The likelihood that a tendency to dissociate is inherited genetically is estimated to be zero (Simeon et al., 2001). Research tends to show that dissociation stems from a combination of environmental and biological factors. The therapist can gently help the patient become aware of these changes (e.g., Fine, 1999 Maldonado et al., 2002 Spiegel & Cardeña, 1991 Steinberg, 1995). If identity alteration is suspected, it may be confirmed by observation of amnesia for behavior and distinct changes in affect, speech patterns, demeanor and body language, and relationship to the therapist. The patient may be able to confirm the experience of identity alteration, but often the part of the self that presents for therapy is not aware of the existence of dissociated self-states. The person may express confusion about their feelings and perceptions, or may have difficulty remembering what they have just said, even though they do not claim to be a different person or have a different name. For example, during a discussion about fear, a client may initially feel young, vulnerable, and frightened, followed by a sudden shift to feeling hostile and callous. These may be associated with a change in the patient’s world view. More frequently, subtler forms of identity alteration can be observed when a person uses different voice tones, range of language, or facial expressions. For example, in the course of an initial discovery of the experience of identity alteration, a person might incorrectly believe they were five years old, in their childhood home and not the therapist’s office, and expecting a deceased person whom they fear to appear at any moment (e.g., Fine, 1999 Maldonado et al., 2002 Spiegel & Cardeña, 1991 Steinberg, 1995). A person may shift into an alternate personality, become confused, and demand of the clinician, “Who the dickens are you, and what am I doing here?” In addition to these observable changes, the person may experience distortions in time, place, and situation. Identity alteration is the sense of being markedly different from another part of oneself. An example of identity confusion is when a person sometimes feels a thrill while engaged in an activity (e.g., reckless driving, drug use) which at other times would be repugnant. Identity confusion is a sense of confusion about who a person is. A dissociative disorder is suggested by the robust presence of any of the five features. These are the main areas of investigation in the Structured Clinical Interview for Dissociative Disorders (SCID-D) (Steinberg, 1994a Steinberg, Rounsaville, & Cicchetti, 1990). There are five main ways in which the dissociation of psychological processes changes the way a person experiences living: depersonalization, derealization, amnesia, identity confusion, and identity alteration. This is sometimes described as the experience of being a “passenger” in one’s body, rather than the driver. Or someone may find himself or herself doing something that they would not normally do but unable to stop themselves, almost as if they are being compelled to do it. Feeling suddenly, unbearably sad, without an apparent reason, and then having the sadness leave in much the same manner as it came, is an example. Typically, a person feels “taken over” by an emotion that does not seem to makes sense at the time. These are thoughts or emotions seemingly coming out of nowhere, or finding oneself carrying out an action as if it were controlled by a force other than oneself (Dell, 2001). Dissociation is a psychological process commonly found in persons seeking mental health treatment (Maldonado et al., 2002).ĭissociation may affect a person subjectively in the form of “made” thoughts, feelings, and actions. Clinically, this is termed emotional numbing, one of the hallmarks of post-traumatic stress disorder. For example, someone may think about an event that was tremendously upsetting yet have no feelings about it. In severe forms of dissociation, disconnection occurs in the usually integrated functions of consciousness, memory, identity, or perception. Dissociated experiences are not integrated into the usual sense of self, resulting in discontinuities in conscious awareness (Anderson & Alexander, 1996 Frey, 2001 International Society for the Study of Dissociation, 2002 Maldonado, Butler, & Spiegel, 2002 Pascuzzi & Weber, 1997 Rauschenberger & Lynn, 1995 Simeon et al., 2001 Spiegel & Cardeña, 1991 Steinberg et al., 1990, 1993). Dissociation is a word that is used to describe the disconnection or lack of connection between things usually associated with each other.
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