Dissociation as an alteration in consciousness

A second usage of the dissociation concept refers to an altered state of consciousness characterized specifically by a disengagement from the self or the environment (Cardena, 1994). As Cardena has pointed out, this sense of the dissociation concept should not be applied to everyday phenomena, such as daydreaming and other states of distraction, where engagement with the environment is less than complete. Rather, it should be reserved specifically for states that are regarded by the experiencing individual as qualitatively different to their normal state of awareness. Although a number of different phenomena fall within the bounds of this definition (e.g. 'trance' and 'possession' states), probably the most commonly reported are depersonalization and derealization. In depersonalization, the individual experiences a profound feeling of detachment from their thoughts, perceptions, actions and emotions, often characterized by a sense of numbness or disembodiment. In derealization, the individual experiences an intact sense of self coupled with a feeling of detachment from the external environment, which often feels unreal or at a distance. Such feelings are extremely common, frequently occurring in the context of psychiatric illnesses such as depression and anxiety; they also occur as a circumscribed problem in their own right, such as in depersonalization disorder. Although DSM-IV identifies depersonalization disorder as a dissociative phenomenon, this condition clearly relates to a different sense of dissociation than that which applies to the other members of this category; this difference further justifies the separation of depersonalization disorder from the dissociative disorders category in ICD-10. Depersonalization and derealization are also found in certain drug states (e.g. those produced by marijuana, LSD and ketamine), neurological conditions such as temporal lobe epilepsy and can occur spontaneously in the context of stress or fatigue.

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