Dissociation, a most mysterious construct: What is it and why is it important clinically?

The construct of dissociation as currently understood in the psychological and psychiatric literatures has its origins in the work of Pierre Janet, despite clinicians and theorists prior to him using the term. 

A contemporary of Freud’s, Janet offered a somewhat circumscribed understanding of dissociation that was limited to those with a constitutional weakness to integrate functionsand processes in the face of distressing experience. Thus, dissociation was restricted to clinical individuals, particularly those presenting with hysteria. 

Since Janet’s time, the term dissociation has been used in different domains of psychology (e.g., cognitive, clinical), and has attracted an increasing number of phenomena proposed to fall under the umbrella of dissociation, from non-pathological absorption to the dissociative identities evident in dissociative identity disorder.  

Relatedly, debate has revolved around whether dissociation should be isolated to clinical phenomena or also reflect experiences evident in the general population. What is clear is that dissociation has become a very messy term that is often used with a lack of conceptual clarity. In addition, there is some confusion about its importance in clinical psychiatric science and treatment. For example, differences have emerged on whether dissociation should be closely attended to or ignore in the treatment of posttraumatic stress disorder, and whether dissociation needs any particular consideration in the treatment of borderline personality disorder.  This paper attempts to provide clarity about the confusion surrounding the construct of dissociation and examine its relevance in psychological therapy.