What Is Dissociation in Borderline Personality Disorder (BPD)?

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You may be surprised to learn that those times when you zone out, feel unreal, or when things around you look strange or unfamiliar can mean you're experiencing dissociation. This is a common occurrence for people with borderline personality disorder (BPD); in fact, around 75 percent to 80 percent experience dissociation in some form. Though it can be difficult to understand, in broad terms, dissociation represents a disconnect between your thoughts, emotions, behaviors, perceptions, memories, and identity.

Symptoms

Dissociation during times of stress is one of the main symptoms of BPD. It's also associated with acute stress disorder and post-traumatic stress disorder (PTSD), either of which sometimes cooccur with BPD.

After years of study, researchers are now able to describe the experiences that go along with dissociation, such as:

  • Depersonalization: This is a feeling of separation between yourself and your body. People who experience depersonalization may say that they feel like they're observing their own body from the outside, or as if they're in a dream.
  • Derealization: Similar to depersonalization, derealization is a feeling of being detached from the external world, such as from other people or objects. It may cause familiar things to look strange, unreal, or unfamiliar. Derealization and depersonalization often occur at the same time.
  • Amnesia: Some people who experience dissociation have periods of amnesia or "losing time." They may have minutes to hours or days when they were awake but can't remember where they were or what they were doing.
  • Identity confusion: This occurs when you experience an inner struggle about who you really are.
  • Identity alteration: When you sense that you act like a different person some of the time, this is identity alteration. For instance, you may see things in your home that you don't recognize, perform a skill that you don't remember learning, or others will say you're acting like a different person. Mild identity alteration is common in the general population; for instance, changing your name. The key is that it doesn't cause problems with everyday functioning or relationships. In other words, you're aware of your identity or role change. Moderate identity alteration is common in BPD and involves changes in mood or behavior that are not under your control. 

    If you haven't ever experienced dissociation—and not everyone with BPD does—you may be puzzled by these descriptions. But even if you don't experience dissociation frequently or it's not very severe, almost everyone has experienced mild forms of dissociation from time to time. Common examples of mild dissociation in everyday life are zoning out—when you can't remember what you were thinking or doing—while you're driving on a highway, causing you to miss your exit; daydreaming; and getting so caught up in a book or movie that you're unaware of anything else.

    Causes

    Dissociation is most often caused by chronic traumatic stress like persistent neglect or abuse, usually in childhood. It's your brain's way of coping in order to separate yourself from the trauma so it becomes more bearable. If you learned to dissociate during times of extreme stress as a child, this likely affected the way your concept of yourself developed and it may have carried over into how you react to stressful situations as an adult. However, this sort of trauma doesn't necessarily cause dissociation to develop, nor do you have to have experienced it to have symptoms of dissociation.

    Preliminary research exploring neuroimaging in people with dissociative symptoms in BPD has shown that there may actually be changes in the way the brain functions and communicates that contribute to dissociation. Using imaging techniques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scans on people with dissociation and BPD, researchers have found evidence of decreased activity in the limbic temporal areas of the brain, increased activity in the frontal area of the brain, and changes in communication between the two areas. Further study in this area may help sort out which brain processes are related to which dissociative symptoms, as well as make psychotherapy even more targeted and beneficial for people who experience dissociation.

    Treatment

    Treatments for BPD such as dialectical behavioral therapy (DBT) often include components that can help reduce dissociation. Usually, treatment for dissociation is based on building skills that help you to reconnect with yourself, the present moment, and your current surroundings.

    Grounding is one skill that can be used to reduce dissociation. Grounding exercises involve using external stimuli and your five senses (sight, hearing, touch, smell, and taste) to reconnect with the present. For example, in a visual grounding exercise, you're instructed to observe small details about the environment around you until you are feeling more connected.

    Some people respond better to grounding exercises that use sensation. For instance, holding on to an ice cube for a few moments, chewing a piece of minty gum, or smelling a lemon can help to bring you back to the present moment.

    Dissociative Disorders

    There are some mental health disorders that include dissociation as a central feature rather than a symptom. For example, dissociative identity disorder (DID) is a disorder that is thought to be the result of very severe dissociation which causes a person to develop different personalities. The vast majority of people with dissociative identity disorder have experienced childhood abuse, such as physical and/or sexual abuse, and neglect.

    Besides dissociative identity disorder, the two other main dissociative orders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the gold standard for diagnosing mental health conditions—include:

    A Word From Verywell

    Stress-related dissociative symptoms occur in the majority of people with BPD. Even so, there is certainly a spectrum of severity, meaning some people with BPD experience minimal or mild symptoms of dissociation whereas others experience more severe symptoms. Research suggests that this severity may be linked to each individual's history of abuse and trauma. 

    If you or a loved one is being treated for BPD with dissociative symptoms, or a dissociative disorder, therapy can be challenging and intense, as you or your loved one may have to remember past trauma. But if you stick with it, therapy can help you take back power over dissociative symptoms and improve your overall quality of life.

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