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Summary
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A person newly in therapy for Post-traumatic stress disorder (PTSD) wonders whether changes in their voice, posture, and conversation while dissociated mean they have DID. They want to better understand the relationship between these terms.
The answer describes dissociation as changes in attention, memory, and awareness that occur across a range of experiences.
It explains that dissociation can be part of PTSD and does not by itself establish DID, distinguishing a shared process from a specific diagnosis.
Question
Reader · Identity withheldI have been diagnosed with PTSD. Therapy has just begun for me. I was diagnosed after being misdiagnosed more times than Carter has liver pills. My therapist has explained that I look different when dissociated.
\nThat I can carry on a conversation about a topic that I know about and even my voice, the way I sit is different. Isn’t that DID? I just wanted to make sure I understand what it is I have, for sure.
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Answer
Mark Vigil Dombeck, Ph.D.You ask a really good question, which I think might be more easy to understand for readers if we break it down into several questions: \"What is the nature of dissociation?\", and \"How is dissociation related to Post-Traumatic Stress (PTSD) and to Dissociative Identity Disorder (DID – otherwise known as multiple personality disorder)?\"
\nDissociation involves an alteration of normal, regular consciousness. It involves (usually) temporary changes to how normal memory and attention work. In normal consciousness, you have access to your memories and those memories inform who you are and how you experience and respond to life events.
\nIn dissociation, your access to memories – your ability to pay attention to memories – is altered so that normal memories may not be available or memories that aren’t normally available become available. Because your access to memories is changed, so too are the ways that you experience the world and the events that occur in the world.
\nDissociation can involve attention as well as memory. For this reason, when someone is dissociated, what they are able to pay attention to may become changed from normal, in the same fashion that what can be remembered may become changed from normal.
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Dissociation is not a disease or a disorder in of itself. Rather, it is just a mode of consciousness, a capacity that most people have, some more than others. It occurs in degrees and may be light or heavy.
\nVery light forms of dissociation happen to people all the time. Whenever someone is said to be daydreaming, or \"spacing out\" they are basically experiencing a very light dissociation. In an important sense, dissociation is a means of avoiding stuff that you don’t want to acknowledge.
\nPeople who are \"in denial\" can be said to be exhibiting a light variety of dissociation in as much as they are successfully able to ward off coming to grips with reality for a time. Heavier examples of dissociation can be induced in normal people when they are hypnotized. Hypnotism is basically the induction of a specialized form of dissociative state.
\nReligious trances (e.g., possession states, speaking in tongues, etc.) are also examples of ways that normal people may experience moderate levels of dissociation.
\nSome religions, such as some forms of Buddhism, and some movies that are based on such religious ideas, such as \"The Matrix\", seem to regard dissociation as the normal state of mankind; a state within which people are \"asleep at the wheel\" and unaware of reality.
\nThey describe states of enlightenment and ultimate consciousness which are essentially the opposite of dissociation; radical states of complete presentness and orientation to real reality. Whether or not this is the case I will leave for other to determine, but it is an interesting idea with at least some merit to it.
\nPeople who have been wounded very severely in some psychological/emotional fashion may find that they are able to use an innate talent or capacity for dissociation as a means of coping with their wound. For example, very young children may stumble onto dissociation as a means of coping with ongoing severe abuse.
\nThrough the process of dissociation, such children are able to build a little \"firewall\" around abuse memories – to keep them compartmentalized into little units that they typically don’t pay attention to. When this process of dissociative encapsulation occurs at a young enough age, before personality and self-concept are mature, a multiple personality (today known as dissociative identity disorder or DID) may result, with different mini-selves or \"alters\" appearing, each containing a separate set of walled-off memories.
\nDID is perhaps the most severe dissociative pathology because it involves dissociation that is so severe that it has fragmented the entire personality which never gets to view itself as a unitary entity (in the singular manner most people experience themselves). There are other forms of dissociative problems however.
\nSome people display dissociative amnesia and forget selective aspects of their experience (typically traumatic experiences) in the shock wake of a trauma. Some people go off on what are called fugue states wherein they forget themselves, travel and live under a new identity for a time, also generally in the wake of a traumatic experience.
\nDissociation can also occur in the context of Post traumatic Stress (PTSD) as well, although only some trauma victims who develop PTSD will show signs of dissociation. By definition, PTSD involves exposure to a traumatic event (where traumatic means mind-blowing, violent, death-involved).
\nIn the wake of the traumatic event, PTSD patients re-live and re-experience that event again and again, often in vivid detail in an invasive, unwanted manner. There is an aspect of dissociation in all PTSD in that such patients become captive to their memories and cannot easily detach themselves from them so as to avoid being debilitated by them. However, some PTSD patients dissociate during their initial exposure to trauma while others do not, and that seems to have an impact on how treatable their PTSD becomes (Patients who did not dissociate during trauma exposure having an easier time).
\nThe idea here (and this is just an idea) is that PTSD involves a sort of failure to integrate and digest experience (not a personal failure, mind you – just in the sense of something that doesn’t occur). When someone dissociates during a trauma, they thereby remove themselves from the experience partially, but only by encapsulating the trauma experience away from their direct conscious experience. The walled-off, encapsulated trauma memories are still sufficient to create PTSD, however, but are not nearly as easy to come to terms with and thus ultimately digest and help resolve the PTSD symptoms.
\nSo – to answer your question, it is perfectly reasonable that one of your PTSD symptoms might be dissociation, which you may have used as a means of coping with the trauma when it happened and since. Because dissociation is an avoidance mechanism, it is generally not particularly helpful when someone is trying to overcome PTSD memories, which in an important sense must be processed (which can’t really be done when they are encapsulated and avoided). Eye movement desensitization and reprocessing (EMDR) therapists might disagree, but that is the way I understand it, anyway.
\nIn any event, your own PTSD-related dissociation does not mean that you have multiple personalities. It is unlikely that you, as a mature adult, could ever become DID; that seems to be reserved for young children only (who later grow up multiple). However, your dissociation is essentially the same sort of basic process as occurs in multiple personality disorder cases.
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