Mindfulness-Based Cognitive Therapy (MBCT), an explanation:

Mindfulness-Based Cognitive Therapy (MBCT) is a psychological treatment that combines mindfulness meditation practices with principles from Cognitive Behavioral Therapy (CBT). It could have been originally developed to help people prevent relapse in depression, but it could be also used for anxiety, stress, and emotional regulation.

Core Idea

MBCT teaches people to observe their thoughts and emotions without automatically reacting to them.

Instead of trying to change or fight thoughts, you learn to notice them as mental events, “just thoughts,” not facts.

Example:

Thought: “I’m a failure.”
Traditional reaction: Believe it and feel worse.
MBCT approach: “I notice my mind is producing a self-critical thought.”

This creates psychological distance from the inner critic.

Key Components

MBCT usually could run as an 8-week program with group sessions.

1. Mindfulness Meditation

Participants practice:

Breath awareness
Body scan meditation
Mindful walking
Mindful eating

These practices strengthen attention and awareness of the present moment.

2. Cognitive Awareness

People learn to notice:

automatic negative thoughts
self-critical inner dialogue
rumination patterns

This is especially relevant to depression relapse, where people often fall back into habitual thinking loops.

3. Decentering

One of the most important MBCT skills.

Decentering: seeing thoughts as mental events, not reality.

Example:
Instead of “This thought is true,” the shift becomes:

“I’m noticing that my mind is generating this thought.”

4. Breaking the Rumination Cycle

MBCT helps interrupt cycles like:

negative mood
self-critical thinking
rumination
worsening mood

Mindfulness interrupts the loop before it spirals.

Conditions MBCT Helps

Research shows benefits for:

recurrent major depression
anxiety disorders
chronic stress
trauma-related rumination
emotional dysregulation

Many studies show MBCT can reduce relapse in depression by ~40–50% in people with multiple past episodes.

A Simple MBCT Exercise

3-Minute Breathing Space

Awareness
Notice what is present: thoughts, feelings, body sensations.
Breathing
Focus attention on the breath.
Expanding
Expand awareness to the whole body.

This short practice is used to interrupt automatic negative thinking.

Possible Psychological Mechanism

MBCT could work through:

metacognitive awareness
reduced cognitive fusion
improved emotional regulation
decreased rumination

It could train the mind to move from “doing mode” to “being mode.”

Interesting Information

MBCT is interesting, because:

intense self-monitoring and inner criticism can suppress intuitive cognition
mindfulness reduces cognitive noise and evaluative filtering

Many researchers believe mindfulness increases open monitoring awareness, which may facilitate subtle perception and intuition.

Shervan K Shahhian

Understanding Medical Trauma:

“CONSULT WITH A PSYCHIATRIST”

Medical trauma is a psychological or emotional injury that might occur as a result of medical events, treatments, or interactions with healthcare systems. It happens when a medical experience is perceived by the person as threatening, overwhelming, painful, or out of their control.

It can possibly be closely related to trauma responses seen in conditions like Post‑Traumatic Stress Disorder.

Key Idea

Medical trauma may not only be about the illness or injury itself, it can also come from:

Fear of death or severe disability
Painful procedures
Loss of control or bodily autonomy
Feeling ignored, invalidated, or mistreated by medical staff
Prolonged hospitalization or intensive care

Some of the Common Possible Causes of Medical Trauma

Severe medical emergencies
- heart attack
- stroke
- major accidents
Invasive procedures
- surgeries
- intubation
- emergency interventions
Medical experiences
- repeated hospitalizations
- painful treatments
Birth complications
- traumatic labor
- emergency C-section
Chronic illness treatment
- long-term painful treatments like chemotherapy
Possible medical system experiences
- misdiagnosis
- medical neglect
- feeling powerless during treatment

Possible Psychological Symptoms

Some people with medical trauma may develop symptoms similar to PTSD:

Intrusive memories of hospital events
Nightmares about medical procedures
Avoidance of doctors and/or hospitals
Panic during medical appointments
Hypervigilance about bodily sensations
Dissociation during examinations

Possible Behavioral Signs

Examples include:

Avoiding necessary medical care
Anxiety before checkups
Refusing procedures
Extreme fear of needles or hospitals

Medical Trauma in Some

Some are especially vulnerable because they often:

don’t understand what is happening
cannot control procedures
may feel physically restrained during treatment

This possibly, can later lead to lifelong medical anxiety.

Related Psychological Fields

Medical trauma could be studied in areas like:

Health Psychology
Medical Psychology
Trauma Psychology
Behavioral Medicine

Treatment Approaches

Possible, Common treatments include:

Trauma-informed therapy
Cognitive Behavioral Therapy (CBT)
Somatic therapies
Gradual exposure to medical settings
Psychoeducation

Clinical Perspective

Some psychologists might, now emphasize “trauma-informed care”, meaning healthcare providers are trained to understand that medical procedures themselves can become traumatic experiences for patients.

Possibly, some patients report near-death experiences, altered states, or anomalous perceptions during severe medical events. These experiences can interact with trauma processing in complex ways.

“CONSULT WITH A PSYCHIATRIST”

Shervan K Shahhian

Mentalization-Based Therapy (MBT), explained:

Mentalization-Based Therapy (MBT) is a form of psychodynamic psychotherapy that helps people better understand their own mental states and the mental states of others, such as thoughts, feelings, intentions, and motivations. This ability is called Mentalization.

Core Idea

Mentalization means being able to ask questions like:

“Why did I react that way?”
“What might the other person have been thinking or feeling?”
“Could I be misinterpreting their intention?”

MBT helps people pause and reflect on internal experiences rather than reacting impulsively.

Research later showed it might also help with:

trauma-related disorders
depression
attachment difficulties
emotional dysregulation

Key Principles of MBT

1. Improving Awareness of Mental States

Patients learn to recognize:

their own emotions and thoughts
how those affect behavior
how others may experience situations differently

2. Reducing Misinterpretations

People under emotional stress often lose the ability to mentalize, leading to:

jumping to conclusions
assuming hostile intentions
relationship conflict

MBT helps restore reflective thinking during emotional situations.

3. Attachment Focus

MBT is strongly linked to Attachment Theory.

The therapy examines how early attachment relationships affect emotional regulation and understanding of others.

What Therapy Looks Like

MBT usually involves:

Individual therapy

exploring emotions and relationship events
examining misunderstandings in interactions

Group therapy

practicing mentalizing in real-time social interactions

Therapists often ask questions like:

“What do you think was going through their mind?”
“What were you feeling at that moment?”
“Could there be another explanation?”

Goal of MBT

The main goals are to:

improve emotional regulation
strengthen self-awareness
improve relationships
reduce impulsive behavior and conflict

Why It’s Powerful

Studies show MBT might reduce:

self-harm
suicide attempts: (SEEK IMMIDIATE EMERGENCY CARE)
emotional instability
interpersonal chaos

especially in individuals with Borderline Personality Disorder.

In simple terms:
MBT might train the mind to slow down and understand minds, both your own and other people’s.

Shervan K Shahhian

Auditory Verbal Hallucinations (AVH), an explanation:

“PLEASE CONSULT a NEUROLOGIST, and/or a PSYCHIATRIST“

Auditory Verbal Hallucinations (AVH) are experiences of hearing voices or speech without an external sound source. The voices are perceived as real and distinct from one’s own internal thoughts.

They might be more common than many people assume and occur across multiple clinical and non-clinical populations.

What They Typically Involve

AVH can vary widely in form:

A single voice or multiple voices
Male, female, familiar, or unfamiliar voices
Speaking in second person (“You are worthless”)
Third person commentary (“He is failing”)
Command voices (“Do this”)
Conversational voices arguing or discussing the person

The key distinction is that the voice is experienced as external or not self-generated, even though no one is speaking.

Conditions Commonly Associated With AVH

AVH are most classically linked to:

Schizophrenia
Schizoaffective disorder
Bipolar disorder (with psychotic features)
Major depressive disorder (with psychotic features)

However, they are also found in:

Trauma-related disorders (especially complex trauma)
Dissociative disorders
Severe stress or sleep deprivation
Neurological conditions, CONSULT A NEUROLOGIST, PLEASE
Substance use or withdrawal

Importantly, some people experience voices without meeting criteria for a psychiatric disorder.

How AVH Differ From Normal Inner Speech

Inner Speech	Auditory Verbal Hallucination
Recognized as your own thoughts	Experienced as not self-generated
Under voluntary control	Often intrusive and uncontrollable
Occurs “inside” your mind	Often perceived as external or spatially located

CONSULT A NEUROLOGIST, PLEASE

Neurocognitively, one leading model suggests AVH may involve misattributed inner speech, where self-generated verbal thought is experienced as coming from outside the self.

Neurobiological Findings

CONSULT A NEUROLOGIST, PLEASE

Research shows involvement of:

Auditory cortex activation (as if real sound is present)
Language production areas
Reduced connectivity between speech production and self-monitoring systems

In other words, the brain may be producing speech internally but failing to label it as self-generated.

Trauma and Dissociation Connection

In trauma populations, voices often:

Reflect internalized abusers
Represent dissociated self-states
Contain shame-based or protective content

From a structural dissociation perspective, some voices may function as parts of the personality, rather than psychotic phenomena per se.

Clinical Questions That Matter

Frequency and duration
Emotional tone (hostile, neutral, supportive)
Command content (especially harmful commands)
Level of distress
Insight (does the person question the reality of the voice?)
Functional impairment

Distress and loss of control are often more clinically significant than the mere presence of voices.

Treatment Approaches

Depending on etiology:

medication: CONSULT A PSYCHIATRIST
Trauma-focused therapy
Cognitive Behavioral Therapy for Psychosis (CBTp)
Voice dialogue approaches
Grounding and self-monitoring training

Increasingly, treatment focuses not on “eliminating” voices, but on changing the person’s relationship to them.

Shervan K Shahhian

Severe Major Depression with Psychosis, what is it:

“PLEASE CONSULT WITH A NEUROLOGIST, MEDICAL DOCTOR.”

Severe Major Depression with Psychosis (also called psychotic depression) is a subtype of
Major Depressive Disorder
in which a person experiences severe depressive symptoms plus psychotic features (loss of contact with reality).

Clinically, it could be referred to as:
Major Depressive Disorder with psychotic features

Core Components

A. Severe Major Depression

Profound depressed mood
Marked anhedonia
Psychomotor retardation or agitation
Significant sleep and appetite disturbance
Cognitive slowing
Intense guilt or worthlessness
Suicidal ideation (often high risk), IT NEEDS IMMIDIATE EMERGENCY ASSISTANCE
Persons presenting suicidality or homicidally should undergo a thorough medical screening examination to determine whether they have an emergency medical condition that requires timely intervention, should be stabilized in a timely manner, and should have treatment, including hospitalization for psychiatric care, initiated to ensure the safety of the person and others.

B. Psychotic Features

Psychosis occurs during the depressive episode and typically includes:

Delusions (false fixed beliefs)
- “I am responsible for the collapse of the economy.”
- “My organs are rotting.”
Hallucinations
- Often auditory (e.g., accusatory or condemning voices)

Mood, Congruent vs Mood, Incongruent Psychosis

Mood-Congruent (most common):

Themes of guilt, punishment, illness, poverty, nihilism
Example: “I deserve to die because I ruined everything.”

Mood-Incongruent:

Paranoid or bizarre themes not directly tied to depressive themes
Example: “Aliens implanted a chip in me.”
(More diagnostically complex)

How It Differs From Other Disorders

Condition	Key Difference
Schizophrenia	Psychosis persists outside mood episodes
Schizoaffective Disorder	Psychosis occurs independently of mood episodes for ≥2 weeks
Bipolar I Disorder	History of mania required

In psychotic depression, psychosis only occurs during the depressive episode.

Neurobiological Factors (Must Be Research-Supported)

“PLEASE CONSULT WITH A NEUROLOGIST, MEDICAL DOCTOR.”

HPA-axis hyperactivation (cortisol dysregulation)
Dopamine dysregulation
Serotonergic disruption
Often strong genetic loading
Frequently trauma-associated

Severity & Risk

Persons presenting suicidality or homicidally should undergo a thorough medical screening examination to determine whether they have an emergency medical condition that requires timely intervention, should be stabilized in a timely manner, and should have treatment, including hospitalization for psychiatric care, initiated to ensure the safety of the person and others.

Psychotic depression carries:

Higher suicide risk than non-psychotic depression
Higher relapse rates
More functional impairment
Greater likelihood of hospitalization

It is considered a psychiatric emergency when:

Command hallucinations are present
Delusions involve self-harm
Severe psychomotor retardation or refusal to eat occurs

Treatment (Evidence-Based)

“Please Consult with a Psychiatrist, Medical Doctor.”

Clinical Presentation Pattern

Many patients:

Do not initially volunteer psychotic symptoms
Experience intense shame about delusions
Present first with severe depressive symptoms

Careful assessment is crucial.

Shervan K Shahhian

Psychological Autopsy, an explanation:

“Consult with a trained forensic psychologist or psychiatrist“

Psychological Autopsy is a structured, retrospective investigative method used to reconstruct a deceased person’s mental state, intentions, and circumstances prior to death, most commonly in cases of suspected suicide.

It is NOT a literal medical autopsy of the body. Instead, it is a forensic psychological evaluation conducted after death.

Purpose

Psychological autopsies are conducted to:

Determine whether a death was suicide, accident, natural, or homicide
Understand the decedent’s psychological functioning
Assess intent and state of mind
Clarify ambiguous deaths (e.g., overdose, single-vehicle crash, firearm deaths)
Provide information for legal proceedings or insurance claims
Assist families seeking understanding or closure

What It Involves

A trained forensic psychologist or psychiatrist gathers data from multiple sources:

1. Interviews

Family members
Friends
Coworkers
Treating clinicians

2. Records Review

Medical and psychiatric records
Therapy notes
Medication history
Police and coroner reports
Suicide notes (if present)
Digital footprint (texts, emails, social media)

3. Behavioral Reconstruction

Investigators look for:

Prior suicide attempts
Verbalizations of hopelessness
Recent stressors or losses
Substance use
Personality traits
Major psychiatric disorders
Changes in behavior before death

Core Psychological Questions

A psychological autopsy attempts to answer:

Was there evidence of suicidal intent?
Was the individual experiencing major depression, psychosis, trauma-related distress, substance intoxication, or other impairments?
Were there protective factors?
Did the person show planning behaviors?

In Clinical & Research Context

Beyond legal investigations, psychological autopsies are used in:

Suicide prevention research
Epidemiological studies
Public health policy

They help identify patterns in:

Risk factors
Sociocultural influences
Psychiatric comorbidities

Important Distinction

A psychological autopsy:

Is retrospective
Relies on collateral data
Cannot establish absolute certainty
Is probabilistic, not definitive

It differs from:

Forensic pathology (physical cause of death)
Clinical diagnosis (which requires direct assessment)

In Context

Psychological autopsies are (Might Be) especially relevant when evaluating:

Complex trauma histories
Dissociative states prior to death
Severe depression with psychosis
Ambiguous self-inflicted injury cases

There could be growing discussion about integrating:

Trauma-informed reconstruction
Attachment history analysis
Neurocognitive vulnerability mapping
Shervan K Shahhian

Peer Support is very important, why:

Peer support is profoundly important, clinically, neurologically, and socially, because it meets human needs that formal treatment alone cannot fully address.

1. It Regulates the Nervous System (Co-Regulation) “PLEASE CONSULT WITH A NEUROLOGIST/MEDICAL DOCTOR”

Humans are biologically wired for connection.

Safety is detected through relational cues, tone, facial expression, presence. Peer support provides:

Social engagement signals
Reduced threat perception
Down-regulation of hyperarousal
Relief from chronic sympathetic activation

For trauma survivors or individuals with chronic stress, this co-regulation is often more powerful than cognitive intervention alone.

2. It Reduces Shame Through Shared Lived Experience

Shame thrives in isolation.

When someone says:

“I’ve been there too.”

It disrupts:

Self-pathologizing narratives
Internalized stigma
Identity fragmentation

Unlike hierarchical clinician-client dynamics, peer relationships are horizontal, which reduces power asymmetry and fosters authenticity.

3. It Rebuilds Identity

In many conditions, addiction, psychosis, dissociation, trauma, identity becomes destabilized.

Peer support helps individuals:

Witness others in recovery
See possible future selves
Move from “patient” to “person”

This is a core principle in Alcoholics Anonymous, where identity transformation (“I am in recovery”) becomes central to healing.

4. It Improves Outcomes in Serious Mental Illness, “PLEASE CONSULT WITH A MEDICAL DOCTOR”

Reduced hospitalization
Increased treatment engagement
Better medication adherence
Higher empowerment scores

Peer specialists often reach individuals who distrust formal systems.

5. It Restores Agency

Trauma often removes agency.

Peer support models are recovery-oriented:

“Nothing about us without us.”
Lived experience becomes expertise.
The individual becomes contributor, not just recipient.

This restores dignity.

6. It Counters Isolation, A Major Risk Factor

Isolation is correlated with:

Depression
Substance relapse
Suicide risk
Cognitive decline

Social belonging is as protective as many interventions. Humans are attachment-based organisms.

7. It Strengthens Meaning Making

Peer environments allow narrative reconstruction:

“This happened to me” becomes
“This shaped me” becomes
“This can help someone else.”

That shift from suffering: service is psychologically transformative.

Clinically Speaking

Peer support complements, it does not replace, psychotherapy.

It addresses:

Relational repair
Social identity healing
Hope modeling
Behavioral reinforcement in real-world contexts

Especially in trauma-informed systems, peer support is not an “extra”, it’s structural.

Shervan K Shahhian

Somatization Disorders, what is it:

“CONSULT WITH A MEDICAL DOCTOR”

Somatization Disorders refer to psychological conditions in which emotional distress manifests primarily as physical (somatic) symptoms, often without a fully explanatory medical cause, or with symptoms far more intense than expected from medical findings.

1. Somatic Symptom Disorder (SSD)

This is could be the main modern diagnosis.

Core Features:

One or more distressing physical symptoms (pain, fatigue, GI issues, neurological complaints, etc.)
Excessive thoughts, anxiety, or behaviors related to the symptoms
Persistent distress (typically >6 months)

The key shift in DSM-5:
It’s not about whether symptoms are medically unexplained.
It’s about the disproportionate psychological response to them.

A person may:

Doctor-shop frequently
Catastrophize normal sensations
Spend excessive time thinking about illness
Experience severe health anxiety

2. Illness Anxiety Disorder

Previously called hypochondriasis.

Core Features:

Minimal or no somatic symptoms
Intense fear of having or developing a serious illness
High health-related anxiety
Repeated checking or medical reassurance-seeking

The focus is fear of illness, not symptom burden.

3. Conversion Disorder

Now called Functional Neurological Symptom Disorder.

Core Features:

Neurological symptoms incompatible with known medical conditions
Examples:
- Paralysis
- Non-epileptic seizures
- Blindness
- Speech disturbances

Symptoms are not intentionally produced.
They often follow psychological stress or trauma.

4. Factitious Disorder

Different from somatization.

Here, symptoms are intentionally fabricated or induced, but for psychological reasons (need for attention, identity as patient), not external gain.

Psychological Mechanisms

Somatization often involves:

1. Interoceptive amplification

Heightened sensitivity to normal bodily sensations.

2. Alexithymia

Difficulty identifying and expressing emotions.

3. Trauma-linked dissociation

Emotional material converted into bodily experience.

4. Chronic autonomic dysregulation

Persistent sympathetic activation (fight–flight–freeze) manifesting somatically.

This aligns with how the body processes unresolved stress biologically.

Neurobiology

“CONSULT WITH A MEDICAL DOCTOR/NEOUROLOGIST”

The body might literally encodes distress.

Common Symptom Clusters

“CONSULT WITH A MEDICAL DOCTOR/NEOUROLOGIST”

Chronic pain
Fatigue
Gastrointestinal distress
Sexual dysfunction
Pseudoneurological symptoms
Cardiovascular sensations (palpitations, chest tightness)

Clinical Differentiation

Important distinction:

Somatization is:

Not malingering
Not “imaginary”
Not voluntary

The suffering is real.
The mechanism is psychophysiological.

Treatment Approaches

Possible Evidence-based treatments include:

CBT for somatic symptom disorder
Trauma-informed therapy
Psychodynamic approaches (symbolization of affect)
Mindfulness-based stress reduction
Somatic experiencing
Regulation of autonomic nervous system

Medication may help if comorbid:

“CONSULT WITH A MEDICAL DOCTOR/NEOUROLOGIST/PSYCHIATRIST”

Depression
Anxiety
PTSD

Clinical Insight

In trauma-heavy cases, somatization can function as:

A nonverbal language of distress
A defense against overwhelming affect
A way to maintain attachment (through care-seeking)

In dissociative structures, symptoms may emerge from split-off self-states.

Shervan K Shahhian

Clinical Dissociative Symptoms, an explanation:

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

Clinical Dissociative Symptoms, an explanation:

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