What can Dissociation Look Like?

So what does dissociation look like? What does it look like between mild and severe experiences? According to Marlene Steinberg and Maxine Schnall (2001) dissociative symptoms can be broken down into core symptoms:

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1. Dissociative amnesia

This can look like gaps in our memories to experiencing a lost of time.

Mild dissociative symptoms for this as mentioned above can look like a brief forgetfulness of going to one room to get something and then being unsure what we came to the room to get or a stressful and nerve-wrecking presentation where we forget the speech we practiced. These are often connected to events that can be considered stressful and overwhelming. For those who have seen the move, The Perks of a Wallflower, it can be like the experiences Charlie had in the cafeteria when trying to protect Patrick from getting beat up and he remembers the situation starting, but comes to when the situation is over and they come to with bloody hands and the bullies on the floor.

Moderate dissociative amnesia is often memory difficulties that are not connected to stressful incidents. It may involve moments throughout the day where we cannot recall what we had been doing for periods of 30 minutes or longer. For instance, you may be vacuuming the living room and then it almost feels like you blink and all of a sudden you are in the bathroom or outside and unsure how you got there or what happened.

Severe amnesia occurs when specific traumatic instances are fragmented or forgotten due to difficulty with integration. An example of this can be state-dependent learning where we learn something when we are in one state of mind. This may arise if a person learns information while anxious and does not have the same information in a calm state, but the information arises again when anxious. Severe amnesia occurs when there are large gaps in memories that impacts day to day functioning; finding yourself somewhere and not knowing how you got there; not being able to recall important information; not remembering large portions of adult memories; suddenly not remembering a talent or skills (i.e., all of a sudden not remembering how to cook).

2. Depersonalization

Depersonalization is a way that we detach and disconnect from ourselves. This can be experienced as looking in the mirror and feeling like your look strange or foreign; numbing or detachment from emotions (including compartmentalizing – can separate emotional and logical part of self); out of body experience; losing feeling in parts of body; distorted perceptions of your body; feeling invisible; not recognizing yourself in the mirror; feeling like you are watching a movie about yourself; feeling unreal or robotic; feeling like you are split between observer and participant.

Mild cases of depersonalization is a sense of detachment during overwhelming and stressful situations. Depersonalization becomes moderate when it occurs without stressful situations. Severe cases are those that are persistent and long-lasting, and high in intensity.

3. Derealization

Derealization occurs when we attempt to detach from the environment around us. It can be feeling detached or disconnected from the world; seeing environments and people that should be familiar as strange or foreign; it could be thoughts that what is happening is not real; and may involve changes in perception of objects as they may appear to change in size and shape or objects appear to change in intensity.

Mild is sometimes instances that occur with our life that are connected to moments of stress, shock, tiredness, substance use, and hypnotic states.

Moderate occurs when these experiences are not connected to moments of overwhelm and stress.
Severe experiences result in discomfort and difficulties in day to day functioning. They occur more often and are persistent.

4. Identity Confusion

Mild experiences of this are often related to major life decisions that can occur in our lives as these experiences often involve transitions and change our sense of stability and identity.

Moderate experiences are no longer tied to stressful events and is distressing.
Severe involves more of a persistent struggle and begins to impact relationships with others, day to day functioning, and career. Individuals experiencing this may feel like there is internal conflict happening (I want to connect with others but I don’t want to connect with anyone).

5. Identity Alteration

Mild involves all the different roles or hats we where as we navigate our lives (for instance, you may be a mother, a professional, a caretaker, a party animal, etc.).

Moderate experiences can involve instances where at times the person feels like two different people such as an individual who drinks may find themselves calm and quiet when they are sober and rageful and angry when they drink.

Severe may at times feel like an individual has different personality states that can control behaviour and thought and influence behaviour. Others may tell you that you seem like a different person; you may find things that you don’t remember ever purchasing; memory difficulties; sudden loss of skills you know you have or having skills you don’t recall having; acting as if you were a teen or child.

References:

Boon, S., Steele, K., & Van Der Hart, O. (2011). Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists (Norton Series on Interpersonal Neurobiology). WW Norton & Company.

Steinberg, M., & Schnall, M. (2010). The stranger in the mirror: The hidden epidemic. Harper Collins.