The word ‘dissociation’ has grown in popularity and become embedded in everyday language, but while the term has gained traction in popular culture and mental health advocacy, misconceptions persist – including some which are harmful, experts say.
Some of the myths – that it happens all the time and is the same as daydreaming or zoning out, or on the other hand, is really rare or fictitious – can be particularly damaging.
Dissociation, explain the editors of Working with Dissociation in Clinical Practice, is far more complex. The editors, Helena Crockford, Melanie Goodwin and Paul Langthorne, describe it as a survival mechanism in response to overwhelming trauma.
“Dissociation is as common as other serious mental health difficulties, yet remains one of the most misunderstood and under-recognised experiences in mental health care,” they explain.
“Dissociation is currently best understood as an adaptive defence to overwhelming trauma. It represents an automatic, reflexive evolutionary response to threat, serving to protect the person by reducing their awareness of intolerable (traumatic) experience.”
We all have the natural ability to dissociate at times, which can allow us to carry on with life and function effectively during heightened emotional stress or trauma, for example, dealing with an emergency calmly in the moment but feeling the shock and emotion later. But for those who experience long-term trauma, the dissociation can become severe and entrenched.
The book, which is published in partnership with the Association of Clinical Psychologist UK, seeks to dismantle these myths and provide clarity on the condition’s profound impact on memory, identity and perception. It features contributions from more than 100 experts in professional practice and research, across various fields including psychology, psychotherapy, psychiatry and mental health services, and those with lived experience of dissociation.
Dissociation is a survival mechanism
Dissociation is not rare, nor is it fictitious. Research confirms its prevalence among individuals who have experienced trauma, particularly early in life.
In fact, research shows between 1.1%-1.5% of the general population will likely have dissociative identity disorder (the most severe form of dissociative experience), with 4.1% likely to present with a dissociative disorder in general (including DID but also other dissociative disorders).
Experts describe dissociation as a mental and physical process that disrupts conscious awareness, impeding the integration of thoughts, feelings and memories.
“Dissociation can involve a wide array of experiences, from mild to severe, from temporary to chronic. However, for people who have experienced overwhelming trauma, often early in life and without a secure attachment to create safeness, more chronic patterns of severe dissociation may develop over time that become entrenched and problematic,” the editors explain.
There is no single ‘dissociation’ or type of dissociation. Instead, the condition can manifest in many ways and can include more commonly known experiences such as feeling detached from your body or that the world around you is unreal. It can also involve less common experiences such as confusion about your identity, sudden shifts in behaviour or identity as if you were a different person, and these shifts can be accompanied by memory loss or amnesia.
Dissociative experiences can be psychological or physical in nature and can result in the person feeling either too much or too little.
These experiences, while protective in the face of trauma, can become chronic and impair daily functioning.
Dispelling myths and addressing stigma
Societal stigma surrounding dissociation is another barrier to understanding, the editors suggest, particularly the myth that the condition is ‘made up’.
Advancements in neuroscience have validated dissociation as a real and measurable phenomenon. Neuroimaging studies reveal distinct patterns of brain activation in individuals with dissociative disorders, providing objective evidence of the condition’s impact. In Dissociative Identity Disorder, for example, very different brain areas are activated depending on the dissociative state the person is experiencing. These differences in brain activation could not be mimicked by actors.
Media portrayals of dissociation, often dramatised and sensationalised, further fuel scepticism and stigma, making it harder for individuals to seek help. The authors emphasise the need for accurate representation and education to counteract harmful stereotypes.
Effective treatment
The experts advocate for dissociation-specific treatment options, particularly in healthcare systems like the UK’s NHS, where such options are often lacking.
Research has shown that untreated dissociation leads to poor physical health, emotional regulation and social functioning. The editors call for increased training and resources for healthcare professionals to recognise and respond to dissociation effectively – saving long-term harm for the individual and being more cost-effective for the healthcare system.
Effective treatments for dissociation, are based on a trauma-phased approach, and a range of adapted psychological therapies, and offer hope for recovery. There is increasing evidence emerging that such treatments are not only clinically effective but also a lot more cost effective than ‘treatment as usual’.
The book’s contributors call for greater awareness, advocacy and compassion for the condition, and challenge people to rethink their understanding of dissociation, and view it as a vital survival strategy.
“Efforts to improve the ability of services to realise, recognise, and respond to trauma-related dissociation will help to benefit not just people who experience trauma-related dissociation but also their families, social networks, and society.”