The Definition of Dissociation for People With PTSD

Basically, "dissociation" means a lack of connection or connections. So what's a useful definition of dissociation for people with post-traumatic stress disorder (PTSD)?​

Dissociation disrupts four areas of personal functioning that usually operate together smoothly, automatically, and with few or no problems:

• Identity
• Memory
• Consciousness
• Self-awareness and awareness of surroundings

"Breaks" in this system of automatic functions within yourself cause the symptoms of dissociation.

If you have PTSD, you may sometimes have felt "disconnected" from yourself. If so, you may have experienced common but distressing incidents like these:

• Having flashbacks to traumatic events related to your PTSD
• Feeling that you’re briefly losing touch with events going on around you (similar to daydreaming)
• “Blanking out” or being unable to remember anything for a period of time

Many people with PTSD have had these types of numbing, self-distancing symptoms. But there is some good news: Although upsetting, they may not last very long.

The definition of dissociation in PTSD also includes the experiences of some people with PTSD who have additional symptoms called depersonalization (feeling as if the world is not real) and derealization (feeling as if the self is not real). Having either of these symptoms is a serious health problem.

Depersonalization and derealization are responses to overwhelming traumatic events that cannot be escaped, such as child abuse and war trauma. They arise in order for the person to keep on functioning at the moment of being severely traumatized.

• Examples of depersonalization include out-of-body experiences, where people “see” themselves from above. This lets them feel, “This is not happening to me.”
• In states of derealization, people “experience” events that aren’t real. This lets them feel, “This isn’t real; it’s just a dream.”

The people with PTSD who are most likely to have symptoms of depersonalization or derealization are found in all cultures. They mainly include those who:

• Are male
• Have lived through repeated severe traumatic events before developing PTSD
• Have other mental health problems including suicidal tendencies
• Have some form of disability that interferes with daily living

Therapists use a number of tests to help identify people with PTSD who may also have one of the severe forms of dissociation. If you think you may need treatment for this as well as PTSD, you may be given the Clinician-Administered PTSD Scale (CAPS).

• The CAPS tests for depersonalization by asking you to respond to such questions as, "Have there been times when you felt as if you were outside of your body, watching yourself as if you were another person?"
• It tests for derealization by asking, for example, "Have there been times when things going on around you seemed unreal or very strange and unfamiliar?"

There is a link between dissociation and substance abuse in people with PTSD. Experiences with dissociation and trauma can predict the potential for addiction, according to a study published in 2014.

Another study showed "relatively high levels" of dissociation among women with both substance use disorder and PTSD, but also suggested that more research into how substances affect dissociation would be helpful.

If you've experienced depersonalization or derealization, you should be aware that such an extreme response to actual traumatic events can be triggered again, even long afterward, by events that may or may not be threatening.

If this happens, you could automatically enter a dissociative state at the first hint of potential trauma. If the situation isn’t actually threatening, you may appear “spaced-out” to others. On the other hand, if there is a real threat, dissociating from it when escape might otherwise be possible could expose you to the risk of harm.