Dissociation in Borderline Personality Disorder (BPD)

In broad terms, dissociation is a psychological phenomenon in which there's a disconnect between your thoughts, emotions, behaviors, perceptions, memories, and identity. Occasional dissociation is usually not a problem, but if it happens frequently or is intense, it can signal a mental health condition such as borderline personality disorder (BPD). About 75% to 80% of people with BPD report stress-related dissociation.

Symptoms of Dissociation

Frequent, severe dissociation during times of stress is a main symptom of BPD. It's also associated with acute stress disorder and post-traumatic stress disorder (PTSD), both of which can co-occur with BPD.

Most people have experienced mild forms of dissociation from time to time. Many but not all with BPD tend to have more severe episodes.

After years of study, researchers can now describe the experience of dissociation, including depersonalization, derealization, amnesia, identity confusion, and identity alteration.

Depersonalization

Depersonalization is the feeling of being separate from your body. People who experience depersonalization often say it feels like they are observing their own body from the outside, or as if they're in a dream.

Derealization

Similar to depersonalization, derealization is a feeling of being detached from the external world, including other people or objects. Familiar things can look strange, unreal, or unfamiliar.

Amnesia

Some people experience periods of amnesia or "losing time"—from minutes to hours or even days. Even though they awake during these times, they cannot remember where they were or what they were doing. This type of amnesia is sometimes referred to as a dissociative fugue.

Identity Confusion

Identity confusion occurs when you experience an inner struggle about who you really are. People might have a hard time figuring out who they are in relation to others.

Identity Alteration

Identity alteration is the sense that you are acting like a different person. For example, you see an object in your home that you don't recognize or perform a skill that you don't remember learning. Sometimes, you might become aware of identity alteration because other people in your life say that you are behaving like someone else.

Mild identity alteration is common in the general population (for example, using a different name in different situations). The key difference is that you are aware of your identity or role change in these situations and it doesn't cause problems with your ability to function in your day-to-day life or relationships.

Causes of Dissociation

The exact cause of dissociation is unknown, but it often affects people who have experienced repetitive, overwhelming trauma, such as severe child abuse or neglect.

Dissociation appears to be the brain's way of coping and separating from trauma, which can make it more bearable. If you learned to dissociate in times of extreme stress as a child, it likely affected the way your concept of yourself developed. It might have even carried over into how you react to stressful situations as an adult.

What the Research Says

Some early research that is using neuroimaging to examine people with BPD and dissociative symptoms has indicated that there might be actual changes in brain function and communication that contribute to dissociation.

Researchers can use imaging techniques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scans to see the brains of people experiencing dissociation.

Brain scans of people with BPD and dissociative symptoms have shown evidence of decreased activity in the limbic temporal areas of the brain, increased activity in the frontal area of the brain, and changes in communication between the two areas.

Treatment

Treatments for BPD such as dialectical behavioral therapy (DBT) often include components that help reduce dissociation. Treatment for dissociation is usually based on building skills to help you reconnect with yourself, the present moment, and your current surroundings.

Grounding is one skill that can be used to reduce dissociation. Grounding exercises involve using external stimuli and your five senses (sight, hearing, touch, smell, and taste) to reconnect with the present. For example, a visual grounding exercise will have you observe small details in the environment around you until you are feeling more connected.

Dissociative Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are two other main dissociative disorders:

• Dissociative amnesia
• Depersonalization/derealization disorder

Certain mental health disorders have dissociation as a central feature rather than a symptom. For example, dissociative identity disorder (DID) is characterized by severe dissociation that causes a person to develop different personalities.

The Takeaway

Stress-related dissociative symptoms are common in people with BPD, but there can be a spectrum of severity. Some people with BPD experience minimal or mild symptoms of dissociation whereas others experience severe symptoms.

Treating dissociative symptoms through therapy can be intense, as it often requires you to remember past abuse. While it can be difficult at times, therapy can help you learn to cope with your symptoms and improve your quality of life.