Clinical dissociative symptoms are disruptions in the normal integration of consciousness, memory, identity, emotion, perception, body awareness, or behavior. They go beyond ordinary “spacing out” and are typically distressing, impairing, or trauma-related.
I will outline both descriptively and diagnostically.
Core Clinical Dissociative Symptoms
1. Depersonalization
A sense of detachment from oneself.
- Feeling like an outside observer of your own thoughts or body
- “I feel unreal” or robotic
- Emotional numbing
- Altered body perception
Seen prominently in Depersonalization/Derealization Disorder.
2. Derealization
Detachment from the external world.
- Surroundings feel dreamlike or artificial
- Visual distortions (foggy, flat, overly vivid)
- Time distortion
Often co-occurs with depersonalization.
3. Dissociative Amnesia
Inability to recall important autobiographical information (usually trauma-related).
- Memory gaps for specific events
- “Lost time”
- Sudden unexplained travel (fugue state)
Associated with Dissociative Amnesia and, in extreme form, dissociative fugue.
4. Identity Disturbance / Identity Fragmentation
Disruption in sense of self.
- Feeling like different parts of self take control
- Internal voices (not psychotic in origin)
- Shifts in behavior, affect, skills
Most pronounced in Dissociative Identity Disorder.
5. Dissociative Numbing
Emotional shutdown or anesthesia.
- Reduced emotional reactivity
- Detachment during trauma reminders
- Often part of trauma-spectrum disorders
Common in Post-Traumatic Stress Disorder (especially the dissociative subtype).
6. Absorption / Trance States
Extreme attentional narrowing.
- Losing awareness of surroundings
- “Autopilot” functioning
- Hypnotic-like states
Mild forms are normative; clinical when frequent and impairing.
Clinical Clusters
Dissociation typically falls into three functional domains:
| Domain | Symptoms |
|---|---|
| Detachment | Depersonalization, derealization, numbing |
| Compartmentalization | Amnesia, identity fragmentation |
| Altered Consciousness | Trance states, time distortion |
Differential Considerations
Dissociative symptoms must be differentiated from:
- Psychotic disorders (loss of reality testing)
- Neurological conditions (e.g., temporal lobe epilepsy)
- Substance-induced states
- Severe anxiety or panic states
- Personality disorders (e.g., borderline-level identity disturbance)
Unlike psychosis, dissociation typically preserves reality testing.
Trauma Link
Clinically significant dissociation is strongly associated with:
- Early attachment disruption
- Chronic childhood trauma
- Overwhelming affect states
- Developmental relational trauma
Neurobiologically, it reflects altered integration between:
“Consult a Neurologist, an MD”
- Limbic system (emotional activation)
- Prefrontal cortex (executive regulation)
- Default mode network (self-processing)
When It Becomes a Disorder
Dissociation becomes clinically diagnosable when it:
- Causes distress or impairment
- Is recurrent and involuntary
- Is not culturally normative
- Cannot be explained by substances or medical causes, get a Medical Doctor’s Opinion”
- Shervan K Shahhian
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