Diagnosis or experience – the slight paradox of dissociation
Dissociation is understood in terms of diagnosis and dissociative type. Yet these types and diagnoses vary and overlap wildly. For instance, there are two types of dissociation known as depersonalization and derealization. The former involves a distinct feeling of being detached from ones self. Whereas derealization involves the distinct feeling of being dethatched from ones surroundings.
This detachment is described as a feeling of separation, distance, and the feeling that things or oneself are not real or fake. It is this detachment that makes dissociation so hard to pin-down. By their nature all dissociative states involve a detachment that make the perception and experience of the state hard to remember and describe. This is a unique occurrence as the individual is dissociated from the very senses they use to describe every other lived experience.
In the case of depersonalization/derealization disorder (DP/DR) these two states reoccur as the defining features of the disorder. As such it is known by this name, yet these states are also experienced within plenty of other disorders.
For example, Post Traumatic Stress Disorder (PTSD), Borderline Personality Disorder (BPD), Bipolar Disorder (BD), Dissociative Identity Disorder (DID) and psychosis are all closely linked with dissociation.
Yet all of these disorders have elements that make them distinctly different, despite sharing the same dissociative states.
What complicates things further is the matter of identity and dissociation. Common feelings for dissociation-plagued individuals is that of a disconnection from themselves and their identity. Yet, in more extreme cases, in what is considered the most extreme dissociative disorder a person’s identity is not only dissociated but altered.
Dissociative Identity Disorder (DID) is better but inaccurately known as Multiple Personality Disorder. This involves the fragmentation of a personality into distinct personality states separated by so-called dissociative barriers.
These barriers keep these distinct personalities – mostly – separate. For example, many of these personality states (known in the community as ‘alters’ for alternative personality states) cannot recall events experienced when another was ‘fronting’ (in control of the body). This ‘dissociative amnesia’ is integral to the memory problems reported by people that experience dissociative symptoms.
Yet, this amnesia can occur in varying forms. Either between alters, as seen in DID. Or for times during a dissociative episode. This is characterized by an ongoing and reoccurring loss of memory for these times, known as time-loss or black-outs.
On top of this, it is reported that some individuals do not knowingly experience dissociation until repressed memories emerge from an event that their brain had locked away and hidden from them.
This adds additional complexity to matters as you have an almost impossible to pin down mental state that can influence your memory of past and present events while also influencing your personality. As such, people that experience dissociation often have trouble finding the right diagnosis as dissociation exists on multiple planes. The type, severity, trigger and related disorder all impact an individuals understanding of their dissociative experience.
With all these variables, trying to find support for dissociation is all too difficult, with many health care providers ill-equipped for such matters. Making finding the right diagnosis next to impossible.