C-PTSD and the Dissociative Spectrum

Video · 19 minutes · C-PTSD · Dissociation

Summary

This is the clearer recording of the dissociative-spectrum talk. Dissociation is disconnection among thoughts, feelings, actions, and sometimes identity. It runs from ordinary daydreaming to disorders that wreck daily life. It is a central feature of C-PTSD, and one of the main reasons people spin in therapy. Many clinicians miss it, mislabel it, or treat it with methods that make it worse. Information without context can send people working against their own recovery. Education only. Michael is not your therapist.

What this video covers

  • Why dissociation sits at the center of C-PTSD
  • Overlooked, misdiagnosed, mistreated
  • Why some self-help and spiritual practices can be dangerous here
  • Overdiagnosis and underdiagnosis at the same time
  • Mild: daydreaming, absorption, highway hypnosis
  • Moderate: transient depersonalization, derealization, stress-related forgetting
  • Severe: amnesia, fugue, DPDR disorder, DID

Key takeaways

  • Mild dissociation is human. Severe dissociation is not “just zoning out.”
  • Timing and condition matter. The wrong method can be neutral or harmful.
  • Depersonalization: detached from yourself, as if outside your body. Common after early sexual abuse in the clients Michael describes here.
  • Derealization: the world feels unreal or “like a drug kicked in.” Often comes and goes with stress.
  • In DPDR disorder, functioning is impaired and reality testing stays intact — not a psychotic episode.
  • Get advice from a licensed clinician who actually treats this.

Who this is for

  • Adults with C-PTSD who lose time, feel unreal, or watch themselves from outside
  • People who have done years of therapy with little movement

Who this is not for

  • Self-diagnosis from a list
  • Anyone in immediate danger — call 911 or 988

Next step

Transcript

Hi everybody, welcome back. It’s Michael Quirke, and I want to talk with you again today about C-PTSD and what’s referred to as the dissociative spectrum.

This video is an update — take two on last week’s video. I received a lot of kind feedback, thank you. I also learned my computer was coming down with something. The sound was choppy. That’s better now.

One reason I’m talking about C-PTSD and dissociation: dissociative symptoms are central in complex PTSD. The second: dissociation is one of the most common reasons people don’t respond well to psychotherapy. These symptoms are common. Most therapists don’t have experience treating them. They are frequently overlooked, misdiagnosed, and mistreated. They can cause you to spin your wheels in therapy and make little or no progress.

Not all treatment and self-help is simply good. If only life were that straightforward. It depends on timing and on the exact condition. Methods can be neutral. They can be harmful. I see this every day.

We have an abundance of information. The problem is that information is often wrong, limited, or incomplete. It has to be directionally accurate and applied wisely — that means context.

If you have unacknowledged dissociative symptoms, some treatments, some self-help, and some spiritual practices can be dangerous, because they make matters worse. Every day I talk with men and women who are working against their own trauma recovery, unbeknownst to them.

My impression is that we are living in a time of both widespread overdiagnosis and widespread underdiagnosis. One reason is a lack of information about the dissociative spectrum.

I am a therapist. I am not your therapist. This is education. Get good treatment advice from a licensed, fully qualified mental health professional who has experience in this area.

The dissociative spectrum is the range of dissociative experiences we all have, from mild everyday ones to severe, problematic conditions. Dissociation is a disconnection among thoughts, feelings, actions, or even sense of identity. Severity and impact vary.

Mild. Common. Typically not a problem. Most people have them occasionally or daily. Daydreaming: you zone out, get lost in thought during mundane tasks — cleaning the bathroom while thinking about something else. I’ve done that. Mild disconnection from the immediate environment.

Absorption. Can be healthy, helpful, adaptive, skillful. Fully engrossed in a book, a movie, an activity. You lose time and surroundings. It can feel good. Example: tennis with friends for hours that felt like five minutes.

Highway hypnosis. A familiar route. You don’t remember parts of the trip. You turn right at the Chevron on autopilot. Automatic behavior. The system is not tracking each action.

Moderate. Some discomfort. Typically does not wreck daily functioning. Common in the practice.

Depersonalization: detached from yourself, as if observing from outside your body. Often transient. Tied to stress or fatigue. Michael is seeing more of this in people with early sexual-abuse histories whose body-mind system learned young to disconnect and leave the body.

Derealization: the external world feels unreal or dreamlike. A man in treatment said it feels as if someone gave him a drug and he starts to feel weird. Palpable. Passes. Often with high stress and anxiety. Comes and goes.

Mild dissociative amnesia: forgetting important but nonessential details — minor conversations, minor circumstances — often under stress, overwhelm, or fatigue.

Severe. More intense. Can significantly impair daily life and effective functioning. Usually associated with a formal dissociative disorder.

Dissociative amnesia: inability to recall important personal information, often connected to trauma. Beyond ordinary forgetting. Causes significant distress.

Dissociative fugue: sudden, usually unplanned travel away from home plus inability to recall what happened. Sometimes a new identity, or confusion about who they were. Disruptive and alarming.

Depersonalization/derealization disorder: persistent, recurrent experiences. Distressing. Get in the way of sleeping, feeding, clothing, taking care of yourself. Reality testing remains intact — not a psychotic episode, not hallucinations or delusions. The person often has some recognition or questioning of what is going on.

Dissociative identity disorder: there is a great deal of misunderstanding and misinformation. Question Hollywood. DID involves significant memory gaps and usually severe impairment in daily functioning.

Understanding the spectrum helps you and the clinicians working with you identify range and severity, and distinguish ordinary dissociation from clinical dissociation.

To learn more about trauma recovery, visit michaelgquirke.com.

Disclaimer

Educational content only. Not therapy, not a diagnosis, not a crisis service. Psychotherapy is available to California residents in San Francisco, Palo Alto, and online. If you are in immediate danger, call 911 or 988.