The concept of "three stages of dissociation" can refer to two different frameworks: the three recognized types of dissociative disorders in the DSM-5, or the three phases of trauma treatment for severe dissociation.
Whether you're dissociating depends on your experiences, but it often involves feeling detached from yourself, your emotions, or reality (like being in a dream or movie), experiencing memory gaps, or feeling like you're outside your body, often as a stress response to trauma or overwhelming situations. Mild dissociation can be daydreaming, while severe forms involve identity confusion or amnesia; seeing a professional for diagnosis is key if you're concerned.
Dissociative identity disorder
Previously called multiple personality disorder, this is the most severe kind of dissociative disorder. The condition typically involves the coexistence of two or more personality states within the same person.
The American Psychiatric Association defines three major dissociative disorders: Depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder.
Dissociation is often a response to traumatic experiences or overwhelming stress. It can be triggered by events such as abuse, accidents, violence, loss, or childhood neglect. These experiences can cause the mind to disconnect as a way to cope with intense pain or distress.
The DMN, active when you reflect on yourself or your experiences, becomes dysregulated during dissociation. This disruption may lead to feeling disconnected from your sense of self, as if you're a stranger in your own body—an experience common in dissociative identity disorder (DID).
Signs of childhood trauma
You might: Switch between different parts of your personality. Speak in a different voice or voices.
[1] The result in such extreme cases is often a highly fragmented sense of life and self-identity that can lead to mental health problems such as depression, anxiety and suicidal thoughts.
What are the differences between ADHD and dissociation? As mentioned earlier, people with ADHD are more likely to experience trauma and in turn dissociation. However they do not have ADHD because of the trauma. Therefore it can be concluded that the two conditions have separate diagnostic criteria.
Dissociation can feel frightening because it often involves feeling detached from your body, thoughts, or surroundings. This can be sudden and unsettling, making it hard to feel in control. But it's important to remember that support is out there.
The most commonly diagnosed personality disorders are borderline personality disorder and antisocial personality disorder. Another personality disorder that primary care practitioners sometimes find difficult to diagnose and treat is narcissistic personality disorder.
In treating patients with DID, there are reports of some success with selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, monoamine oxidase inhibitors, beta blockers, clonidine, anticonvulsants, and benzodiazepines in reducing intrusive symptoms, hyperarousal, anxiety, and mood instability.
People who have experienced physical and sexual abuse in childhood are at increased risk of dissociative identity disorder. The vast majority of people who develop dissociative disorders have experienced repetitive, overwhelming trauma in childhood.
If you have DID, you might feel or experience the following:
Shutdown dissociation is when someone appears to “shut down” emotionally or physically in response to overwhelming stress or trauma. It can happen suddenly and may last for a short time or much longer.
Dissociation often feels good because it serves as the brain's natural defense mechanism against overwhelming stress, trauma, or emotional pain.
Transient and mild dissociative experiences are common. Almost 1/3rd of people say they occasionally feel as though they are watching themselves in a movie, and 4% say they feel that way as much as 1/3rd of the time. The incidence of these experiences is highest in youth and steadily declines after the age of 20.
Individuals with these symptoms of dissociation feel like their surroundings are unreal. It might seem foggy or dreamlike, as if they're looking at it through a veil. Objects and people around them might look distorted, such as being colorless or flat.
Key Signs a Client is Dissociating in Therapy. Emotional Numbness: One of the foremost indicators is when clients become emotionally detached. This is not a mere distraction; they might feel as if they're observing themselves from afar. It's as if their feelings have been muted or switched off.
Dissociation is also a normal way of coping during traumatic events. For example, some people may dissociate while experiencing war, kidnapping or during a medical emergency. In situations we can't physically get away from, dissociation can protect us from distress.
Dissociation is not a form of psychosis. These are two different conditions that may easily be confused for each other. Someone going through a dissociative episode may be thought to be having a psychotic episode, and in some cases, dissociation may be the initial phase to having a psychotic episode.
Eight common categories of childhood trauma, often called Adverse Childhood Experiences (ACEs) by the CDC and others, include physical/sexual/emotional abuse, neglect, domestic violence, household substance abuse, mental illness in the home, parental separation/divorce, or having a household member imprisoned, all of which significantly impact a child's development and long-term health. These traumatic events teach children that their world is unsafe, affecting their brains, bodies, and ability to form healthy relationships later in life, leading to issues like chronic stress, attachment problems, dissociation, and hypervigilance.
The 10 ACEs of childhood trauma are:
In univariate analyses, all 5 forms of childhood trauma in this study (ie, witnessing violence, physical neglect, emotional abuse, physical abuse, sexual abuse) demonstrated statistically significant relationships with the number of different aggressive behaviors reported in adulthood.