What is Dissociation?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Confusion.

Confusion.
Photo courtesy of Pixabay.com

Does Dissociation really happen? What causes it?

Personally, I think there is more misunderstanding around this condition than most other mental health issues. First off Dissociation is way more common than most people realize. It comes in varying intensities; much of it is mild and goes unrecognized, denied and undiagnosed.

Dissociation, particularly Dissociative Identity Disorder has so much stigma around it that when we see it in clinical practice, I believe most clinicians call it something else more acceptable, like stress or Posttraumatic Stress Disorder, and let it go at that. This leaves people with more severe cases of dissociation with less than adequate treatment.

My view is that milder forms of dissociation are a normal protective behavior for most vertebrates, humans included. Under stress, the brain stem engages the “F’s” and takes over the functions of the brain to ensure survival.

Dissociation in its milder forms is, as I understand it, a functional survival mechanism. It is a close cousin to daydreaming and alcoholic blackouts.

Some simple examples of Dissociation.

I am driving along, I am thinking about something I need to do tonight. In my mind, I am picturing a set of slides that I want to create for the PowerPoint. I realize all of a sudden that I am miles past my freeway exit and I have no memory of driving this way. My mind has blanked out.

At this point, I turn around, drive as fast as I can, and reach my destination. Do I tell everyone about my “zoning out?” Not a chance. I make some lame excuse about traffic and getting off work late.

Next example, more severe

A woman who was gang-raped in the past is walking around downtown. She sees some men who are wearing gang colors and look kind of like the men that assaulted her. She becomes frightened and crosses the street, she begins walking fast to get away. A few minutes later she slows down. Her panic is subsiding. She looks around and finds she is walking through a neighborhood and she has no idea where she is or how she got here.

So now we can see a mechanism by which someone who is upset might do actions like run away and be functioning essentially on autopilot. High levels of stress, like high levels of alcohol in blackouts, might shut off the connection between current functioning and memory.

Does that mean this woman has some form of Dissociative Disorder?

Maybe, maybe not. The new DSM-5 lists five major kinds of Dissociative Disorders plus some specifiers and or sub-types.

This woman, now upset because this past problem, memories of the rape, is messing up her life and also a lot worried because she ended up in a strange neighborhood with no memory of how she got there comes to see a therapist.

She begins to talk about her experience. She had an experience that brought back memories of her rape (Intrusive thoughts.) She tried to avoid things, ran away (avoidance, yes.) She has been anxious for several nights since and has lost sleep over this. Maybe even had a nightmare and this has been affecting her home life and her relationship.

At this point she gets assessed, a treatment plan created and treatment begins.

She was embarrassed so she left out the part about walking for a while and having no memory how she got there.

Her diagnosis – it’s likely to be Posttraumatic Stress Disorder.

In clinical settings, stress-related disorders get diagnosed a lot more than dissociative disorders. Sometimes it is a judgment call. Which disorder are this woman’s symptoms more like? But I think we professionals may be overlooking a lot of dissociative symptoms. The result may be that in outpatient settings we are under-diagnosing Dissociative Disorder and over-diagnosing PTSD.

In carefully controlled research the prevalence of Dissociative Disorders of all 5 types exceeded 5% of the population. That makes dissociation up to 17 times more common than Schizophrenia.

Dissociative Disorders are the next chapter over in the DSM-5 from stress-related disorders. We see a huge overlap between those two groups. There is also an overlap with Borderline Personality Disorder another misunderstood condition.

If we think of all these conditions as reasonable responses to stress given the person’s biology and experiences we can see how some of the things that occur to a person with dissociation make sense.

Dissociative Disorders are most commonly found in the aftermath of traumatic events. Some of the symptoms of dissociation are embarrassment, confusion, and a desire to hide the existence of your symptoms. If you are the victim of trauma and let on how much the trauma affected you, this might put you at risk to be revictimized.

People under stress will have gaps in their memory. People with dissociation may also not know they have those gaps until someone asks about something they can’t remember. This is referred to in the literature as “amnesia about the amnesia.”

Dissociative Disorders, all 5 of them according to the DSM-5, include both positive and negative symptoms. In the past the only other disorder that I remember being described that way was Schizophrenia, but as I think about them other disorders have both also.

Positive and negative symptoms do not mean they are good and bad. What this means is that people with a disorder lose the ability to do some things others can do. This loss is called negative symptoms.

They also develop symptoms that others do not have. These added symptoms are called positive symptoms.

Since I believe people can and do recover I think that these areas of altered functioning can vary in intensity and can get better or worse depending on time, traumas, conditions, and treatment. More on negative and positive symptoms in future posts.

Another area of concern in talking about dissociation is something called state or trait theory. Trait would imply that once you got it you always got it. So if you dissociate then you are a goner and who wants to believe that. But if dissociation is a state then you can move into and out of it.

One other cause of Dissociative symptoms are efforts to reprogram or expose someone to “thought reform.” This mental reprogramming, like brainwashing, results in a brain that at some level believes two contradictory things. Can you see how that brain could pop in and out of contact with others?

Last, despite all the press about extreme cases of dissociation and the recurrent belief that this is something that only happens to women, the research tells me it is, in fact, more common among men than women. I have some theories about why that might be but that like the rest of this needs to wait till another post.

Dissociative disorders vary from person to person and from time to time. Nothing I can say will fit everyone and there is a lot to be said for listening to the “lived experience” of those who have these disorders. More to come on this topic, but in the meantime what do all of you think about this?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Does Multiple Personality Disorder really exist?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

personality disorder

What Causes DID Disorder?
Photo courtesy of Pixabay.com

Are Multiple Personality Disorder, Manic-Depressive Disorder, and Addiction real illnesses?

There have been some books, articles, and blog posts recently saying that many things we are calling illness either do not exist or if they do exist they are not really illnesses but choices people make.

Some of the arguments these people are making seem to have some merit on the face, but when I look deeper there are some serious flaws in this kind of reasoning. All good lies have some truth in them and so these misconceptions about illnesses take some sorting out. Most of these efforts to deny the existence of a particular illness are cases of – if I do not believe in this it can’t hurt me.

Let’s look at some examples of ways people try to deny the existence of mental disorders.

1. Change the name and the illness ceases to exist – Denial one.

“There is no such thing as Consumption. When people believed in consumption they got it and died. No one gets it now because we know it does not exist.”

You buying that?

Consumption is the old name for Tuberculosis. Yes, people still get T. B. and die from it. We do have medication to treat it, but if you take no meds, you still can die from this illness. Changing the name did not erase the disease.

What about Manic-Depressive Disorder? No such thing right?

Well, we changed the name of that one to Bipolar Disorder so in that sense there is no such thing as Manic Depressive Disease. No difference really in the condition. Still, a serious illness and still needs treating, but not in the strictly literal sense, there is no such thing as Manic Depressive disorder anymore at least not in the DSM.

Which brings us to Multiple Personality Disorder.

The name misled a lot of people into thinking that everyone who had this issue would look like Sybil.  The truth is that there are lots of variations. The new name is “Dissociative Identity Disorder” so while technically, semantically, Multiple Personality Disorder no longer exists, there are still millions of people living with exactly these symptoms; we just call this condition by a new name.

Watch for an upcoming post on Dissociation Disorders. (Yes, there are more than one of these creatures.)

2. Second denial – There is no such thing as mental illness.

The argument runs – mental illness is not a “real disease” these are just people who think or behave differently from the rest of us and we want to force them to act and think like the rest of us.

A lot was made of this a few years back. Again in a strictly semantically way, this has some truth to it. Just enough truth to be misleading.

One definition of illness or disease is a process of an organism, bacteria, or virus, invading the body, and damaging cells. The proponents of this “no mental illness” idea argued that if mental illness was a real illness we should be able to find the bug that caused it and a drug that removed this infection from the body.

Newer research on the brain is chipping away at this one. There are lots of changes that nerve cells undergo that cause a change in functioning. Thoughts and traumatic experiences can change the wiring and the chemistry of the brain.

Most mental issues are correctly referred to as “disorders” not technically diseases. The specific definition of a disorder is essentially something that causes you a thinking, feeling, or behavioral issue.

So if the emotional, mental, or behavior problem cause you to have impairment in Social functioning, (You can’t get along with family and or friends) occupational functioning (the ability to hold a job) of subjective distress (You say it bothers you) then we diagnose it as a mental disorder. The DSM-5 adds “other important area of functioning” I am still not sure what all that might be but if we find that we can give you the diagnosis also.

So while there does not appear to be any Dissociative Disorder germ, I still think that the effects of trauma can alter your emotions sufficiently that we can say you have a disorder.

3. Denial three – I do not believe in Dissociative Disorders so they do not exist.

I take this to be the funniest reason of all to pretend that disorders do not exist. Still, some people cling to the notion that there was no evolution or that the sun does, in fact, revolve around the earth.

Personally, I have taken to believing that Arizona does not exist. California just runs all the way to New Mexico. Those of you that think you live in Arizona knock that foolishness off and start sending your taxes my way.

People have denied the existence of addiction for years saying those people just chose to be that way. Some of them say the same thing about schizophrenia. Now the medical people are saying almost all medications including prescribed ones can cause tolerance and withdrawal so they all met the old definition for addiction.

We are getting around this one by eliminating addiction – it is no more. All of you that thought you knew someone with an addiction you were wrong – there is no such thing as addiction – We will, however, be treating a lot of people next year for substance use disorders and the key characteristic of that disorder will be a loss of control over their use of a substance.

See how this works.

4. Straw man argument.

The way this one goes is: When you talk about Multiple Personality Disorder or Dissociative Disorder what you really mean is –

They then proceed to spend the rest of their post arguing about things that you never said and wouldn’t have said, but it makes them feel better to win an argument even if they need to misrepresent what you think to win one.

Oh, my – another long post. So in the future let’s talk some more about all the things that we have been learning about stress, trauma, and dissociation.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Alexithymia – the disease of feeling labels

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Man with feelings

Managing feelings.
Photo courtesy of Pixabay.com

So you have a feeling but what is it?

Alexithymia is defined as the inability to recognize feelings or to be able to identify what it is that you are feeling. Texts report that this is largely a disorder characterized by men who the authors tell us, prefer taking action over having feelings.

This personality disorder has not yet risen to the level of a recognized disease that insurance will cover but I expect that as soon as a researcher does enough work in the area it may well be.

This is not a disorder of numbing. We do believe that a normal response of the brain to severe physical and emotional pain is to numb out and not feel. Numbing is related to dissociative identity disorder and trauma.

Alexithymia is NOT related to dissociation in any meaningful way I am aware of. I put NOT in the sentence to confuse those people who like to leave comments saying “you said A was the same as B.” I also put that in tests for my students some of whom insist on missing the question anyway and tell me they missed the word “NOT.”

So since we now know what Alexithymia is Not – what is it.

Well, it is best described as the inability to know what you are feeling and if you do feel something, then you just don’t have a word to describe that feeling. Men are mostly prone to this disorder.

Most men have three feelings. They also have about 6 colors. For men, it is either Red, Blue, or maybe a shade of purple. Women have wisteria, plum, fuchsia, and a whole lot more colors between Red and Purple. Also Red, for the record, is a lot closer to Crimson than to the blood color we men think it is.

So men recognize three feelings GOOD, BAD, and Pissed off. Pissed off comes in three shades loud, louder, and loudest. This results in a lot of conflict between men and women. Women want men to share how they are feeling. Men believed “we shared that on the first night we were together when we said we felt GOOD.” There should be no need to report on a feeling again until that GOOD turns into BAD or pissed off.

So one thing that people with Alexithymia need to do is go to a color mixing class. Not literally but figuratively.

So how many shades of good are there?

I have seen “feelings wheels” and charts but they just do not capture those levels of intensity. There are some differences between being irritated, upset, angry, and ENRAGED.  Men are prone to describe this as moving from Bad to PISSED-OFF.

How does happy look? Is it closer to the color of contentment or ecstasy?  So as we begin to learn new feeling words we increase not only our feelings vocabulary but also our ability to recognize these feelings as they occur.

We do not expect everyone to progress in this getting to know feelings at the same rate. Some of you are in feelings kindergarten and others of you have been to a feelings graduate school. I am aware some of you majored in one feeling, say ANGER, to the exclusion of all others.

I did not say anything about sharing your feelings just yet. You can’t share anything about a subject you don’t understand. So the process goes, feel what you are feeling, identify what this feeling is, decide what to do with this feeling, and lastly, if you chose to share with someone, do so in an appropriate way.

Women complain that men are emotionally unavailable. This is often true. We are also menstrual and makeup unavailable. We are also more willing to learn about makeup than feelings most of the time. If you grew up, as most men do, believing that men are tough and do not have feelings, learning to be emotionally available is like learning to take torture in a foreign language.

Now ladies, don’t go getting superior on me. Remember that the man you are with, the emotionally unavailable one, he learned about feelings and how to deal with them from – did you guess?

We guys learned that stuff mostly from our mothers who were just as quick as our fathers to tell us that men did not cry and that we should just get back into that soccer or football game anyway.

Having not learned to recognize and make use of feelings we guys miss out on a lot of valuable information that we should have recognized. If this business deal feels risky, that may be because our gut is telling us things our brain wants to ignore.

People who do not listen to their feelings can make really bad decisions. We can work or play on an injured limb. You may win this game but permanently harm that joint.

Come to think of it, you ladies do the same thing sometimes. You marry that guy anyway even if something about him feels wrong, thinking that he will change, love will conquer all, and that wishing and trying will make it so. You know you do those things, don’t you?

Some of you are sharpening your pens right now to tell me all men are not like and that there are women who have no feelings. I know all that. These are generalities; sometimes the pumps or work boots are on the other foot.

The point is that if you never learned to identify and make use of feelings this can all seems strange. Believe me, learning to recognize, identify, and then make proper use of feelings can be well worth the effort.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel