Understanding Dissociative Symptoms: From Everyday Experiences to Post-Traumatic Stress Disorder

Leah Fung – EMDR & CBT Therapist, CBT Supervisor in Guildford, London Bridge and Online

Understanding Dissociative Symptoms

Dissociation can be experienced as a disconnection between thoughts, memories, feelings, actions or sense of identity. It can often be described as feeling distant from the present ‘here and now’ moment. It’s a spectrum that can range from mild, everyday experiences to severe, disruptive conditions often associated with trauma. For instance, many people may have encountered times where they don’t remember parts of a familiar journey, daydreaming or being on auto-pilot. Whilst these are relatively harmless there are some dissociative experiences that may impact on a person’s day to day functioning, especially in the context of post-traumatic stress disorder (PTSD).

Dissociation in Everyday Life

Dissociation that has no or mild impact on functioning is quite common and can happen to anyone. It includes:

• Losing track of time while your mind wanders for example when daydreaming, dwelling on past events or worrying about the future.
  
• Being on auto-pilot, perhaps due to engaging with something that does not require much attention or is repetitive, multi-tasking or your mind and attention is elsewhere
  
• Not remembering parts of a conversation, what you have watched or read or an activity

These experiences are usually brief and not problematic. However, when dissociation becomes frequent and intense, it can interfere significantly with daily life and mental health.

Dissociation and Post-Traumatic Stress Disorder (PTSD)

In PTSD, dissociation serves as a coping mechanism to deal with overwhelming trauma responses.

PTSD-related dissociation can include:

• Flashbacks to traumatic events which are dissociative experiences as individuals relive the memories as though it is happening now
  
  
• Depersonalisation: Feeling detached from your body or mind, as if you’re observing yourself from outside.
  
  
• Derealisation: Feeling that the world around you is unreal, dreamlike, or distorted.
  
  
• Amnesia: Inability to recall important aspects of the traumatic event.

These symptoms can disrupt a person’s ability to function, making it hard to maintain relationships, work or go about daily activities.

Polyvagal Theory Perspective on Dissociation

Polyvagal Theory, developed by Dr. Stephen Porges, offers another perspective on dissociation, focusing on the autonomic nervous system’s role in emotional regulation and social connection.

According to Polyvagal Theory:

• Ventral Vagal State: Represents a state of safety and social engagement. When in this state, individuals feel calm, connected, and present.
  
  
• Sympathetic State: Associated with the fight-or-flight response, activated in the face of actual or perceived danger.
  
  
• Dorsal Vagal State: Linked to immobilisation and dissociation, activated when the individual feels overwhelmed and unable to escape a threat. This is a protective shutdown response.

In the context of PTSD, trauma can trigger a shift to the dorsal vagal state, leading to dissociative symptoms. Understanding this physiological response helps in developing therapeutic interventions aimed at restoring the balance in the autonomic nervous system.

Cognitive Behavioural Therapy (CBT) for Dissociative Symptoms in PTSD

Cognitive Behavioural Therapy (CBT) is an effective treatment for PTSD. CBT focuses on the role of thought patterns and behaviours in maintaining emotional distress and aims to help individuals develop skills to respond differently to thoughts, feelings and behaviours.  Further information about CBT can be found in this blog on what is CBT https://yourtherapywithleah.co.uk/what-is-cbt/

The therapy process of CBT aims to help you understand how your current difficulties have developed and factors that are currently maintaining symptoms of PTSD and dissociation.  

Below are some examples of how CBT can help with PTSD and dissociative symptoms:

1. Grounding Techniques: a range of resources are developed to help an individual become aware of when they are disconnecting from the ‘here and now’ and to drop an anchor to connect with the present moment. 
   
   
2. Self-Soothing Resources: to help you emotionally connect with trauma focused therapy and to be able to regulate your emotions so that you are processing and engaging within your window of tolerance.  See this blog for more information about the window of tolerance https://yourtherapywithleah.co.uk/window_of_tolerance_and_emotion_regulation/
   
   
3. Spot the difference: this technique is used to help the brain and body to learn that when you experience flashbacks and nightmares that this is associated with a past event that happened ‘then’ and what is different ‘now’ in the present moment when you are experiencing this.
   
   
4. Processing the traumatic memories: Sometimes people say that in non-therapeutic conversations (e.g. police statements, talking with friends and family) they have talked about what has happened and know that they are no longer in danger but despite this, they still feel intense anxiety, fear and distress when they experience flashbacks and nightmares. The process of CBT involves talking and experiencing in a particular way about the traumatic events. This can help people make sense of what has happened and to integrate information about what you know now with the traumatic memory.

Dissociation, ranging from everyday occurrences to severe disruptions associated with PTSD, can significantly impact one’s life. Understanding and treating dissociative symptoms through CBT can provide effective strategies for managing and reducing these symptoms, promoting recovery and improving quality of life. 

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