Dissociation vs. Dissociation vs. Dissociation???

[I like vanilla]

I have only recently learned that I have CPTSD, and that I often dissociate. I think... Now I think I must dissociate way more than I ever thought or perhaps way less It depends a lot on what dissociation is exactly, and I am getting different ideas from different sources, so am also getting confused and a little distressed.

Recently, I read an article by a therapist whose client was all flustered and 'overreacting' to a particular situation. The client was fully conscious of where she was and had a discussion with the T about her response to the situation. The T noted the client was 'dissociating' because she was responding to internalized emotional cues rather than the situation at hand. The T reported that the client agreed with that assessment. I do occasionally do that but never thought of it as 'dissociation'.

I also have been reading that there is a type of dissociation where you kind of 'leave' your body and take in what is going on around you but from a sort of 'floating' position outside your body, as if you were watching everything on TV. I often do this (unfortunately) along with a type of freeze response along with it - e.g. if a soccer ball were accidentally kicked toward me it would hit me; I would see it coming and know I should move but would stay frozen and 'let' it hit me because I would not be enough inside myself to react. I am, however, starting to learn my triggers and be able to 'grab ahold of myself before I can float away'.

Then there seems to be another form of dissociation where you go somewhere else entirely for a while. During extremely stressful times and/or very triggering moments I do that too. Where it is, for example 10 am, then 'poof' it is 11:15 am and I have no idea what happened in between, because it feels as if it should be only be 10:01 am.

And still yet again there seems to be this cloudy kind of fogginess that I can walk around in and mostly function in, but if I have to handle anything too complex or detailed I try to put the task off for another day or I am in big trouble trying to figure it out (where on another day it would be fine). I have usually just called this 'I must be tired' (even when I have had enough sleep). But I am now learning that this might be dissociation too.

Recently, and most terrifyingly, I did not leave my body so much as got sucked right into it, where a memory (maybe? memory) took hold of me during a therapy session and pulled me in where I could not get out. It was pretty horrible. But, I know that while I was fully pulled into the memory, I was also 'out' of the room. My T was had apparently been talking to me to try and get me out of it, but we had to wait until I escaped. We talked a bit to make sure I was, in his words 'fully back' - I lost time but did so in my body rather than out of it. I think this might be dissociation but I am not sure.

It's a bit like a intro university exam: Q1. Is dissociation 'all of the above', 'none of the above', 'some of the above', 'something else entirely', 'some of the above but these other things too', 'none of the above but this instead' and so on.

I am not generally one to try and box complex concepts into definite true-false types of boxes, but I am trying to figure all of this out. Also, if all of those types of 'being less than fully present' are types of dissociation than I think I might be spending way more time dissociating that I thought possible. That worries me somewhat.

Please, does anyone know? Which of the above are 'dissociation'? Are there other types? If these are not examples of dissociation than what are they? 

[Camomille]

Recently, I read an article by a therapist whose client was all flustered and 'overreacting' to a particular situation. The client was fully conscious of where she was and had a discussion with the T about her response to the situation. The T noted the client was 'dissociating' because she was responding to internalized emotional cues rather than the situation at hand. The T reported that the client agreed with that assessment. I do occasionally do that but never thought of it as 'dissociation'.

If that is true, then being human is a dissociative state. If this is where dissociation starts per definition in psychology and psychiatry, psychology and psychiatry are overshooting the mark. I won't be surprised, but I will still think it's ridiculous. Because, regardless of our mental state, we all do that. We all react to events against the backdrop of our previous experience. So we could call all human reaction dissociative, or we could stay reasonable and not call a reaction dissociative if it is proportional to that person's previous experiences with that or similar situations.

Surely people must realise that, if they disagree, then what constitutes dissociation - an internal state - becomes incidental and dependent on external and even coincidental circumstances. Schrödinger's dissociation. 

Example, in hopes of triggering as few people as possible:
Let's say you've been in the middle of a natural disaster and experienced the fear and destruction and loss that come with it. It could be anything: a tsunami, a heavy earthquake, a [fill in the blank]. You remember the moments before disaster struck and the warning signs. Let's pick the earthquake. I've never been in one, so I must apologise for a. possible triggers and b. my simplistic concept.

I've heard earthquakes sound like really loud freight trains, excluding for the moment any additional ambient noise from the destruction, like things falling over or buildings collapsing. So, with that experience in your past, you're sitting somewhere and suddenly hear an approaching freight train in the background, one that is running on a rail line that you aren't aware is closeby. You start to react in a way that prepares for the worst: an earthquake. If you're wrong - no harm done. If you're right - so much the better you got out from under that parapet.

Possibility a: It was an earthquake and you reacted quickly and appropriately and survived. No one is going to call you dissociative because of it, but they may thank you later for having reacted to so quickly and warned them through your actions.

Possibility b: It was a freight train and you are seen to have 'overreacted'. Select mental health professionals may choose to call you dissociative.

All other things being equal, there is no shift in the person's mental state between possibility a and possibility b.

To define dissociation without the need for incidental externalities to validate it - or to invalidate the person (ostensibly) experiencing it - I think we will have to use criteria that are not dependent on an incidental outcome.

Are all the people who dislike some thing or other because they mentally connect it with a negative experience dissociating? Dear Flying Spaghetti Monster - all of humanity is dissociative then!! You've disliked chocolate icecream ever since your parents sat you down with a bowl and broke the news to you that your dog had died. You've given up on oil pastels because of the upsetting experience of giving your all to a picture that ended up the star of an exhibition but earned you a failing grade in class and a gratuitous verbal bashing by the teacher in front of everybody.

The icecream, the crayons - most people have at least one of these types of experiences and certain aversions because of them. Those would now have to be considered dissociative, i.e. pathological, if the definition above were correct. That's a bit out there. Contrary to the earthquake example, they're not as rational at first sight: it's unlikely that having chocolate icecream again will result in news of another pet's demise. However, they are indeed connected to that negative experience in the mind, and because they evoke the feelings from that experience, they are avoided in order to avoid the bad feeling. That's actually quite rational, if there's no good reason to relive that feeling at that time.

I'm not convinced, at this time, that defining exactly where dissociation begins and ends has any particular value in recovery. I try to stay or become aware of what I'm doing, internally and externally, and why I'm doing it, but whether it's given a particular name or currently considered pathological or not doesn't really interest me that much if I'm not harming anyone - not least because what's considered pathological can change quite a bit, so I'm not going to put much stock in what side of the mental health barrier this phenomenon or that is currently on.

I do know that definitions are helpful in order to validate personal experiences, sometimes. That's usually when troubles are rationalised away by unsympathetic people around you or society in general. But, in my opinion, psychology and psychiatry have a tendency to pathologise when they're trying to define clearcut boundaries to where good-enough mental health ends and mental illness and disorders begin. Calling conditions what they are isn't so much trouble if you're not so close to the borderline, but with the part I quoted, they're really pushing the envelope. In that context, it's also worth remembering that extending the definition of what constitutes pathology carries financial incentive for health professionals.

[Dutch Uncle]

Thanks Camomille, I think you raised a couple of very important points.

Like I like Vanilla I struggle with the concept and identifying them if I am at a particular moment or not. So I can't answer that question at the moment, I like Vanilla.

The icecream, the crayons - most people have at least one of these types of experiences and certain aversions because of them. Those would now have to be considered dissociative, i.e. pathological, if the definition above were correct

I think this is key: at which point does dissociation become pathological, as in 'sick', problematic, impairing, dysfunctional. Dissiociation is probably on a continuum, meaning you have good, and bad, and everything in between.
Just like with the Fight, Flight, Freeze, Fawn reactions: there is no 'one is better than the other'. It all depends on the circumstance. When you see a starved large predator, Flight is probably a good reaction. If you are already to close to pull it of, Freeze or even Fawn might be the best survival strategy available to you. Unless you are Dirty Harry with a piece of artillery in your hands, then Fight suddenly becomes an option. (there's a bloody good reason why the mouse plays dead when caught, e.g. Fawn)

In the context of therapy, when the T says "you are dissociating", it's probably safe to assume the T knows if it is a pathological dissociation to not. They are trained to make the distinction. (and so they identify it as pathological when they tell you about it)

I've heard earthquakes sound like really loud freight trains, [...]

Possibility a: It was an earthquake and you reacted quickly and appropriately and survived. No one is going to call you dissociative because of it, but they may thank you later for having reacted to so quickly and warned them through your actions.

Possibility b: It was a freight train and you are seen to have 'overreacted'. Select mental health professionals may choose to call you dissociative.

My immediate reaction when I read this was (so I'm now just freely letting my mind flow. I have not thought this through, so please correct me if you think I'm wrong or missing some points here), I think that in clinical terms in case b) the person is 'associating'. (s)he associates the freight train with the earthquake and takes (from that perspective) proper action.
Dissociating in that example would be to 'stay put', 'numb out' and just 'pretend' it's all not happening: not the earthquake, but also not the freight-train.

But, in my opinion, psychology and psychiatry have a tendency to pathologise when they're trying to define clearcut boundaries to where good-enough mental health ends and mental illness and disorders begin. Calling conditions what they are isn't so much trouble if you're not so close to the borderline, but with the part I quoted, they're really pushing the envelope. In that context, it's also worth remembering that extending the definition of what constitutes pathology carries financial incentive for health professionals.

Within medical science as whole (and in fact, within ALL scientific fields) these are very fundamental questions that actually have great merit and therefore do have specialists who tackle/research the issues: "philosophy of Science". Anyone who has finished a Masters Degree (possibly also Bachelors degrees, I don't know) has had a course in the subject ,which includes "philosophy of Science" in its own right, and the appliance of it in their own specific scientific field.
(IMHO nobody should be allowed to get a degree without at least having had a 7.5/10 score on that particular subject (so not a 6/10, a 'just pass') since it's so to the core of what their specific scientific profession is all about. But that might be just my personal frustration and/or perfectionism  )
Understanding the core uncertainty of their scientific knowledge makes the difference between a good T, or M.D., or Engineer for that matter, and a not so good one. The good ones switch to other options if the results are not what was expected. To the extend they say: "I don't know how to treat this, this is clearly not my field of expertise, I'm going to forward you to another field of Therapy, to another T." Or even: "You were misdiagnosed. From my field of expertise I can confidently say: there is nothing wrong with you there."

[Dutch Uncle]

Please, does anyone know? Which of the above are 'dissociation'? Are there other types? If these are not examples of dissociation than what are they? 

Kizzie actually has put up some articles on this, see the 'sticky'-post on top of this forum-section.
"Dissociation: An Insufficiently Recognized Major Feature of Complex PTSD:  http://www.onnovdhart.nl/articles/jts_complex_%20ptsd.pdf" addresses a lot of your questions (presumably), but it's a hard read (as all scientific papers are, with their endless references to previous related research). And as all scientific research papers, they are 'pushing the envelope' and in the end usually don't give a clearcut answer.

It might be worth a read though. (Or some of the other links provided.)
I've just scanned trough it, and I know it will take me many more hours of studying to get the gist of it.
IF I can make out the gist of it. 

[mourningdove]

Yes, there are types. I was confused about this too when I first started learning about dissociation, because the word is used to described so many different experiences.

This goes into some detail about it all: https://www.isst-d.org/default.asp?contentID=76#diss.

[arpy1]

t's a bit like a intro university exam: Q1. Is dissociation 'all of the above', 'none of the above', 'some of the above', 'something else entirely', 'some of the above but these other things too', 'none of the above but this instead' and so on.

i just read the van der Hart article that D/U linked to there. it took ages, becos it's in quite scholarly language, but for me it was the clearest explanation of dissociation as a co-presenting symptom in CPTSD that i have read yet.  and it really helped me.

it basically differentiates between the 'altered states of consciousness' types of dissociation and the kind of 'structural dissociation' which is a feature in complex trauma survivors and explains how the two relate to cptsd. not sure i can explain it in words, tho, you'd have to have a read.

the article set out to present a definition of dissociation as it pertains to cptsd. which, imo, it did very well. i feel much clearer now i can put a name onto the various bits of me that kick in when i am triggered, etc. 

[Kizzie]

Tks for the link mourningdove, I'm just adding resources to each of the childboards (sub-topics) and that's a great one.

[mourningdove]

Great, Kizzie! I'm glad it's useful.

[Dutch Uncle]

I've just posted this in the 'sticky thread' on 'resources'.
Perhaps it helps:
http://www.traumahealed.com/articles/gaining-awareness-dissociation.html

[I like vanilla]

Wow! Thank you everyone for the feedback! I am having some trouble with my touchpad at the moment so can't select text to quote bits from your responses (a friend promised to help me fix it next week .

Thank you to everyone for the references to articles and webpages. I find I am having a bit of a difficult time reading right now. I had a bit of a difficult incident recently (the 'getting sucked into what might have been a dissociation part of my original posting) so I am still moving in and out of the fog a bit. Fortunately, things seem to be clearing a little.

I did start the article about dissociation and it seems useful. You couldn't know it, but I actually am science/social science nerd so I have some practice reading this type of writing. OK, I actually read this type of article for personal interest and healing even if it does not apply to my work ;-). I think once I am out of the fog, I will process the information better. Right now I am sticking to lighter, more fun reads which I also enjoy


Camomille, I appreciated your earthquake example. I tend to agree with where you are coming from. I think it is useful to have terms to describe concepts and phenomenon, I also (like everyone on this board) would like to be respectful of others experiences. But, when I read the article with the T telling his upset client that the upset was dissociation I had my doubts, or at least thought my idea and experience of dissociation were different. I think too that if 'everything' is included under a particular definition then ultimately the definition becomes useless. In the article I mentioned, the client was 'overreacting' because she was really upset when a loved one was late and had not called. To me, it seemed reasonable to be upset in that situation, and even if the woman was deemed to be 'more upset than was appropriate' I still could not understand how that equalled dissociation. (OK, and I admit part of me was thinking, and aren't we women so often being told we're overreacting anyway? I kind of got the impression of that type of dynamic from the article).

Dutch Uncle, I think you might be on to something too. Again, I do want to be respectful of others' experiences and feel that there is no 'better or worse' when it comes to trauma and responding to traumatic/triggering situations; there is only the context that the person is in and whether a particular response is working for a particular individual. That said, I do not know what type of marks my T got in school. I do know he's really smart and quite gifted at what he does. Many times during our sessions he has picked up on something so tiny but so important in what I am communicating to him both in words and meta-communication (body language, tone of voice, etc.). I am not sure how he does it but am glad that he does.

For me, I think it is important to be able to define or describe a concept, so long as it remains a tool to aid discussion rather than becoming a hammer to cram people into a particular box. We, all of us, unfortunately share CPTSD but we all also have some many other traits and experiences. We have a great deal of overlap and common ground in what we are dealing with (that is part of the reason I joined the group) but we also also filter and interpret through our own Selves. For me, I tend to feel safer if I can learn 'everything' about a topic. So, knowing what dissociation is, what it looks like, what is going on in my body, what I can do about, etc. helps empower me. However, I would object strenuously if someone were to tell me (or someone else) that I am 'dissociating in a wrong way' if, for example, I were to be feeling angry instead of afraid about a particular situation before zoning out (my last T tried that on me - good riddance).

It seems, as some of you noted, that the definitions, for now, lie most strongly in the 'centres' of the definitions and less so around the edges. I am OK with being in grey areas (and generally uncomfortable with black-and-white thinking). The good news is that so many of you have given me reading to follow-up on. I appreciate that, both for the information to be gained as well as because I really do enjoy that type of reading . On that note, thank you Kizzie for setting up resource sections. That is great.

[Dutch Uncle]

That said, I do not know what type of marks my T got in school. I do know he's really smart and quite gifted at what he does. Many times during our sessions he has picked up on something so tiny but so important in what I am communicating to him both in words and meta-communication (body language, tone of voice, etc.). I am not sure how he does it but am glad that he does.

Sounds like a pretty good T, and what's more important, you are appreciative of the good/effective work he's doing, so he's a good fit for you, in your own experience.

For me, I think it is important to be able to define or describe a concept, so long as it remains a tool to aid discussion rather than becoming a hammer to cram people into a particular box.

I fully agree.
I think it's the difference between a T (or any anyone for that matter) who has a profession and one who has a job.

This is a great thread. Thanks for starting it. 

[arpy1]

i just want to say, YAY for someone else who like to read scholarly articles for fun. i thought i was weird.