or time.

• Generalized amnesia: A very uncommon form of DA where you lose your identity and all past life experiences.

Later, even years down the track, people may recall their memories. This is called delayed recall. Contrary to popular belief, people’s memories are not “scrambled” or “confused” due to delayed recall.

Researchers have found that the accuracy of traumatic memory is similar to whether the recall is immediate or delayed. Factors associated with DA include: 

• In cases of abuse, a close or personal relationship with the offender

• Sexual abuse

• Ongoing or multiple occurrences of trauma

• Trauma in childhood, particularly early childhood

Depersonalization/Derealization disorder (DPDRD)

This condition is associated with childhood emotional abuse and is rarely linked to physical or sexual abuse. People with DPDRD usually also have mood disorders like anxiety or depression and ongoing, severe limitations caused by the condition.

As the name suggests, DPDRD involves depersonalization and derealization as forms of dissociation. To be diagnosed, you must experience these signs to a considerable degree, possibly repeatedly. Here is a description of these symptoms: 

• Depersonalization involves losing control and being separated from yourself physically and mentally.

• Derealization consists of feeling like things aren't real and feeling distant from your environment and surroundings.

Dissociation subtype PTSD (DS-PTSD)

As discussed, DS-PTSD is a type of PTSD characterized by dissociation. This condition can sometimes involve aspects of PTSD, like avoidance, hypervigilance, and traumatic memories.

However, people with DS-PTSD usually respond to triggers or trauma with dissociation and depersonalization, as well as a “freeze” response, rather than the classic PTSD symptoms.

Symptoms of dissociation

The key symptoms and signs of any form of dissociation include a sense or feeling of disconnection from your thoughts, memories, and identity. Along with this, people experience amnesia or forgetfulness to various degrees.

They may also experience depersonalization and derealization. These are the classic signs of dissociation.

There are also some physical signs. You may have heard of the fight or flight response. There is also another response typical in dangerous situations — the freeze response. In animals, this is like “playing dead.” Researchers think that dissociation may be part of the human freeze response. There are some physical signs caused by this freeze response, including a lowering of blood pressure and less tension in the muscles. 

Another physical sign is tonic immobility. This is also a form of “freeze” response that you cannot control. It usually happens in traumatic or dangerous situations.

Studies³ of sexual abuse victims have found that this “freeze” response is common and is also a risk factor for developing PTSD down the track. 

Peritraumatic dissociation is dissociation that happens during or immediately after the event or experience. In this case, there are a few unique symptoms. These include people being in a trance-like state, confusion, loss of their sense of time, and forgetfulness. 

DID symptoms

DID has a wide range of unique symptoms. Many people think of DID as a dramatic, outward-presenting condition.

However, researchers have found that symptoms of DID are less noticeable. Those with DID develop multiple distinct personalities and identities. They may also have multiple inner dialogues. Changes between different alters can be slow shifts that might not be readily noticeable to observers.

Significantly, people with DID do not always change outward signs like clothes to fit with their different identities.

Can dissociation be a positive coping mechanism? 

Dissociation is one of your mind’s coping strategies to help you deal with significant trauma or distress. While dissociation is often scary, upsetting, and harmful, there can be some positives.

For example, dissociation is a way of protecting some of your mental processes. These include the ability to become attached, creativity, and hope. Usually, the real harm comes from related PTSD symptoms and dissociation that are ongoing and uncontrollable.

Consult a doctor or psychologist if you are concerned about dissociation.

Causes of dissociation 

There are many potential causes of dissociation. In people with dissociation disorders, there is often more than one factor at play. For instance, there may be a genetic component to dissociation, even though other factors like trauma trigger the dissociation. Here are three key factors that cause or are associated with dissociation. 

Trauma 

Trauma is arguably the most common cause of dissociation, including dissociative disorders. Many studies have linked high levels of dissociation to traumatic events.

However, other researchers argue that, while trauma is a significant risk factor, trauma alone cannot cause dissociative disorders. In these cases, additional risks like genetics may play a role.

As mentioned, there may be an evolutionary reason for dissociation. Experts have suggested that dissociation could be the mind’s way of coping with and adapting to trauma. Additionally, some forms of trauma are more likely to cause dissociation than others.

There are more significant risks if the trauma occurs when you are younger and builds over time.

Drug use

Some drugs create short-term dissociation⁴ that does not lead to any dissociative disorder. However, there are also clear links between drug abuse and dissociation disorders. Between 83–96% of people with DID reported a current or past substance use disorder.

In saying that, dissociation disorders are usually caused by a more complex interplay of factors than drug use or abuse alone.

Research⁵ has found that dissociative symptoms are more common in those with particular drug abuse issues. There are many possible reasons for this link.

For example, people with dissociative symptoms might use drugs to help cope. Also, many overlapping risk factors lead to both of these conditions. For instance, trauma is a risk factor for dissociative symptoms and substance abuse. 

Other mental conditions

Other mental conditions, like anxiety and depression, do not necessarily cause dissociation. However, people with dissociation disorders often have other mental health issues. For instance, there are connections to depression and suicidal feelings.

In particular, suicidal ideation is prevalent amongst people with DID. Additionally, other mental health conditions might have similar symptoms to dissociation disorders. This can result in people with dissociative disorders being misdiagnosed with other mental health conditions, hindering their treatment and recovery.

The lowdown

Dissociation involves a disconnect from your identity, memory, thoughts, emotions, actions, and senses. Dissociation is a normal process. Everyone experiences mild dissociation once in a while. However, dissociation can also become an issue. There are a few different dissociative disorders, including:

• Dissociative identity disorder (DID)

• Dissociative amnesia (DA)

• Depersonalization/derealization disorder (DPDRD)

Dissociation is linked to a psychological condition called PTSD. PTSD involves a range of symptoms caused by one or more past traumatic events. There is a particular form of PTSD that involves dissociation, called DS-PTSD. It is usually caused by traumatic stress in childhood.

In contrast to other types of PTSD, people with DS-PTSD respond to triggers with dissociation symptoms. These include depersonalization and derealization. DS-PTSD is different from complex PTSD, although they share some similarities.

There are many symptoms of dissociation. In addition to depersonalization and derealization, there are physical signs. Physical symptoms include increased blood pressure and decreased muscle tension. People might also experience forgetfulness, confusion, and numerous other symptoms. DID has its own set of symptoms, including the development of multiple inner dialogues and slow shifts between different identities.

The fundamental cause of dissociative disorders is trauma. However, there are many other overlapping causes. Some conditions, like depression and substance abuse, have a complicated relationship with dissociation. It is difficult to determine if these are causes or just associated with dissociation. If you are concerned that you have dissociation that is interfering with your daily function and life, you should see your doctor and discuss your symptoms.