Dissociation & Body-Focused Repetitive Behaviors
What is dissociation?
Dissociation is a psychological process that involves a disconnection or detachment from one's thoughts, feelings, memories, or sense of identity. It is a defense mechanism that the mind employs to cope with overwhelming or traumatic experiences. As such, dissociation has a protective function, although it can cause us numerous other difficulties. Dissociation can range from mild and temporary experiences, such as daydreaming or "spacing out," to more severe and chronic dissociative disorders.
During dissociation, a person may feel as if they are observing themselves from outside their body, or they may have a sense of unreality or detachment from their surroundings. They might also experience a loss of time or memory gaps, where they cannot recall important details of their experiences, a sense of not having or knowing their own identity, numbness, fogginess or experiencing a dreamlike nature of reality, an out-of-body experience, etc.
While dissociation can serve as a protective mechanism in the short term, chronic and severe dissociative disorders can significantly impact a person's daily functioning and well-being. Some common dissociative disorders include dissociative identity disorder, dissociative amnesia, depersonalization/derealization disorder, dissociative fugue, etc.
Full blown dissociative disorders are present in only about 2% of the population or less, but dissociation as a defense mechanism is relatively common and most people have at least one experience with it. Different resources provide different numbers, but a moderate estimate is that about half of the total population has experienced at least one episode of dissociation.
Body-focused repetitive behaviors and dissociation
As you can see based on what I wrote above, BFRBs are not considered a dissociation disorder, yet here I am, writing this blog, suggesting that there might be some connection between dissociation and BFRBs!
Many people with BFRBs report engaging in picking or pulling as a way to temporarily manage or alleviate negative emotions such as stress, tiredness, anxiety, or boredom. The act of pulling hair or picking at the skin, for example, may provide a temporary sense of relief or distraction from uncomfortable emotions. In other words, when an internal experience becomes to much to handle, you turn to your BFRB for comfort, relief and escape. A BFRB may be a way to channel the “energy” of that feeling into the action of picking/pulling itself which then provides relief.
This is not the same thing as dissociation, but you can already spot one similarity – both dissociation and BFRBs are protective (albeit not always healthy) ways to cope with experiences that are too much to process in the moment.
When can we create a connection between BFRBs and dissociation?
· Very intense picking or pulling episodes where a person loses a sense of time.
· Spacing out and daydreaming while pulling/picking.
· Picking/pulling are repetitive behaviors, and repetition and focus can serve as dissociation mechanisms.
This is not to say that BFRBs and dissociation are connected for every person who struggles with a BFRB! It’s extremely important that not ascribe generic theories to everyone’s experience and instead look at every person’s lived experience individually. One of my favorite things about the BFRB Club is precisely that people get to share their diversity of experiences and we can see all the different life stories and ways of making sense of reality that lead to similar behaviors. So if dissociation doesn’t ring true to you – that’s OK. It doesn’t have to at all.
Trances
A picking/pulling trance is not a technical term. It’s a term that I learned from my clients and adopted because it’s quite useful. A trance is technically speaking an altered state of consciousness characterized by a narrowed focus of attention, heightened suggestibility, and a reduced awareness of the immediate surroundings. It’s a state in which an individual's conscious awareness is altered or shifted from the ordinary waking state. It’s open to debate whether a picking/pulling trance is what is technically described as a trance state, but I think that’s beside the point. The term is used in the BFRB community, we all know what we mean when we use it and that should be sufficient.
During a BFRB trance, a person may experience a hyper-focused state where most of the outside world is blocked out. Very often, my clients will report picking or pulling for hours before they are able to stop, or even notice the time that has passed. Just recently, a client wrote about this in a journal that she shares with me as a part of our work. I will share the whole lengthy entry with me because it describes the interplay between dissociation and BFRBs rather well:
Looking back at it with 24h of distance and after a good night of sleep (finally!!!), the whole day was a nightmare. One long, bad dream, the kind that makes you turn in bed all night and wake up sweating like a pig. I already woke up stressed because my youngest had been sick and because he was cranky and sensitive, my husband and I couldn’t sleep well for a few days. As a result, I was pretty unfocused and basically just going through the motions at home and at work. I didn’t pick that much, to my surprise, but my days were like watching a movie unfold and I was emotionally completely unengaged, maybe that’s why? I’ve actually had a whole lunch break at work where I was staring out the window and I forgot to eat!!! That was on Wednesday, I didn’t write about it then. My mind was completely blank, I was looking at the adjacent building and… well just looking at it, no “and”. Then on Friday I almost fucked up at work and gave the wrong IV to a patient. It wouldn’t have killed him had I done it, but I would most definitely fire myself for being such a loser. Luckily Nancy noticed it and she just grabbed my hand without saying anything and looked at the label. I followed her gaze and just felt like I was going to die! I spent the rest of the day completely beside myself, angry, tired, frustrated, very anxious that I will do something similar again and even though Nancy tried to comfort me and told me that this happens and that this is why we work together and that everything is fine, for me, nothing was fine. I ALMOST KILLED SOMEONE! I came home, said hello to my husband, went straight into the bathroom and picked for 3.5 hours, I kid you not!!!! I didn’t notice that this much time had gone by until my husband started hitting the bathroom door, obviously knowing what’s going on inside.
Do I regret it? I don’t honestly. I’ve made a mess of my arms and my back and my face partially, but I went out of that bathroom a reborn woman. For a few hours at least, this nightmare of a week didn’t exist anymore.
The trance itself was so soothing and comforting. I was seeing the grossness come out of my body and I could see it close up, I would scan my skin completely and utterly absorbed in the texture of it, then I would find something that sticks out in that particular special way, I would touch it a few times, run my index finger over it back and forth, then squeeze and feel this disgusting and beautiful relief. I wasn’t thinking about my child, I wasn’t thinking about my husband, I wasn’t mortified with my almost error at work – none of it was there. Just empty beautiful space. Even *I* wasn’t there in a messed up way. My fingers were, my body was, but there was no pain, no feelings, no thoughts.
I know I should feel guilty about it all but even as I’m writing this I can tell that this saved my fucking sanity, so I don’t feel guilty. I don’t want it to happen again, but I don’t feel bad even one bit.
Hopefully this wasn’t too long to read, but I feel like it’s a valuable journal entry to read. I’m also very grateful to my client for allowing me to share it with you. The only change from the original format that we decided to make was to replace her husband’s name with “my husband”, while we left the name Nancy as it’s common enough and doesn’t reveal anything about my client.
What can we see here? First, she described instances of spacing out and dissociating throughout a very stressful week. From my conversation with her I know that she wasn’t quite aware of it as it was happening. She was aware of the experience, but not that it was a reaction to stress, and it was only in retrospect that she connected what was happening to dissociation and being overwhelmed with stress.
The journal entry also illustrates how she went about her week ignoring but being aware of her needs at least indirectly: she couldn’t focus well, she was tired, overwhelmed and extremely stressed, yet her entry doesn’t show any effort to deal with these or at least alleviate some of the suffering all of it caused. This neglect of her own emotional well-being is, of course, why she is in therapy, but we can also see why her neglect was present. Whenever things got too much, she would detach from her feelings and thoughts, perhaps most visible in her description of her “lunch break”.
In this context, her picking trance served as an intersection of excoriation disorder and dissociation. Her description of what a picking trance experience was like is easy to recognize as dissociation:
- Detachment from feelings and thoughts
- Detachment from external environment
- Altered sense of time
Is my BFRB connected to dissociation?
There’s no easy way to tell other than to carefully observe your experience and see what’s true for you. Here are some things to consider:
- Dissociation is commonly associated with individuals who have experienced trauma, especially repeated and severe trauma during childhood, such as physical or sexual abuse, neglect, or witnessing violence. Dissociation as a defense mechanism used occasionally doesn’t have to be linked to severe trauma but dissociation disorders are linked to traumatic experiences in up to 90% of the cases, according to some studies.
- Dissociation can be a feature of several mental health conditions, including post-traumatic stress disorder, borderline personality disorder, and certain anxiety disorders.
- Intense stress, whether due to a single event or ongoing life circumstances, can trigger dissociation. Situations such as accidents, natural disasters, combat experiences, chronic stress, high intensity of stress or medical emergencies can contribute to dissociative experiences. Being overwhelmed often enough is sufficient, you don’t need to live through a devastating earthquake to dissociate!
- Some individuals with highly suggestible or imaginative tendencies may be more prone to dissociative experiences. They may have an innate ability to create vivid mental imagery or temporarily disconnect from reality.
- Statistics don’t show any definitive predilection for a specific gender; regardless of your gender identity or sex, you may equally dissociate, although some dissociation disorders seem to be more common in women.
What to do about it?
The answer is obvious: psychotherapy. But seeing how you can’t necessarily call your therapist every time you experience dissociation or that you may not be able to afford to see a therapist at all, here are some practical things that you can do in the moment when you become aware of dissociation:
1. Pay attention to your breathing and take slow, deep breaths. Notice the sensation of the breath entering and leaving your body. This can help anchor your attention in the present moment and gently detach you from whatever is causing such an intense experience that requires dissociation to protect you.
2. Do a structured breathing exercise. There are plenty of them out there (we have a whole worksheet in the Downloads section): box breathing, 3x3 breathing, ocean breathing, etc. Not every exercise will work for everyone, so try out several and choose one that works. This is a useful thing to remember: you don’t want to have 50 tools at your disposal, you only need one or two that work. When you’re feeling overwhelmed, you don’t have time or the focus to flip through a complex collection of techniques. You want something you can think of quickly.
3. Engage your senses and anchor yourself in them. Use your senses to bring yourself back to the present. Look around and name objects you see, touch different textures (this is particularly useful if sensory stimulation is an important part of your BFRB) - describe how they feel, listen carefully to the sounds around you, or even taste something to bring your focus to the present sensory experience.
4. Use different grounding objects. Carry a small object in your pocket, such as a smooth stone or a textured keychain, a rosary, mala beads, bracelets, necklaces, anything that you can touch or hold to help ground yourself. This is very similar to my previous suggestion: these objects will anchor you in something pleasant and firm (therefore also safe). Focus on the sensations of the object to connect with the present moment.
5. Verbally or mentally label the things you see around you. Describe their colors, shapes, or functions. This can help shift your attention from internal experiences to the external environment.
6. Engage in activities that create a sense of comfort and relaxation. This could include gentle stretching, listening to calming music, creative activities such as singing or painting, or simply holding a warm cup of tea. Find what brings you a sense of relaxation and safety.
7. Reach out to a trusted friend, family member, or therapist who can provide support and help you feel grounded. Talking to someone who understands your experience can be comforting and reassuring.
The keyword here is: safety. You can be creative and combine my suggestions from above or create a technique of your own. The point is to simplify your world and make yourself feel safe in whatever way works for you.
