Dissociation Mood Disorders and Fear of Harm (FOH)

Question: I noticed my child experiences dissociation during a mood or Fear of Harm (FOH) crisis.  Do other children or adults who live with mood disorders or FOH also dissociate, and if so, why?


Answer: Dissociation is the act of disconnecting from some part of the brain, body, senses, memories, or environment. During a dissociative episode the body is able to compartmentalize discomfort or distress by detaching from the source of the stress. It is a normal and common occurrence most people experience and can happen when scrolling through social media and “losing track of time”, or when the “mind wanders” while driving and the person doesn’t actively remember the details of their drive, which is often referred to as being on “autopilot”. 


For those who experience trauma, cumulative stress, anxiety, and other effects of mental illness, dissociating is the body’s way of coping and protecting itself from real or perceived danger. 


Dissociation can take on different forms. Three common forms children living with FOH report are 

    1. Depersonalization, 
    2. Derealization, and 
    3. Localized amnesia. 


Depersonalization is feeling detached from parts of your body  such as a hand or arm, but it can also include feeling detached from one’s emotions. In this case, an individual might not “feel real” or the experiences they are having don’t feel as though they are actually happening to them. It can feel like being an outside observer of oneself and the body is a completely separate entity from that person. 


Derealization is feeling detached from one’s surroundings or environment, and things don’t appear real. A six year old identified living with the bipolar phenotype FOH described it as feeling as if other people were fake, he wasn’t sure if maybe his parents were robots. 


Another form of dissociation is localized amnesia. It is memory loss that can occur for a very short amount of time (minutes to an hour). 


When people live with mental illness, it is common for the mind to attempt to cope with overwhelming stress or trauma through experience depersonalization, derealization, and to a lesser degree localized amnesia.


Living with FOH is traumatic, especially before accurate diagnosis and treatment. Very real and traumatic features of this medical condition include remembering or re-experiencing gory graphic nightmares, being unable to control aggressive and irritable mood outbursts, feeling paranoia, severe anxiety, obsessive or intrusive thoughts, and fearing that something bad is going to happen to oneself or loved ones.


It’s common for children who have experienced an energized explosive rage episode not to recall the damage that was caused as a result of their illness. 


Every part of the brain and body is impacted by this illness, and it impacts how they see themselves, how others view them, their relationships, and their ability to function throughout the day. Instinctively people who live with chronic stress and trauma “shutdown” (dissociate) to escape these kinds of situations and experiences. Dissociating is not a choice or willful behavior. On the contrary, it causes further distress. Feeling as if the world around you is not real, or body parts are not real, can lead to panic, anxiety, or additional trauma. 


Learning there is an explanation for the symptoms, and understanding FOH, provides a path to a recovery process through knowledge, healing , and hope. 


The goal is to learn more adaptive ways to cope with the illness to reduce symptoms of bipolar and FOH, and as a result reduce or resolve dissociative symptoms. 


Suggestions for helping to cope with dissociative symptoms include:

    • Tracking moods,
    • Joining supportive communities,
    • Using mindfulness techniques,
    • Practicing self-care,
    • Being proactive with cooling strategies, and
    • Working with a specialized therapist. 


One tool currently available for mood tracking is CMHRC’s Toolkit. This tool helps track overall mood, specific symptoms, medications, and even the weather. Using the Toolkit helps patients and caregivers get a clear picture of when, why, and how disruptive dissociative episodes occur and impact daily life. Parents can also encourage their children to keep a journal to compare the individual’s experiences with those that are observed by others.


Parents and caregivers can join supportive communities, like CMHRC’s membership program, to meet face to face with other parents who live with the same mental health disorders. This connection not only helps parents understand their child’s illness better, but support group meetings are a place where caregivers can share information on effective therapies, interventions, school accommodations, cooling products, and other issues that help families transform from living with unrelenting symptoms to finding the peace and harmony they need to thrive.


Mindfulness activities such as meditation, visualization, progressive muscle relaxation, deep breathing, and grounding techniques help keep individuals in the moment and connected to their bodies as they navigate daily life with unpredictable symptoms. 


Self-care is essential for both patients and caregivers. An easy way to do this is to build enjoyable activities into your weekly schedule so they are more likely to happen and are not dependent on mood fluctuations. 


Proactive cooling measures reduce overheating and can assist in avoiding a medical emergency or an urgent overwhelming cascade of symptoms. 


One of the three pillars of good and effective treatment includes working with a therapist who specializes in early onset pediatric bipolar and has knowledge on dissociative symptoms. It is important to disrupt the dissociative symptoms as soon as they begin to occur. This helps to stop dissociative experiences when they happen, and to reduce their use as the default coping mechanism when a stressful trigger is presented. 


Through the use of these tools it is possible to find relief and reduce symptoms.

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