Analyzing the Relationship Between Dissociation (Depersonalization vs. Derealization), Emotional Regulation, and Insecure Attachment

Writer: Cristian Whatley

Editors: Keila Cruz

Have you ever been listening to a couple of songs on your favorite playlist and suddenly you encounter a song that abruptly takes you away from your immediate surroundings and ushers you into a hypnotic state? Or perhaps you’re in class learning the process of cell division and you find your attention drifting randomly or toward that unpatched tile on the ceiling, you become so deeply entrenched in thought that  you do not realize twenty minutes have elapsed and before you know it you have missed the information your professor said would be on the next exam. If so, then chances are you’ve just experienced mild dissociation. Dissociation is a disconnect a person has with their thoughts, memories, feelings, actions, or senses in relation to who he or she is. It is a normal process that most people have experienced at least once in their lives. However, dissociation wears many masks, when cases become severe and cause a disorder in one’s life, depending on the individual’s symptoms, they may be diagnosed with dissociative amnesia, depersonalization/derealization disorder, dissociative identity disorder (DID), and other specified dissociative disorder (OSDD) according to DSM-5 (Chiu CD, Meg Tseng MC, Chien YL.et al., 2017). Dissociative symptoms widely interfered with different psychological functioning such as consciousness, memory, emotion, motor control, and identity. Dissociative Disorders can become an ongoing experience that can affect one’s daily life (Krause-Utz, A., Frost, R., Winter, D. et al., 2017). The cause of dissociative disorder is still unclear, but researchers have theorized that these disorders manifest as a way to cope with trauma, especially prolonged childhood trauma (National Alliance on Mental Illness. Dissociative Disorders).  According to a subset of hypothesized associations in the trauma-related voices (TRV) model, a study sought to explore the relationships between trauma and the frequency of unusual perceptual experiences (UPEs) (Strachan, L. P., Paulik, G. et al., 2023).  Based on their findings, insecure attachment provides an indirect pathway from trauma to other mediating factors within the TRV model, which are linked to UPEs via dissociation. This association aligns with other theories of emotional regulation and attachment theory. The present review paper aims to explore  the ways that insecure attachment styles, specifically disorganized attachment contribute to poor emotional regulation, increasing vulnerability to dissociation (both depersonalization and derealization), while dissociation itself serves as a maladaptive emotional regulation strategy. 

Before we dive into this topic, it's important to lay out some groundwork. Depersonalization is an experience tied to detachment or unreality from one’s cognition, self, or body. People often share that they feel like they 're outside their body, seeing things happening to them. Derealization is similar in that individuals also experience detachment, yet unlike dissociation, it is experienced in relation to one's surroundings. People may feel as if the world and the people around them aren’t real (American Psychiatric Association. What are dissociative disorders?). Attachment can be broken up into two categories: secure and insecure. Insecure attachment originates from early attachment caregivers providing inadequate emotional availability and responsiveness (Bowlby, 1982; Prebble et al., 2013; Shaver & Mukulincer, 2012). The ability to control one’s own emotion or set of emotions is called emotional regulation of an individual to modulate an emotion or set of emotions. Disorganized/fearful avoidant attachment is a complex pattern of behavior characterized by both high levels of anxiety and avoidance in relationships. Now that we know the structure of our building blocks, let's piece them all together. Starting with insecure attachment, at a young age, these individuals rarely received emotional responsiveness in times of need from their caregivers ; neglect and abuse were also shown more often than care and compassion. As a result, a child isn’t properly equipped with the emotional self-regulation strategies to deal with stress and trauma they may face later on in their life. 

This then compels us to ask: What are the possible outcomes when a household inflicts unbearable suffering, especially from a loved one? There needs to be a means of escape for these individuals and as they think of a way to claw out an exit from this stress. One can see how derealization starts to manifest itself and becomes like an “emergency override” button for these individuals when their “fight or flight” response goes over the threshold. Or maybe dissociation is the puzzle in piecing together the third stress response “freeze”. With depersonalization, this out of body experience of detachment from one’s mind, self or body can be a result of individuals suffering from identity crisis. Using Marcia (1966) and Erikson’s (1968) Theory of Identity, identity diffusion is a state where an individual has not yet developed a clear sense of identity or purpose (Marcia et al., 1993). With Depersonalization individuals are disconnected with themselves. Identity diffusion plays a part because individuals never had a sense of security and positive reinforcement in forming themselves. This is due to the multiple forms of trauma and individual experiences. How can a person try to cope and process their trauma when they can’t even piece themselves together first? Imagine trying to connect the dots of your past when you don’t even have a clear vision of yourself. Having a sense of identity can aid individuals in guiding them through life experiences and shapes how they see themselves in a positive light. (look for evidence to support this). Not having a sense of identity makes it difficult for an individual to associate their perceptions of themselves. This ability to understand the behavior of others in terms of intentional mental states is referred to as mentalization (Fonagy et al., 2002).  

Going back to disorganized/fearful attachment now, there's this push-pull phenomenon when attempting to form genuine intimate relationships. They have this unbearable need for closeness, but also have a fear of rejection (Cassidy, 1994). It’s like the Irresistible Force Paradox that highlights the contradiction between the immovable object vs. the unstoppable force. Which one wins? The disorganized individual wants to connect, but pulls away at a moment's notice, they see signs of rejections where none are present, and conjure a self-fulfilling prophecy: Act in ways that protects themselves from rejection and pain. It’s not as if they don’t want love. They’re human beings just like you and I. They want to be understood, to feel safe around others, and feel a genuine connection with another person. But this process is extremely taxing, and developing feelings for another person can bring about more negative emotions than positive. Not only is the process of attempting to form a genuine connection with another person extremely jarring, but also the act in opening Pandora's box in an attempt to reflect back at one’s traumatic past to attack the issue at the source. That being negative experiences one has with the interactions with their caregiver and traumatic experiences they might’ve suffered from individuals who weren’t their caregivers as well. Now how does a person regulate all these negative affects that they're experiencing in the present and upon reflecting on their past trauma? Especially when they were never in a positive environment during childhood that would’ve better prepared them for life experiences. 

This insurmountable task of mentalization warrants the mind to develop dissociative symptoms in an attempt to regulate the tremendous toll of one’s psyche. Dissociation isn’t an active attempt to push one’s traumatic past in the back of their psyche and to be confused with repression. This is true because individuals with a disorganized attachment want to be in love and loved back. They often feel intense loneliness because of a genuine want for intimate connection, but the fear and stress response, attached to that want, causes them to act unpredictably, driving away potential connection. Dissociation can be seen as this negative regulation strategy that those with disorganized attachment use to suppress the intensity of emotions felt when processing all this information (Kennedy et al., 2004; Shaver & Mukulincer, 2012).

In closing, we have noted that insecure attachment styles foster emotional dysregulation and provide an indirect pathway from trauma to other mediating factors via dissociation. While dissociation typically serves as a coping mechanism, it simultaneously exacerbates emotional dysregulation. However, dissociation, attachment, and emotion regulation are complex and iterative processes. (Gross, 2015; Kennedy et al., 2004; Shaver & Mukulincer, 2012). Further studies should include longitudinal studies to track developmental trajectories and exploring interventions that address all three constructs simultaneously. Understanding the interplay between dissociation, emotional regulation, and insecure attachment is vital for both clinical practice and advancing psychological theory and helping to further understand the complexity of how disorganized attachment is associated with other personality disorders (i.e. Borderline Personality Disorder) and other psychopathological symptoms other than dissociation that may arise in an attempt to process one’s past and self.