- Hey everybody,
today we're going to talk about dissociation,
why it happens and what I do if a patient of mine
is dissociating in session, because it's been
a really, really long time since I've made
a video about this, and so many of you
asked for this type of video on Instagram.
But before I jump into that topic,
I just wanted to remind everyone that unfortunately,
the COVID-19 pandemic is still here
and it is still recommended that we wear face masks
over our nose and our mouth when out in public,
stay at least six feet away from others,
wash our hands regularly and avoid touching our faces.
If we all do our part, we can stop the spread
and protect those around us and ourselves
from contracting the virus.
And if wearing a mask is uncomfortable,
something I became aware of recently
is that you can purchase a mask bracket
that holds the mask out from our mouth and nose
just a little bit so that you don't breathe in your mask.
I know this has been really, really hard,
and this is a very difficult time
and we're all sick of hearing about it,
but if we each try our best and do those things,
we can slow the spread and save lives.
Okay, now back into today's topic.
Now, dissociation is when our brain
and the rest of our nervous system feel overwhelmed
and unable to deal with what's going on in the moment,
and therefore they pull us away.
Ahh! Right?
I've always talked about dissociation as our brain
pulling the rip cord on reality because it's just
too much for us to manage.
And when it comes to the DSM, they call any dissociation
DPDR, or depersonalization derealization disorder.
Now depersonalization is when we feel out of our body,
like we're kind of watching ourselves
from above or in a haze, and derealization
is when we feel separated from our environment.
So it can feel kind of like we're in a dream
or like everything around us just isn't real.
These experiences are really common.
It's estimated that half of all adults
have had at least one episode of DPDR.
50%! That is a lot of people.
So know that you are not alone in having these symptoms.
Now for the sake of this video, I'm just going to call
all of these symptoms, collectively, dissociation.
Cool?
And the reason that these dissociative symptoms happen
is usually because of us being triggered.
And I know the word triggered has been overused
and therefore has lost some of its meaning and impact,
but being triggered is when something in our environment
reminds us of our past trauma.
This could be a smell, a feeling, something we see
or really anything at all, and it usually
involves our five senses.
And if we don't have good grounding techniques
or coping strategies, we can be triggered
and that can lead to us dissociating.
Now, remember we dissociate because what we're experiencing
right now is too much for our nervous system to handle.
So it pulls us away until it's calm
or safe enough to come back into our awareness.
Dissociative symptoms can also be part of a PTSD diagnosis,
and that stands for, if you don't know,
post-traumatic stress disorder.
However, not everyone with PTSD will have these symptoms.
I just wanted you to know that it can
fall under that diagnosis as well.
Overall, we don't know exactly why dissociation
happens to some and not others,
but we do know that it's connected
to a traumatic experience or experiences.
And do you remember the little Ts and big Ts
that my friend and colleague
Dr. Alexa Altman talked about?
Well, if not, she shared that not all traumas
are these big horrific events.
They can also be a bunch of smaller upsets
that slowly overwhelm our system and give us
the same traumatic response as one big trauma could.
Now these small things are like moving,
having an emergency surgery,
going through a divorce or losing a job,
and big Ts could be things like being abused as a child,
being in a really bad car accident,
going to war or being assaulted.
Whether we have big or little Ts, it doesn't matter.
Not one is worse or better than the other.
They can all lead to PTSD symptoms
and possibly dissociation.
And in all honesty, as I was researching for my new book,
I found that our ability to be traumatized
doesn't have as much to do with what happens to us.
Rather, it leans on our ability to deal with it
and to know that we're going to be okay,
meaning our level of resiliency plays a huge role
in whether or not we experience symptoms of PTSD
or dissociation as a result of being in
a threatening and traumatizing situation.
And also, I just want to briefly mention
that I believe association happens on a spectrum.
Some people have periods of spacing out
or not remembering how a stressful event went.
I've had that experience.
While others have had so much trauma and upset
that they break their personality
into multiple alters to cope and survive, and that's
what's called dissociative identity disorder or DID.
And there is everything in between those two experiences.
I have patients who struggle with maladaptive daydreaming,
which is when we create a daydream that runs
pretty parallel to our regular life,
but without any of the upsets, and we can prefer
to spend time in that space rather than our own reality.
There are so many ways that dissociative symptoms
can affect us, so if you find yourself having memory loss
or think that you're struggling with some of the symptoms
I've mentioned, please reach out to a professional
so that you can get a proper assessment and treatment.
Okay, so that is why dissociation happens.
But many you wanted to know what I do
if a patient of mine dissociates in session.
And the first thing I want to talk about with this
is that in order for me to know what to do,
I have to have a conversation with my patients first.
Meaning that if in our first few sessions together
you tell me that you struggle with dissociation,
or perhaps I see it happen, when you are okay and present
we're going to have to talk about it.
I'm going to want to know how often this is happening,
how long it's been going on, and if you know
any specific things that trigger it
or if you have any tools that have helped to bring you back.
We'll work together to build on what you already know.
And one of the goals I will add to your treatment plan
will be to build up your resiliency.
I will also ask you if touch helps,
if you want me to touch your arm or back
when you're dissociated, or if there's certain things
that I can say, or if you prefer for me to be quiet
and to just stay where I am.
this all helps us better be prepared
for when and if it happens again.
In a way, we learn together how to best manage it
because if we're doing the hard work in therapy,
like we should all be doing in therapy,
there are going to be times when we just get overwhelmed
and I want to make sure that we have tools in place
to help bring you back safely and quickly.
And I also want to build you up so that these
dissociative symptoms happen less and less.
And these can be things like taking care
of your basic needs as homework.
You know, that good old HALT,
hungry, angry, lonely, tired.
Making sure we're showering regularly
and just all sorts of stuff like that.
Next, I want to challenge that negative self-talk.
You knew this was coming.
Because we all know how much our trauma
loves to pull us into a shame spiral,
telling us there's something innately wrong with us
when in fact there isn't.
And finally, I will want you
to build up your support system.
having people that we can count on
and talk about the real things
can make all the difference.
And I want you to have the resources and support
that you need when you need it most.
Oh, and I also keep things in my office to help.
Whether that's something like thinking putty
which is like Silly Putty but much better,
or a roller ball filled with spearmint essential oils
or could be a weighted blanket or really,
whatever helps you stay present
and not let dissociation pull you away.
I've had patients bring in all sorts of things
over the years, so if you find something that works,
let your therapist know and ask if you can either
leave something there in their office,
or they may offer it to get one
and keep it in the office themselves.
Overall, know that dissociation is common
and it can happen with more frequency
as we work through any past traumatic experience.
Just be honest with your therapist about it,
work to build up your resources and know
that we can get it to go away for good.
Now I know some of you love to be dissociated
and even prefer it to regular life.
And I know it feels safer and better there,
but trust me when I tell you that not feeling connected
to our world or body isn't any way to live.
Not to mention that forming memories when we're dissociated
is really difficult if not impossible,
therefore, even if it's more comfortable now,
we do have to find a way for us to come back to reality
and feel safe and know that you can be present
in your body and feel good.
Trust me, just getting the right therapeutic support
and working to heal the wounds caused by
our trauma experiences will make
the urge to dissociate go away, because you will be
happy and healthy being present in your body
and in the world around you.
I promise it does get better.
Well, that's it for me.
Thank you so much for watching.
I hope that this was helpful
and I will see you next time.
Bye.
(soft music)