What are dissociation and depersonalisation?
Possibly the most common question we get asked when we explain what we do at the Midlands Dissociation & Depersonalisation Centre (MDDC) is “but what exactly is dissociation?”
You could be forgiven for thinking that as experts in this area, we have an easy answer… However, as Paul Dell wrote in 2009, unfortunately, the definition of dissociation ‘has never suffered from clarity’.
There are many different definitions, opinions, and theories about dissociation and how best to explain it. To make matters more confusing, scientific writers often use these explanations interchangeably, just referring to them all as ‘dissociation’.
The dissociation “umbrella”
At MDDC, we think about dissociation being an ‘umbrella’ term. This means we see it as a broad category, under which many specific ‘subtypes’ of dissociation can be found. An analogy would be talking about “vehicles” as a broad category, with different “subtypes” of vehicle, like van, bus, car, etc. falling under this umbrella term.
Most clinicians, researchers, and writers agree that what all of these subtypes have in common (for dissociation, not vehicles) is that the person experiencing it describes feeling - or visually displays - some form of disconnection from parts of themselves or the world around them.
In some forms (subtypes) of dissociation, this can be feeling detached from the world around you - like being trapped in an invisible bubble. In others, it might be a disconnection from a part of your memory, so that it feels unfamiliar or may even be completely missing (also known as amnesia).
Whilst this is certainly true, at MDDC, we also think about a sense of “strangeness” or “oddness” being another common theme amongst many of the subtypes under the dissociation umbrella. By this, we mean experiences that are incredibly hard to put into words, and can make your body, mind, emotions, and the world around you seem unreal, unfamiliar, disconnected, or outside of your voluntary control.
Dissociative disorders
As psychologists, we are interested in understanding your experiences as they are. This means that we do not need to try and diagnose, and can work with you without perhaps ever using a specific diagnostic label. Instead, we identify the problem(s) you want to solve, and work together to consider what is keeping them “stuck” so that we can “unstick” them. However, some people may be curious about possible diagnostic labels, so to give an idea of the “dissociative disorders” that exist in medical textbooks, these include:
Depersonalisation Disorder (sometimes called Depersonalisation-Derealisation Disorder): distressing and impairing levels of depersonalisation and/or derealisation, but the person is able to understand that these are subjective experiences. Experiences are not better explained by substance use, or another medical or mental diagnosis.
Dissociative Identity Disorder: distressing and impairing disruption in identity resulting in distinct self-states and clinically significant memory difficulties that are not an accepted part of the person’s religious or cultural context and cannot be better explained by substance use, or another medical or mental diagnosis.
Dissociative Amnesia: distressing and impairing difficulties recalling important information about yourself that cannot be better explained by substance use, or another medical or mental diagnosis.
Other Specified Dissociative Disorder: distressing and impairing difficulties very similar to those detailed in other diagnoses above, but which do not meet their full criteria.
Depersonalisation
Unsurprisingly, given our name, a specific subtype of dissociation that we focus on a lot at MDDC is “depersonalisation”. This kind of dissociation describes feeling disconnected from yourself - including your thoughts, emotions, actions, and/or body. The disconnection may be a feeling of oddness, strangeness, detachment, or a sense that that part of yourself is somehow “unreal” or unfamiliar.
These experiences can vary a lot between people. One person with depersonalisation might feel like a stranger to themselves, and not recognise themselves in the mirror. Someone else may know their hands are their own, but experience them as moving without their conscious control.
Depersonalisation can come on suddenly or gradually, and last a short time (acute) or for a longer time (chronic). In short, everyone’s experience is different. Which is why we treat everyone who comes into therapy with us as an individual with their own unique experiences.
An excellent resource for anyone struggling with depersonalisation, or who has been diagnosed with depersonalisation disorder (DPD), is the UK charity for DPD: Unreal.
Derealisation
“Derealisation” is a term often used to describe similar sensations as depersonalisation, but in relation to the world or people around you. For example, the world around you seeming flat and two-dimensional, or other people seeming unfamiliar.
Derealisation experiences typically accompany depersonalisation - meaning you’re probably more likely to experience them together, rather than separately. This is why you may see people refer to “depersonalisation-derealisation” (or “DPDR”) (including in using the term depersonalisation-derealisation disorder interchangeably with DPD).
In short, dissociation and depersonalisation are confusing, highly personal, and difficult to describe experiences. At the MDDC, we help people to make sense of how they are feeling without judging - no matter how strange people worry things may sound! As experts in this area, we understand what it is like to live life ‘in a bubble’, and are committed to helping people break free.
The Midlands Dissociation & Depersonalisation Centre offers support for people with dissociation, their loved ones, & their clinicians. Dr Emma Černis is a qualified and HCPC-registered Clinical Psychologist with over a decade of research and clinical experience in dissociation and depersonalisation.
