Dissociation

Category:Not Plural Exclusive
Category:Common Terms
Dissociation is the state of disconnection from one's thoughts, surroundings, identity, consciousness, or memory. It often functions as a coping mechanism to protect the individual from overwhelming experiences, but can become maladaptive. Dissociation exists on a broad spectrum, encompassing common occurrences like "highway hypnosis"https://www.inquirer.com/philly/blogs/healthcare/How-highway-hypnosis-works.html (archive) to Dissociative Identity Disorder and Otherwise Specified Dissociative Disorder, and can last minutes or days. It can be found in other disorders like PTSDhttps://www.ptsd.va.gov/professional/treat/essentials/dissociative_subtype.asp (which has a dissociative subtype), maladaptive daydreaming,SomerClinic. What is Maladaptive Daydreaming ADHDhttps://www.verywellmind.com/adhd-symptom-spotlight-dissociation-5270278, anxietyhttps://www.verywellmind.com/dissociation-anxiety-4692760, eating disordershttp://estd.org/eating-disorders-and-dissociation, and borderline personality disorderhttps://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml (archive), or during substance use.
==Symptoms==
The exact definition and categorisation of dissociation varies greatly over the course of history. While the DSM-III-R defined dissociative disorders by “a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness", a categorisation of dissociative symptoms into five general areas was presented with the development of the SCID-D in 1990: 
* Depersonalization, or disconnection from the self, appearance, body, or thoughts; can also present as "out-of-body" experiences
Depersonalization refers to detachment from oneself-a sense of "going through the motions" or of looking at oneself as an outsider.
* Derealization, or the disconnection from one's surroundings or life
Derealization refers to the sense that one’s surroundings are unreal.
* Identity Alteration, or a shift in one's feeling of identity or behaviour over time
Identity alteration focuses on behavioral manifestations of identity confusion, such as exhibiting a special knowledge or skill without knowing how this skill was acquired.
* Identity Confusion, or the feeling of not having internal consistency or acting outside of one's character
Identity confusion refers to subjective feelings of confusion, uncertainty, or puzzlement centered on patients’ knowledge of their own identity.
* Dissociative Amnesia, or forgetting critical personal information, chunks of time that can range from seconds to decades, or past emotions
Amnesia represents a specific and substantial block of time that cannot be accounted for by memory.
Identity confusion and identity alteration were specifically introduced with the SCID-D"For the purposes of the SCID-D, the symptom areas of identity confusion and identity alteration were developed and are now an integral part of the SCID-D."(Steinberg, 1990, p.77), while amnesia, depersonalisation, and derealisation had been in use before.
Since then, these categories are still in use both in the DSM and by the ISSTD.https://www.isst-d.org/resources/dissociation-faqs/ (archive)
== Plurality ==
Plural people often experience dissociation (notably in DID or OSDD-1, but not exclusively to these types). In DID, all five forms of dissociation are present (but not necessarily equally), while in OSDD-1, four forms are present. Headmates are typically holders of dissociated memories, traits, or ideas that other headmates could not integrate; work towards integration can minimize day-to-day dissociative symptoms, though. Trauma may be hidden behind amnesic barriers, only to be uncovered later when the individual or system feels safer. 
Both the presence of multiple members within a system and non-plural experiences of identity disturbance may fall under identity alteration. 
== Grounding ==
A dissociative state is often unpleasant and can last for any amount of time. Not knowing how long a dissociative episode may continue could cause further distress to the dissociative person(s). A common recommendation for persisting through the event is to attempt grounding exercises.
Popularly effective grounding techniques include:https://www.healthline.com/health/grounding-techniques (archive)
* Engaging the body's sensory abilities, such as describing objects around oneself, smelling a comforting scent, and massaging limbs or the scalp
* Pacing, especially while also listening to lyrical music through headphones
* Using ice or another cold substance on the body's surfaces, such as rubbing an ice pack over the skin
* Counting backward from a high number
* Reading a written work, such as a poem or short story, out loud
* Narrating one's situation and the things around oneself
* Petting and talking to a docile, nearby animal
Asking for another person to help coach them through their actions and do grounding techniques along with them may help dissociative individuals to better ground themselves.
==History==
The phenomenon of dissociation was described from different perspectives during the 19th century. It may have first been mentioned in concept by Rush in 1812, and was then further defined and named as disaggregation, opposed to association / aggregation / integration, by de Tours in 1845. Charcot, de la Tourette, and Janet may have been the first to use the specific term dissociation in 1887, and Janet went on to extensively research and describe dissociation in connection with trauma.van der Hart, O. (1989). The dissociation theory of Pierre Janet
==Related Terms==
There are three major dissociative disorders in the DSM-V: Dissociative Amnesia, Depersonalization/Derealization Disorder, and Dissociative Identity Disorder. Additionally, Unspecified Dissociative Disorder or UDD and Otherwise Specified Dissociative Disorder are used for cases where the symptoms do not fit in the earlier three, or it cannot be determined. 
Integration can be considered the opposite of dissociation. It is the process of bringing together memories & feelings across dissociative barriers.
Category:Psychiatric Terms
Category:Dissociation-Related Terms
Category:Disorder-Related Terms