Dissociation

Dissociation is a temporary psychological disconnection from reality.  Because dissociation is often viewed as a defense mechanism to avoid painful memories, dissociation is most commonly associated with trauma. It can manifest in multiple ways along a continuum of brief episodes to, rarely, dissociative fugue that can last for months.

Dissociation is usually an involuntary reaction that is a symptom of a psychiatric disorder.  People have been reported however to voluntarily make themselves dissociate in situations of extreme stress such as sexual abuse and torture as a prisoner of war. 

What causes dissociation?

Like most psychiatric problems, scientists do not have a clear understanding of what causes this.  It is likely a multifactorial combination of genetics and environmental stressors.  There is speculation that individuals who suffered more extreme and more frequent experiences of trauma are more likely to dissociate.  However, there are individuals who dissociate who have not experienced any trauma.

How common is it?

Dissociation in children is thought to be relatively uncommon.

Symptoms:

• Flashbacks.  A person behaves as if they are back in the threatening, traumatic situation.  For example, a boy who had been physically abused backs into a corner and screams for a person to stop beating him when the person is actually not threatening.
• Freezing.  A child becomes overwhelmed by mental images or memories of a traumatic event and physically freezes and stares ahead into space. 
• Derealization.  A person feels like the environment around him or her has changed and seems unreal.
• Depersonalization.  A person feels like they are not themselves.  This may feel like a disconnection from one’s body.  There can be much overlap between derealization and depersonalization.

Screening:

Any signs of dissociation ought to prompt a referral for further assessment. Dissociation symptoms are involved in other psychiatric disorders, such as PTSD and panic attacks.  An exception in which dissociation is the primary feature of a disorder is dissociative identity disorder, formerly known as multiple personality disorder.

A caregiver questionnaire for children 12 years old and younger is the Child Dissociative Checklist (CDC) (Putnam, Helmers, & Trickett, 1993).  A questionnaire for adolescents is the Adolescent Dissociative Experiences Scale (ADES) (Armstrong et al., 1997).  The CDC and ADES are available to download below. These measure relatively severe types of symptoms found in dissociative identity disorder.  There is no known questionnaire for children for less severe symptoms such as depersonalization and derealization.

Treatment:

Psychotherapy is the first-line treatment.  Therapists ought to have expertise in this area to deal with the special issues of safety, impairment in functioning, confusion, and trauma.  Treatment may need to be adjusted to process less threatening memories until the patient has developed more solid coping skills.

Local Experts

On the Find A Provider page of the Kid Catch Directory, you can use the Issues filter box to search for local experts on dissociation.  Clicking on this filter selection will return results of clinicians who advertise themselves as working with this problem.  Kid Catch cannot guarantee that clinicians who advertise themselves this way are truly expert.

- Updated 9/11/19