Dissociation in Borderline Personality Disorder (BPD)

Table of ContentsView AllTable of ContentsSymptomsCausesWhat the Research SaysTreatmentDissociative Disorders

Table of ContentsView All

View All

Table of Contents

Symptoms

Causes

What the Research Says

Treatment

Dissociative Disorders

Close

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 asborderline personality disorder (BPD). About 75% to 80% of people with BPD report stress-related dissociation.

Signs and Symptoms of BPD

Symptoms of Dissociation

Frequent, severe dissociation during times of stress is a main symptom of BPD. It’s also associated withacute stress disorderandpost-traumatic stress disorder (PTSD), both of which canco-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.

Examples of Mild DissociationDaydreamingGetting so caught up in a book or movie that you miss what’s going on around youZoning out (for example, you are driving on the highway and realize that you missed your exit, but you don’t remember driving the last few miles)

Examples of Mild Dissociation

DaydreamingGetting so caught up in a book or movie that you miss what’s going on around youZoning out (for example, you are driving on the highway and realize that you missed your exit, but you don’t remember driving the last few miles)

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.

Derealization and depersonalization often occur at the same time.

An Overview of Depersonalization/Derealization Disorder

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.

Dissociative Fugue: Symptoms, Causes, Treatment, Coping

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.

Sometimes (and particularly for people with BPD), identity issues make it hard for a person to figure out where they end and another person (such as a spouse) begins.

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.

Moderate identity alteration is common in BPD and involves changes in mood or behavior that are not under your control.

Identity Issues in BPD

Causes of Dissociation

The exact cause of dissociation is unknown, but it often affects people who have experienced repetitive, overwhelming trauma, such as severechild abuseor 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.

Trauma doesn’t necessarily cause dissociation to develop, nor do you have to have experienced it to have symptoms of dissociation.

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 thelimbic temporal areas of the brain, increased activity in the frontal area of the brain, and changes in communication between the two areas.

More research in this area could help researchers determine which brain processes are related to dissociative symptoms, as well as make psychotherapy more targeted and beneficial for people who experience dissociation.

What Causes BPD?

Treatments for BPD such asdialectical 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.

Groundingis 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.

Some people respond better to grounding exercises that use sensation to bring them back to reality, such as holding an ice cube for a few moments, chewing a piece of minty gum, or smelling a lemon.

Self-Help Strategies for BPD

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

The vast majority of people with dissociative identity disorder have experienced childhood abuse, including physical and/or sexual abuse, and neglect.

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.

Research suggests that the severity of a person’s symptoms might be linked to an individual’s history of abuse and trauma.

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.

How to Find a DBT Therapist

3 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Krause-Utz A, Elzinga B.Current understanding of the neural mechanisms of dissociation in borderline personality disorder.Curr Behav Neurosci Rep. 2018;5(1):113-123. doi:10.1007/s40473-018-0146-9Şar V.The many faces of dissociation: opportunities for innovative research in psychiatry.Clin Psychopharmacol Neurosci. 2014;12(3):171-179. doi:10.9758/cpn.2014.12.3.171Dorahy MJ, Middleton W, Seager L, McGurrin P, Williams M, Chambers R.Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups.J Affect Disord. 2015;172:195-203. doi:10.1016/j.jad.2014.10.008Additional ReadingAmerican Psychiatric Association.What Are Dissociative Disorders?Updated August 2018.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: 2013.Choi-kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT.What works in the treatment of borderline personality disorder.Curr Behav Neurosci Rep. 2017;4(1):21-30. doi:10.1007/s40473-017-0103-z

3 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Krause-Utz A, Elzinga B.Current understanding of the neural mechanisms of dissociation in borderline personality disorder.Curr Behav Neurosci Rep. 2018;5(1):113-123. doi:10.1007/s40473-018-0146-9Şar V.The many faces of dissociation: opportunities for innovative research in psychiatry.Clin Psychopharmacol Neurosci. 2014;12(3):171-179. doi:10.9758/cpn.2014.12.3.171Dorahy MJ, Middleton W, Seager L, McGurrin P, Williams M, Chambers R.Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups.J Affect Disord. 2015;172:195-203. doi:10.1016/j.jad.2014.10.008Additional ReadingAmerican Psychiatric Association.What Are Dissociative Disorders?Updated August 2018.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: 2013.Choi-kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT.What works in the treatment of borderline personality disorder.Curr Behav Neurosci Rep. 2017;4(1):21-30. doi:10.1007/s40473-017-0103-z

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Krause-Utz A, Elzinga B.Current understanding of the neural mechanisms of dissociation in borderline personality disorder.Curr Behav Neurosci Rep. 2018;5(1):113-123. doi:10.1007/s40473-018-0146-9Şar V.The many faces of dissociation: opportunities for innovative research in psychiatry.Clin Psychopharmacol Neurosci. 2014;12(3):171-179. doi:10.9758/cpn.2014.12.3.171Dorahy MJ, Middleton W, Seager L, McGurrin P, Williams M, Chambers R.Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups.J Affect Disord. 2015;172:195-203. doi:10.1016/j.jad.2014.10.008

Krause-Utz A, Elzinga B.Current understanding of the neural mechanisms of dissociation in borderline personality disorder.Curr Behav Neurosci Rep. 2018;5(1):113-123. doi:10.1007/s40473-018-0146-9

Şar V.The many faces of dissociation: opportunities for innovative research in psychiatry.Clin Psychopharmacol Neurosci. 2014;12(3):171-179. doi:10.9758/cpn.2014.12.3.171

Dorahy MJ, Middleton W, Seager L, McGurrin P, Williams M, Chambers R.Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups.J Affect Disord. 2015;172:195-203. doi:10.1016/j.jad.2014.10.008

American Psychiatric Association.What Are Dissociative Disorders?Updated August 2018.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: 2013.Choi-kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT.What works in the treatment of borderline personality disorder.Curr Behav Neurosci Rep. 2017;4(1):21-30. doi:10.1007/s40473-017-0103-z

American Psychiatric Association.What Are Dissociative Disorders?Updated August 2018.

American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: 2013.

Choi-kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT.What works in the treatment of borderline personality disorder.Curr Behav Neurosci Rep. 2017;4(1):21-30. doi:10.1007/s40473-017-0103-z

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