i guess i am not understanding that because my sense of reality when there is dissociation can almost completely disappear. and when you look at derealization and depersonalization, they are where a person feels like they are not real, their thoughts aren't real, or their surroundings are not real and variations like that. so, knowing what is real in those cases becomes difficult as a result of dissociation.

what happens with me at some times where dissociation is involved is like a dissociated part mixed with i guess an emotional type of flashback or state, but the combination of it can sometimes cause an extreme reaction including paranoia where there is the fear something very bad will happen (beyond a panic attack type of fear). so, it's like layers of things mixed but still related to severe dissociation which also causes the sense of reality to be confused, unreal, like a waking nightmare, etc. where my head is foggy, memory of it is fuzzy/disappears after it lessens, etc. so it's hard for me to sort out what is what..i just know things feel very scary and parts of me get stuck in it including me.

at times, it has caused hallucinations as well...but it's all a result of dissociation and the reactions and combinations of things. i have no diagnosis of psychosis or anything like that. i have discussed it with my psychiatrist, and she has recognized it is all a result of trauma reactions and related dissociative experiences. i don't have a diagnosis of PTSD either, just borderline personality disorder (but that doesn't include any of this), DID, and OCD.