Dissociation happens when parts of ourselves that are usually integrated are disrupted and separate. This might involve feeling like everything is unreal, feeling detached from one’s body, or detachment from memories.
Some types of dissociative symptoms are:
- Depersonalisation – feeling like you are outside of yourself and observing your own actions
- Derealisation – feeling like everything is unreal or like you’re in a dream
- Emotional withdrawal or detachment – a lack of emotional reactions or responses to events
- Dissociative amnesia – forgetfulness of personal information or events that are too extreme to be explained
- Altered sensory perception – such as changes in your perception of time or your senses, including what you see, hear, and taste
- Identity alteration – experiencing multiple identities or feeling possessed or controlled by something else
Some people experience dissociative symptoms occasionally or from time to time. People with other mental health disorders are more likely to experience dissociative symptoms than other people.
When someone experiences dissociative symptoms of a certain frequency and severity, they may be diagnosed with a dissociative disorder.
What Causes Dissociation?
Dissociative experiences often happen when someone is exposed to a traumatic event. When someone experiences trauma, they may be overwhelmed by stress and detach, in some way, from their experience, emotions, and/or body. People who have experienced acute trauma often describe dissociating from their bodies and watching something happen to themselves.
Dissociation may also happen after a traumatic event when someone is reminded of a trauma to avoid the emotional distress caused by the memory. Sometimes, dissociative amnesia may prevent them from remembering a traumatic event in the first place.
Some people experience dissociative symptoms without any apparent exposure to trauma – and that doesn’t seem explainable by other environmental factors. Researchers think that genetics may also sometimes play a role in dissociative experiences.
People with a dissociative disorder or who experience dissociative symptoms usually experience them in response to stress. This can include reminders of traumatic events but also stress caused by other circumstances. In each case, dissociation seems to prevent the usual fear-arousal response to stress, turning off a panic reaction through detachment from the mind and body.
While dissociation can have a protective function, preventing the mind and body from experiencing intense and intolerable distress, persistent dissociative symptoms can also cause distress and harm. Dissociation may also prevent a person from processing a traumatic event and from forming an integrated, cohesive sense of self.
Dissociation and Early-Life Trauma
Early-life trauma has a profound and long-lasting effect on a person’s mental health and well-being. During the first years of a child’s life, the brain makes huge and important developmental steps. When these processes are disrupted, it has far-reaching social, emotional, and cognitive consequences that are reflected in altered brain structures.
In one study, almost 90% of people with dissociative identity disorder reported childhood sexual and/or physical abuse. However, only a minority of people who experience early life trauma or disorganised attachment go on to develop dissociation in adulthood.
Dissociation and the Brain
Researchers have found that people with PTSD who experience dissociative symptoms when reminded of a traumatic event show different kinds of brain activity to other people. They found that there was increased activity in the prefrontal cortex (the part of the brain that regulates thoughts, emotions, and actions) but no noticeable activation of the amygdala (the brain region that creates emotional responses like fear and anxiety).
Experts suggest that these patterns may underpin the suppression of a fear response by the pre-frontal cortex, by shutting down intolerable fear or by causing a ‘freeze’ response.
Dissociation and Borderline Personality Disorder
Most studies about dissociation have found that people with borderline personality disorder have more dissociative experiences than any other mental health disorder (except for dissociative disorders).
That said, dissociation is not a necessary part of BPD. Research has found that around ¼-⅓ of people with BPD don’t dissociate.
Dissociation in BPD is linked to co-occurring disorders such as PTSD, as well as more behavioural issues and instances of self-harm. These associations make it all the more important to identify dissociative symptoms among people with BPD and offer effective treatment.
What Causes Dissociation Among People With BPD?
Research suggests that childhood trauma is an important factor in the development of dissociative experiences among people with BPD.
Around 70% of people with borderline personality disorder have experienced some form of childhood trauma. Because trauma and dissociation are so strongly linked, these experiences of trauma may partly explain why dissociative experiences are so common in people with the disorder.
However, aside from childhood trauma, other factors may also make dissociative symptoms more likely.
Various studies have found that dissociation in BPD is also linked to:
- witnessing violence
- disorganised attachment styles
- neglect
- inconsistent treatment by a caregiver
- sexual assault as an adult
These connections suggest that dissociation experiences within borderline personality disorder may sometimes be explained by similar mechanisms to dissociative disorders – namely, past experiences of trauma. But there also seem to be possible causal pathways that are not trauma-related and may be specific to BPD.
Disorganised Attachment Styles and Dissociation
Attachment styles describe relationships between – and perceptions of – the self and others. They describe the way we form and maintain relationships, our trust in other people, and our confidence in ourselves.
Attachment styles can change throughout a lifetime. Close relationships, experiences of hardship or security, and exposure to trauma can all influence and change the way we attach to others.
Young children’s attachment styles are predominately shaped by their relationship with their primary caregiver(s). When a caregiver is attentive and responds to a child’s needs, they usually form secure attachments. They understand themselves as worthy of love, trust in other people, and believe that their caregiver will be there for them if needed.
However, when caregivers do not, or are unable to, meet an infant’s needs, they tend to form insecure attachments. Disorganised attachment is one type of insecure attachment style that is particularly relevant to dissociation and BPD.
Disorganised attachment styles develop when a caregiver is either frightened or frightening. This is common in instances of abuse or when a caregiver themselves has experienced trauma. In these circumstances, the infant faces a dilemma: on the one hand, they feel afraid of their caregiver; on the other hand, they rely on them for safety and security.
These contradictions can cause a young person to develop multiple, incoherent ideas about themselves and their caregiver. It may create a fragmented and unintegrated consciousness that resembles dissociative experiences. Some experts suggest that among certain individuals, these experiences may be sufficient to cause dissociation later in life.
BPD, Emotional Dysregulation, and Dissociation
Emotional dysregulation is a core trait of borderline personality disorder. It’s characterised by strong emotional reactions and difficulties bringing intense emotional states back to more moderate ones. People with emotional dysregulation may be unable to self-soothe in times of distress, creating intense, lasting, and dysphoric experiences.
People with borderline personality disorder usually have a heightened ‘startle response’ compared to other people (a form of emotional dysregulation). However, research has found that those who also experience dissociation may have weaker startle responses, sometimes at the same level as people without BPD.
Some experts have suggested that dissociative experiences like derealisation and depersonalisation may represent an alternative form of emotional dysregulation – a ‘dysregulated’ emotional response to events in someone’s inner or external world. They think that this understanding can help to explain why some people with BPD appear to have ‘normal’ emotional responses according to some measures, even though emotional dysregulation is usually considered a core feature of the disorder.
Recent research shows that dissociation may have negative effects on processing and remembering both positive and negative emotions, including remembering positive social events. This may make it more difficult for people with BPD and dissociative symptoms to build trust in other people. The consequences of this are far-reaching, affecting both interpersonal relationships and the ability to learn from social interactions – often an important foundation of personal growth and recovery.
How Is Dissociation in BPD Treated?
There are several BPD treatments that effectively treat dissociation in people with borderline personality disorder, as well as other BPD symptoms. These include dialectical behavioural therapy, cognitive analytic therapy, and psychodynamic trauma-based therapy.
- Cognitive analytic therapy aims to increase awareness, understanding, and control of dissociated states.
- Dialectical behavioural therapy conceptualises dissociation as an unhelpful behaviour, seeking to identify its triggers and develop positive coping mechanisms for distress.
- Psychodynamic, trauma-based therapy aims to make traumatic memories less distressing.
Other trauma-based techniques, psychoeducation, and skills learning may also improve dissociative symptoms. Some of these include:
- affect regulation, self-soothing, and problem-solving
- social skills and boundaries
- grounding skills
- safety planning
- working through trauma re-enactments
- safe-place imagery
The Wave Clinic – Trauma-Focused Recovery Programs for Young People
The Wave Clinic offers specialist mental health treatment spaces for young people, orientated towards the future. We support young people to discover new life paths, develop invaluable skills, and learn through experiences as they recover from mental health disorders.
We specialise in complex trauma, recognising the way that past experiences continue to affect a young person’s thoughts, feelings, and behaviours as they move towards adulthood. We address symptoms of trauma from the start of our mental health programs, integrating trauma therapy with other treatment approaches.
If you’re interested in finding out more about our programs, get in touch today. We’re here to help.
