Disassociation subtype of PTSD


Disassociation is a relatively common and normal response to trauma; an instinctive way of mentally blocking out unbearable thoughts or feelings as a result of a trauma, and so is often found alongside PTSD.

Thought to be an automatic defence mechanism when we are faced with overwhelming emotional or physical pain, research shows that up to 50% of adults experience some level of disassociation occasionally, and as a psychiatric condition it might affect up to 3% of the general population. Chronic, and problematic dissociation is most likely to develop where there is repeated threat or trauma (even more so when it starts at a young age).

The term ‘disassociation’ includes those experiencing depersonalization, derealisation or Dissociative Identity Disorder (DID) and can range from mild to severe (and everything in between). It may even last just a few moments or may be ongoing.

General disassociation disorder sufferers may experience:

  • memory loss
  • feel that their body (or the world around them) is not real
  • feel that they have several different identities
  • Sensitivity to light and sound
  • Tunnel vision
  • Feeling as if your body is larger or smaller than it is
  • Stationary objects may appear to move
  • Not being aware of the passage of time

Depersonalisation

Sufferers of ‘depersonalisation’ experience changes in self awareness and are likely to feel detached from themselves; observing themselves and their feelings, actions and thoughts as if they belong to someone else, perhaps feeling as they are ‘watching themselves from the outside’.

Some of the typical symptoms are:

  • feeling like you are watching a film of yourself
  • feeling ‘this is not happening to me’
  • reduction of the intensity, and a sense of detachment from emotions
  • loss of feeling in parts of your body
  • distorted views of your body
  • unable to recognise yourself in the mirror
  • ‘out-of-body experiences’

Derealisation

Those experiencing ‘derealisation’ may see the environment around them as ‘dream-like.’ They may also perceive objects as unsolid, smaller in size than they actually are, or two-dimensional. Derealisation has been described as ‘peering at the world through a fog, with the world unreachable and meaningless’.

Some of the typical symptoms are:

  • feeling like a normal environment is unfamiliar
  • feeling detached from the world
  • your perception of objects changes: shape, colour, size
  • feeling that people you know are strangers
  • a sense that what is happening is not real

Disassociative Identity Disorder (DID)

Dissociative identity disorder, or ‘multiple personality disorder’, is the most extreme of the three types of disassociation. Sufferers may feel uncertain about who they are, or even feel the presence of other identities.

Some of the typical symptoms are:

  • writing in different handwriting
  • being confused about your sexuality or gender
  • feeling like a stranger to yourself
  • feeling like there are different people within you
  • referring to yourself as ‘we’
  • behaving out of character

The relationship between disassociation and PTSD

One study of PTSD sufferers found that roughly 15 – 30% also reported symptoms of depersonalization and derealization.

Research assessing the relationship between PTSD and dissociation has suggested that there may be a ‘dissociative subtype’ of PTSD.

Studies have shown that those with the dissociative subtype of PTSD generally showed a repeated traumatization and early adverse experience prior to onset of PTSD.


Treatment of disassociation alongside PTSD

Disassociation in PTSD sufferers should be considered when looking at treatment options for PTSD.  It’s been found that those with PTSD who displayed symptoms of depersonalization and derealization generally responded better to treatments that included particular cognitive behavioural therapy and exposure therapy (which is desensitization and cognitive restructuring) rather than exposure treatment which can lead to further dissociation.


I think I may have the disassociation subtype of PTSD, what can I do?

If you think you may have disassociation subtype PTSD you should speak to your GP, but for more information you can complete this screening test DES (Dissociative Experiences Scale) online. This is not a formal diagnosis and will only indicate the likelihood of you having a dissociative disorder.

 

 


SOURCES: US Department of Veterans Affairs, PODS online, NHS UK, Panic Attacks, Anxiety Care UK,

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