Mental Health Blogs

Increasing Awareness, Decreasing Dissociation

Dissociation is the process by which we separate ourselves from our experiences, memories, bodies, and very selves. When we’re dissociating, we’re disengaged from some or all of our own reality. It’s not inherently a bad thing; I truly believe dissociation serves a valuable purpose, and not just in traumatic circumstances. But there’s no doubt that the chronic, severe dissociation intrinsic to Dissociative Identity Disorder is problematic, disruptive, even at times actively destructive. By increasing awareness, by being more fully present in our bodies and minds, we can mitigate the damaging effects of dissociation.

sapere-aude-croppedDecreasing Dissociation Is a Natural Byproduct of Increasing Awareness

I used to approach decreasing dissociation by actively trying not to dissociate. To quote The Sound of Music, that’s like trying to keep a wave upon the sand for those of us with Dissociative Identity Disorder. In fact, I now believe that trying not to do something – whether it be dissociating, binging on food or alcohol, getting angry, self-injuring, etc. – is rarely effective. Resistance, as they say, is futile. At first this realization left me feeling defeated and at the mercy of my disorder. Then I discovered that, merely by focusing on increasing awareness, I could decrease my dissociation without fighting it. While increasing awareness does require some effort, dissociation decreases naturally as a result of mindfulness.

If one is tense, one simply observes one’s tension. You will never understand yourself if you seek to change yourself. The harder you try to change yourself the worse it gets. You are called upon to be aware. – Awareness, by Anthony de Mello

Simple Ways of Increasing Awareness

Mindfulness doesn’t appear to come naturally to anyone, whether they have Dissociative Identity Disorder or not. Increasing awareness therefore does require some effort. When I engage in the following activities regularly, I see a marked increase in self-awareness, a more profound connection with my system, and a decrease in dissociation:

  • Exercise – Moving my body, particularly when I’m not distracted by anything else, calls my attention to my breathing, the feeling of my muscles contracting and expanding, the thump of my heartbeat. Exercise brings me into my body and the present moment.
  • Subjective Units of Distress Scale (SUDS) – Anxiety, pain, depression, dissociation – pick something that you struggle with, take a few minutes out of every hour (give or take), and rate its severity at that moment on a scale from 0 to 10. Without even trying, you’ll begin to notice patterns.
  • Physical/Emotional Check – I learned this one in an inpatient program. About every waking hour, I ask myself for a one word description of how I’m feeling physically and emotionally. (Fine and okay are not acceptable answers.) This simple task creates a connection with my body and mind.

Increasing Awareness Helps Ease the Symptoms of Dissociative Identity Disorder

It sounds elementary, I know. But that’s the beauty of it. Rather than wasting energy fighting dissociation, we can decrease its severity simply by increasing awareness. Give it 90 days. If you don’t find that the symptoms of Dissociative Identity Disorder are less intrusive and more manageable I’ll be surprised.

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12 Responses to Increasing Awareness, Decreasing Dissociation

  1. dogwatcher says:

    thank you for this, it is very helpful!

  2. Holly Gray says:

    Thanks for reading! And the feedback is the cherry on top. :)

  3. Laurie says:

    Holly,

    All of those strategies have worked for me as part of a bigger process.

    It wasn’t until I learned how it feels when I’m dissociating that I saw much progress. So for example, I began learning early into my treatment that there were some physical changes or responses that took place when I dissociated. The first thing I noticed was that my vision changed when I dissociated. When different parts switched in and out of control, my ability to see with my glasses changed. Some of my parts needed my bifocals for reading, some needed them for distance vision and some needed no glasses at all! The therapist is very body focused in her orientation and she encouraged me to identify how my body felt, to pay attention to changes in physical experiences such as pains, vision, headaches, coordination, awareness that things should burn or be cold or hurt but they weren’t, changes in my posture – one part sits tall, the younger parts slouch when seated, one vibrates one leg when seated – you get the picture. Once I learned to be aware (and stopped fighting being aware) of these subtle changes I became more aware of the dissociation. At the time I had no idea what part owned which physical characteristics. I learned something triggered the part that was out to either step back or be forced back.

    The next challenge was to figure out what the trigger was that caused the switch.

    So for example, I could be interacting with my colleagues at work and suddenly I’d have trouble visually focusing on the person I was speaking to. The first challenge was to recognize the vision had changed then the next was to try and sort out what was going on that caused the dissociation and switching.

    At first it was slow methodical work. Often times I’d write what took place in detail in my journal and then the therapist and I would talk about the experience to try and understand what the trigger was. Understanding the trigger helped me to learn more about the parts, helping me to hear them and listen to their issues. As I learned to listen to their issues, the therapist, I, and the system worked to resolve some of those issues – that’s the hard part.

    I’m well into the process and still have a few parts – hard core parts – that continue to need chipping away at their issues. These parts will cause me to loose time, feel sick, make me essentially dysfunctional when they feel threatened or feel the system is threatened. When that happens I’ve become better at CHOOSING to dissociate and place a part, that’s better suited to a situation, in place to control things until a more appropriate time to deal with the upset part is available. Initially this kind of choosing took a lot of negotiating with all parts to facilitate the change. Sometimes I still need to be reminded by the therapist to do these things.

    All of the things you mention are part of this process. For me focusing on how dissociation feels, what part owns the various feelings and characteristics, and what triggered the part to be active seems to have facilitated the healing process.

  4. Sherry says:

    Hi Holly,

    It has been a long time since I responded to your blog …July 22,2010. Not that I have not been following, but with moving to a new location (closer to my daughter’s treatment providers; and away from a lot of “negatives”), it has been very busy and not just lots of transitioning for my daughter with DID, but for all us!

    As a single mom with an adopted teenage daughter diagnosed with DID and PTSD from prior adoption abuse; I spend much time studying/analizing information, observing my daughter through dissociations, and just plain supporting her through the ups and downs of her healing. I have quite a few years of visual and auditory proof in supporting the knowledge that “awareness” is key; not force to decreasing dissociation. I use the word “force”, as this is what the related feeling can be when pressured to do or comply to something we feel is wrong, we are unsure about, or lacking knowledge about.

    I have watched the results after listening to what should be great therapists, try to force my daughter’s dissociative episodes to stop while in their office. I have seen my daughter suffer the aftermath of full blown episodes (remember she has high level PSTD), with what I believe is from lack of educating her throughly with awareness and chosing to use force instead. I truely believe if therapists would educate their patients with more awarenes; (and this needs to be done on an educational level that suits all ages; as parts can be very young, thus incapable of absorbing to much “talk’) they would not only build the trust they are so striving for, but also better support their patient’s healing.

    My daughter now uses “Logosynthesis” treatment which really helps her to focus and become aware of her reactions to feelings and their triggers. Through this treatment a way to release the negative energy and gain back the positive is carried out . To gain control of “self” is attained by becomingmore aware. This therapist, though she may not be a “specialist” with treating DID, has been involved with my daughter’s treatment since initial inpatient stays starting 4 years ago. She has always worked with encouraging awareness; never force. In addition to this treatment she is also seen regularly by her long time psychiatrist monthly.

    Since taking this journey of self awareness without force; my daughter is now back in a small private school (I homeschooled with her through the highly unstable years)and getting on with a life that had seen her prior teen years controlled by her past. I am proud of my daughter and her decision, at eighteen, that after becoming aware herself she was feeling forced with her main therapist and unsafe, to end these sessions. Although this scared me for what would happen; it was more important to support her decision and her feelings. This was not a quick decision; but one given much consideration and discussion. But one thing I knew was as an experienced mother a lot more responsibility is claimed if the child is aware of “why” and “what” they are suppose to be responsible for.

    In closing I would like to add this quote that I love … “All things in nature are accomplished, but nothing is forced”. Force is what brought on DID in the first place … how could anyone think it could help it heal?
    Sherry

  5. Laurie says:

    Sherry

    You make such a great point about force with respect to working with DID! I have progressed in leaps and bounds since the therapist I was working with recognized that any request she made of me (or any parts in my system) was perceived as something I must respond to or do as she suggested. In terror parts of my system would attempt to tell her what she asked or do what she suggested until she realized that I was unable to say no – none of my parts could say no I can’t say that or do that. Now she reminds me when there is any sign of distress or switching/dissociating and she points out what she just saw as she reminds me that it’s okay if we don’t answer her question or can’t talk about something or do something. Each time she tried to get us to dig a little deeper we had a PTSD-like reaction because we were terrified to refuse anything she asked of us.

    Often times we might not talk directly to the issue raised in a session but after thought and internal discussion we were able to write about the issue and subsequently talk about it with the therapist after she had read what we had written. Taking the pressure off removed the automatic stress reaction- usually dissociation – that made it difficult to move toward an understanding of more distressing material.

    So while it was my perception that I was being “forced” to respond it was not the therapist’s intention. When we began to discuss this more openly it became easier for the parts inside to refuse to answer something without fear of reprimand or negative impact on the relationship – we were terrified she’d decide she was done with us and we’d be left to solve this puzzle on our own (therapists with DID experience are hard to come by). Your points about force are good ones! Thanks!

  6. Sherry says:

    Laurie,

    Thanks Laurie for your reply and input from your own experiences with feeling forced during therapy sessions. In my daughter’s case she was able,while inpatient resulting from these feelings, to email her outpatient therapist; twice, however, the emails were not mentioned. Emailing thoughts were acceptable in prior sessions, but for some reason it was not worked with at this very unstable time. Unfortunate to say the least. Another trust broken … trust which is so hard to establish. In the therapist defence; our children’s hospital does not allow outpatient therapist whom are not on their staff list to come on the inpatient unit to work therapy sessions. For effects sake I’ll let you know I’m clenching my teeth here! Is that normal in the treatment you or anyone else is receiving in hospital? T

    I’m going to take this opportunity to ask for support, from those working through and with DID, on the fact that my daughter is going to be turning 19. What this means, here in Nova Scotia, Canada, is that she will be entering the adult mental health system. She will now be changing her long term psychiatrsit from our children’s hospital and transitioning to a new one in adult care. This may be good, as our children’s hospital is not experienced in dealing with DID teens. Actually, this is probably true across the board! She will be keeping her Logosynthesis therapist, and long term stable. I am concerned however with this transition; as I know my daughter is also. Transition is hard.

    I would love to be able to sit down with a group discussion! But thank God for people like our Holly who is so devoted to this blog; creating awareness! I can see there are not a lot of mom’s with DID kids diagnosed. Addictions can mask this disorder in teens, plus they can be tossed from foster home to foster home without the proper advocating. Addictions were not and are not an issue with my daughter; plus she has been with me since I adopted her at age of four. She was one of the fortunate to be diagnosed and receive treatment. The treament road has been very rough – inpatient being the place most without knowledable. This has been very tough, but with strong advocating mom’s we can make little steps towards changing the treatment available and the stigma within the mental health system itself for our children and in the future for everyone!

    Sherry

  7. Holly Gray says:

    Hi Laurie,

    I like what you said about focusing on physical changes. But I will say that I think a lot of people may have a more difficult time with that if they’re thinking of it as, ‘I’m attempting to notice what dissociation feels like.’ That’s why I recommended these three simple things … doing these things raises awareness without the pressure of trying to notice dissociation. They are, I believe, an excellent starting point and solid, basic tools we can continue to use as the pressure wears off and it doesn’t create as much anxiety to actively try to notice dissociation.

  8. Holly Gray says:

    Hi Sherry,

    I love that quote! Thanks so much for sharing it.

    The Logosynthesis treatment sounds very interesting. I’m glad it’s helping your daughter. If the aim is to gently increase awareness I can see why it works for her.

    “I truely believe if therapists would educate their patients with more awarenes; (and this needs to be done on an educational level that suits all ages; as parts can be very young, thus incapable of absorbing to much “talk’) they would not only build the trust they are so striving for, but also better support their patient’s healing.”

    I agree.

    “Force is what brought on DID in the first place … how could anyone think it could help it heal?”

    That is an excellent point and one I suspect more DID therapists should consider.

    Thanks for sharing your personal experience with your daughter’s treatment and how awareness, not force, has been instrumental in her progress. Your story is a great example of why I believe the way to decrease dissociation is to focus on awareness, not dissociation.

  9. Holly Gray says:

    Hi Sherry,

    “Is that normal in the treatment you or anyone else is receiving in hospital?”

    My guess is that it varies. In my very limited experience, general behavioral psych wards have no problem with outside therapists coming onto the inpatient unit. A specific inpatient program however might approach it differently.

    I hope that your daughter’s transition into adulthood and the adult mental health system is smooth and positive for both of you. Change can be difficult and I hope this one brings more healing, rather than less help. :)

  10. Rick says:

    Hi as a male with 8 alters 6 which are female life can really be out of balance.I have been in and out of therepy for 30yrs.Diagnosed in my early teens.Have come along ways but feel like im really against a wall now and really frustrated.I can not open up to anyone other than my wife who I know is loosing paitence and I cant blame her for that.It is really tough on us and our kids.Just when things seem to be getting better it cmes to a halt.Like falling into a deep dark hole with no ladder or rope to climb out.

  11. Sarah says:

    Thanks Holly. You are a very clear and concise writer. I have been able to quickly figure out that I experience dissociative amnesia when I am anxious, I am probably not DID, and increased mindfulness practice should help. Best wishes to you and your community here.

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