What is it?

“Dissociation” is a term of art that is frequently referenced in connection with trauma and PTSD, particularly Complex PTSD. The terms dissociation and dissociative can be confusing because they refer to both symptoms of trauma and to disorders that may be a result of traumatic experiences.

According to Dissociation and the Dissociative Disorders (Dell, 2009; p.226):

“The phenomena of pathological dissociation are recurrent, jarring involuntary intrusions into executive functioning and sense of self.”

What are the symptoms of dissociation?

The DSM-5 (p.291) offers the following description:

  • unbidden intrusions into awareness and behavior, with accompanying losses of continuity in subjective experience with
    • fragmentation of identity,
    • depersonalization (experiences of unreality or detachment from one’s mind, self or body), and/or
    • derealization (experiences of unreality or detachment from one’s surroundings)


  • inability to access information or to control mental functions that normally are readily amenable to access or control such as
    • amnesia and/or
    • numbing

Dissociative Symptoms that occur in connection with more severe dissociative disorders as well as PTSD, acute stress disorder, somatic symptom disorder, panic disorder, major depression and borderline personality disorder (and others) include:

  • general memory problems
  • depersonalization
  • derealization
  • flashbacks
  • somatoform symptoms
  • trance

What additional symptoms might indicate a more severe form of dissociation?

Dissociative intrusions, such as might occur in a diagnosis of a dissociative disorder, are experienced as occurring outside of one’s control or choice. These may include:

  • hearing a child voice inside the head
  • hearing internal parts struggle or argue (manifested as voices or loud thoughts inside the head)
  • persecutory voices
  • speech insertion (words that “come out of nowhere” that seem out of one’s control)
  • thought insertion (thoughts that “come out of nowhere” that don’t seem to belong to the person experiencing them)
  • intrusive feelings (feelings that “come out of nowhere” for no apparent reason)
  • intrusive impulses
  • intrusive actions
  • temporary loss of skills and knowledge
  • experiences of self-alteration
  • puzzlement about self resulting from the dissociative experiences

Severe dissociative disorders, such as Dissociative Identity Disorder, also include:

  • loss of time with no memory or recall
  • “coming to” with no memory of having done something or in the middle of doing something
  • fugues (where one has no memory of going to where they find themselves)
  • being told of actions one does not recall doing
  • finding objects in one’s possessions with no sense of how they got there
  • finding evidence of engaging in recent actions one does not recall engaging in

More common than we think

It is important to be aware of dissociation and dissociative symptoms as they relate to trauma because they are more common and prevalent than believed in the past. Years ago dissociation was not well understood and usually thought to be related to “multiple personality disorder” (now designated as Dissociative Identity Disorder or “DID” by the DSM-5) alone. However, we now know that there is a broad spectrum of dissociative experience. For example, we all dissociate when we lose track of time or can’t recall the drive when we arrive somewhere. What’s more, trauma may include elements of dissociation that are directly related to the experience but are not indicative of a more serious diagnosis such as DID. In fact, certain dissociative symptoms (as described earlier) could be considered a “normal” symptom to a traumatic event.

Dissociative symptoms and treatment of trauma

Complex trauma and dissociation often go hand-in-hand. However, this is not always recognized by the therapist. Complex trauma treatment should take into account the specific needs of a client due to the nature of dissociative symptoms or dissociative disorders. Typically clients need more preparation and a strong foundation of feeling “safe” in treatment before actual trauma work should be undertaken. Otherwise the client may lose trust in the therapist due to a worsening of dissociative symptoms. For example, the standard EMDR protocol is not designed for complex trauma treatment and dissociative episodes, thus it’s use may lead to retraumatization. Fortunately, options are available in lieu of using the standard protocol wherein EMDR has successfully been implemented in the treatment of complex trauma and/or dissociation. To summarize, whatever the model of treatment, complex trauma and dissociative symptoms require extensive preparation to ensure the safety of the client and the integrity of the therapeutic process.

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