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Dissociative Symptoms in PTSD

Dr. Martin speaking with patient

Andrew L. Martin, PsyD

Have you ever been driving down the highway and suddenly thought, “I don’t remember the last few miles! How did I stay on the road!?” More than likely, you were thinking something like, “what am I having for dinner,” or “how did that farmer get so many cows with black spots?” Before you knew it, you came back to consciousness and realize you’ve driven several miles down the road. Most of us have done this, and its good example of mild dissociation.

What is dissociation? Well, dis means ‘not,’ and association means ‘being with.’ In other words, not being with. So, what’s not being with what? In dissociation, we are no longer ‘with’ all of our thoughts, feelings, or senses. In the highway example, we’re still doing everything to stay safe and on the road, even though we’re not consciously aware of our speed, other cars, and staying in our lane.

With posttraumatic stress disorder dissociation, our mind is actively trying to avoid a thought or memory by turning off as much of our conscious awareness as possible. The point is to put distance between us and anything that might make us think about a painful memory, thought, or emotion.

An example I hear frequently goes something like this, “A bunch of us went to a gathering in the house where I was assaulted all those years ago, but even though I was sober, I don’t remember much of went on. My friends told me about stuff we did together, and I don’t remember a lot of it.”

At its worst, dissociation can involve whole separate personalities within one person (Dissociative Identity Disorder), but that is extremely rare. Most dissociation is mild, and comes in two forms:

  1. Feeling detached and as if one were an outside observer of one’s mental process or body (for example, feeling as if one were in a dream; feeling a sense of unreality of self or body, or of time moving slowly).
  2. Feeling of unreality of one’s surroundings (for example, the world around the individual is experienced as unreal, dreamlike, distant, or distorted).

Posttraumatic stress-related dissociation can feel quite strange, but in general is not dangerous. It’s just a sign that we might benefit from working with a therapist to resolve our feelings about past troubling events. Dissociation and other symptoms of posttraumatic stress disorder respond well to appropriate treatment by a qualified mental health professional.

Ref: American Psychiatric Association. (2022). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

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