Dissociation and Depression: An Unholy Matrimony

March 7, 2011 Holly Gray

While not everyone with Dissociative Identity Disorder also has a diagnosable depressive disorder, I’d wager at least 50% live regularly with some type of depression. As for me, I have Major Depression and Dysthymia. The former is a real pain; the latter is far more manageable. I’ve never taken either one very seriously and I think the magnetic relationship between dissociation and depression is the primary reason why.

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Dissociation and Depression Exacerbate Each Other

Dissociation is the process by which we move things – thoughts, feelings, information – out of conscious awareness. It’s essentially a form of self-hypnosis and those of us with Dissociative Identity Disorder are experts at it. What that means when it comes to depression is that we're capable of recognizing that we’re hurting, but may fail to do anything about it because we're constantly separating ourselves from that very reality. In other words, depression triggers dissociative coping, and dissociative coping allows depression to gain momentum. And it’s not just that dissociation and depression exacerbate each other. They're like dysfunctional soulmates, coming together in unholy matrimony.

Dissociation and Depression Work in Tandem

Depression does all kinds of nasty things to my mind. It warps my perspective and makes even the simplest of tasks seem utterly insurmountable. It saps me of energy, motivation, even interest. It makes me believe I cannot cope. And that, my friends, is where dissociation and depression dovetail.

The habitual use of dissociation ... as a defense is based not only on perceived threats, but also on an individual’s perceived ability to cope. Consequently, as your stress level rises, due to present circumstances or triggers related to past trauma, the key issue becomes whether you believe that you have the resources available that will allow you to cope. – The Dissociative Identity Disorder Sourcebook, by Deborah Haddock

Dissociation and depression are perfectly suited for each other - the former specializes in carrying you when you cannot cope, and the latter specializes in convincing you of your inability to cope. It's a match made in mental illness heaven and, if you have Dissociative Identity Disorder, a difficult partnership to dissolve.

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Dissolving the Relationship between Dissociation and Depression

Picture dissociation and depression as the angel and demon on each shoulder, only let’s make them both demons for the sake of this discussion. Depression whispers, “Oh no, you can’t possibly do all that laundry. Let’s face it, you don’t care if your clothes are dirty anyway.” Dissociation whispers from the other shoulder, “It’s okay. The laundry doesn’t even exist. You don’t exist. Relax.” The laundry pile gets bigger, becomes even more difficult to deal with, depression deepens, dissociation numbs, and so on. It's difficult to recognize the voice of depression before dissociation casts it's spell, but I suspect if I could do that I might be able to remember that I'm depressed long enough to do something about it. Living with Dissociative Identity Disorder is challenging enough without the toxic relationship between dissociation and depression making things worse.

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APA Reference
Gray, H. (2011, March 7). Dissociation and Depression: An Unholy Matrimony, HealthyPlace. Retrieved on 2024, July 14 from

Author: Holly Gray

December, 25 2015 at 4:48 pm

I have been diagnosed for only a year and I have been on an anti-depressant for 5 years. I finally found one that works for me and really helps. I still have times of crying (or another identity crying) but I don't have days of depression. (In the past I have had not only weeks or months of depression but also years) It has really helped me to be able to identify my emotions and trace back what may be causing the upset.

December, 19 2015 at 4:36 am

I was diagnosed with DID 2 year ago. So many things I my life made sense to me and I started understanding my ongoing depression . I was misdiagnosed for so many years. I stopped seeing my therapist after 6 months. Could not afford it anymore and the sessions catapulted me into even more chaos, I was barely able to function as my alters would share with my therapist leaving me with flashbacks and my family having to deal with depressed and angry alters. I consulted with a psychiatrist this week as I need help to manage my depression and she is thinking of prescribing something for depression. I am not sure if the anti-depressants will have the same affect on every individual that suffers from depression though and I am wondering if anyone can share their experience with taking anti-depressants.

Alice Burrows
October, 14 2015 at 10:01 pm

I know this is an old post. But, it's been very helpful. I suspect that I have DID in the past I have laughed at that possibility because it couldn't possibly be true. I don't have alters with different names unless you count my online life. But, now it turns out I have a whole year that I don't remember being at home. I remember work but only have a few memories of what I did after I got home. Furthermore, it wasn't just this one year, there have been several years where this is the case. I don't remember living in one apartment for example. I know I was there and I remember work and doing things outside of that apartment. To this day I can't remember a single thing while in that apartment like if we even had a television or not. I don't remember any meals there or what we did for the holidays.
I have only just gotten a diagnosis of major depression the kind that is atypical but I don't remember the exact name of that the therapist is using. I have never thought of myself as depressed. Unmotivated at times sure. But, it's taken on a life of it's own since 2007 and I am unable to do most things that I had no problem with before that like household chores, going to work, and hanging out with my children. I don't "think" depressed like telling myself bad things. But, then maybe I have alters doing that that I can't hear, but keep me from having the energy to do what I need and want to do.
I hope this makes some sense. I am very new to this idea that I am depressed. I just found out in September about the fact I lived in a house that I don't remember living in. I gave it as the my living address when I went to a doctor for a sore throat, so I am sure I lived there.

May, 16 2013 at 9:33 pm

I've only just started to have problems with dissociation. I have a diagnosed case of MDD, but just over the last week, I'll have episodes in which I will literally sit somewhere and feel as though I am not real and cannot move. It's like instead of piloting my body, my consciousness is just floating and questioning the existence of everything. I begin to feel drunk even though I haven't been drinking. It's getting to be a real problem. It's good to know that depression and dissociation go hand-in-hand

April, 25 2013 at 2:24 pm

Thank you, Holly for this. I NEEDED to read this tonight.

Mark Freyer
February, 18 2013 at 4:07 pm

I understand all of these posts and I ackowledge that I have some type of disassociative depression issue. I also suffer from panic attacks. I have been in therapy before and I just stopped again. I see no way out of this.

September, 8 2011 at 10:24 am

I just got home from a doc appt. I told him I don't really feel depressed because I can do just about all I am supposed to do. I just feel like a zombe or robot as I go along my way. I don't feel happy when I know I should. I don't cry when I probably could use to. I have HORRIBLE memory problems. I didn't know how to get to my therapy room after break one day. I forgot where I needed to go when I was in the car last week. It did come to me but it took great energy to THINK. My doctor says it is the depression and I must be disassociating. I freaked out on my way home because the word disassociating sounds so horrible. I just got online and found this thread about this topic. I can't believe others have felt the same and have gone through the same things. I am starting to calm down now from my doctor appointment now. I really thought he was just telling me something to keep me quiet. Now I know what I am experiencing is real. Thank you to everyone who has shared. You have no idea how helpful you have been and how much hope I just got.

In reply to by Anonymous (not verified)

Holly Gray
September, 12 2011 at 9:28 am

Allison - I am so glad the dialogue here was helpful. It's totally feasible that your psyche would employ dissociative processes to help you function while in such a deep depression. That's absolutely what dissociation is designed to do. It can be enormously frustrating, I know. Hopefully, you'll experience some relief from the depression soon. And that, in turn, should ease the dissociation.
It's great to see your comment, thanks so much for sharing it with us all. :)

July, 15 2011 at 5:17 pm

Try telling yourself that you don't want to wear dirty laundry because you are an adoult and will take care of yourself and other voices should stop telling you otherwise because nobody has to change my/your diaper any more. That is why I need to do my laundary and not neglect myself and it. Nobody else is going to do it. Just a little self talk to those voices.

July, 15 2011 at 5:10 pm

I'm reallizing some kind of issue with this DID problem and one thing that was very helpfull, and started by a counceler long ago, was to ask myself what am I feeling, "to get in contact with everything that was going on and why I was, was, well, out of my head at a particular time. It would take me quite a while at first to answer or just forget about it, but I kept on at it and improved over the years. It's still a bit of a sneaky thing. I had to confess to my new councilor that starting councilling triggers my organizational skills to kerflop but I should be ok soon. Try telling yo

May, 2 2011 at 1:12 am

I’ve been here a few times and it seems like your articles get much more informative each time. Maintain it up I enjoy reading them.

Dr Musli Ferati
March, 17 2011 at 8:37 am

Mental disorders, usually, in real life coexist as comorbid psychiatric entities. Your original case report, Ms Gray, confirms this ascertainment, which often in clinical workout remains neglected. In other side, your comparison of Dissociative Identity Disorder (DID) and Depression as an unholy matrimony notes an impressionable mental self-experience. Although in common psychiatric service depression is secondary complication of any psychic disease, this authentic description indicates the opposite possibility. And this is fact that should accepted as useful guideline to handle psychiatric patients. At the same time, we ought to convince that in medicine there are only sick people and not diseases. The best lesson for that conclusion are wording of illness fellows.

March, 16 2011 at 9:11 am

"I just wanted to offer that thought as it’s a distinction that has helped me to see my coping in a less judgmental way."
Thank you, Holly. What you said is actually very helpful to me. I hadn't considered dissociative coping vs. denial. I am pretty sure I can see where I do a bit of both. When I see glimpses, or have a vague awareness of my depression, but continue to go about my days distracting myself as if nothing is wrong... that probably is dissociative coping. Makes sense. When I am sitting in front of my therapist knowing full well that I am depressed, and I tell her I'm doing fine, I think I may be denying. When I do the latter, I rationalize it in my own head by telling myself that so many people have it much worse than I do, so I don't count....or I don't matter. Just my thinking that sort of speaks for the depression itself, I suppose.
"It’s so innate, so instinctual, that is isn’t even a matter of choice for the most part." very true! And because it's so instinctual, it's difficult to recognize when we're doing it. It can be very confusing, and very difficult to untangle. As far as being judgmental, I do acknowledge that I judge myself harshly, so explaining dissociative coping might help me be a little easier on myself. It will definitely help me to try to be more aware of what's really going on with me, and awareness is certainly something to strive for. :)

In reply to by Anonymous (not verified)

Holly Gray
March, 16 2011 at 9:18 am

Hi Mareeya,
And now I thank YOU! Your example illuminating the distinction between dissociative coping and denial is very helpful for me. Both denial and dissociative coping can be so difficult to recognize. But the way you described both helps clarify the difference between the two.
"When I see glimpses, or have a vague awareness of my depression, but continue to go about my days distracting myself as if nothing is wrong… that probably is dissociative coping. Makes sense. When I am sitting in front of my therapist knowing full well that I am depressed, and I tell her I’m doing fine, I think I may be denying. When I do the latter, I rationalize it in my own head by telling myself that so many people have it much worse than I do, so I don’t count….or I don’t matter."
Ah yes, I do know the "other people have it worse, I've no right to complain" thing for myself as well. Of course, if you asked my partner I'm sure she'd tell you I do just fine in the complaining department. ;)
Awareness sure is something to strive for. I'm taking my own advice and re-dedicating myself to the tools that have been so helpful for me in increasing awareness. Hopefully in the coming months it will pay off.

March, 13 2011 at 10:45 pm

My depression confuses most mental health professionals that I've encountered... I have a diagnosis of Dysthymia, but most mental health professionals don't get how I can be so suicidal, yet still go to work, shower and keep up the appearance of coping. I've been tried on nearly all of the anti-depressants, and haven't found one that has worked - prompting the psychiatrists to say that I might have something that looks like depression, but actually isn't. They didn't suggest what else it might be, but then I think I zoned out after that brilliant insight.
I know my dissociation effects my depression and vice versa... I've forgotten what it's like to live without suicidal ideation.
Hi jc, for me the way to minimise the conflicts are to increase the levels of communication - easier said than done, I know.
Take care,

March, 12 2011 at 7:40 am

I so agree with all that has been posted...but I have a parts are opposite on everything and I acnt get them to agree or find middle of I "float" thru days to avoid my inner conflict...Is there any way that makes these parts more agreeable to each other?

In reply to by Anonymous (not verified)

Holly Gray
March, 16 2011 at 7:41 am

Hi jc,
This inner conflict is one of the more frustrating realities of life with Dissociative Identity Disorder. I'd be interested in hearing how others respond to your question but for my part, the answer is empathy and gratitude. Negotiating with alters, in my personal experience mind you, always boils down to genuinely understanding where they are coming from. I don't believe much will change if I cannot empathize and find appreciation for how an alter's behavior is benefiting me. So I think if I were in your shoes, I'd ask myself, "How does this pervasive inner conflict serve me? What is it protecting me from?" You mentioned that you float through your days to avoid the conflict. Perhaps floating through your days is cushioning you from the discomfort of daily life? Keep in mind these are just my immediate thoughts and may not reflect your situation at all.
Working through DID means increasing awareness and moving towards a more cohesive sense of self. So your awareness of the inner conflict and of your dissociative response to it is positive. You're aware of a dynamic that happens within your self-system. You may find that you don't have to try to get parts to agree if you continue to focus on increasing awareness in general.

March, 11 2011 at 8:23 am

Except...I obviously don't learn how to type....hence the typos throughout my reply. Lol. :) I should know how to type, because it's like my job all day long!

March, 11 2011 at 5:49 am

Love the title of this post. So clever, and so very true! And also something that I think takes place within my system pretty much all the time.
When it comes to my mental health, I have a really bad habit of denying, and avoiding which means my emotional laundry pile is growing enormously with each day that goes by. When my therapist mentions any sort of treatment for depression, I tend to minimalize it, and then dismiss her suggestions.
"What that means when it comes to depression is that we’re capable of recognizing that we’re hurting, but may fail to do anything about it because we’re constantly separating ourselves from that very reality."
That's exactly it!! Like right now, I know I'm in a downward spiral. I've seen glimpses of this downward spiral all week, but I separate myself from it. It really does seem as though someone else is feeling the depression, but I'm watching it from the outside, and choosing to ignore it. What happens next is that I will frantically grasp for any kind of distraction I can find. It's great for a quick fix, but I that is just what it is....a quick fix.
Even as I write this, and acknowledge that I'm spiraling, I'm denying it at the same time. It's pretty confusing. I often tell my therapist that it feels like a war inside my head.
I also was confused by the whole "we" and "us" thing. I usually refer to all my parts as "I". I do that even when I feel more than one part present at the same time. I think I confuse my therapist when I do that because I can be talking about totally different perspectives on a subject, and still be saying "I" throughout the entire conversation. I try now to correct myself by saying "I feel this", and then saying "this part of me feels that".
Laurie, I like the light that you shed on this subject. It really makes sense, and give me more food for thought. I always learn so much when I come here.
Until I read this, I never thought about the relationship that Dissociation has with Depression. This really explains a lot about what goes on with me.

In reply to by Anonymous (not verified)

Holly Gray
March, 16 2011 at 7:17 am

Hi Mareeya,
Thanks for your comment.
"When it comes to my mental health, I have a really bad habit of denying, and avoiding which means my emotional laundry pile is growing enormously with each day that goes by."
You are the expert on you, but I do want to mention something that may - or may not - resonate for you. And that is that sometimes what we think of as denial, a refusal to accept things as they are, is really dissociative coping. I see how that can sound like splitting hairs ... after all, separating oneself from one's reality is, in effect, denying its existence. But the connotations of the word "denial" sometimes don't with how dissociation works in people with Dissociative Identity Disorder. If someone has DID, their primary coping mechanism is dissociation. It's so innate, so instinctual, that is isn't even a matter of choice for the most part. So, for instance, if I feel uncomfortable enough, my brain will move whatever is causing me discomfort - including awareness of the discomfort! - out of my conscious mind without me ever recognizing that that's what's happening. It isn't that I am choosing to ignore my depression, it's that I'm quite genuinely unaware of it.
Which isn't to say those of us with DID can't get into denial. We can and do, no doubt about it. I just wanted to offer that thought as it's a distinction that has helped me to see my coping in a less judgmental way. (To be clear, I'm not suggesting you're being judgmental ... I simply mean that when I say I'm in denial, I'm being judgmental.)
I don't think I ever considered the relationship between depression and dissociation before either. It really has helped to think about it.

March, 7 2011 at 6:12 pm

You know Holly you really are good at analyzing your experience and describing it!
I think the relationship between depression and dissociation is, as you point out, closely related. Your evaluation of the dynamic between the two is interesting. I have experienced that the two go hand in hand. I’ve read that along with the depression is the constant hue of suicidal ideation – in part my experience would support that. What I’ve learned is, as each of my parts has addressed their unique concerns, the generalized depression has lessened and I’ve become aware of non-depressed experiences. There continues to be a hue of suicidal ideation that comes and goes in strength and depression continues to present itself. What I have noticed, however, is that as each part heals I experience increasing unusual experiences of feeling contented and without depression on some levels while at the same time hear this voice that says “I want to die, can’t I just die?” There’s a black cloud of depression underlying life’s experiences while at the same time a perception of everything being okay in the world.
You say “It’s difficult to recognize the voice of depression before dissociation casts it’s spell, but I suspect if I could do that I might be able to remember that I’m depressed long enough to do something about it.” It could be that a depressed part or alter does not want you to remember long enough to do something about it. It could also be, as I experienced it early in my treatment, that many parts or alters are depressed and until some begin to heal their issues the depression and dissociation will continue to dance and be illusive.
It becomes easier to recognize and work with more severely depressed parts as the individual parts heal. There really is an unusual feeling of lightness and weight at the same time because separate parts experience the world differently. Better than all of me being depressed but strange, very strange until I understood what was going on. When I first experienced this, and finally shared it with the therapist, she was able to help me sort out which parts were struggling with depression and which were feeling better about life.
Hope this adds a further explanation of your experience and maybe hope that in time it will become less illusive.

In reply to by Anonymous (not verified)

Holly Gray
March, 10 2011 at 4:05 pm

Hi Laurie,
Thanks so much for sharing on this topic. You bring up some important points:
"It could be that a depressed part or alter does not want you to remember long enough to do something about it."
There are often so many layers aren't there? Many dynamics coming together at once. And I'm glad you brought up this one - that parts may be experiencing a depression that affects the rest of the system; and, in fact, may actively be preventing anyone from doing anything about it. I think it shows in my writing that checking in with my system - asking inside, as they say often say - is not my strong suit. Despite the fact that I talk about DID day in and day out, I sort of forget that I am a member of a system. (Which could also be, come to think of it, due to parts not wanting my awareness of that fact.) I operate from a very "I" place. It's funny ... I remember all the talk about "we" and "us" really throwing me for a loop when I was first diagnosed. I definitely do not think of myself as "we." I think of myself as "I" and other members of my system as "they." Anyway, that's a tangent. ;)
"It becomes easier to recognize and work with more severely depressed parts as the individual parts heal."
That makes a lot of sense. And it's great to hear. Gives me hope!

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