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Dissociation in Borderline Personality Disorder

Understanding Dissociation in BPD

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Updated December 27, 2009

Dissociation is a common experience for people with borderline personality disorder (BPD). Do you sometimes feel as if you have "zoned out?" Do you have times when you feel "unreal" or when things around you look strange or unfamiliar? Do you sometimes lose periods of time, or have chunks of the day that you do not remember? Do these experiences usually happen when you are under a lot of stress? You may be experiencing dissociation.

What is Dissociation?

The American Psychiatric Association defines dissociation as "disruption of the usually integrated functions of consciousness, memory, identity, or perception of the environment."

But what does this mean? Actually, even experts are not entirely sure how to define dissociation. However, years of study have allowed researchers to describe experiences that go along with dissociation. These are:

  • Depersonalization. Depersonalization is a feeling of separation from yourself and your body. People who experience depersonalization may say that they feel like they are observing their own body from the outside, or as if they are in a dream.

  • Derealization. Derealization is similar to depersonalization, but it is a feeling of being detached from the external world, such as other people or things. Derealization may cause familiar things to look strange, unreal, or unfamiliar. Derealization and depersonalization often occur at the same time.

  • Amnesia. Some people who experience dissociation have periods of amnesia or "losing time." They may have minutes to hours or days when they were awake but cannot remember where they were or what they were doing.

If you haven't ever experienced dissociation, you may be puzzled by these descriptions. But, even if you do not experience dissociation frequently, most people have experienced mild forms of dissociation from time to time. For example, have you ever been driving along the highway, and suddenly you look up and realize you have missed your exit, but you can't really remember what you were doing or thinking about that caused you to zone out? Or, have you ever looked at a printed word on a page and felt that the word just looked strange or unfamiliar, even though you had read that word before countless times? This is a very mild form of what people who dissociate experience.

Is Dissociation a Disorder?

There are some disorders that include dissociation as a central feature. For example, dissociative identity disorder (DID) is a disorder that is thought to be the result of very severe dissociation which causes a person to develop different personalities. However, there is a lot of controversy about what DID is and whether it can be defined scientifically.

Dissociation is also a feature of other disorders. For example, one symptom of BPD is dissociation during times of stress. Dissociation is also associated with posttraumatic stress disorder (PTSD).

Can Dissociation Be Treated?

Yes. Treatments for BPD often also include components that are meant to reduce dissociation. Usually, treatment for dissociation is based on building skills that help you to reconnect with yourself, the present moment, and your current surroundings.

For example "grounding" is one skill that can be used to reduce dissociation. Grounding exercises involve using external stimuli to reconnect. For example, in a visual grounding exercise, you will be instructed to observe small details about the environment around you until you are feeling more connected. Some people respond better to grounding exercises that use sensation; for example, holding on to an ice cube for a few moments can help to bring you back into the present moment.

Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed, text revision. Washington, DC, Author, 2000.

Holmes EA, Brown, RJ, Mansell, W, Fearon, RP, Hunter, ECM, Frasquilho, F, and Oakley, DA. "Are There Two Qualitatively Distinct Forms of Dissociation? A Review and Some Clinical Implications." Clinical Psychology Review 25:1-23, 2005.

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