More Thoughts on Dissociative Disorders

Self-portrait by Maria Louisa Vancea in her Depersonalization. Derealization series.

In my last post we discussed the different types of dissociative disorders, what they have in common and how they are different.  I also acknowledged that I struggle with the Derealization type of dissociation.  Today, I want to add a brief note about how religion affects Dissociative Disorders and I also want to provide some tried and true methods of combatting dissociative episodes in case you also struggle with this.

Religion and certain cultural beliefs can cause “out of body experiences” and a feeling of detachment from self and the world around you.  The ideas of divine possession and demon possession are religious notions, but they also fall under the purview of dissociative identity disorder.  We need to recognize the difference between a devout believer and someone who legitimately has a dissociative disorder.  Conversely, a person who is splitting into alter egos and seems possessed may not be tied to religion at all and they warrant help.  The National Alliance on Mental Illness (NAMI) admits that dissociation and religion are complicated.

There are a few lines of defense that we can use to battle dissociation.  Psychotherapy is the most important, and finding a therapist who can treat you with Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) will be super helpful.  Hypnosis and EMDR, which is Eye Movement Desensitization and Reprocessing, is a therapy that enables people to process traumatic memories and have both proven to be effectual.  Make sure the therapist has been adequately trained in providing whichever therapy they think will help the most!

What if your dissociation seems to be mild and doesn’t affect you that much?

Maybe you just have a hard time sometimes with being rooted in reality.  Maybe you notice yourself driving somewhere and not remembering how you got there.  Most everyone has these feelings from time to time.  If they are not affecting your daily life or otherwise severe, you might not need to see a therapist.  Here are some strategies that you can use instead:

1. Be aware of your thoughts and emotions. Thoughts cause emotions and emotions lead to thoughts.  They are very closely tied together.  Try to connect your past experiences with what emotion you felt as you reacted to them.  Figure out what triggers your emotions. Jot down ways that you can try to express yourself in a way that makes you feel heard. 
2. Create a psychological toolbox.  I don’t mean this metaphorically.  I mean have a literal storage space/box where you can collect pictures, poems, inspirational quotes and messages, memorabilia that reminds you of a special memory, pieces of art that evoke positive emotions, etc.  Don’t worry about making your toolbox perfect.  There is no perfect.  It’s just supposed to represent things important to you. When you are feeling down, triggered, or detached, go to your toolbox and take time to look through your treasures.  They can honestly be anything that helps you grow or become more grounded.  For example, at the moment I have a tiny basket (reminds me that my basket has to be full in order to serve others), a rock that says “Calm,” a little jade elephant that reminds me of my time in Thailand, two panda stress balls of my dad’s that reminds me to take a breath and relax, pictures of each of my loved ones, notes that people have written me in the past that were especially comforting or encouraging, dance shoes to remind me of my love for dancing….and I’m still adding things.
3.  Create a strong support system.  Make sure you find people in your life who know you and know of your struggles.  They love you for who you are and truly want you to be your best self.  When you are struggling, reach out to them.  If they love you, they want to support you!
4. Maintain your boundaries. I have a super difficult time with this, because I hate disappointing people and saying no.  However, there is absolutely nothing wrong with respectfully, kindly, and firmly saying “No” to someone or something that you do not want to do or is not healthy for you.  You are the one in charge of you.  You are the one responsible for yourself.  You determine what space you need and what goes in and out of that space.  You are strong and I promise you can do this, even when the other person has good intentions. 
5. Nurture yourself.  Make a list of things that you need physically and emotionally and spiritually.  For example, you need food, water, a roof over your head, sleep, and air to breathe.  Make sure you are taking care of these things just like you would for another person. What if you need quiet to be able to focus? A nonchaotic home in order to feel at peace? A warm bath to feel comforted?  Have a list of ideas that you can refer back to again and again to treat yourself kindly.
6. Stay grounded.  I know depersonalization and derealization can be and feel super weird.  Scary and distressing even.  Learn how to master, how to contain, regulate, and communicate your feelings in appropriate ways.  Don’t be alone with them.  The more you practice, the easier it will become.  Remind yourself of what you see, hear, feel, taste, and smell.  Practice mindfulness and being present in the moment.  The Bay Area CBT Center has some other helpful ideas as well as the lightonanxiety Treatment Center.

What happens if you can’t see a therapist?

You can do some things that will help you overcome elements of depersonalization and derealization. There are three exercises that specifically can help: Selfie Diary, Vigorous Physical Activity, and a Bathroom Exercise.

1. With the Selfie Diary, take a picture of yourself every day for 10 days.  Print them out and paste them where you can see them under the labels Day 1, Day 2, Day 3, etc. Once you finish the 10 selfies, look at all of them and choose the one you like the most and the one you like the least.  Under each selfie, describe when you took the selfie, what you were doing when you took it, and what you remember feeling when you took the selfie.  How do you see yourself? How do you feel about yourself?  Why did you choose this as your favorite/least favorite selfie?
2. Believe it or not, vigorous physical exercise can really help with grounding which helps fight those feelings of disconnection.  For five separate days (they do not have to be consecutive), complete five vigorous activities.  This could be running up and down stairs, using the elliptical, sprinting on the bike, etc.  After completing each activity, fill in the date, type and length of activity, how your body feels, and what you’re thinking after the activity.  At the end of the five days when you have all five exercises recorded, think about which activity made you feel more yourself? Which made you feel like a stranger? What sensations did you experience? Were you alone or with someone else when you completed the activity? If you had company, how did the presence of the other person make you feel? Which of these activities do you think would be good to do on a regular basis?
3. The bathroom exercise seems overly simple but it is effective.  For ten (10) consecutive days, take a shower or bath and record your bodily sensations before and after taking the bath.  As you towel each body part, say out loud, “I am toweling my neck,” “I am toweling my left foot,” etc.  Record your thoughts and feelings before and after drying off.  This is another mindfulness sort of exercise that grounds you in reality.

Remember, not every idea will help. Every person is different…you just have to find what works for you.

Take a look at some of the following resources!  Let me know if you have any questions and I will try to find the answers for you.