Dissociation is an
altered state of consciousnessAn altered state of consciousness , also named altered state of mind, is any condition which is significantly different from a normal waking beta wave state. The expression was used as early as 1966 by Arnold M. Ludwig and brought into common usage from 1969 by Charles Tart: it describes induced...
characterized by partial or complete disruption of the normal integration of a person’s normal conscious or psychological functioning. Dissociation is most commonly experienced as a subjective perception of one's consciousness being detached from one's emotions, body and/or immediate surroundings. Van der Kolk
et al. describe dissociation as a "compartmentalization of experience." Under normal conditions, consciousness, memory, emotions, sensory awareness, affect, etc., are integrated; with dissociation, in contrast, these traits are discretely compartmentalized to greater or lesser degrees.
Dissociation describes a wide array of experiences that can affect any aspect of a person’s mental functioning. Although some dissociative disruptions involve
amnesiaAmnesia is a condition in which one's memory is lost. The causes of amnesia have traditionally been divided into categories. Memory appears to be stored in several parts of the limbic system of the brain, and any condition that interferes with the function of this system can cause amnesia...
, other dissociative events do not. At one end of a continuum, dissociation describes such common events as becoming lost in thought while driving a vehicle and not recalling parts of the journey. At the other end of the continuum are a cluster of dissociative disorders, such as dissociative amnesia, that can occur in response to severe psychological trauma such as rape or military combat. In such cases of abuse or trauma, dissociation can be regarded as a coping mechanism to help with an overwhelming experience.
Since dissociations are normally unanticipated, they are typically experienced as startling, autonomous intrusions into the person's usual ways of responding or functioning. Due to their unexpected and largely inexplicable nature, they tend to be quite unsettling. Different dissociative disorders have different relationships to stress and
traumaPsychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...
.
Dissociative amnesiaPsychogenic amnesia, also known as functional amnesia or dissociative amnesia, is a memory disorder characterized by extreme memory loss that is caused by extensive psychological stress and that cannot be attributed to a known neurobiological cause...
and
fugue stateA fugue state, formally dissociative fugue or psychogenic fugue , is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying characteristics of individuality...
s are often triggered by life stresses that fall far short of trauma.
Depersonalization disorderDepersonalization disorder is a dissociative disorder in which the sufferer is affected by persistent or recurrent feelings of depersonalization and/or derealization. Diagnostic criteria include persistent or recurrent experiences of feeling detached from one's mental processes or body...
is sometimes triggered by trauma, but may be preceded only by stress, psychoactive substances, or no identifiable stress at all. The
ICD-10The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
but not the DSM-IV classifies
conversion disorderConversion disorder is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fits without a neurological cause. It is thought that these problems arise in response to difficulties in the patient's life, and conversion is considered a psychiatric...
as a dissociative disorder.
History
The
FrenchThe French are a nation that share a common French culture and speak the French language as a mother tongue. Historically, the French population are descended from peoples of Celtic, Latin and Germanic origin, and are today a mixture of several ethnic groups...
philosopher and
psychiatristA psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
Pierre JanetPierre Marie Félix Janet was a pioneering French psychologist, philosopher and psychotherapist in the field of dissociation and traumatic memory....
(1859–1947) is considered to be the author of the concept of dissociation. Contrary to some conceptions of dissociation, Janet did not believe that dissociation was a psychological defense. Psychological defense mechanisms belong to Freud's theory of
psychoanalysisPsychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
, not to Janetian psychology. Janet claimed that dissociation occurred only in persons who had a constitutional weakness of mental functioning that led to
hysteriaHysteria, in its colloquial use, describes unmanageable emotional excesses. People who are "hysterical" often lose self-control due to an overwhelming fear that may be caused by multiple events in one's past that involved some sort of severe conflict; the fear can be centered on a body part, or,...
when they were stressed. Although it is true that many of Janet's
case historiesA case study is an intensive analysis of an individual unit stressing developmental factors in relation to context. The case study is common in social sciences and life sciences. Case studies may be descriptive or explanatory. The latter type is used to explore causation in order to find...
described traumatic experiences, he never considered dissociation to be a defense against those experiences. Quite the opposite: Janet insisted that dissociation was a mental or cognitive deficit. Accordingly, he considered trauma to be one of many stressors that could worsen the already-impaired "mental efficiency" of a hysteric, thereby generating a cascade of hysterical (in today's language, "dissociative") symptoms.
Although there was great interest in dissociation during the last two decades of the nineteenth century (especially in France and England), this interest rapidly waned with the coming of the new century (Ellenberger, 1970). Even Janet largely turned his attention to other matters. On the other hand, there was a sharp peak in interest in dissociation in America from 1890 to 1910, especially in Boston as reflected in the work of
William JamesWilliam James was a pioneering American psychologist and philosopher who was trained as a physician. He wrote influential books on the young science of psychology, educational psychology, psychology of religious experience and mysticism, and on the philosophy of pragmatism...
,
Boris SidisBoris Sidis, Ph.D., M.D. was a Ukrainian Jewish psychologist, physician, psychiatrist, and philosopher of education. Sidis founded the New York State Psychopathic Institute and the Journal of Abnormal Psychology. He was the father of the child prodigy William James Sidis...
,
Morton PrinceMorton Henry Prince was an American physician who specialized in neurology and abnormal psychology, and was a leading force in establishing psychology as a clinical and academic discipline. He was part of a handful of men who disseminated European ideas about psychopathology, especially in...
, and
William McDougallWilliam McDougall FRS was an early twentieth century psychologist who spent the first part of his career in the United Kingdom and the latter part in the United States...
. Nevertheless, even in America, interest in dissociation rapidly succumbed to the surging academic interest in psychoanalysis and behaviorism. For most of the twentieth century, there was little interest in dissociation. Discussion of dissociation only resumed when
Ernest HilgardErnest Ropiequet "Jack" Hilgard was an American psychologist, professor at Stanford university, who became famous in the 1950s for his research on hypnosis, especially with regard to pain control...
(1977) published his neodissociation theory in the 1970s and when several authors wrote about multiple personality in the 1980s.
Carl JungCarl Gustav Jung was a Swiss psychiatrist and the founder of Analytical Psychology. Jung is considered the first modern psychiatrist to view the human psyche as "by nature religious" and make it the focus of exploration. Jung is one of the best known researchers in the field of dream analysis and...
described pathological manifestations of dissociation as special or extreme cases of the normal operation of the psyche. This structural dissociation, opposing tension, and hierarchy of basic
attitudesAn attitude is a hypothetical construct that represents an individual's degree of like or dislike for something. Attitudes are generally positive or negative views of a person, place, thing, or event— this is often referred to as the attitude object...
and functions in normal individual consciousness is the basis of Jung's
Psychological TypesPsychological Types is the title of the sixth volume in the Princeton / Bollingen edition of the Collected Works of Carl Jung. The original German language edition, "Psychologische Typen", was first published by Rascher Verlag, Zurich in 1921....
. He theorized that dissociation is a natural necessity for consciousness to operate in one faculty unhampered by the demands of its opposite.
Attention to dissociation as a clinical feature has been growing in recent years as knowledge of
post-traumatic stress disorderPosttraumaticstress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity,...
increased, due to interest in
dissociative identity disorderDissociative identity disorder is a psychiatric diagnosis and describes a condition in which a person displays multiple distinct identities , each with its own pattern of perceiving and interacting with the environment....
and the multiple personality controversy, and as
neuroimagingNeuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain...
research and population studies show its relevance.
Diagnosis of dissociative disorder
The
DSM-IVThe Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
considers symptoms such as
depersonalizationDepersonalization is an anomaly of the mechanism by which an individual has self-awareness. It is a feeling of watching oneself act, while having no control over a situation. Sufferers feel they have changed, and the world has become less real, vague, dreamlike, or lacking in significance...
,
derealizationDerealization is an alteration in the perception or experience of the external world so that it seems unreal. Other symptoms include feeling as though one's environment is lacking in spontaneity, emotional coloring and depth. It is a dissociative symptom of many conditions, such as psychiatric and...
and
psychogenic amnesiaPsychogenic amnesia, also known as functional amnesia or dissociative amnesia, is a memory disorder characterized by extreme memory loss that is caused by extensive psychological stress and that cannot be attributed to a known neurobiological cause...
to be core features of dissociative disorders. However, in the normal population dissociative experiences that are not clinically significant are highly prevalent, with 60% to 65% of the respondents indicating that they have had some dissociative experiences. The SCID-D is a structured interview used to assess and diagnose dissociation.
Relation to trauma and abuse
Dissociation has been described as one of a constellation of symptoms experienced by some victims of multiple forms of childhood
traumaPsychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...
, including
physicalPhysical abuse is abuse involving contact intended to cause feelings of intimidation, injury, or other physical suffering or bodily harm.-Forms of physical abuse:*Striking*Punching*Belting*Pushing, pulling*Slapping*Whipping*Striking with an object...
,
psychologicalPsychological abuse, also referred to as emotional abuse or mental abuse, is a form of abuse characterized by a person subjecting or exposing another to behavior that may result in psychological trauma, including anxiety, chronic depression, or post-traumatic stress disorder...
, and
sexual abuseChild sexual abuse is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include asking or pressuring a child to engage in sexual activities , indecent exposure with intent to gratify their own sexual desires or to...
. This is supported by studies which suggest that dissociation is correlated with a history of trauma. Dissociation appears to have a high specificity and a low sensitivity to having a self-reported history of trauma, which means that dissociation is much more common among those who are traumatized, yet at the same time there are many persons who have suffered from trauma but who do not show dissociative symptoms.
Adult dissociation when comorbid with a history of
child abuseChild abuse is the physical, sexual, emotional mistreatment, or neglect of a child. In the United States, the Centers for Disease Control and Prevention and the Department of Children And Families define child maltreatment as any act or series of acts of commission or omission by a parent or...
and otherwise interpersonal violence-related posttraumatic stress disorder (PTSD) has been shown to contribute to disturbances in parenting behavior, such as exposure of young children to violent media. Such behavior may contribute to cycles of familial violence and trauma.
Symptoms of dissociation resulting from trauma may include
depersonalizationDepersonalization is an anomaly of the mechanism by which an individual has self-awareness. It is a feeling of watching oneself act, while having no control over a situation. Sufferers feel they have changed, and the world has become less real, vague, dreamlike, or lacking in significance...
, psychological numbing,
disengagementApathy is a state of indifference, or the suppression of emotions such as concern, excitement, motivation and passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical or physical life.They may lack a sense of purpose or meaning in...
, or amnesia regarding the events of the abuse. It has been hypothesized that dissociation may provide a temporarily effective defense mechanism in cases of severe trauma; however, in the long term, dissociation is associated with decreased psychological functioning and adjustment. Other symptoms sometimes found along with dissociation in victims of traumatic abuse (often referred to as "sequelae to abuse") include anxiety, PTSD, low
self-esteemSelf-esteem is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame: some would distinguish how 'the self-concept is what we think about the self; self-esteem, the...
, somatization, depression, chronic pain, interpersonal dysfunction, substance abuse, self-mutilation and suicidal ideation or actions. These symptoms may lead the victim to erroneously present the symptoms as the source of the problem.
Child abuse, especially chronic abuse starting at early ages, has been related to high levels of dissociative symptoms in a clinical sample, including amnesia for abuse memories. A non-clinical sample of adult women linked increased levels of dissociation to sexual abuse by a significantly older person prior to age 15, and dissociation has also been
correlatedIn statistics, dependence refers to any statistical relationship between two random variables or two sets of data. Correlation refers to any of a broad class of statistical relationships involving dependence....
with a history of childhood physical as well as sexual abuse. When sexual abuse is examined, the levels of dissociation were found to increase along with the severity of the abuse.
Psychoactive substances
Psychoactive drugA psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior...
s can often induce a state of temporary dissociation. Substances with dissociative properties include
ketamineKetamine is a drug used in human and veterinary medicine. Its hydrochloride salt is sold as Ketanest, Ketaset, and Ketalar. Pharmacologically, ketamine is classified as an NMDA receptor antagonist...
,
nitrous oxideNitrous oxide, commonly known as laughing gas or sweet air, is a chemical compound with the formula . It is an oxide of nitrogen. At room temperature, it is a colorless non-flammable gas, with a slightly sweet odor and taste. It is used in surgery and dentistry for its anesthetic and analgesic...
,
alcoholIn chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
,
LSDLysergic acid diethylamide, abbreviated LSD or LSD-25, also known as lysergide and colloquially as acid, is a semisynthetic psychedelic drug of the ergoline family, well known for its psychological effects which can include altered thinking processes, closed and open eye visuals, synaesthesia, an...
,
tiletamineTiletamine is a dissociative anesthetic and pharmacologically classified as an NMDA receptor antagonist. It is related chemically and pharmacologically to other anesthetics in this family such as ketamine and phencyclidine...
, marijuana,
dextromethorphanDextromethorphan is an antitussive drug. It is one of the active ingredients in many over-the-counter cold and cough medicines, such as Robitussin, NyQuil, Dimetapp, Vicks, Coricidin, Delsym, and others, including generic labels. Dextromethorphan has also found other uses in medicine, ranging...
,
2C-E2C-E is a psychedelic and phenethylamine of the 2C family. It was first synthesized by Alexander Shulgin. 2C-E is typically found as a white crystalline powder....
,
PCPPhencyclidine , commonly initialized as PCP and known colloquially as angel dust, is a recreational dissociative drug...
,
methoxetamineMethoxetamine or 3-MeO-2-Oxo-PCE is a chemical of the arylcyclohexylamine class which has been sold as a designer drug. It is a derivative of ketamine that also contains structural features of eticyclidine and 3-MeO-PCP...
,
salviaSalvia divinorum is a psychoactive plant which can induce dissociative effects and is a potent producer of "visions" and other hallucinatory experiences...
, Relaxinol (MNG, Mr. Nice Guy, Spice, K2
JWH-018JWH-018 or AM-678 is an analgesic chemical from the naphthoylindole family, which acts as a full agonist at both the CB1 and CB2 cannabinoid receptors, with some selectivity for CB2...
),
muscimolMuscimol is the major psychoactive alkaloid present in many mushrooms of the Amanita genus. Unlike psilocin , which is a serotonergic psychedelic and agonist for the 5-HT2A receptor set, muscimol is a potent, selective agonist for the GABAA receptor set and is a deliriant as a opposed...
,
atropineAtropine is a naturally occurring tropane alkaloid extracted from deadly nightshade , Jimson weed , mandrake and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects...
, and
ibogaineIbogaine is a naturally occurring psychoactive substance found in a number of plants, principally in a member of the Apocynaceae family known as Iboga . A hallucinogen with both psychedelic and dissociative properties, the substance is banned in some countries; in other countries it is being used...
.
See also
- Altered state of consciousness
An altered state of consciousness , also named altered state of mind, is any condition which is significantly different from a normal waking beta wave state. The expression was used as early as 1966 by Arnold M. Ludwig and brought into common usage from 1969 by Charles Tart: it describes induced...
- Emotional detachment
Emotional detachment, in psychology, can mean two different things. In the first meaning, it refers to an "inability to connect" with others emotionally, as well as a means of dealing with anxiety by preventing certain situations that trigger it; it is often described as "emotional numbing" or...
- Psychological numbing
- Splitting (psychology)
Splitting may mean two things: splitting of the mind, and splitting of mental concepts . The latter is thinking purely in extremes Splitting (also called all-or-nothing thinking in cognitive distortion) may mean two things: splitting of the mind, and splitting of mental concepts (or black and...
- Dissociative Substance
- Repressed memory
Repressed memory is a hypothetical concept used to describe a significant memory, usually of a traumatic nature, that has become unavailable for recall; also called motivated forgetting in which a subject blocks out painful or traumatic times in one's life...
External links