Post-Traumatic Stress Disorder And Dissociation: What Do You Need To Know?

What's dissociation, and how does it relate to trauma? As I looked for research on the topic, one study preview showed, instead of an abstract, the following words: "Sign In. Username. Forgot Username? Password. Forgot password? Keep me signed in. New User." That caught my eye, because dissociation can actually be a quite bit like that. 

When "Sandra" (not her real name), a young soldier who was severely traumatized during childhood, was hospitalized for some really odd behavior, the psychiatry team considered all sorts of diagnoses, from schizophrenia to bipolar disorder and alcohol or drug abuse. Sandra had no idea where she was, instead convinced she was at another hospital hundreds of miles away, had aggresive outbursts, and large memory gaps that really disoriented her. When her doctors tried hypnosis, a different (part of her) identity that called herself Mary emerged instead. Mary cut Sandra's leg to punish her and believed she'd reemerge in someone else's body if Sandra died. 

Sandra's story represents the more severe end of dissociation, and she was diagnosed with dissociative identity disorder (previously called multiple personality disorder) before starting treatment — but many people who have suffered trauma dissociate to some degree, and many of them have diagnoses of post-traumatic stress disorder. 

In fact, if you have PTSD, you'll almost certainly experience some level of dissociation from time to time, and symptoms that many researchers would consider dissociative are an integral part of the diagnostic criteria for PTSD, as laid out in the diagnostic and statistical manual of mental disorders (DSM-5). 

What exactly is dissociation, and what dissociative symptoms might people with PTSD experience?

In plain English, dissociation is being disconnected from the present, something that can happen in a range of different ways.

If you're not put off by academic language, one study more fully defined it as "an experienced loss of information or control over mental processes that, under normal circumstances, are available to conscious awareness, self-attribution, or control, in relation to the individual’s age and cognitive development". 

That means that common intrusion symptoms people with PTSD experience would be considered dissociation as well. Intrusive memories and flashbacks may sometimes last very briefly, even less than a second, but will make you feel like you're truly reliving some element of the past, cutting you off from the here and now.

Flashbacks "insert" an experience from the past into your present. When trauma-related dissociation is discussed, on the other hand, it usually refers to experiences in which some aspect of the present is removed, instead:

• Derealization, a state of mind in which you feel detached or alienated from your environment, which becomes foggy, dreamlike (or nighmarish), or disorted. 
• Depersonalization, in which you're instead alienated or detached from your own body — you may feel like you're an outsider observer just looking on, something is not really happening to you but to someone else, or you're "on autopilot". 
• Memory gaps (amnesia), in which you're unable to remember some aspect of the past. 
• A "fugue state", in which a person temporarily loses their sense of identity and flees. 

Dissociation during traumatic events: A defense mechanism

Many people dissociate during emotionally and physically traumatic events they cannot get away from. They may describe themselves as "acting on autopilot", "being a bystander in their own body", "going blank", "switching off", "spacing out", or more generally going emotionally numb. Their environment, meanwhile, might have seemed like not really there, or they may instead have focused on some really small details like a blanket, smell, or other aspect of their surroundings. 

Quite a few studies suggest, however, that dissociating during trauma may increase a person's risk of developing post-traumatic stress disorder later on, especially if it continues once the traumatic event has come to an end. 

After the trauma: Dissociation and PTSD

Dissociative symptoms like memory gaps, depersonalization, and derealization are far from rare in people who suffer from post-traumatic stress disorder. Research has found that anyone with PTSD, from combat veterans to vehicle accident survivors and sexual assault victims can have dissociative symptoms — and somewhere between 15 and 30 percent of PTSD suffers experience derealization, depersonalization, or both after their trauma. This is why the DSM-5 now recognizes a dissociative subtype of post-traumatic stress disorder. 

Treatment for PTSD can help people who have dissociative symptoms — as you process the "unfiled" trauma-related memories and consolidate them into a chronological timeline you can make sense of and come to terms with, these symptoms may improve automatically.

Grounding techniques that help you stay focused on the present can also help, and the good thing is that they're easy to practice even outside the therapist's office. Depending on your preferences, grounding can involve anything from spending time in nature to taking note of, and naming, the physical objects that surround you. Journaling and keeping a paper notebook with all your plans may also help you "stay signed in".