Dissociation (psychology)

This article is about the psychological experience. Forother uses, see Dissociation (disambiguation).

In psychology, the term dissociation describes a widearray of experiences from mild detachment from im-mediate surroundings to more severe detachment fromphysical and emotional experience. The major char-acteristic of all dissociative phenomena involves a de-tachment from reality, rather than a loss of reality as inpsychosis.[1][2][3][4] Dissociative experiences are furthercharacterized by the varied maladaptive mental construc-tions of an individual’s natural imaginative capacity.Dissociation is commonly displayed on a continuum.[5]In mild cases, dissociation can be regarded as a copingmechanism or defense mechanisms in seeking to mas-ter, minimize or tolerate stress – including boredom orconflict.[6][7][8] At the nonpathological end of the con-tinuum, dissociation describes common events such asdaydreaming while driving a vehicle. Further along thecontinuum are non-pathological altered states of con-sciousness.[5][9][10]

More pathological dissociation involves dissociativedisorders, including dissociative fugue anddepersonalization disorder with or without alter-ations in personal identity or sense of self. Thesealterations can include: a sense that self or the world isunreal (depersonalization and derealization); a loss ofmemory (amnesia); forgetting identity or assuming a newself (fugue); and fragmentation of identity or self intoseparate streams of consciousness (dissociative identitydisorder, formerly termed multiple personality disorder)and complex post-traumatic stress disorder.[11][12]

Dissociative disorders are sometimes triggered bytrauma, but may be preceded only by stress, psychoactivesubstances, or no identifiable trigger at all.[13] The ICD-10 classifies conversion disorder as a dissociative disor-der.[5] The Diagnostic and Statistical Manual of MentalDisorders groups all dissociative disorders into a singlecategory.[14]

Although some dissociative disruptions involve amnesia,other dissociative events do not.[15] Dissociative disordersare typically experienced as startling, autonomous intru-sions into the person’s usual ways of responding or func-tioning. Due to their unexpected and largely inexplicablenature, they tend to be quite unsettling.

1 History

The French philosopher and psychiatrist Pierre Janet(1859–1947) is considered to be the author of the con-cept of dissociation.[16] Contrary to some conceptionsof dissociation, Janet did not believe that dissociationwas a psychological defense.[17][18] Psychological defensemechanisms belong to Freud’s theory of psychoanalysis,not to Janetian psychology. Janet claimed that dissoci-ation occurred only in persons who had a constitutionalweakness of mental functioning that led to hysteria whentheywere stressed. Although it is true thatmany of Janet’scase histories described traumatic experiences, he neverconsidered dissociation to be a defense against those ex-periences. Quite the opposite: Janet insisted that disso-ciation was a mental or cognitive deficit. Accordingly,he considered trauma to be one of many stressors thatcould worsen the already-impaired “mental efficiency” ofa hysteric, thereby generating a cascade of hysterical (intoday’s language, “dissociative”) symptoms.[16][19][20][21]

Although there was great interest in dissociation duringthe last two decades of the nineteenth century (especiallyin France and England), this interest rapidly waned withthe coming of the new century.[16] Even Janet largelyturned his attention to other matters. On the other hand,there was a sharp peak in interest in dissociation in Amer-ica from 1890 to 1910, especially in Boston as reflected inthe work of William James, Boris Sidis, Morton Prince,and William McDougall. Nevertheless, even in Amer-ica, interest in dissociation rapidly succumbed to the surg-ing academic interest in psychoanalysis and behaviorism.For most of the twentieth century, there was little interestin dissociation. Discussion of dissociation only resumedwhen Ernest Hilgard (1977) published his neodissocia-tion theory in the 1970s and when several authors wroteabout multiple personality in the 1980s.Carl Jung described pathological manifestations of dis-sociation as special or extreme cases of the normal oper-ation of the psyche. This structural dissociation, oppos-ing tension, and hierarchy of basic attitudes and functionsin normal individual consciousness is the basis of Jung’sPsychological Types.[22] He theorized that dissociation isa natural necessity for consciousness to operate in one fac-ulty unhampered by the demands of its opposite.Attention to dissociation as a clinical feature has beengrowing in recent years as knowledge of post-traumaticstress disorder increased, due to interest in dissociativeidentity disorder and the multiple personality contro-versy, and as neuroimaging research and population stud-

1

2 5 SEE ALSO

ies show its relevance.[23]

Historically the psychopathological concept of dissocia-tion has also another different root: the conceptualizationof Eugen Bleuler that looks into dissociation related toschizophrenia.[24]

2 Diagnosis

Main article: dissociative disorder

Dissociation in community samples is most commonlymeasured by the Dissociative Experiences Scale. TheDSM-IV considers symptoms such as depersonalization,derealization and psychogenic amnesia to be core fea-tures of dissociative disorders.[25] However, in the nor-mal population dissociative experiences that are not clin-ically significant are highly prevalent, with 60% to 65%of the respondents indicating that they have had some dis-sociative experiences.[26] The SCID-D is a structured in-terview used to assess and diagnose dissociation.

3 Relation to trauma and abuse

Dissociation has been described as one of a constel-lation of symptoms experienced by some victims ofmultiple forms of childhood trauma, including physical,psychological, and sexual abuse.[27][28] This is supportedby studies which suggest that dissociation is correlatedwith a history of trauma.[29] Dissociation appears to havea high specificity and a low sensitivity to having a self-reported history of trauma, which means that dissociationis muchmore common among those who are traumatized,yet at the same time there are many persons who havesuffered from trauma but who do not show dissociativesymptoms.[30]

Adult dissociation when combined with a history ofchild abuse and otherwise interpersonal violence-relatedposttraumatic stress disorder (PTSD) has been shown tocontribute to disturbances in parenting behavior, such asexposure of young children to violent media. Such be-havior may contribute to cycles of familial violence andtrauma.[31]

Symptoms of dissociation resulting from trauma mayinclude depersonalization, psychological numbing,disengagement, or amnesia regarding the events of theabuse. It has been hypothesized that dissociation mayprovide a temporarily effective defense mechanismin cases of severe trauma; however, in the long term,dissociation is associated with decreased psycholog-ical functioning and adjustment.[28] Other symptomssometimes found along with dissociation in victims oftraumatic abuse (often referred to as “sequelae to abuse”)include anxiety, PTSD, low self-esteem, somatization,depression, chronic pain, interpersonal dysfunction,

substance abuse, self-harm and suicidal ideation oractions.[27][28][32] These symptoms may lead the victimto present the symptoms as the source of the problem.[27]

Child abuse, especially chronic abuse starting at earlyages, has been related to high levels of dissociative symp-toms in a clinical sample,[33] including amnesia for abusememories.[34] A non-clinical sample of adult womenlinked increased levels of dissociation to sexual abuse by asignificantly older person prior to age 15,[35] and dissoci-ation has also been correlated with a history of childhoodphysical and sexual abuse.[36] When sexual abuse is ex-amined, the levels of dissociation were found to increasealong with the severity of the abuse.[37]

A 2012 review article supports the hypothesis that currentor recent trauma may affect an individual’s assessment ofthe more distant past, changing the experience of the pastand resulting in dissociative states.[38]

4 Psychoactive substances

Main article: Dissociative drug

Psychoactive drugs can often induce a state of tem-porary dissociation. Substances with dissociativeproperties include ketamine, nitrous oxide, alcohol,tiletamine, marijuana, dextromethorphan, MK-801,PCP, methoxetamine, salvia, muscimol, atropine, andibogaine.[39]

5 See also

• Altered state of consciousness

• Coping (psychology)

• Dissociative disorder

• Dissociative Experiences Scale

• Dissociative Identity Disorder

• Dissociative substance

• Emotional detachment

• Fantasy prone personality

• International Society for the Study of Trauma andDissociation

• Psychological numbing

• Repressed memory

• Splitting (psychology)

3

6 References[1] Dell P. F. (March 2006). “A new model of dissocia-

tive identity disorder”. Psychiatric Clinics North Amer-ica 29: 1–26, vii. doi:10.1016/j.psc.2005.10.013. PMID16530584.

[2] Butler LD, et al. (July 1996). “Hypnotizability and trau-matic experience: a diathesis-stress model of dissociativesymptomatology”. American Journal of Psychiatry 153 (7Suppl): 42–63. PMID 8659641.

[3] Gleaves, DH; May, MC; Cardeña, E (June 2001). “Anexamination of the diagnostic validity of dissociativeidentity disorder”. Clinical Psychology Review 21 (4):577–608. doi:10.1016/S0272-7358(99)00073-2. PMID11413868.

[4] Dell P. F. (2006). “The multidimensional inventory ofdissociation (MID): A comprehensive measure of patho-logical dissociation”. Journal of Trauma Dissociation7 (2): 77–106. doi:10.1300/J229v07n02_06. PMID16769667.

[5] Dell, P. F., &O'Neil, J. A. (2009). “Preface”. In P.F. Dell& J.A. O'Neil. Dissociation and the dissociative disorders:DSM-V and beyond. New York: Routledge. pp. xix-xxi.

[6] Weiten, W.; Lloyd, M.A. (2008). Psychology Appliedto Modern Life (9 ed.). Wadsworth Cengage Learning.ISBN 0-495-55339-5.

[7] Snyder, C.R., ed. (1999). Coping: The Psychology ofWhat Works. New York: Oxford University Press. ISBN0-19-511934-7.

[8] Zeidner, M.; Endler, N.S., eds. (1996). Handbook ofCoping: Theory, Research, Applications. New York: JohnWiley & Sons. ISBN 0-471-59946-8.

[9] Lynn S&Rhue JW (1994). Dissociation: clinical and the-oretical perspectives. Guilford Press ISBN 978-0-89862-186-0. pp. 19.

[10] Van der Kolk, B. A., Van der Hart, O., & Marmar, C. R.(1996). “Dissociation and information processing in post-traumatic stress disorder”. In B. A. van der Kolk, A. C.McFarlane, & L. Weisaeth. Traumatic stress: The effectsof overwhelming experience on mind, body, and society.New York: Guilford Press. pp. 303–27.

[11] Coons PM (June 1999). “Psychogenic or dissociativefugue: a clinical investigation of five cases”. PsychologicalReports 84 (3 Pt 1): 881–6. doi:10.2466/PR0.84.3.881-886. PMID 10408212.

[12] Kritchevsky, M; Chang, J; Squire, LR (2004).“Functional Amnesia: Clinical Description andNeuropsychological Profile of 10 Cases”. Learning andMemory 11: 213–26. doi:10.1101/lm.71404. PMC379692. PMID 15054137.

[13] Abugel, J; Simeon, D (2006). Feeling Unreal: Deper-sonalization Disorder and the Loss of the Self. Oxford:Oxford University Press. p. 17. ISBN 0195170229.

[14] American Psychiatric Association (June 2000).Diagnostic and Statistical Manual of Mental Disorders-IV (Text Revision). Arlington, VA, USA: Amer-ican Psychiatric Publishing, Inc. pp. 519–34.doi:10.1176/appi.books.9780890423349. ISBN978-0-89042-024-9.

[15] Van IJzendoorn, MH; Schuengel, C (1996). “The mea-surement of dissociation in normal and clinical popula-tions: meta-analytic validation of the dissociative experi-ences scale (DES)". Clinical Psychology Review 16 (5):365–382. doi:10.1016/0272-7358(96)00006-2.

[16] Ellenberger, H. F. (1970). The Discovery of the Uncon-scious: The History and Evolution of Dynamic Psychiatry.New York: BasicBooks. ISBN 0-465-01673-1.

[17] Janet, P (1977) [1893/1901]. The Mental State of Hys-tericals: A Study of Mental Stigmata and Mental Acci-dents. Washington, DC: University Publications of Amer-ica. ISBN 0-89093-166-6.

[18] Janet, Pierre (1965) [1920/1929]. The major symptoms ofhysteria. New York: Hafner Publishing Company. ISBN1-4325-0431-2.

[19] McDougall, W (1926). Outline of abnormal psychology.New York: Charles Scribner’s Sons.

[20] Mitchell, TW (1921). The Psychology of Medicine. Lon-don: Methuen. ISBN 0-8274-4240-8.

[21] Mitchell, TW (2007) [1923]. Medical Psychology andPsychical Research. New York: E. P. Dutton. ISBN 1-4067-3500-0.

[22] Jung, C.G. (1991). Psychological Types. Routledge Lon-don. ISBN 978-0-7100-6299-4.

[23] Scaer, Robert C. (2001). The Body Bears the Burden:Trauma, Dissociation, and Disease. Binghamton, NY:Haworth Medical Press. pp. 97–126. ISBN 0-7890-1246-4.

[24] Di Fiorino, M; Figueira, ML, eds. (2003). “Dissociation.Dissociative phenomena. Questions and answers”. Bridg-ing Eastern & Western Psychiatry 1 (1): 1–134.

[25] Dissociative Disorders ( Diagnostic and Statistical Manualof Mental Disorders, Fourth Edition )

[26] Waller, NG; Putnam, FW; Carlson, EB (1996). “Typesof dissociation and dissociative types: A taxometric anal-ysis of dissociative experiences” (PDF). PsychologicalMethods 1: 300–21. doi:10.1037/1082-989X.1.3.300.Archived from the original (PDF) on 2008-04-14. Re-trieved 2008-01-31.

[27] Salter, Anna C.; Eldridge, Hilary (1995). TransformingTrauma: A Guide to Understanding and Treating AdultSurvivors. Sage Publications. p. 220. ISBN 0-8039-5509-X.

[28] Myers, John E.B. (2002). The APSAC Handbook on ChildMaltreatment (2nd ed.). Sage Publications. p. 63. ISBN0-7619-1992-9.

4 7 EXTERNAL LINKS

[29] van der Kolk, BA; et al. (1996). “Dissociation, somatiza-tion, and affect dysregulation: The complexity of adapta-tion of trauma”. American Journal of Psychiatry 153 (7Suppl): 83–93. PMID 8659645. Retrieved 2008-05-13.

[30] Briere, J (2006). “Dissociative symptoms andtrauma exposure: Specificity, affect dysregu-lation, and posttraumatic stress”. Journal ofNervous and Mental Disorders 194: 78–82.doi:10.1097/01.nmd.0000198139.47371.54. PMID16477184.

[31] Schechter, DS; Gross, A; Willheim, E; McCaw, J; et al.(2009). “Is maternal PTSD associated with greater expo-sure of very young children to violent media?". Journal ofTraumatic Stress: 658–62. doi:10.1002/jts.20472. PMC2798921. PMID 19924819.

[32] Briere, J (1992). “Methodological issues in the study ofsexual abuse effects” (PDF). Journal of Consulting andClinical Psychology 60 (2): 196–203. doi:10.1037/0022-006X.60.2.196. PMID 1592948.

[33] Merckelbach, H; Muris, P (2001). “The causal link be-tween self-reported trauma and dissociation: A critical re-view”. Behaviour Research and Therapy 39 (3): 245–54.doi:10.1016/S0005-7967(99)00181-3. PMID 11227807.Retrieved 2008-05-13.

[34] Chu, J; Frey, LM; Ganzel, BL;Matthews, JA (May 1999).“Memories of childhood abuse: Dissociation, amnesia,and corroboration”. American Journal of Psychiatry 156:749–55. PMID 10327909.

[35] Briere, J; Runtz, M (1988). “Symptomatology associ-ated with childhood sexual victimization in a nonclini-cal adult sample”. Child Abuse and Neglect 12: 51–59.doi:10.1016/0145-2134(88)90007-5. PMID 3365583.

[36] Briere, J; Runtz, M (1990). “Augmenting Hop-kins SCL scales to measure dissociative symp-toms: Data from two nonclinical samples”. Jour-nal of Personality Assessment 55 (1–2): 376–9.doi:10.1207/s15327752jpa5501&2_35. PMID2231257.

[37] Draijer, N; Langeland, W (March 1999). “Child-hood trauma and perceived parental dysfunction in theetiology of dissociative symptoms in psychiatric inpa-tients”. American Journal of Psychiatry 156: 379–85.doi:10.1016/j.biopsych.2003.08.018. PMID 10080552.

[38] Stern, DB (January 2012). “Witnessing across time:Accessing the present from the past and the past fromthe present”. The Psychoanalytic Quarterly 81 (1): 53–81. doi:10.1002/j.2167-4086.2012.tb00485.x. PMID22423434.

[39] Giannini, AJ (1997). Drugs of Abuse (2nd ed.). Los An-geles: Practice Management Information Corp. ISBN 1-57066-053-0.

7 External links• International Society for the Study of Trauma andDissociation

• The official journal of the International Society forthe Study of Dissociation (ISSD), published be-tween 1988 and 1997

5

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