The Continuum of Dissociation
By: Shari Kim, Ph.D.
EMDRIA Consultant
Although we think of the various types of dissociative disorders as being a series of separate diagnoses, dissociation is really a continuum. On one end of the continuum is the sort of commonplace and infrequent dissociation that most people have, like absorption. Imagine you are driving or riding in a car somewhere, lost in thought, not really paying attention to where you are. Suddenly you look up and realize you are halfway to your destination and don’t remember the last 10 minutes of your travel. That type of dissociation is absorption.
At the next level of dissociation are the types that come with PTSD, which are depersonalization and derealization. Depersonalization is the feeling of living in someone else’s body or being disconnected from one’s body, while derealization is the feeling of walking around in a dream state. Depersonalization might manifest as looking in the mirror and seeing an unfamiliar face looking back. People experiencing derealization may describe it as if they live in “The Matrix” or the world is not real. It is also common for clients to experience both of these types of dissociation at the same time, and with varying levels of frequency and intensity; even our levels of dissociation have their own levels.
Our next level is Other Specified Dissociative Disorder (OSDD). In this type of dissociation, we might see some parts (also known as alters or ego states) develop. Clients at this level may even have names for those parts, but they will not have any amnesia when those parts appear. Our key distinction between OSDD and our highest level of dissociation is the level of communication among parts. If parts communicate easily and do not lose any time when others are present, then we would categorize the dissociation as OSDD. If parts lose time, it is Dissociative Identity Disorder (DID).
Our highest level of dissociation is the aforementioned DID. In this case, our client has built a complicated network of compartments to house trauma, because the trauma was simply too big to hold at the time it was occurring. Those compartments have developed distinct identities, usually with unique vocal tones and mannerisms. The level of communication among those parts varies from open to completely closed, which may leave clients to experience large periods of amnesia. It is incredibly frustrating for clients to experience those amnesic periods, so our goal is to increase communication among the parts and to decrease those amnesic periods.
The truth is that most people dissociate on some level, but disordered dissociation comes with other problems that make it difficult for people to function in their daily lives. The most important thing to remember about dissociation, however, is that people learn to dissociate as a means to protect themselves. Dissociation requires a great deal of brain power and strength, and those who have acquired this skill should be understood as the strong and intelligent survivors that they are. If you would like to learn more about how to use EMDR with dissociative clients, check out one of these books:
- Easy Ego State Interventions: Strategies for Working With Parts by Robin Shapiro
- Looking Through the Eyes of Trauma and Dissociation: An illustrated guide for EMDR therapists and clients by Sandra Paulsen
For more training on dissociation, check out Trauma Specialists Training Institute for upcoming EMDR Basic Trainings and Advanced Trainings.
To learn more from Dr. Shari Kim, check out her upcoming Advanced Training on Human Trafficking and EMDR.
