*What is dissociation? Your sense of identity, reality and continuity depend on your feelings, thoughts, sensations, perceptions and memories. If they become "disconnected" from each other, or don't register in your conscious mind, it changes your sense around you. This is what happens during dissociation. Everyone has periods when disconnections occur naturally and usually unconscioulsy. We often drive a familiar route, and arrive with no memory of the journey or of what we were thinking about. Some people train themselves to use dissociation to calm themselves, or for spiritual reasons. Dissociation is a defence mechanism helping people to survive traumatic experiences. Dissocition can also occur as a side effect of some drugs, medication and alcohol. *Are they different form of this response? They are five types of dissocaition, which are listed below. Occassional, mild episodes are part of ordinary, everyday life. Sometimes - at the time of a one-off trauma or the prolonged confusion of adolesence, for instance - more severe episodes are quite natural. Amensia: This is when people can't remember incidents or experiences that happened at a particular time, or when they can't remember important personal information. Depersonalisation: A feeling that your body is unreal, changing or dissolving. It also includes out-of-body experiences, such as seeing urself as if watching a movie. Derealisation: The world around u seems unreal. You may see objects changing in shape, size, colour, or you may feel that other people are robots. Identity confusion: Feeling uncertain about who you are. You may feel as if there is a struggle within to define yourself. Identity alteration: This is when there is a shift in your role or identity that changes your behaviour in ways that others could notice. For instance, you may be very different at work from when you are at home. *What are the dissociative disorders? Dissociative disorders occur when people have persistent and repeated epsides of dissociation. These usually cause distressing internal chaos and may interfere with work, school, social, or home-life. Five different forms of these disorders are defined in DSM-IV, the American diagnostic manual commonly used. They can be arranged, in order of complexity, along the "dissociation continuum", which also includes everyday dissocaition and post traumatic stress disorder. A person's position on the continuum will depend on the severity and mix of the types of dissociation they experience. The dissocaition continum - everyday dissociation - depersonalisation disorder - dissociative amensia - dissocaitive fugue - post-traumatic stress disorder (PTSD) - dissociative disorder not otherwise specified (DDNOS) - dissociative identity disorder (DID) Depersonalisation disorder This features strong feelings that you are detached from your body, or that your body is unreal. A person may also experience mild to moderate derealisation and mild identity confusion. Dissociative amensia An inability to remember significant personal information or particular periods of time, which can't be explained by ordinary forgetfulness. People may also experience mild to moderate depersonalition, derealisation and identity confusion. Dissociative fugue A person travels to a new location during a temporary loss of identity. He or she may assume a different identity and a new life. These severe amensia, with moderate to severe identity confusion and often identy alteration. Post-traumatic stress disorder (PTSD) Post-traumatic stress disorder is not currently classed as a dissociative disorder, but people who experience dissociative distress frequently also meet diagnostic criteria for PTSD. They may experience flashbacks, reliving the trauma repeatedly, which cause extreme distress. This , in turn, triggers a dissociative numbing action. Modertate to severe amensia is common to both PTSD and dissociative disorders, as is deralisation and depersonaalisation. Dissociative disorder not otherwise specified (DDNOS) In DDNOS, each of the five types of dissocation may occur, but the pattern of mix and severity does not fit any of the other dissocaitive disorders. Dissociative identify disorder (DID) This is the most complex dissociative disorder. It is also known as multiple personality disorder (mpd) according to the ICD10, the British diagnostic manual. This has given rise to the idea that this is a personality disorder, although it is not. Its defining feature is severe identity alteration. Someone with DID experiences these shifts of identity as seperate personalities. Each identity may assume control of behaviour and thoughts are different at times. Each has a distinctive pattern of thinking and relating to the world. Severe amensia means that one identity may have no awareness of what happens when another identity is in control. The amensia can be one-way or two-way. Identity confusion is usually moderate to severe. It also includes severe depersonalisation and derealisation. *Additional Problems: People may have other problems, too, such as depression, mood swings, anxiety and panic attacks, suicidal tenencies, self harm, headaches, hearing voices, sleep disorders, phobias, alcohol and drug abuse, eating disorders and obessive-compulsive behaviour. These may be directly connected with the dissocaitive problem, or could mean the person also has a non-dissociative disorder. In the case of DID, these problems may only emerge when a particular identity has control of the person's behaviourm such as schizophrenia, manic depression and borderline personality disorder, have dissociative features. *What causes dissocaitive disorders? This is open to arguement. Some experts believe dissocaitive disoders are directly linked to trauma or abuse. Others suggest that they are a result of distruptions to the normal parent/child relationship. Still others believe they come from a disturbance in the stages of childhood development. There is one extremely sceptical view, particularly with DID, that symptoms are just a product of poor therapy with vulnerable, suggestive clients. There are studies showing that a history of trauma is almost universal for people who have modertate to severe dissociative symptoms. Usually, this is abuse in childhood. But some people may develop PTSD, or more rarely dissociative amensia or fugue, after a traumatic or extermely stressful experience in adulthood. Children generally have a greater natural ability to dissociate. This ability declines in adults, unless is has become habital in response to repeated trauma during childhood. However, not all adult survivors of child abuse have a dissociative disorder. Several experts agree that the following factors have to be present for a person to develop the most complex dissociative disorders. -Abuse is severe and repeated over an extended period. -The abused child has an enhanced natural ability to dissociate easily. -There is no adult to provide comform; the child had to be emotionally self-sufficient. *What are the effects of dissociative disorders? Dissociation can affect perception, thinking, feeling, behaviour, body and memory. So, the person with a dissociative disorder has to cope with many challenges in life. The impact of dissociation varies from person to person and may change over time. How well a person appears to be coping is not a good way of telling how severely affected they are. People can be doing responsible jobs or raising families. By using dissocaition, and compensating for with other exhausting strategies, people put up a good front. Almost everyone coping with these difficulties strives to keep hidden from others. Few people with a dissociative disorder will switch rapildly and openly between identities, in the way that is often portrayed on TV and Film. Nor is the classic "Dr Jekyll and Mr Hyde" shift of idenity common. The effects of dissociative disorder may include: - Gaps in memory - Finding urself in a strange place without knowing how you got there. - Out-of-body experiences - Loss of feelin in parts of your body - Distorted views of ur body - Forgetting important information - inability to recognise your image in a mirror. - a sense of detachment from ur emotions - the impression of watching a movie or urself. - Fellings of being unreal. - Internal voices and dialogue - feeling detached from the world - forgetting appointments - feeling that a customary environment is unfamiliar - a sense that is happening is unreal - forgetting a learned talent or skill. - a sense that people you know are strangers. - a perception of objects changing shape, colour or size. - feeling you don't know who u are. - acting like different people, including child like behaviour - being unsure of the boundaries between yourself and others. - feeling like a stranger to urself. - being confused about ur sexuality or gender. - referring to yourself as 'we' - being told by others you behaved out of character. - finding items in ur possession that you don't remember buying or receiving. - writing in a different hamdwriting - having knowledge of a subject you don't recall studying. *How are dissociative disorders diagnosed? There are questionaires that can be used as tools to screen for and diagnose dissociative disorders. Two of the most common are the Dissociative Experiences Scales (DES) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). These can provide a more accurate diagnosis than is possible for most psychiatric illnesses. But only when administered by a professional who has been trained in their use, and who is prepared to consider dissociative disorders. Some people, who have been in contact with mental health services for years, have made astounding progress once dissociative distress was recognise and treated. Its also important to bear in mind that other cultures may have a different view of these symptoms. Dissociative states are a common and accepted feature of culture activities or religious expereince in many non-western societies. *What helps recovery? The aim of treatement and self help is to bring about increased connection between feelings, thoughts, perceptions, and memories and to foster a sense of empowerment. This should create a greater sense of wholeness and internal order, and less disruption in work, social and home life. Talking treatments: Effective treatment for the dissociative disorders may combine several methods, but always includes talking treatment. It is important that this helps people to approach underlying causes as well as the effects of dissocaitive problems. Its is helpful if the therapist is familiar with dissociation and trauma work, but its the quality of the therapist-client relationship that is most important to recovery. The therapist should be accepting of the clients expereince; willing to learn how to work with dissociation and trauma; able to tolerate high levels of frustration and bear extreme pain; and be prepared to work with the client long, often for several years. Getting talking treatment through NHS may depend on where you live. Usually, only short term therapy is availiable, which may do more harm then good for the dissociative client. You may be able to get low-cost of free psycotherapy through voluntary organisations. Therapists in the private sector are another option. Some offer fees on a sliding scale. Medication: Medication can be helpful in treating symptoms of depression, anxiety, or insomnia, but there is not drug to treat the dissociative itself. Antipsychotic drugs are generally not helpful. Crisis interventation: If a person is suicidal or otherwise unable to stay safely in the community, a GP or community mental health worker may make a referral for admission to hospital, of for intensive care from a home treatment team. Alternatively, you may ask for help at hospital accident and emergency. Mainstream crisis interventation services are unlikely to understand or acknowledge the dissociative expereince, but they may be the only option to help a person survive through the crisis. Before a crisis occurs, it's a good idea to make a personal crisis plan with the help of a care co-ordinator, a friend or other supporter. This about things that help you avoid going into crisis, and what helps u survive if a crisis occurs. Self Help: Recovery usually requires active self help. It's common for therapists to set 'homework'. This may include a variety of self-help techniques and exercises. If you want to try self-help techniques on ur own, remember that dissociation can complicate this. In DID, for instance, the identity that self harms must be involved in any self help activity for these behaviours. Keepin a journal is one way to help improve connections and (in DID) awareness and co-operation between identities. It can include the writings or artwork from any aspect or identity of the dissociated self. Imaging is a way to use ur imagination to create internal scenes and environments , which help you stay safe and contain difficult feelings and thoughts identities to an internal conference table to make co-operative decisions. Grounding techniques, which keep you connected to the present, can help you avoid flashbacks or intrusive thoughts, feelins, or memories that you can't cope with. The techniques include breathing slowly, walking barefoot, talking to someone, sniffing something with a strong smell, and many others. Planning for child, adolescent and other identities to have control, at times and in places that are safe, it is essential self-help for people with DID. This is time for them to do things they like, to have experiences they were denied during an abusive childhood. You may wish to develop coping strategies for everyday challenges. For instance, a person who loses time, due to dissociation, may decide to wear a watch with the date and time on it. Many people have found that reading about the life and expereinces of survivors with similar problems has help them.