#this post is primarily me excercising my plain language muscle i need a lot for work

[someguys]

What Do We Mean by Normal and Pathological Dissociation?

Dissociation is when someone feels separated from their thoughts, feelings, or memories. Sometimes, dissociation is considered a normal reaction to certain situations. Other times, it can be seen as a pathological (or harmful) condition. Although the difference between normal and pathological dissociation is talked about in many research papers, it often isn't clearly explained on its own. As different experts write about it, they use different ways (or “dimensions”) to separate what they call “normal” dissociation from what they call “pathological” dissociation. The following sections highlight some key dimensions that people use to make sense of these two forms of dissociation.

1. Type

Some experts theorize that certain “types” of dissociation are normal, while others are not. For example, research suggests that amnesia (forgetting important parts of an experience), depersonalization (feeling disconnected from oneself), and identity problems (like in DID) are a part of pathological dissociation. In contrast, absorption (losing yourself in a good book or movie) is often seen as normal.

Some researchers also talk about a “dissociative taxon.” A taxon, in this specific context, is a special group of people who show a certain kind of dissociation. (Note that in a broader sense, 'taxon' can refer to any category used for classification, but here it specifically focuses on dissociative features.) If you have this taxon, you might have a dissociative “disorder.” If you do not, you are probably not at risk. In this view, “normal dissociation” is any kind that does not lead to clear mental health problems.

2. Level

Other scientists view dissociation as existing on a continuum (a line that goes from low to high). At one end are mild forms of dissociation, such as absorption. At the other end is structural dissociation, such as DID, which is much more severe. In this way of thinking, what makes dissociation “pathological” is how intense or extreme it is.

3. Timing

In recent years, people have started talking about the terms peritraumatic and posttraumatic in the context of dissociation.

Peritraumatic dissociation is dissociation that happens during or right after a traumatic event. This may be a normal and helpful response at the time, but it can also make someone more likely to develop PTSD.

Posttraumatic dissociation happens after a trauma, sometimes lasting long after the event.

For example, it can be normal to

feel “out of body” right after or during a scary event

have a short time when you notice less pain during a crisis

or experience a kind of “shock” that can make you feel confused or disoriented and cause gaps in your memory right after very distressing news

However, if these experiences continue when there is no current threat, it may become pathological. According to Lisa Butler, dissociative disorders are not considered disorders just because dissociation happens or because it helped someone survive trauma. Instead, they become disorders when severe dissociation and its harmful effects continue long after the traumatic situation is over.

4. Relationship to Defense

Some researchers say that normal dissociation happens when we put all our attention on one thing and block out everything else. For instance, if you are absorbed in a video game and do not hear someone calling your name, that is a normal kind of dissociation.

In pathological dissociation, the blocked memories or feelings might be clearly recorded in the brain but are pushed away on purpose, almost like a defense mechanism. This can cause problems later because these memories and feelings may come back in distressing ways.

5. Frequency

Sometimes people call dissociation “normal” if it happens often in the general population. For example, items that measure absorption on a test (such as the Dissociative Experiences Scale) are common. On the other hand, items that measure amnesia or depersonalization happen less often. Because absorption is more frequent, it is often seen as normal.

6. Purpose

The last way to tell apart normal and pathological dissociation is to look at its purpose. For example, imagine a soldier who ignores the pain of a combat wound just long enough to get to safety. This dissociation helps the soldier survive, so it might be called “normal.” But if the same numbness or lack of awareness shows up in a safer situation (like someone who harms themself because they don't notice their own pain) that might be a “pathological” use of dissociation.

Evolutionary ideas suggest that dissociation can help us:

Protect ourselves by separating out terrible experiences,

Save energy by focusing only on what is necessary, or

Avoid conflict by pushing away thoughts and feelings we cannot face.

When dissociation is used for a helpful reason and does not harm us, it is seen as normal. However, if it is used in an unhealthy way or lasts too long, it can become pathological.

This post has been adapted from Constance J. Dalenberg, PhD, and Kelsey Paulson, BS, in their chapter “The Case for the Study of ‘Normal’ Dissociation Processes,” found on page 147 of Paul F. Dell and John A. O’Neil’s edited book, Dissociation and the Dissociative Disorders: DSM-V and Beyond.