What Causes Dissociation?
In my last blog we covered what dissociation is, the difference between ‘normal’ and ‘pathological’ dissociation and the types of pathological dissociation (I highly recommend you read this blog first in order to bring some context into this article). In today’s blog we will take a look at what causes dissociation and its treatment options.
What are the causes of dissociative disorders?
The main causes of dissociative disorders and those which are found in majority of cases are stressful life events, trauma and often as a result - post traumatic stress disorder (PTSD). Childhood trauma is particularly common for people experiencing dissociative identity disorder (DID). In fact, in one study childhood trauma was reported in approximately 97% of cases of people with DID. This seems to make sense from a theoretical point of view; children generally lack the coping skills and resources necessary for ensuring their safety and wellbeing and therefore rely on their parents or caregivers for this security and stability. When this is not given, or worse, when abuse is inflicted, they in turn create an alternative reality to cope and often times this results in an alternate identity. In this way it appears that the abuse is happening to this ‘alter’ rather than the person themselves.
The thing is, the behaviour and emotions that people experience with dissociative disorders are actually related to normal tendencies that we all have to some extent or another. It is very common for otherwise normal individuals to dissociate when they are experiencing intense emotional and physical pain. Common among these are a sense of not being grounded in reality, a blunting of emotional and physical pain and feeling separate from ones body. Dissociative amnesia and fuge states are reactions to extreme life stress however in regards to DID the stress has usually occurred in the past. Furthermore, a dissociative disorder is also more likely to occur when a person experiences a lack of social support following the trauma.
What are the treatment options?
Dissociative amnesia and fuge states are related to current life stress; therefore, effective interventions focus on a therapeutic resolution of the stressful situation and increasing the strength of ones coping mechanisms through talk therapies. Throughout therapy there is generally a need to recall what occurred throughout the amnesic or fuge state and at times it is useful to involve ones friends and family. In some instances where this proves challenging, techniques such as hypnosis may be used.
Depersonalization-derealization disorder is often treated through the use of talk therapies. CBT has been suggested as a useful intervention for people with this disorder and may assist in learning coping strategies to deal with stressful situations, understanding why these symptoms occur and addressing the emotions underlying these experiences. Often, depression and anxiety may accompany experiences of depersonalization and derealization and so learning how to cope with these can also be useful.
Dissociative Identity Disorder can be trickier to treat, however as most people with DID have experienced past trauma, trauma focused therapy may be a useful option. While each person is different, usually a therapist may assist in identifying triggers that provoke memories of trauma, dissociation or both and to neutralise them. This often involves confronting and reliving the trauma in order to gain control in the present. Therapists will assist in carefully helping clients visualise and perhaps relive aspects of their trauma until it becomes a terrible memory rather than an active event. Hypnosis might also be used to access unconscious awareness and bring various identities into conscious awareness. While there do not appear to be medications that specifically address dissociative disorders there is some evidence to suggest that antidepressant drugs might be beneficial in some cases.
Dissociation is a useful and sometimes even functional coping mechanism that assists people experiencing trauma or intense physical or emotional turmoil in that moment. It becomes problematic when these experiences carry on in life and begin to interfere with daily functioning, relationships and physical and psychological wellbeing. If you or someone you know may be experiencing a dissociative disorder it is important that you reach out to your GP or mental health professional for support.