What is dissociation?

  • Dissociation is a mental process that causes a lack of connection in a person's thoughts, memory and sense of identity.
  • It falls on a continuum of severity.
  • Mild dissociation could be like daydreaming, getting "lost" in a book, or when you are driving down a familiar stretch of road and realize that you do not remember the last several miles.
  • A severe and more chronic form of dissociation is seen in the disorder Dissociative Identity Disorder, once called Multiple Personality Disorder. 71
  • Dissociation is a normal response to trauma, and allows the mind to distance itself from painful or overwhelming experiences. 72
  • Several studies have found a relationship between childhood sexual abuse and dissociation in adulthood. 21 22 23 24
  • Dissociation can also be defined as emotional detachment from traumatic stimuli that can be triggered by anxiety or a stressful situation. 19
  • It can be one of the methods of self-preservation that survivors may have used has children to cope with repeated sexual abuse. 19 20
  • Dissociation can be triggered by anxiety and is related to the severity of the abuse. 41 20

What to do if a patient dissociates?

  • Ask them to keep their eyes open and to look at you and around the room, ask questions calmly and slowly: For example: "Are you here? Are you with me? Are you following me? Do you have any techniques for staying present?"
  • Once the patient appears less upset or more present, talk to them about what just happened. Don't ask for details of the abuse that contributed to being triggered.
  • Acknowledge that people sometimes react to circumstances in the present that remind them of past experiences.
  • Ask what they need right now. Do they want company, or to be left alone? It is important to ask whether they feel able to continue the exam/procedure 2
  • Be aware that if a patient is dissociating they may need to have the information repeated and provided in written form. 37