Dissociation, Depersonalization, and Derealization

What is Dissociation?

Many individuals come into therapy expressing feelings of numbness or a sense of disconnection from their bodies, moving through the day as though they are observing their life rather than living it, feeling like things around them are not real, noticing a lack of emotion, blurry or foggy vision, and many other symptoms that are unsettling and confusing for them. Often times, these symptoms fall under the category of dissociation. When we think about dissociation in the context of trauma, according to the work of Dr. Janina Fisher, Ph.D., dissociation is not just a disconnection from traumatic memories or experiences; it is also a disconnection from one's sense of self, bodily sensations, and emotional experience. Fisher emphasizes that dissociation is a survival strategy, allowing individuals to endure unbearable situations by disconnecting from their full experience. While dissociation serves as a vital protective strategy during traumatic experiences, enabling individuals to withstand overwhelming situations, its aftermath can significantly disrupt daily life once the trauma has passed. This disconnection, once a source of safety, may lead to challenges in feeling fully present and engaged in one's life post-trauma. Therefore, it becomes essential in trauma therapy to identify, understand, and work through dissociative symptoms. Addressing dissociation is not only about confronting past traumas but also about reclaiming a sense of self and connection to the world, laying the groundwork for deep and lasting recovery for those who have survived trauma. Given my deep understanding of dissociation and commitment to using trauma-informed approaches, I am well-equipped to support individuals struggling with dissociation on their journey toward healing and reconnection with their sense of self. Below is a more detailed list of the symptoms of dissociation.

Symptoms of Dissociation: 

Symptoms of dissociation can often be subtle, elusive, and easily confused with other psychological conditions. However, a keen awareness of the following symptoms can guide both clinicians and clients toward a more accurate diagnosis:

Emotional Symptoms

• Emotional Numbness: Reduced ability to feel emotional highs or lows.

• Mood Swings: Rapid and extreme changes in mood.

• Depersonalization: Feeling detached from oneself or observing oneself from an outsider’s perspective.

• Self-puzzlement: Confusion about one’s own behaviors, emotions, or experiences.

Physical Symptoms

• Numbness: Reduced physical sensation or emotional response.

• Paralysis: Inability to move, typically in the absence of a physical cause.

• Unexplained Pains: Somatic complaints without a clear physical origin.

• Pseudoseizures: Episodes resembling seizures but without the typical electrical activity in the brain.

• Unexplained Injuries: Bruises or other injuries that the person can't explain.

Psychological Symptoms

• Highly Fluctuating Symptoms: Like anxiety, depression, and suicidal thoughts.

• Phobia of Inner Experience: High avoidance of exploring internal emotional states.

• Treatment Resistance: A lack of progress despite undergoing different types of therapies.

Cognitive Symptoms

• Amnesia: Gaps in memory for past or present events.

• Time Loss: Periods of time that are unaccounted for.

• Disorientation: Confusion about time, place, or identity.

• Intrusive Thoughts: Unwanted thoughts that seem disconnected from the current situation.

• De-realization: Feeling as if the world around you is unreal.

Auditory Symptoms

• Hearing Voices: Especially voices of parts conversing or commenting internally. These voices have specific characteristics that differentiate them from psychotic hallucinations.

Behavioral Symptoms

• Switching: Overt changes in state of consciousness, mannerisms, or speech patterns.

• Being in a Child State: Or alternate personality states at times.

• Fluctuations in Skills and Abilities: Such as speaking a language you haven't studied or being able to play a musical instrument you haven't learned.

Understanding these symptoms is crucial for identifying dissociative processes and planning effective treatment.