When the Nervous System Checks Out: Recognizing and Treating Dissociation

Since gaining my license to practice psychology, I have been learning about and engaging in therapy with folks who dissociate. Over the years, through training and my experience with clients, I have learned a great deal about what dissociation looks like in people, as well as how to help folks with this experience. I never propose that we can eradicate dissociation, and I believe it is possible for it to be more controlled and more manageable. 

What is Dissociation?

Throughout my experience as a clinician, I have come to understand dissociation as a mental state that occurs on a spectrum that can influence how we perceive and interact with our inner and outer world. 

Who Dissociates?

Everyone dissociates to some degree. Some folks experience dissociation as part of their symptoms for mental health conditions, including but not limited to ADHD, BPD and PTSD. I especially witness this mental state when working with folks with complex trauma that started in childhood. Dissociation can also be diagnosed as a condition all on its own, with or without a history of trauma. 

Image courtesy of "SarcasDID & Bright."

What does dissociation feel like? 

In my experience assessing for and treating dissociation of various levels, my clients have reported some of the following experiences: 

Struggles with memory 😖

Struggles with memory could look like forgetting what you did earlier in the day. You might be told that you have done something recently, but have no memory of doing it. You might also forget what people tell you, right after they’ve said it. You might remember very little of your past or forget how to do things you know how to do really well. You would understandably be bothered by how much you forget. 

Going into a trance-like state 😵‍💫

Going into a trance-like state could look like you are staring off into space and have no awareness of what is going on arround you. You might do this for hours, so much so that it interferes with your daily activities. It might even last for days for you. You might not notice you are going into a trance-like state, and having trouble leaving that mind state. 

Disconnection from emotions and behaviour 🤷🏼‍♀️

It is common for folks who dissociate to feel disconnected from their emotions and their responses to them. Some people might feel like the emotions they are having don’t belong to them. It might feel like you are going through the motions, feeling disconnected from everything arround you. You might notice that you say things, feeling like you have little control over what was said. You might also feel disconnected from your behaviour in a way in which you change your appearance, or change locations without realizing that it was you who made that change. It might even be that you “come to” and find you have engaged in self-harming behaviour. 

Hearing Voices 👂🏻

I want to be clear that hearing voices does not always indicate psychosis. Sometimes folks can experience auditory or visual hallucinations that are related to emotional overwhelm and dissociation. How voices might show up in a dissociative way is hearing a voice of a child in your mind. A voice might be really critical, calling you names, telling you you should die or hurt yourself. An important distinction between hearing voices in dissociation and hearing them in psychosis is that someone who dissociates is often more able to recognize that the voices are coming from their mind and are not in fact reality. 

Experiencing flashbacks ↩️

For those with a trauma history, dissociation can occur as a flashback. Flashbacks can include reliving a traumatic event so much that it feels like you are back in that moment. These flashbacks can be really hard to get rid of, influencing your mood for the rest of the day or several days in a row. 

Temporary motor and sensory difficulties without a medical reason 🩺

Some folks will have trouble with certain bodily functions as a result of dissociation. I see this less often in my practice, and it can still happen. Some of the more common sensory and motor issues I have observed include difficulty swallowing, having trouble seeing or struggling to hear. Sometimes folks also find it hard to move their bodies. One experience I have yet to witness is someone having a seizure for no known medical reason.

Losing touch with reality 😳

These experiences can be defined in two terms according to the DSM-5-TR (the manual used to diagnose mental health conditions, including dissociative disorders). The first is derealization, which involves disconnection from the world arround you. This experience might include feeling as though things arround you or other people are not real. Depersonalization occurs when you feel like your body isn’t yours, or like you are observing your lived experience from a distance as a third-party observer. 

Identity fluctuation and confusion 🤔

The final pattern I have witnessed in my experience working with and diagnosing dissociation includes struggles with identity. I have found that the folks who experience this feature of dissociation the most are also diagnosed with Borderline Personality Disorder (BPD), and that isn’t a requirement. You might feel uncertain or confused about who you really are. It could feel like pieces of you are missing or like you have multiple personalities within yourself.

How does Alexis treat Dissociation?

When coming to therapy in hopes of improving dissociative symptoms, it is important to know that there is no quick fix. Working with trauma and dissociation is a long term persuit. The following are the therapies I use to help people who dissociate:

Dialectical Behaviour Therapy (DBT) 🧘🏼‍♀️

DBT uses both mindfulness strategies and distress tolerance techniques to help bring people out of dissociation and back into the present moment. Alexis' key DBT strategy for pulling folks out of dissociation is the TIPP skill,l which may include using an icepack under the eyes to elicit the dive response or engaging in a short bout of intense exercise to bring awareness back to the body.

Parts Work 🧩

Parts work is an umbrella term for engaging with aspects of yourself that exist within a person's inner world. Within this inner world, folks who diddosciate often notice "parts" or elements of themselves that seem distinct from one another. Parts can be responsible for causing a lot of the feelings that are associated with dissociation, which are mentioned above. This work is all about building a relationship with, helping, and nourishing the inner parts that are struggling. Once a relationship is built, the client can often start to gain more control of their inner world, their emotional experience, and their behaviour.

Eye Movement Desensitization Reprocessing (EMDR) ⚠️

Once, and only once, all parts in the nervous system have given the OK, EMDR may be used to help reduce the overall occurrence of dissociation. Doing EMDR with folks who dissociate is an advanced therapeutic approach and should only.be only be conducted by therapists who have formal and advanced training in dissociation and EMDR, as Alexis does. Conducting EMDR with dissociative folks without proper training can make dissociation worse, not better.

Conclusion

Disconnection happens to everyone from time to time, but for some, it is a significant clinical issue. Dissociation shows up differently in everyone, and there are common themes people tend to experience. Alexis has been familiarizing herself with these themes as well as advanced therapeutic approaches that can help.

If this blog resonated with you, whether as a client or as a therapist, don't hesitate to reach out to Alexis for therapy or professional consultation.