A Guide to Dissociation

A beautiful disaster.

I have wanted to write about this topic for quite sometime as dissociation is something which has had a huge impact on my life and I think that a lot less is known about it than other mental health associated things.  In this post I want to use my experiences to explain what dissociation is and how I have learnt to cope with it in the hope of providing some helpful tips for others who suffer from dissociation and also for people who may know someone who suffers from dissociation and would like ideas on how they can best support them.

What Is Dissociation?

Dissociation is where a person temporarily loses touch with reality and it is for this reason that it is categorised as a symptom of psychosis.  Everyone dissociates to a mild extent on a regular basis.  You might have taken a familiar car journey but can't remember much of the journey itself.  You might daydream from time to time when you look out the window.  These are examples of dissociation and in these instances it is not really a problem, in fact it can be quite healthy to zone out from time to time.

Dissociation becomes a problem when it happens to a more severe extent, more regularly and it has a pronounced negative impact on a person's life and their ability to engage with the world around them.  There are many different types of dissociation and it is something which is hard to explain to someone unless they have experienced it themselves.  The type of dissociation I suffer from is depersonalisation dissociation.  I would describe this as my mind leaving my body.  When I am in a situation of high stress and anxiety or feel particularly threatened, as a defensive mechanism, my mind leaves my body, my perception of everything around me becomes hazy and sometimes dream like and I feel as though I am watching myself from the outside.  I have sat in restaurants before and have felt as though I was watching myself from outside a window.  When I dissociate I feel completely cut off from everyone and everything around me.  In this sense, dissociation can be very scary and make the sufferer feel quite helpless and out of control.

Physical Symptoms of Dissociation

Everyone experiences dissociation differently so it is difficult to generalise.  It can be very unclear to others that a person has dissociated as from the outside it can appear that there is nothing wrong.  In my case, it only becomes clear to others that I have dissociated when the level of dissociation has become more severe.

Here are some of the physical symptoms that others have said I show when i dissociate.  They might help others to recognise when a person has dissociated...

~ Dizziness/feeling faint and light headed - This is usually the first thing I notice when I begin to dissociate.
~ Eyes glaze over - this is a more difficult one for other people to spot but it is a very clear sign.  My eyes will appear vacant and distant.
~ Eyes begin to roll back - When my dissociation becomes more severe my eyes will actually roll back.
~ Unresponsive in speech/ speech disjointed and weak - I find it very difficult to speak when I'm dissociated.  I will often struggle to respond to people's questions and when I do speak my voice is very weak and faint.
~ Posture becomes more slumped - Probably due to dizziness, I begin to slump over when I'm sitting down.
~ Float a hand in front of my face - I've heard that this is actually a very unusual symptom of dissociation but it is something I always do for some reason.
~ Unsteadiness/loss of balance - The light headedness often makes me unsteady on my feet.
~ Loss of bowel control - This is a bit of an embarrassing one to include but it is a reality for me.
~ Arm turns blue - This is another one that may be unique to me but often when I dissociate my right arm turns blue but not the left - strange!
~ Collapse and seizures - At its most extreme, dissociation results in collapse or seizures.  When I severely dissociate, it is as though my body begins to shut down and I collapse.  This is when dissociation can get particularly scary for both the sufferer and those around them.  When I have had dissociative seizures I've been told that it appeared almost the same as an epileptic seizure.

Causes Of Dissociation

Dissociation is a defensive coping mechanism.  Often people will develop dissociation as a result of experiencing some form of trauma as it enables them to cut themselves off from the emotional or physical pain they experienced when the trauma occurred. It is very common for people who suffered sexual abuse in childhood to develop dissociative episodes in response as it can make the sufferer feel as though the abuse is not happening to them.  This was the case for me as the first time I dissociated was when I was sexually abused at the age of 5.  However, it is important to note that not all people who struggle with dissociation have a history of sexual abuse, people can develop dissociative episodes for a number of different reasons.

What makes People Dissociate - My Experiences

While dissociation is categorised as a symptom of psychosis, I would say, at least in my experience, that it often occurs as a result of anxiety.  When we become extremely anxious or overwhelmed, the need to zone out as we can't cope with the situation becomes very prominent.  I used to suffer with panic attacks a lot, I still do but not as regularly.  When I began to manage and control my panic attacks better, I found that I would tend to dissociate in response to the situation instead.  Dissociating can become a very automatic and an immediate reaction.  I often find this is a case for me when a traumatic memory is strongly triggered.  There have been other occasions when I have dissociated for no other reason than the fact that I had dissociated in the same place before.  The mind stores dissociative episodes and the circumstances surrounding the episode so sometimes you can dissociate if you are a similar situation to one in which you have dissociated before.

Speaking from experience, there is no doubt that dissociation can have a huge impact on a person's life.

As I have said, I experienced dissociative episodes from a very young age.  Some of my family have said that as a child growing up there were times when I would appear very vacant and as though I was just going through the motions and speaking to them but no one was really at home.  I would say that my dissociative episodes were quite milder then in general but as I became a young adult they became considerably worse.

My worst experiences of dissociation...
~ I have sat in many a pub and restaurant with friends, been unable to engage in any form of conversation and didn't have a clue where I was.
~ During a period in which my social anxiety had become very severe, I used to take dissociated trips out to places alone.  It was as though I found everything so difficult to deal with, the only way I felt I could go out was by being pretty zoned out.  I would have very little if no memory of the trip afterwards.  Sometimes I would take photos on my trips and discover them later.  It's funny, even the photos have a bit of a spaced out quality about them!
~ I've dissociated in front of a class of students when I was working (they didn't know) and that's when my dissociation became scary as it began to affect my work.
~ I would find myself at work and have no memory of getting up or driving there.
~ I have had a dissociative seizure when staying over at a friends and most probably scared the crap out of her.
~ While in inpatient care I collapsed a number of times due to dissociation.
~ When I relapsed back into my eating disorder and was restricting and starving heavily, on occasion I would find myself sitting in my room with an empty tub of ice cream or Pringles next to me and have no idea how it got there.  I would then find money missing from my purse, sometimes a receipt and notice that my car keys had moved and realise that I must have driven to the shops, bought the food and eaten it while dissociated.  It was a very scary when I realised what had happened, it made me feel very out of control, which I was at the time.
The list could go on...

As hard as it may be to believe, generally, I appear a very together and on the ball person.  People say I've almost got a photographic memory, if someone wants to know the date or time of something, they usually ask me and I don't have to look it up.  I therefore have always found it difficult to accept and deal with my dissociative episodes as being a person who is generally so there and present, it bewilders me that all of a sudden I can find myself in such a state of nothingness and be left with gaps in my memory.

However, in the past few months I have managed to cope with dissociation a lot better and prevent episodes.  In fact, up until a couple of weeks ago, I had not experienced a severe dissociative episode for over 3 months which felt absolutely liberating as at one point it was a day to day occurrence.  Then, during one of my therapy sessions a couple of weeks ago when one of my traumatic memories was triggered, I experienced the worst dissociative episode I had ever experienced.  Usually my dissociative episodes last up to 15 minutes but this one went on for over 40 minutes.  I collapsed on the floor and wet myself (I made such a fantastic impression on my new therapist!).  I have also never struggled as I did during that episode to bring myself back to the present.  The episode really shook me up. I thought I had cracked it as I hadn't dissociated in so long and yet all of a sudden I was reminded of just how awful and scary dissociation is.

After a few days of reflection and talking through what happened with my therapist, I picked myself up and this is part of the reason why I am writing this post.  I realised that I must not let one dissociative episode destroy all the improvements I have managed to make over the past few months.  A therapy session is a very different setting to the ones I come across in everyday life.  Therapy is hard, it brings up things we'd probably not talk about on a day to day basis with anyone else and so it's only natural that such a setting would make it more likely for a person to struggle to manage their dissociative symptoms.  My therapist and I made a bit of a strategy so that both of us could deal with the situation better if I was to have an episode again and that has made me feel a lot more reassured and positive.  I also reminded myself that I have shown that I can manage my dissociation better outside of therapy and I mustn't lose sight of that.

How to Cope With or Stop Dissociation

Possible Solution = Medication

As dissociation is a symptom of psychosis, a lot of psychiatrists will encourage you to be prescribed antipsychotic medication if you suffer from dissociation.  From what I've been told, even though no one is a hundred percent sure how it happens, antipsychotics tend to completely stop dissociation.  Some even call them a magic cure.

Personally, I have always refused to take antipsychotics as I have issues with some of the side effects of taking that type of medication.   Besides, as I have said, my dissociative episodes have always been anxiety induced so I don't feel as though taking antipsychotics would allow me to deal with the root of the problem.  I do take an antidepressant though which also has a sedative affect so it reduces anxiety as well.  Ever since I started taking the antidepressant, my dissociative episodes decreased dramatically, even though the medication does not directly help with dissociation.  I think that because the medication has taken the edge off my anxiety, I am able to manage my anxiety and stop it reach such great heights in which I end up dissociating.

My Guide to Dealing with Dissociation

I know that medication does not always feel like the right option for everyone.  There are many other coping strategies you can use to help with dissociation.  Please not that I am not a mental health professional or an expert by any stretch of the imagination but I am just going to share with you a few tips that I have found helpful...

Step 1 - Recognise Your Symptoms

It is much easier to deal with a dissociative episode if you catch it early on so it is important to try to recognise your symptoms.  I find my warning signal is when I start to become lightheaded and my vision becomes a bit hazy. That's when I ask myself, 'Am I dissociating?'

Step 2 - Use Grounding Techniques

As dissociation is a way of zoning out, to stop dissociating, you have to try to bring yourself back into the present moment or rather ground yourself.

Here are some grounding techniques I use...

~ Put your hands on the chair your sitting on, feel your feet on the floor or touch the nearest object to you.

~ Orientate yourself - think about where you are positioned compared to the other things in the room, ie. 'To the left of me is a table, to the right of me is a door, on the table is a lamp' etc.

~ Establish the basic facts - Ask yourself what the date is, what the time is, where you are, what you were planning to do later in the day etc.

~ Get your mind working again - name in your head as many animals as you can beginning with the letter 'a', how many types of plants or flower can you think of, count backwards from 20...

Step 3 - Assess How Present You Are

After you have attempted some grounding techniques assess how present you now feel.  I always tend to think of a percentage in my head, 'I'm 50 percent here, I'm 70 percent here'.  If you still don't feel particularly present, go back to some grounding techniques and then re-assess.

Step 4 - Look After Yourself

After a dissociative episode, it is important to look after yourself.  Although it might not seem logical, dissociation leaves me feeling exhausted.  Thinking about it though, your mind and body has to work really hard in order to dissociate so it is almost like having a full on workout.  Because of this, you need to allow yourself to rest up afterwards and accept that it is okay to feel tired.  Every time I dissociate, I almost feel as though my self esteem takes a bit of a knock.  It is very easy to see dissociation as a sign of weakness but it isn't.  It is incredibly clever that people develop dissociation and have the ability to completely shut down and zone out.  If we have the ability to dissociate then we must be equipped with the skills to bring ourselves back from it, it's just a matter of practice.  Don't let dissociative episodes get you down.  Tell yourself - at the moment dissociation is my way of coping but there are other ways of coping.  I always find getting some fresh air and having a cold glass of water makes me feel a lot better after a dissociative episode.

Step Five - Reflect

When you feel recovered from a dissociative episode and are feeling in a stronger place, it can help to reflect on the episode.  Try and think about what might have triggered the episode so you are more prepared in the future. What grounding techniques worked best.  See a dissociative episode as an opportunity to learn more about yourself.

How to Help someone who is Having a Dissociative Episode

It can be very distressing to see someone dissociate, especially if the episode is severe and you have not seen it before.  However, having the support of another person when you dissociate can be really helpful, or at least it has been for me on occasion.

Here are some tips for supporting someone who is having a dissociative episode...

If you know the person struggles with dissociation and is open to talking about it, the best thing to do is to have a conversation beforehand in which you ask them what would be most helpful if they were to dissociate.  After all, we are all the best guides to ourselves and dissociation affects everyone differently.

Nonetheless, here are some tips that might help when a person is experiencing a dissociative episode...

~ Look out for the physical symptoms

~ If you suspect the person may be dissociating, ask them if they are present.  It is probably not the best idea to boldly ask the question 'Are you dissociating?' as some people may be reluctant to admit that they are for various reasons.  Something along the lines of, 'Are you ok? I'm just noticing that you don't seem a hundred percent with me or present', will usually work better.

~ If the person says they are not feeling present or their physical symptoms make it obvious, you can help them to ground themselves...

~ Try to stay calm - dissociation can be really distressing to see but it is more helpful to the sufferer if you become a supportive and calming presence.  Avoid touching them or even shaking them to get their attention.

~ Ask them basic questions - What day is it? What's the date? What time is it? What's the weather like? What colour is the chair you're sitting on? Where did you get the top you're wearing?

~ Be patient and don't put them under pressure to respond

~ Ask the person how present they feel out of 10

~ When you notice the person becoming more present encourage them.  Trying to ground yourself when you are dissociating can become a real internal battle so it can really help to have someone's encouragement - 'I can see you're with me a lot more now, you're doing a really good job, keep it up'

~ Be there for them after the dissociative episode - Recognise that the person is likely to feel quite tired and vulnerable after an episode.  Tell them that they coped with the episode really well.  Be understanding if a person needs to rest, wants some space or doesn't feel they can keep to the plans you might have made with them.

I hope that this post has been helpful.  I would be interested to hear about other people's experiences with dissociation.  Remember dissociation is not a sign of weakness, it's a sign of inner strength and it can be managed if you keep working on it.  At one point in my life, I felt as though I had absolutely no control over my dissociative episodes and it was a very scary and helpless way to feel.  I can't even put into words just how different and positive I feel about it now.  If you have the intelligence to develop dissociation, then you have the intelligence and the skills somewhere inside of you to stop it.  It's just a matter of unlocking them.

Love and strength,
The One Day Seeker

Escaping the world to a hazy illusion of reality.