How to stop dissociating

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1:17Hello and welcome. I'm Kimberley Wilson. I'm a counselling psychologist and this is Complex. The psychology podcast helping you chart a course through the vast world of mental health information. In today's episode, I'm exploring dissociation. Now, most of us know that feeling of maybe arriving home after a long journey and having no real memory of how we got there. or snapping back to attention in a meeting when someone calls your name and then you realise your mind has been somewhere else entirely for the last 10 minutes.

2:02Zoning out, mind-wandering and daydreaming are common parts of the human experience, sometimes even a very welcome escape. But for some people, it goes much further than that. huge stretches of feeling disconnected from themselves the world around them and sometimes reality itself these experiences can be deeply unnerving frightening and really hard to make sense of much less to talk about so my dear listener in this episode that's exactly what we're going to do, talk about it, and hopefully find a little comfort and clarity along the way. And as usual, I've invited an expert guest to join me.

2:50So let me be your guide from the office blinds of misinformation to the open window of understanding.

3:02I'm delighted that psychotherapist and trainee counselling psychologist Zoe Ross is back in the Complex studio with me. Hello, Zoe. Hello. Nice to be here. Now, we have had two excellent conversations at this point, one about narcissism and one about red and green flags in relationships. And our listeners can find that on a Complex feed on BBC Sounds. But what have you been up to lately?

3:27Zoe Ross:I've been working a lot with my colleagues around dissociation. So there was a conference that I attended called The Future of Dissociation in the UK. And that was with a number of experts in the field talking about how we can get better at, particularly in health services, diagnosing and recognising trauma-based dissociation. Thank you. I think this is going to be a really helpful conversation and you are just the right person to be having it with.

4:00so let's get started with a definition Zoe what do we actually mean by dissociation so dissociation

4:09Zoe Ross:is really about a disconnection it's about a disconnection in things or a lack of connection in things that are normally connected so as you explained we all dissociate sometimes but it becomes a problem when it's chronic and it goes on for a long period of time and starts to impact our functioning. So it could be our social relationships, it could be our ability to work and our day-to-day ability to live our lives. That's when it can become pathological and we can be looking at dissociative disorders. And it's important to understand that dissociation has commonalities for people, but everybody's different.

4:49Zoe Ross:And it's often very hidden. So it's very much an internal experience often that people are having, and they can struggle to explain it. And there can be a lot of inner conflict about whether that's actually okay or not to voice it. So it can be very hard to talk about, it can be hard to spot as well.

5:12now at this point I would usually share a listener's dilemma but dissociation doesn't often present by itself you know it's usually tied up in often quite complex histories of trauma and distress and I think it's fair to say that both you and I have had experience working with people experiencing trauma or histories of quite complex and difficult traumas so I wondered whether we could paint a picture for the listener of what a dissociative episode might look and feel like.

5:44Zoe Ross:So obviously everybody's an individual and will have their own individual experience of dissociation but there are five main areas that we're looking for when we're assessing a dissociative disorder. The first one is dissociative amnesia so that can look like not remembering big chunks of traumatic experience, for example, in childhood. So if someone says, I actually don't remember the years of primary school. Exactly, exactly. That would be a sign that there could be something dissociative going on, or it could be not remembering, struggling to remember your daily activities in the present, you know, having to have very complex systems for remembering what you're supposed to do and to be able to function and do your tasks.

6:30Zoe Ross:So that's dissociative amnesia. There's also then depersonalization and that's where we have a sense of disconnect from ourselves, from our bodies. So that can look like observing ourselves. Feeling like you're floating. Yeah, exactly. It can be floating or it can be feeling like you're going through the motions of life, sort of observing yourself doing it. So there's a detachment from the self. then there's derealization and that's a detachment from the world around us so it can feel like everything's just a bit distorted or it can feel like you're in a movie like the matrix or something like that but it's like the world is a little bit unreal and then there's identity confusion where we can be a little bit confused about who we actually are who our real self is and struggle to actually identify who I am and then there is identity alteration that we would see in the most serious dissociative disorders where we actually have different parts of the self that can take executive control with their own thoughts, feelings, behaviours that can look very different to an outsider.

7:40Zoe Ross:Sometimes they don't look different though it can be hard to spot that but that's where a person is actually perhaps being told that they've done something and they have no memory of actually doing that at all. And as you can imagine, that's really quite distressing for somebody if that's happening over a long period of time. And so it's really important that we identify it and that somebody gets the right treatment because often we see people coming to us in the clinic where I work who've had very long histories of misdiagnoses and they've been essentially failed by services along the way. So they may have been getting treatment for anxiety or borderline personality disorder or emotionally unstable personality disorder but actually treatments just doesn't seem to be working in the usual way and that's often a sign that actually underlying that is dissociation and dissociative disorder that needs specialist treatment.

8:37Zoe Ross:Thank you for walking us through that And I think we have a real sense of the depth and breadth of these experiences. So let's get into the complexity.

8:53So Zoe, what do we know about why dissociation happens?

8:59Zoe Ross:So dissociative identity disorder used to be called multiple personality disorder or split personality disorder. You might see it in movies like Split called those different names, but we call it dissociative identity disorder where somebody has different parts of the personality that are taking executive control. And we know that that usually is attributed to very early childhood maltreatment and trauma. there would be some quite significant abuse that's happened there. And that leads a person to dissociate, to be able to survive in an environment that they have no control over being in. So almost if the child were to stay connected, it would be so overwhelming for the psyche that as a safety mechanism, the mind cuts off, shuts it out, in order so that a different part of them can be preserved and continue functioning.

9:57Zoe Ross:Exactly. So a different part can stay moving on with normal life and functioning and growing, but there are these traumatized parts that are holding separately the trauma. So when I think of my clients who have dissociative identity disorder, so DID, one part of them will sometimes be present in therapy and then sometimes another part will be present in therapy and that can look quite different. Yeah, it might be contradictory behaviours or attitudes that they're bringing. Exactly. There's a different energy in the room sometimes. Very different energy and confusing, contradictory and sometimes harmful behaviours that can be difficult to work out what's going on.

10:39Zoe Ross:And when you say parts of the self, what do you mean by that? So we obviously all have different parts of ourselves. We have different ways that we can show up, but we usually have a coherent sense of self and identity. But when we have a dissociative disorder, particularly one of the more serious ones, we can have different parts of us that are really fragmented. So some people might call them alters, so alternative parts of the personality. Some people call them friends. Some people call them team members. But a common way we talk about them in therapy is parts. And we've discussed traumatic histories, but is dissociation always linked to trauma or are there other reasons that people might dissociate?

11:24Zoe Ross:Absolutely we can dissociate for other reasons usually to do with stress so we've had a conflict with our partner that's quite serious or something has happened in our life that is quite distressing so the death of a significant person can mean that we dissociate but usually in a temporary way but where we see long-term chronic dissociation it is usually linked to complex trauma and that usually is childhood but it can also be long-term abusive adult relationships too and as we know there's a strong link between childhood trauma and then developing relationships that are also traumatic so it can be very very difficult for people to recognize actually that dissociation is there because sometimes this is how they've always been in the world they don't realize exactly they just think that this is the way it is until it becomes too much to cope with.

12:24And the picture that you paint feels very very different from the kind of sensationalized depictions that we see not just on social media but also in films I mean there are so many films that depict or claim to depict DID or different types of dissociation and I think one of my first experiences was watching the film Sybil where it was a woman I think she had had early trauma but then went on to develop 16 different personalities and the film followed her kind of treatment experiences and that kind of getting to know and integrate the different parts of herself I mean maybe we go back all the way to Dr Jekyll and Mr Hyde yeah absolutely and you know you're describing these subtleties and these quiet distresses and these ways that people are in internal conflict but all of our social depictions are often of quite dangerous frightening strange people in the world yeah and that's really important to raise i think and

13:28Zoe Ross:most people who struggle with dissociative disorders are really not a danger to anybody because they are dealing with this internally and they work extra hard to make sure that it doesn't actually come out into the world. The sensationalist portrayals are all about trying to sell movies or trying to make things look very exciting but that really does distract and take away from those people that are actually really suffering and really struggling. The people that we see in the clinic need a lot of help with their dissociative symptoms which are really stopping them from living the life that they would want to live.

14:08They're kind of interfering with their capacity to be functioning in the world.

14:12Zoe Ross:Yeah, absolutely. Although I would say it's important to recognise that there are many, many people who hold down very, very good jobs, who seem to be very successful in the world, but actually internally they are really struggling with symptoms of dissociation and feeling quite disconnected from their own self. Why do you think clinicians struggle with accepting it as a diagnosis? It's a good question. It can be very difficult to work with and to diagnose. And there are some excellent clinical instruments that allow us to do it, but it does need to be done by people who are properly trained in it and who have specialist supervision for it.

14:51Zoe Ross:But there are some circles that still believe that it is a fantasy, that some people do make it up. And some people do, okay? Or some people who are trying to make sense of their own difficulties can misattribute their own experiences to having a dissociative disorder. So it's important that we get people who need the help to the right help as quickly as possible. because with the right treatment, outcomes are good. Dissociation is very often comorbid, which means it shows up within the context of other diagnoses. And we've been thinking about DID, but where might it also turn up? We could start off with something like anxiety.

15:36Zoe Ross:So it can look like feeling dizzy, zoning out. So long periods of time have passed and you're like, what's happened here? so you might come home from work and then what's happened to the evening and all of a sudden it's 11 o 'clock yeah what you've been exactly you don't know what you've been doing or feeling a bit disconnected from your body so sometimes we see that in you know eating disorders there can be a sort of body dysmorphic element to it in depression for example again that zoning out can really happen a lot feeling very numb not having any connection to your emotional world So it's important that we can look at what are you experiencing?

16:18Zoe Ross:How does dissociation fit into that? And could dissociation actually be explaining what's going on for you? And are all dissociative experiences negative? Are they all kind of painful and distressing for people? It's a good point. I mean, dissociation can be really helpful, right? It's an adaptive response. so it can be a helpful way of dealing with overwhelm particularly emotional overwhelm but that becomes a problem if we're doing it all the time if it's the only tool we have for dealing with distress exactly and if we're disconnected from our emotional world that's going to cause issues in our relationship to ourselves but also in our relationship to other people because we connect to each other on an emotional level so even if we're not suffering from a dissociative disorder, the dissociation is becoming maladaptive.

17:15Now, research suggests that up to three quarters of us will experience depersonalization or derealization at some point in our lives. So Zoe, where is the tipping point between perhaps our everyday daydreaming or zoning out and something that's a bit more concerning?

17:33Zoe Ross:so the mild end is that daydreaming you know i'm a daydreamer i daydream a lot um getting very heavily involved in a task and time passes but we would sometimes call that flow in psychology you know where we're so absorbed in something or in a film or in a game and time is just passing so that's not problematic you know sometimes people have those very engaged like conversations in their minds that go on for, it can be half an hour, 40 minutes, an hour. Would that count or is that something else? Yeah, no, it can do. Absolutely. That can be fine. It's when it causes an issue, right? So if we're having a pleasant chat in our minds, we all have a chatterbox, right?

18:14Zoe Ross:If we're having a pleasant chat with the chatterbox, it's not really a problem. But if that's a critical voice, if that's a voice that's telling you to do things that are not helpful, that are hurting you, then that starts to become an issue. It's almost like we're driving the car and they are then trying to take the wheel or they do take the wheel. Then that starts to become problematic and can cause real issues with how we are being in the world and with our relationship to ourself and our relationships with other people and our ability to function. And I guess if you are having dissociative episodes, that would make you quite vulnerable.

18:53You know, if you're finding yourself in strange places.

18:56Zoe Ross:Oh, I mean, can you imagine how scary it is to basically wake up somewhere or come around somewhere and you have no idea how you got there. And in some cases, you have no idea who you are and what on earth you're doing there. That's terrifying. Absolutely terrifying. So that would be at the extreme end of the scale that that's when somebody really needs some help straight away.

19:25But people listening and those who might be beginning to understand or wonder whether some of their experiences are dissociation, what can they do?

19:37Zoe Ross:If you think that some of this may apply to you, you can have a look at the Dissociative Experiences Scale. It's freely available online and it will give you an idea about whether you may need to look for some support. And then it would be a case of trying to go and speak to your GP to see if they can get a referral to somebody who can do a little bit more investigation. Or people may choose to go directly to somebody themselves to try and find out if dissociation explains some of their experiences. and are there ways i'm feeling kind of hesitant as i ask the question that people can keep themselves safe yeah so especially if we are having dissociative experiences but we're not maybe moving up into the disorder territory then grounding is very very helpful so trying to keep connected to the present moment using our senses is a really really good way of doing that and doing things that keep you in your body that you enjoy so that might be going for a walk and looking at the trees it might be for example using some really nice hand cream that's got a lovely scent that you enjoy and taking time to rub it into your hands and to smell it so these small things can help us to stay grounded and there's lots of resources online about grounding techniques that people can use.

21:03Zoe Ross:And I think talking about it, telling somebody supportive that you are experiencing some of this is really helpful for many people. If they're experiencing more serious dissociation, they're probably not going to want to do that or may not have supportive people around them who they can actually talk to about their experiences. So that's where it's really important that you get some specialist help. And what would that specialist help look like? Yeah, so if we're talking about dissociative disorders, then there's a three-phase treatment that's the gold standard treatment, if you like. The first phase is all about stabilisation and safety.

21:42Zoe Ross:So that can be teaching some grounding skills, building up the therapeutic relationship, trying to create a sense of safety in the self and in the environment. And that can take some time. Months. Sometimes years. Yeah, absolutely. Depending on where a person is with that. And that's really important that this is long term treatment for most people who are struggling with serious dissociative disorders. and then phase two of the treatment is usually some form of trauma processing getting to know what's actually happening internally within a person and becoming more comfortable with that but that's a very individual process between the therapist and the person to work out whether that's needed or whether that's appropriate and then the third phase would be about trying to become more integrated as a whole self so it's not always about trying to get rid of parts in fact it very rarely is but certainly working in a more collaborative way with different parts of the self and a compassionate way is usually what we're trying to encourage throughout those three stages but we can go backwards and forwards between those as we progress through treatment And if someone were looking for someone specifically, would a therapist list dissociative work as one of their specialisms?

23:14Zoe Ross:Possibly, or we would hope complex trauma would be the other one. But yeah, people who are working with complex trauma should have an understanding of dissociation. But of course, you can ask that. You can say, I seem to be dissociating and find out, have a conversation with them about whether they actually understand. And there are some clinics in the UK that specialise in dissociative disorders. So they're good sources of information too. I want to be really realistic, I think, because if we're talking about histories of very complex, very painful trauma, then we will expect treatment to take a while.

23:57Yeah, absolutely. And maybe people might find themselves engaging with different services at different times, either as part of the treatment or before they find the right treatment for them.

24:10Zoe Ross:Yeah, absolutely. In the clinic, we'll often see people that have been involved in services in different ways for many, many years, but have never really got to the bottom of what's actually going on for them. And obviously that's deeply distressing and it can be really hard to continue and to keep going on. It can really lead to feelings of hopelessness and helplessness. Absolutely, of course. And so it is really important that we get them the right help. Because people can go from really struggling in the world to actually living good lives. And that's wonderful to see.