Dissociation and Dream Revision

February 11, 2013

Dissociation, in the realm of psychology, refers to detachment from one’s immediate surroundings.  Dissociation can range from mild to severe.  Mild dissociation takes the form of distractibility.  Severe dissociation may involve significant periods of time, and is often related to PTSD.  One form of severe dissociation, dissociative identity disorder (DID), formerly known as multiple personality disorder, involves multiple personalities, each dissociated from the others.  Both PTSD and DID can result from severe sexual abuse in early childhood.  

Many combat veterans with PTSD, but not DID, have significant periods of dissociation.  One Vietnam veteran patient of mine experienced dissociation while driving his car.  He had no problem driving safely, but would often miss his exit from the freeway, and have to turn around and come back, sometimes involving many extra minutes.  He had no recollection of events occurring during his temporary dissociative lapses.

Dissociation during severe trauma from which one cannot escape may have originally served a protective function, reducing emotional overload to the brain.  Why do people continue to dissociate after they develop PTSD?  Most likely they experience a trigger, a sensory stimulus (a sight, sound smell, or skin sensation) that reminds them of a past traumatic event.  The memory brings back unpleasant emotions from the past, possibly including a flashback, a vivid re-creation of the trauma scene.

If the memory/flashback is sufficiently intense and unpleasant, the PTSD sufferer may utilize dissociation as an avoidance technique.  The memory and its accompanying emotions are blocked, and the flashback goes away, at least temporarily.

Nightmares can cause dissociation as well.  My patients with PTSD sometimes say they are aware of having nightmares, but cannot recall details.  They have an ominous feeling, a sense of dread or disgust, and wake up sweating, with their heart racing.  They say they aren’t sure whether their nightmares are recurrent, since they can’t remember the content.

Many people with PTSD continue in this way for years, not wanting to expose themselves to traumatic memories.  Instead, they become repeatedly exposed to flashbacks and nightmares, which cause retraumatization.  PTSD, once established, tends to get worse rather than better unless effective treatment is initiated.

Effective treatment of PTSD involves breaking through dissociative defenses and confronting the trauma, however frightening this may be.  A therapist may be needed for support in this endeavor.  Dream revision therapy is one of the least traumatic ways of breaking through dissociation and avoidance.  This is because dreams are often symbolic or metaphorical.  One can work with the symbolism, within the metaphor, reducing direct confrontation with the original trauma.  It is often easier to face up to one’s nightmare than to directly face up to one’s original trauma.

However, dream revision therapy requires remembering one’s dream.  Dissociation may prevent this.  How can one overcome dissociation that occurs during and after a nightmare?  What can we do to remember our dreams more frequently and effectively?

The first step is simply to try.  It can be helpful to see a therapist.  During my psychiatric training I had weekly therapy sessions with a psychoanalyst.  He wanted me to tell him my dreams.  This was difficult for me at first, but over time I became much better at remembering them.  I kept paper and pencil near my bed, and wrote down my dreams whenever I could in the middle of the night.  Eventually, this became a habit, and I got quite good at it.  If you wait until morning to remember your dreams from the middle of the night, you may have nothing left but vague impressions and feelings.

Another trick is to set your alarm clock for late in the night (4-5AM), when you have a pretty good chance of being in the middle of a dream.  If you awaken directly out of a dream, there is about an 80% chance that you will be able to remember it.  I was able to affirm this myself by awakening people in a sleep lab in the early 1990’s while doing a research fellowship on sleep and dreaming at UC San Diego.

In the sleep lab we awakened people when their brain waves and eye movement recordings indicated they were in rapid eye movement (REM) sleep, the phase of sleep most closely associated with dreaming.  There are now several electronic devices on the market that can be set to wake you up at home when you are in REM sleep.  These devices, ranging in cost from $100-300 dollars, are known as “sleep cycle alarm clocks”.  They are safe and non-invasive.  Using such a device on a regular basis may increase the likelihood of awakening yourself in the middle of a dream so you can write it down.

Dissociation could have been useful at an earlier time in one’s life as a mechanism for avoiding traumatization, but if you are suffering from PTSD and having dissociation, it may be best to try to break through the dissociation and “TAKE CONTROL OF YOUR DREAMS”.  This is the title of a book I am in the process of getting published.  Once available in the marketplace, it could serve as a manual to help people change their dreams and recover from PTSD.  Recently I demonstrated the dream revision technique during an interview with Michele Rosenthal on her excellent weekly call-in radio show, Your Life After Trama. Listen to it here.

  • Shelly

    This is a very helpful article. I have benn for the last month in very peek and valleys of my PTSD. Nightmares and flashbacks consume me. I also have been told I dissociate. I never know when I am dissociating. Is this normal? Is it also normal to feel body pain after nightmares. Body memory? It feels as though the trauma just happened.

    • brucedow

      Hello Shelly,

      I appreciate your interest in my blogs, and will try to answer your questions in future blogs. It would be good for you to discuss your concerns about physical symptoms with a therapist. Dream revision could be helpful in eliminating both nightmares and flashbacks.

      Bruce Dow, M.D.

  • Yunonya Lightning Sword

    My dreams are very intense. Many doctors and psycologists are baffled when I tell them about my dreams.

    I’m almost always concious while dreaming. This is called “lucid dreaming”. I have been able to tell myself within a dream that I’m dreaming and this is a dream world. Then I start doing things. Pleasant and not so pleasant. The first dream like this I had when I was about 7 years old.

    I see lots of disturbing nightmares. Due to extreme mental stress I need to find a way to escape a horrible situation. Like escaping from certain death during volcanic eruption. I will lift myself up in the air before I get killed.

    But it’s not the worst thing my life is in danger. When I’m at safe distance from danger zone..I look back and see that massive volcano violently exploding and lava covering a village I had just visited. My friends..relatives..they were left behind. I’m watching in horror and imagine all of my loved ones dying in a very horrible, cruel way. Mental pain is overloading my whole being. I wake up my heart pounding, lips, fingers and toes numb. On the brink of panic attack.

    Then I fall back to sleep..and the same dream starts over again. Starting from a different place but those same things will happen and I can’t stop it from happening. I can only control my own escape by flying away. This may repeat itself 3 or 4 times. After this I’m completely exhausted, out of breath and dehydrated due to extreme sweating.

    During my whole childhood I was afraid I’d lose my parents and family..they were extremely depressed and suicidal.

    Lucid part here was minor but it was me flying away from danger. I develop super powers in extreme situations. I can take others flying with me and create a powerful invisible shield against flying bullets. I have cultivated these skills over a long time. I remember when I was unable to carry another person with me because it was too heavy and flying was impossible. Now I can lift up to 3 people up in the air and create a protecting sheild.

    It requires lots of mental power to do these things because they’re out of this world even within a dream. Laws of physics apply even in dream world because that’s how we understand the world when we’re awake. To defy them needs lots of out of the box thinking and extreme concentration. When I pull off these stunts I know it’s somewhat impossible to do so and I need to believe I can change laws of physics in my own dream.

    This is still mild lucid. But it’s nightmares that trigger my mind to become active character rather than passive bystander in a dream.

    Truly lucid dreams are those when I know from the very start I’m dreaming. They’re not nightmares. I conciously explore things and perform tests and even magic. I pour clear water on the ground and think: “turn red…turn red..can I turn this water red if I really concentrate enough?” And then the water will slowly change to red color. Then I try blue. I walk outside the house and imagine I’d love to grow a cherry blossom tree here. I point my hand to the place where I want the tree. And it quickly starts growing there..soon I have a huge beautiful cherry blossom tree. “I’m so excited I can create this!” I want to see my cat that died some time ago. Soon she will appear from behind a bush and will come to me purring and meowing.

    Once I thought: “If this is a dream..can I kill myself and not die? Sure I can? What will happen?” I jumped headfirst off the roof of a high building. Then realism caught me and I was laying on the ground unable to move. I panicked a bit. “Oh god did I actually jump from my apartment window sleepwalking and now I’m laying on the backyard unconcious?! Omg am I going to die?” Then I paniced and soon woke up.

    I travel around the world in my lucid dreams, visit exotic places I’ve always wanted to go and it feels awesome! When I wake up it feels like I actually was there!

    And the confusing part is..sometimes I don’t know if something’s really happened or not. I have to ask people did we do this and that. Make sure if I actually called my dentist for an appointment and feel funny when I they say me I didn’t. I was sure I did! Sometimes I don’t know if I’m awake or not. I stare in the mirror and do tests to make sure it’s not a dream. So I don’t jump off buildings or anything..my dreams can be that realistic.

    One of the most disturbing things is pain. Like all of my senses, pain is very real in my dreams. Once I woke up crying in agony trying to rip hundreds of thick needles off my skin. It hurt like hundreds of thick needles!! When I woke up the pain disappeared along with needles. But I couldn’t sleep that night anymore because the pain was so immense and scary.

    I’ve spent so many nights crying because of intense and horrible dreams.

    Sleep paralysis is sometimes a problem. I hate it. I see and hear hallucinations and can’t move! I’m awake but my body isn’t. I can only move my eyes. If I try to talk..my “speech” is like.. I try to say “call 911″ instead my boyfriend hears me say ” haoo haihaaa”. I feel so helpless when that happens. Can’t move or communicate. It’s very frightening.

    Because of my sleeping problems I’m unable to function. I’m always tired and sleep deprived. I can’t go to work or school. Always on sick leave.

    My psychologist is now diagnosing me and she is positive I’m experiencing conciderable dissociation due to extreme trauma and stress. My mind is very overactive. I have also been diagnosed with borderline personality. I will get trauma therapy for a long period of time and hopefully I’ll be able to function again.

    When awake I’m always anxious and my mind is racing. Emotions control my every day. I’ve tried practicing mindfulness to stay in the present. I’ve lost that ability. My mind is always wandering and it makes my life difficult. I’m always late, forget important things, get lost in familiar places, can’t hear what people are saying, difficulty to concentrate, I lose stuff in funny places and forget my turn in a card game. All dissociative symptoms.

    It’s become so pathological I don’t know if I ever fully heal..but I hope I can at least sleep peacefully at some point and enjoy the moment.

    Is there someone else experiencing same kind of thing?

    • bruce dow m.d.

      I suggest you read “Lucid Dreaming” Gateway to the Inner Self” by Robert Waggoner. He has many helpful suggestions about lucid dreaming, as well as other lucid dreamers you might contact for help. Also, there is a meeting of IASD (international association for the study of dreams), which includes many lucid dreamers.
      Bruce Dow