3. Falling Apart: Dissociation and the Dissociative Disorders

  1. James A. Chu MD

Published Online: 28 MAR 2011

DOI: 10.1002/9781118093146.ch03

Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders, Second Edition

Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders, Second Edition

How to Cite

Chu, J. A. (2011) Falling Apart: Dissociation and the Dissociative Disorders, in Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders, Second Edition, John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118093146.ch03

Publication History

  1. Published Online: 28 MAR 2011
  2. Published Print: 6 APR 2011

ISBN Information

Print ISBN: 9780470768747

Online ISBN: 9781118093146



  • Dissociation;
  • depersonalization;
  • depersonalization disorder;
  • derealization;
  • amnesia;
  • dissociative amnesia;
  • fugue;
  • dissociative fugue;
  • dissociative identity disorder;
  • imaginative absorption;
  • imaginative involvement;
  • trance;
  • possession states;
  • trauma;
  • mental status examination


Dissociation—the disruption of the normal integration of experience—occurs as a response to traumatic or stressful experiences. This dissociative sense of fracturing results in psychic distress and a paralysis of functioning in which associative capacity—access to thoughts, feelings, normal abilities, and judgment—is lost or becomes limited. Extreme, overwhelming, and prolonged stress can have long-lasting pathological effects. Some younger children have an innately higher dissociative capacity, and if such children are exposed to severe chronic stress during critical developmental periods, they may fail to achieve the normal integration of cognition, memory, emotions, perceptions, abilities, and a sense of self that supports optimal functioning, potentially leading to the development of dissociative disorders. Clinically relevant dissociation is manifested in PTSD, depersonalization and derealization, dissociative amnesia and fugue states, and alterations and disruptions of identity. Most dissociative disorders (with the exception of depersonalization disorder) are linked to traumatization, especially childhood abuse. Harsh and chronic early trauma is associated with more severe dissociative disorders such as dissociative identity disorder.

From a dynamic perspective, the use of dissociation serves an important psychological defense function in helping the individual to manage overwhelming, conflicting, and intolerable experiences. When a person is overwhelmed, the experience may remain fragmented and separated into compartmentalized components. However, clinically relevant information concerning trauma and dissociation is often overlooked by care providers, as patients do not usually volunteer such information because of shame and secrecy and a need to maintain an emotional distance from traumatic events. Furthermore, routine mental status examinations do not inquire about dissociation. Pathological dissociation—both in terms of its clinical significance and its relationship to traumatic experience—remains a critically important but poorly understood and underdiagnosed condition in clinical practice. Unrecognized dissociative symptoms and disorders result in poor clinical outcomes, frustrating clinicians and leaving patients with unrelieved suffering. This is particularly unfortunate, because there are accepted and effective treatments and a body of evidence that shows good clinical outcomes for treating dissociation. Psychiatric examinations must adequately screen for trauma histories and dissociative symptoms by asking appropriate questions that can be supplemented by the use of diagnostic instruments.