References:
- Psychiatric-Mental Health Nursing, 8th Edition, 978-1-975116-37-8, by Sheila L. Videbeck
Dissociation is a subconscious defense mechanism that helps a person protect his or her emotional self from recognizing the full effects of some horrific or traumatic event by allowing the mind to forget or remove itself from the painful situation or memory. Dissociation can occur both during and after the event. As with any other protective coping mechanism, dissociating becomes easier with repeated use.
Dissociative disorders have the essential feature of a disruption in the usually integrated functions of consciousness, memory, identity, or environmental perception. This often interferes with the person’s relationships, ability to function in daily life, and ability to cope with the realities of the abusive or traumatic event. This can vary greatly in intensity and onset. Dissociative symptoms are seen in clients with PTSD.
- Dissociative amnesia: the client cannot remember important personal information (usually of a traumatic or stressful nature). This category includes a fugue experience where the client suddenly moves to a new geographic location with no memory of past events and often the assumption of a new identity.
- Dissociative identity disorder (formerly multiple personality disorder): the client displays two or more distinct identities or personality states that recurrently take control of their behavior. This is accompanied by the inability to recall important personal information.
- Depersonalization/derealization disorder: the client has a persistent recurrent feeling of being detached from their mental processes or body (depersonalization) or sensation of being in a dream-like state in which the environment seems foggy or unreal (derealization). The client is not psychotic nor out of touch with reality.
Treatment
Survivors of abuse who have dissociative disorders are often involved in group or individual therapy in the community to address the long-term effects of their experiences. Therapy for clients who dissociate focuses on reassociation, or putting the consciousness back together. This specialized treatment addresses trauma-based, dissociative symptoms. The goals of therapy are to improve quality of life, improved functional abilities, and reduced symptoms. Clients with dissociative disorders may be treated symptomatically, that is, with medications for anxiety or depression or both if these symptoms are predominant.