#//one cause of depersonalization is prolonged physical abuse / otherwise intensely stressful relationships

[troublcmakcrs]

I was writing a reply earlier, and it made me realize Craig suffers from pretty severe depersonalization, most prominently as a teenager, but it follows him into adulthood, too. I've got some more research to do before I hit him with an actual diagnosis of the triple-D's (Depersonalization-Derealization Disorder), but he is definitely experiencing Symptoms, and they do become debilitating and affect his relationships with other people.

The change is a subtle one that grows steadily worse as time passes, and at first, I would imagine very few people notice it. People don't take notice of the way Craig has become increasingly stiff, monotonous, robotic, and apathetic because... well... that's just Craig. But he stops answering texts from or spending time with even his closest friends because it requires more than the bare minimum of socialization out of him, and he can only manage the automatic and mechanical responses to most people. Going through the motions of life because he has to. Piloting the vessel he somehow came to be in possession of around the world because people would find it more odd if he didn't.

He becomes a much better student, leaning more heavily into his studies, because it allows him to engage in a lot of mindless repetition that comes most easily to him in those days and actually relaxes him in a way that few other things and the expectations that come with them do.

He often thinks about how he doesn't exist and bristles easily when other people speak to him, their perception of him clashing miserably with his own.

His nonexistence is a concern for him, and he is prone to tears when he suddenly awakens back into being and has to confront every feeling at once, although he tries to hide those tears from people and put himself back together as quickly as possible.

He often leaves his concept of personhood wrapped up in other places and things, and at his amusement park job, he finds a sense of being in the rollercoasters he works with, often viewing them as more alive than he is. He intertwines his existence with them and comes to feel that he only exists because they do. And he sees the world of the amusement park as much more real and substantial than the one outside. Whenever he leaves his job in the evenings, his energy rapidly depletes, and he goes back to feeling hollow and like he is navigating the rest of the world through a thick fog.

He is not disconnected from reality, though, and he understands the world outside the amusement park is the real world and that he must at least try to pay attention to it, although he struggles to reconcile his knowledge and his feelings.

Craig is, unfortunately, also resistant to the idea that he is "crazy" after putting up with Tweek for so many years. He feels like the more normal of the two of them and adamantly insists to both himself and others that he is not mentally ill and that everyone must feel as he does sometimes -- never mind that his "sometimes" has lasted multiple years. He tells himself that the agony of getting hollowed out every time he leaves a certain location, the way he blinks and suddenly it's been two months since the last time he texted someone (having a shaky relationship with the concept of time), or how the world seems more desaturated than it reasonably should be with only small pockets of vivid color here are there... are all just... quirky things about himself. The same growing pains that everyone must experience. He'll shake it off eventually, any day now.

He gets better at like... being aware and trying to work past it as an adult, although it is less of an acknowledgment of his mental illness and more of a resolution that he has got to be around for the people he cares about, and he starts working to repair a lot of his neglected friendships. He does, however, still experience periods where he gets "spacey" and seems/feels suddenly empty. He tries to stay in existence for as long as possible, but he still slips out of it now and again.

[dissociart]

Trauma Related Dissociation and Associated Conditions

There are 5 types of dissociation

 1. Amnesia: Dissociative amnesia is characterized by an absence of memory for a period or periods of time in the person’s life. The memory loss may take a variety of different patterns. These include:

Localized- Not being able to recall events that took place during a limited period time

Selective- Being able to recall only some, but not all events that took place in a limited time period.

Generalized- Not being able to recall anything from their whole life (considered the rarest form of amnesia)

Continuous- Not being able to remember anything from the time of a traumatic event until the present 

Systematized- Amnesia for certain categories (such as a person)

2. Identity Alteration: A shift in aspects of someone’s identity that alters your behavior (example: someone with DID switching from one alter to another).

3. Identity confusion: an inner struggle about one’s sense of self/identity, which may involve uncertainty, puzzlement or conflict. (from traumadissociation.com)

4. Depersonalization: This is often described as watching yourself as if you are an outside bystander or as if you are watching a movie of yourself. You may feel as if you are not real.

5. Derealization: The feeling that the world is not real, feeling as though you are looking at the world through a fog.

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Complex Post-Traumatic Stress Disorder (C-PTSD), also called Disorders of Extreme Stress Not Otherwise Specified (DESNOS)

C-PTSD is caused by prolonged and/or repeated traumas. Traumas may include longterm emotional abuse by a parent/guardian, living in a war zone, repeated sexual abuse, neglect, bullying, and many other kinds of trauma. C-PTSD can developed at any age. 

C-PTSD involves dissociation but is not categorized as a dissociative disorder. Repeated and/or prolonged trauma encourages the person to dissociate as a way to survive. C-PTSD is not a diagnosis in the DSM but is used among clinicians since it has many symptoms that PTSD does not, such as:

Emotional Regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.

Consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body (dissociation).

Self-Perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.

Distorted Perceptions of the Perpetrator. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.

Relations with Others. Examples include isolation, distrust, or a repeated search for a rescuer.

One’s System of Meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.

             (from the National Center for PTSD)

Post-Traumatic Stress Disorder (PTSD)

PTSD is caused by a single traumatic incident. Rape, sexual assault, car accidents, natural disasters, robbery, war, and physical assault are common causes of PTSD. PTSD is not a dissociative disorder and usually does not include as many dissociative experiences as others on this list. In the DSM-5 there is a subtype for dissociative PTSD:

Specify if: With dissociative symptoms.

In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).

Derealization: experience of unreality, distance, or distortion (e.g., “things are not real”).

(Diagnostic and statistical manual of mental disorders, 5th Edition)

Borderline Personality Disorder (BPD)

Although BPD is not always caused by trauma, many people with the cluster B personality disorder have experienced trauma. Dissociation experienced in BPD usually includes derealization, depersonalization, and/or dissociative amnesia. 2/3 of those with BPD experience dissociation, and around 82% have experienced abuse and/or neglect (Borderline Personality Disorder, Childhood Trauma and Structural Dissociation of the Personality).

-Other conditions can be accompanied by dissociation, but BPD, PTSD, and cPTSD (and dissociative disorders) are more associated with trauma related dissociation than other disorders-

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Dissociative Disorders:

Dissociative Identity Disorder (DID)

DID is defined by having at least 2 distinct self-states (which means host and 1+ part, though the host is also considered a part, as well as not every system having one host). Amnesia must be present between parts (alters) at least some of the time to be classified as DID (the DSM-5 puts any amnesia, including amnesia solely for traumatic events, as DID, not OSDD-1b). Derealization and depersonalization are often experienced by individuals with DID, as well as dissociative trance. Many people with DID do not see alters as the problem but rather the amnesia and trauma responses that come with it. 

DID is caused by chronic childhood trauma before ages 6-9. Different children have different thresholds for stress and trauma therefore trauma that can cause DID can range from chronic bullying and/or emotional abuse to ritual abuse, however, those with primary caretakers who promoted disorganized attachment seem to be more likely to develop DID than those who experienced other attachment forms.  PTSD/cPTSD is almost always present in a person with DID due to the nature of how it forms.

Many people believe DID is not real or is extremely rare, when in realty 1-3% of the general population have DID. Some people believe that they have never met someone with DID due to representation in TV and movies showing the character as having extremely obvious switches, when in reality only 6% of people with DID experience the disorder in an overt way (having overt DID is just as valid as covert, though, just less common). It is very probable that any given person has met many people with DID, but didn’t know it.

Dissociative amnesia

Dissociative amnesia is present in DID but can also be experienced by itself. Around 7% of the population will experience dissociative amnesia at some point in their life. Trauma is the biggest cause of this dissociative disorder. Dissociative fugue is now part of dissociative amnesia, instead of its own diagnosis, as of the DSM 5.

Otherwise Specified Dissociative Disorder (OSDD)

OSDD was previously called DDNOS until the release of the DSM 5. There are 4 types of OSDD. OSDD-1 has 2 subtypes.

OSDD-1a is extremely similar to DID, but the parts are not distinct enough to be counted as those found in a DID system. Amnesia is present.

OSDD-1b is the same as DID minus the amnesia. To be classified as OSDD-1b the person must have at least 2 distinct self-states.

*OSDD-1 is caused by trauma similar (or the same) as trauma that can cause DID.

OSDD-2 is a dissociative disorder that results from “intense coercive persuasion.” The person experiences a change and/or confusion in personality due to the coercion.

OSDD-3 is a dissociative disorder that is experienced as transient and usually  lasts less than a month. Dissociative symptoms may include (but are not limited to) depersonalization and/or derealization, micro-amnesia (short periods of amnesia), and poor motor skills. OSDD-3 is a disorder that comes from stressful events.

OSDD-4, also known as dissociative trance, is characterized by an acute narrowing or complete loss of awareness of immediate surroundings that manifest as profound unresponsiveness or insensitivity to environmental stimuli. Those who experience dissociative trance may seem unresponsive and look dazed. (from traumadissociation.com/)

Depersonalization/Derealization Disorder (DpDr)

DpDr is not strictly a result of trauma, but often is. Common thoughts found in those with DpDr can include (but are not limited to) “I’m not real”, “I am not a person”, “Nothing is real”, and “The world is fake”. Experiences often include seeing the world through a fog, the person watching themselves outside of their body, and feeling as if they themselves are not real and/or the world is not real. 

 Unspecified Dissociative Disorder (UDD)

This diagnosis is given when there is not enough information to diagnose a specific dissociative disorder, often in hospitals. Before the DSM-5, UDD was categorized under DDNOS, as was OSDD. Click here for more information on UDD.