Dissociation, Depersonalisation, and Derealization - How to Come Back When You Dissociate

Transcript

Do you ever feel numb, detached, or like you're 
completely separate from your body? Like you're   floating above it or watching yourself? Like 
you aren't even real? Or or does the world   around you sometimes feel foggy or dream-like 
or like time is moving super fast or super   slowly? These are all signs of dissociation, also 
called derealization or depersonalization. Now,   these three terms all have some overlap in 
symptoms. Dissociation is a common response   to trauma and other overwhelming experiences, 
but it can also become a chronic state or alert   response to emotions. So in this video you'll 
learn to identify the triggers and internal signs   leading up to dissociation, and when you have a 
framework to understand why dissociation happens,   then you can be more gentle with yourself and 
learn skills to manage overwhelming situations   more adaptively and flexibly and be more 
resilient. So let's get better at feeling. [Music] I've worked with many clients who've experienced 
dissociation or depersonalization, and often they   have a history of trauma. I can remember one 
time a young woman who I'd been working with   was sitting on the ground outside the office. 
She wasn't shaking or crying or speaking, but you   could tell something was very wrong. Now, there 
were some staff members who had tried to talk   to her, but they weren't getting any response, and 
her eyes seemed like they were gazing off into the   distance, like seeing right through the walls. 
She didn't acknowledge me or recognize me. She   seemed frozen and trapped in her world. She seemed 
very upset. But she wasn't moving. Right? So I   sat on the floor next to her. I probably stayed 
there for five to ten minutes. And then I asked   her if I could hug her. She didn't say anything, 
but in the past she'd been okay with side hugs,   so I put my arm around her shoulders. She barely 
even seemed to register that. So we just sat with   her. Sometimes the staff members or I would 
ask her a question, but she was, you know,   completely disconnected for a while. We started to 
ask her if she could hear us, if she could see us.   Um I asked her to feel the ground under her. And 
she started to talk, but in a pretty disconnected   way. So we decided to try something else. I 
asked a staff member to bring an ice cube,   which she held in her hand. And, you know, 
gradually she started to come back. We could see   her getting more emotional. She actually became 
a little bit panicky, then shaky, then crying.   And she told us that she'd had a really bad bad 
flashback to some childhood abuse, and that that   had triggered her to dissociate. So we we sat 
with her and we supported her for over an hour,   um and eventually she started to come back 
to herself and, you know, be able to function   again. And then with her in therapy we continued 
to process trauma and work through skills to   manage those intense symptoms for about a year. 
And over time her ability to manage her thoughts   and her emotions and her bodily sensations really 
increased, and those dissociative episodes became   less frequent and less intense. So so this is 
an example of a dissociative episode that's not   uncommon for survivors of trauma. Dissociation 
can vary in severity from like a severe disorder   to simple distraction. And I've I've seen how on 
a much smaller level like even like I slip into a   shutdown mode in certain situations. In situations 
like maybe like a revolving fight with your   husband or an annoying management issue at work 
or a difficult and unresolvable issue with your   health, like can you notice that feeling you have 
when you check out, when you turn off, when you   shut down and withdraw emotionally? Like this is 
dissociation on a very small scale. In some ways   we all seek to dissociate a little bit through 
daydreaming, through watching TV or diving into   social media. And some people walk through life 
just feeling numb or detached most of the time.   Now, this can be a common defense mechanism 
for many people, but when separating from   your thoughts, your memories, or reality becomes 
involuntary or it interferes with your ability   to function, it becomes a disorder. Now, at its 
most severe dissociation can cause amnesia or   the formation of alternate identities. In the 
DSM there are three dissociative disorders:   dissociative amnesia; dissociative identity 
disorder, which is also previously been   known as multiple personality disorder; and 
depersonalization derealization disorder. And   then by itself dissociation can just on its own 
be a symptom of PTSD. So first let's understand   why we dissociate. Dissociation is most common 
for people who have experienced childhood trauma   or other intense situations where they were unable 
to escape or overcome the danger. It's our body's   innate wisdom. It's a survival strategy for when 
things are overwhelming to protect us from feeling   the pain by temporarily disconnecting the mind 
from the body and environment. So for example,   in this video a cheetah chases an impala, 
and you can see the impala go through the   nervous system stages: safety; then flight, 
which is run away; fight, which is kick; and then, after the cheetah catches, 
her, freeze. And the impala stops moving   and shuts down. The cheetah has her neck 
in his mouth. But then a hyena menaces,   and the cheetah takes off. The hyena takes a bite 
at the impala, and the impala appears to be dead.   It doesn't even flinch. And then the cheetah and 
the hyena, they fight each other for a minute, and the impala hops up and sprints away. And it 
seems as though when the cheetah or the hyena   had their mouths on the impala, she was still 
calm and perhaps had dissociated. She wasn't   feeling the pain. She was mentally separated 
from her body. Now, in inescapable situations   like these it seems like dissociation protects 
the impala from suffering. It detaches from pain,   and in rare situations even saves her life by 
keeping her aggressors from causing further damage   before she can escape. So dissociation is an 
adaptive protective mechanism when the situation   is extreme and inescapable. Like we just have to 
acknowledge that it serves a function. Bessel van   der Kolk shares this story of his own experience 
of dissociation in the book The Body Keeps the   Score. Let me just read this for you real quick. 
So he said, "I was once mugged late at night in   a park close to my home, and floating above the 
scene I saw myself lying in the snow with a small   head wound surrounded by three knife-wielding 
teenagers. I dissociated the pain of their stab   wounds on my hands and did not feel the slightest 
fear as I calmly negotiated for the return of   my emptied wallet." Isn't that interesting? 
And maybe you've read or watched Life of Pi,   where a young man essentially creates a false 
reality to cope with overwhelming trauma. So   dissociation is a powerful method our brain 
uses to protect us. But when we overuse that   protective mechanism, that coping skill for 
things like triggers and work assignments   and stress and relationship problems, it can 
often interfere with our life. Like my client,   for example. She didn't even know where she was. 
Or if every time you get in a disagreement with   your spouse you shut down and withdraw, 
eventually the relationship will go cold.   Or if you chronically distract or avoid problems 
by watching too much TV, you won't solve a fixable   problem, and you might struggle at work or school 
or in your functioning in general. You know, when   dissociation becomes so severe that you have split 
identities or you slip into amnesia or fugue,   which is basically where you run away and you 
don't know who you are anymore, then obviously   this interferes with your ability to function 
at work, in relationships, or even live a happy   life. So what can be done to heal dissociative 
disorders? The first thing I would say is like get   support from a trauma expert for working through 
a dissociation. Like with severe childhood trauma   or severe dissociative disorders, it's actually 
probably best to be very cautious about trying to   do the work by yourself because you're gonna need 
someone to help coach you through dissociative   episodes. When you're working through trauma 
it's easy to get overwhelmed by these survival   responses and just revert back into old, an old 
survival strategy like dissociation. So the first   thing to do is to work with someone who can help 
you regulate your nervous system. And that's what   you do in therapy. Right? Whether it's obvious or 
not, a therapist uses their own nervous system to   help their client know that they are safe, that 
they're good, that they're loved. And they're   present there in case of an emergency. Now, other 
safe people and pets can also be really helpful,   but when the association is severe enough that 
you don't know where you are or who you are,   like definitely seek professional support from 
a skilled trauma expert. Okay. Number two:   create safety. Right? It's pretty hard to do any 
trauma work when you're still in danger and when   your body thinks that you need dissociation to 
survive. So do everything in your power to create   a safe and sustainable environment for yourself. 
That includes like leaving toxic and manipulative   relationships and developing an internal sense 
of safety with, you know, positive statements   and a supportive network and visualizing your 
safe places and, you know, just developing   this repertoire of body-calming techniques. 
Okay. Number three: at its core, dissociation   is your body's attempt to escape pain. So often 
you're trying to escape something inside of you   like a painful memory or an uncomfortable body 
sensation. Now, you can develop the ability to   face these triggers and memories and sensations 
with courage and calm. And grounding skills can   also help you with dissociation and help you 
regulate your stress response. You can you can   come back to your senses by literally using 
your senses. The 54321 grounding skill is a   great place to start. It's really simple. And you 
just start by focusing on five things you can see,   and then four things you can touch, and then three 
things you can hear, two things you can smell,   and one thing you can taste. Now, obviously, go a 
lot slower than what I just said right there. And   you can learn all of these in my grounding skills 
course. It's free. The link is in the description.   Um and some other things you can do is just 
trying to slow your breathing or notice your   breathing or, you know, pay attention to the 
pressure of your feet on the ground, you know,   pat your legs like this. Another thing that 
can help you, you know, get better at feeling,   get more grounded is to just engage in a 
physical activity like running or yoga.   Another thing that can help with dissociation 
is to learn mindfulness skills. Like mindfulness   skills can help you learn to face the pain and 
and get better at making space for it so that you   don't need to dissociate as a way to protect 
yourself from pain. Now, I'm not saying that   dissociation is a choice, but I am saying that 
you can replace the need for dissociation when   you increase your skills to manage emotions. 
Okay. Number five: process your trauma. Old,   unprocessed trauma can make even small triggers 
cause dissociation. After developing grounding,   mindfulness, and internal safety resources, and 
then, you know, whenever possible with the help   of a therapist, you work through your old trauma 
through body movement and writing and talking and   other expressive techniques. And this can help 
decrease the intensity of emotions around the   traumatic memories and triggers. Now, EMDR 
has a lot of strategies that may be helpful   for dissociation, and that includes bilateral 
stimulation. This involves alternating stimulation   of the left and right sides of the body. So, 
you know, they might have you do eye movement   where you're tracking something that's moving on 
a bar, or they might have you pat your legs like   this. And basically this helps you re-engage the 
dissociated part of the brain and allows the brain   to reprocess old memories so that they aren't so 
painful. A somatic experiencing practitioner would   treat dissociation by helping the individual build 
the skills necessary to re-establish awareness   and connection with their own body. And this could 
include helping the individual to gradually become   more aware of the sensations in their body and 
to learn to regulate their emotions and and their   bodily responses. And, you know, they, a somatic 
experiencing practitioner would help you develop   the ability to self-soothe and self-regulate. 
And then an internal family systems practitioner,   someone who does parts work would help someone 
acknowledge and accept all of their parts and   possibly integrate those parts into a cohesive 
unit. But, you know, integration isn't always   necessary. It's not always the goal. But it can 
be. While dissociation, whether it's mild or   severe, it can be really uncomfortable and 
it can get in the way of living your life,   it is treatable. So with the right skills and 
support, you really can learn to re-regulate your   nervous system and face and resolve pain and spend 
more time right here in the present moment living   your life and making it better and better each 
day. So thank you for watching, and take care. [Music]