What Is Dissociation?
Dissociation is a disconnection between a person's sensory experience, thoughts, sense of self, or personal history. If you have trouble remembering a certain period of time in your life, for example, you may be experiencing a type of dissociation called dissociative amnesia.
APA Definition of Dissociation
The American Psychological Association (APA) defines dissociation as "a defense mechanism in which conflicting impulses are kept apart or threatening ideas and feelings are separated from the rest of the psyche."
This disconnection can occur as part of a dissociation disorder, or it may be a symptom of another mental health issue. For instance, people with borderline personality disorder, post-traumatic stress disorder, and schizophrenia sometimes experience dissociation.
What Dissociation Feels Like
Someone with dissociation might feel a sense of unreality and lose their connection to time, place, and identity. This is because dissociation disrupts four areas of personal functioning that usually operate together smoothly, automatically, and with few or no problems.
These areas are:
- Consciousness
- Identity
- Memory
- Self-awareness and awareness of surroundings
Breaks in this system of automatic functions can cause dissociation symptoms. Dissociation can range from feeling a mild sense of detachment (daydreaming) to experiencing a more severe disconnection from reality (feeling as if the world is unreal).
Types of Dissociation
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), a handbook published by the APA to help mental health professionals diagnose mental illnesses, identifies three types of dissociative disorders:
- Depersonalization-derealization disorder (DPDR): This dissociative condition involves feeling detached from one's own body and thoughts. People with DPDR may feel like they are observing their own life as an outsider, or they might feel disconnected from their surroundings.
- Dissociative identity disorder: This dissociation disorder was previously known as multiple personality disorder. It is characterized by having two or more persistent personality states, sometimes referred to as "split personalities."
- Dissociative amnesia: This type of dissociation is characterized by forgetting one's personal information. This includes not being able to recall or "losing" memories of past events.
Related Conditions
In addition to these dissociative disorders, dissociation may also occur as a symptom of another condition. Conditions in which someone may experience dissociation include:
- Acute stress disorder
- Affective disorders, also known as mood disorders
- Anxiety
- Attention-deficit/hyperactivity disorder (ADHD)
- Borderline personality disorder (BPD)
- Depression
- Epilepsy
- Migraines
- Obsessive-compulsive disorder (OCD)
- Phobias
- Post-traumatic stress disorder (PTSD)
- Schizophrenia
- Substance use disorders
Symptoms of Dissociation
If you have a dissociation disorder or a mental health condition involving dissociation, you may sometimes have felt "disconnected" from yourself. Examples of dissociation include:
- “Blanking out” or being unable to remember anything for a period of time
- Experiencing a distorted or blurred sense of reality
- Feeling disconnected or detached from your emotions
- Feeling like you’re briefly losing touch with events going on around you, similar to daydreaming
- Feeling numb or distant from yourself and your surroundings
- Feeling that the world around you is unreal and distorted
- Having an altered sense of time and place
- Having flashbacks of traumatic events
- Memory loss about certain events, people, information, or timeframes
It is possible to experience dissociation without being aware of it. Sudden mood changes, difficulty remembering personal details about yourself or your life, and feeling disconnected are all symptoms of dissociation.
Related Symptoms
Some people with dissociation may experience additional symptoms of depersonalization (feeling as if the self is not real) and derealization (feeling as if the world is not real). Both of these are serious mental health issues.
Depersonalization and derealization are often responses to overwhelming traumatic events that cannot be escaped, such as child abuse and the trauma of war. They help the person to keep functioning at the moment of being severely traumatized.
An example of depersonalization is an out-of-body experience, where people see themselves from above. This lets them feel that whatever is occurring “is not happening to me.” In states of derealization, people are detached from their surroundings. This lets them feel that their situation isn't real, or that it is “just a dream.”
Causes of Dissociation
Several factors can play a role in the development of dissociation. Among the potential causes are trauma, drug use, and other mental conditions.
Trauma
The main cause of dissociative disorders is trauma. In cases such as this, dissociation occurs as a way to keep memories of the traumatic event from feeling overwhelming or too massive to handle.
Dissociation also helps the person distance themselves from the situation.Assault, abuse, accidents, natural disasters, and military combat are all sources of trauma that can cause dissociation.
Drug Use
Substance use can also cause dissociation. Experiences with dissociation and trauma can even predict the potential for addiction according to a study published in the International Journal of High Risk Behaviors and Addiction.
Another study in the Journal of Trauma & Dissociation showed "relatively high levels" of dissociation among women with both substance use disorder and PTSD, but also suggested that more research into how substances affect dissociation would be helpful.
Other Mental Conditions
Certain mental health disorders can also cause symptoms of dissociation. PTSD, for example, is often characterized by symptoms of dissociation and detachment. A 2021 study also found a direct connection between dissociation and hallucinations, grandiosity, paranoia, anxiety, and depression.
Diagnosis of Dissociation
To be diagnosed with dissociation, your healthcare provider will assess your symptoms, take your medical history, perform a physical exam, and possibly order lab tests to rule out any underlying medical conditions. They may also refer you to a mental health professional for diagnosis.
A number of assessments can be used to help evaluate and diagnose dissociation. If you are experiencing dissociative symptoms, you may be given:
- A structured clinical interview for dissociation
- The Dissociative Experiences Scale (DES)
- The Clinician-Administered PTSD Scale (CAPS)
The CAPS assessment tests for depersonalization by asking questions such as "Have there been times when you felt as if you were outside of your body, watching yourself as if you were another person?" It tests for derealization by asking, for example, "Have there been times when things going on around you seemed unreal or very strange and unfamiliar?"
Treatment for Dissociation
If you or someone you love has a dissociative disorder, it's important to know that treatment can be a lengthy and sometimes difficult process. However, several treatment options have been found effective and can include psychotherapy, medication, or a combination of both.
Psychotherapy
Your health provider may recommend psychotherapy to help treat dissociation. Types of psychotherapy used for dissociation treatment include:
- Cognitive behavioral therapy (CBT), which focuses on helping people identify and change negative thoughts and behaviors
- Dialectical behavioral therapy (DBT), which helps people learn skills that allow them to better manage emotions and stop harmful behaviors
- Eye movement desensitization and reprocessing (EMDR), which utilizes CBT strategies along with visual exercises to help reduce psychological distress
Medications
There are no medications specifically approved for the treatment of dissociation. However, there are some medicines that can be prescribed to help manage its symptoms.
For example, you may be prescribed antidepressants, sleep aids, or anti-anxiety drugs to help manage dissociation symptoms related to mood, anxiety, and sleep. If the dissociation is due to a psychiatric condition such as schizophrenia, your health provider may prescribe an antipsychotic.
Complications of Dissociation
If left untreated, symptoms of dissociation can be lifelong. This makes seeking treatment when signs first appear important to recovery. Research has also connected dissociation with worsened psychiatric symptoms in the future.
Another complication of dissociation is that it increases a person's vulnerability to abuse since the disconnection leaves them unprotected. Sadly, this abuse sometimes occurs in the form of a therapist sexually abusing a patient with dissociation. This is a form of revictimization known as "sitting duck syndrome."
Taking the time to find the right therapist can help avoid this type of situation. It is also helpful to know the signs of a bad therapist and make a switch should any of these become apparent during treatment sessions.
Dissociation After Trauma May Indicate Increased Mental Distress in the Future
Coping With Dissociation
Since stress and anxiety sometimes trigger dissociation, finding ways to deal with these issues can help you better cope with their symptoms. Actions to consider taking include:
- Eating a healthy diet to lower your stress levels
- Getting adequate sleep each night
- Getting regular physical exercise
- Identifying and avoiding or managing dissociation triggers
- Practicing grounding techniques to help bring you back to the present moment
- Using relaxation strategies to reduce your anxiety
If you or a loved one are struggling with dissociation, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
A Word From Verywell
If you've experienced depersonalization or derealization, be aware that such a response to actual traumatic events can be triggered again—even long afterward—by events that may or may not be threatening. Should this happen, you could automatically enter a dissociative state at the first hint of potential trauma.
If the situation isn’t actually threatening, you may appear “spaced out” to others. On the other hand, if there is a real threat, dissociating from it when escape might not otherwise be possible could expose you to the risk of harm. Talk to your health provider if you think you might be experiencing symptoms of dissociation or a related condition.
FAQs
What is a simple explanation of dissociation? ›
Many people may experience dissociation (dissociate) during their life. If you dissociate, you may feel disconnected from yourself and the world around you. For example, you may feel detached from your body or feel as though the world around you is unreal.
What does it mean if you experience dissociation? ›Dissociative disorders are mental disorders that involve experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity. People with dissociative disorders escape reality in ways that are involuntary and unhealthy and cause problems with functioning in everyday life.
What are some examples of dissociation? ›Examples of mild, common dissociation include daydreaming, highway hypnosis or “getting lost” in a book or movie, all of which involve “losing touch” with awareness of one's immediate surroundings.
What does it mean to dissociate emotionally? ›Dissociation is a process linked to lapses of attention, history of abuse or trauma, compromised emotional memory, and a disintegrated sense of self. It is theorized that dissociation stems from avoiding emotional information, especially negative emotion, to protect a fragile psyche.
What happens in the brain during dissociation? ›Dissociation involves disruptions of usually integrated functions of consciousness, perception, memory, identity, and affect (e.g., depersonalization, derealization, numbing, amnesia, and analgesia).
What are the three types of dissociation? ›There are three dissociative disorders, including dissociative identity disorder, dissociative amnesia and depersonalization/derealization disorder. These conditions typically develop as a response to trauma. They're treatable — usually with psychotherapy (talk therapy).
What are the 5 types of dissociation? ›There are five main ways in which the dissociation of psychological processes changes the way a person experiences living: depersonalization, derealization, amnesia, identity confusion, and identity alteration.
What can be mistaken for dissociation? ›Dissociative Identity Disorder
The most common misdiagnoses are Bipolar Disorder (formerly known as manic depression), Schizophrenia, and Borderline Personality Disorder (BPD).
They can happen to us all sometimes. For example, during periods of intense stress or when we're very tired. Some people also find that using drugs like cannabis can cause feelings of derealisation and depersonalisation. Dissociation is also a normal way of coping during traumatic events.
How long do people dissociate? ›The symptoms often go away on their own. It may take hours, days, or weeks. You may need treatment, though, if your dissociation is happening because you've had an extremely troubling experience or you have a mental health disorder like schizophrenia.
Why do trauma victims dissociate? ›
Trauma-Related Dissociation is sometimes described as a 'mental escape' when physical escape is not possible, or when a person is so emotionally overwhelmed that they cannot cope any longer. Sometimes dissociation is like 'switching off'. Some survivors describe it as a way of saying 'this isn't happening to me'.
Is dissociation the same as zoning out? ›Zoning out is considered a form of dissociation, but it typically falls at the mild end of the spectrum.
Are you aware during dissociation? ›The difference from active avoidance (on purpose avoiding thinking about or doing something) is that dissociation tends to happen without planning or even awareness. Many times, people who are dissociating are not even aware that it is happening, other people notice it.
Do you think during dissociation? ›You could feel as though you're observing yourself from the outside in — or what some describe as an “out-of-body experience.” Your thoughts and perceptions might be foggy, and you could be confused by what's going on around you. In some cases, dissociation can be marked by an altering of your: personality. identity.
Is dissociation a form of anxiety? ›Dissociation – feeling detached from yourself, like in a dreamlike state, feeling weird or off-kilter, and like everything is surreal – is a common anxiety disorder symptom experienced by many people who are anxious.
Is dissociation a form of trauma? ›Dissociation can occur in response to traumatic events, and/or in response to prolonged exposure to trauma (for example, trauma that occurs in the context of people's relationships). Dissociation can affect memory, sense of identity, the way the world is perceived and the connection to the physical body 3.
Is dissociation a form of ADHD? ›While dissociation is not a symptom of ADHD, the two are closely related because they are often comorbid. 123 People with dissociative disorders may also show symptoms of ADHD and vice versa.
Is dissociation an addiction? ›November 16, 2022. Dissociation is a common part of active addiction. Substance use disorder (SUD) and dissociation can both be causes of one another, making them part of a self-perpetuating cycle.
How common is dissociation? ›People from all age groups and racial, ethnic and socioeconomic backgrounds can experience a dissociative disorder. Up to 75% of people experience at least one depersonalization/derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes.
Can you hear during dissociation? ›Auditory hallucinations are common in dissociative identity disorder, borderline personality disorder, and complex posttraumatic stress disorder and are not specific to psychosis.
Does dissociation feel calm? ›
Normal dissociation may feel like daydreaming at a boring work meeting or zoning out when driving down a long highway. But it can also be your mind's coping mechanism when confronted with too much stress, such as a traumatic event.
Is dissociation OK sometimes? ›Dissociation may be a normal phenomenon, but like everything in life, all in moderation. For some, dissociation becomes the main coping mechanism they use to deal with the effects of a trauma response in anxiety disorders, such as PTSD, or other disorders, such as depression.
What can trigger dissociation? ›...
Long-term dissociation
- Physical abuse.
- Sexual abuse.
- Severe neglect.
- Emotional abuse.
Dissociation commonly goes along with traumatic events and PTSD. Dissociation as avoidance coping usually happens because of a traumatic event. Being powerless to do anything to change or stop a traumatic event may lead people to disconnect from the situation to cope with feelings of helplessness, fear or pain.
What is dissociation reaction with example? ›Dissociation examples
A dissociation reaction occurs when water splits into hydroxide and hydrogen ions. Ionisation is a chemical reaction when a molecular molecule dissociates into ions. Acids produce hydrogen ions due to dissociation.
Not so in dissociation. When people are dissociated, they still are out doing things, but they are not aware of doing those things. Further, they are not able to recall having done things either. It is as though they were going about their business on autopilot.
How do I know if I am dissociating? ›Symptoms of a dissociative disorder
feeling disconnected from yourself and the world around you. forgetting about certain time periods, events and personal information. feeling uncertain about who you are. having multiple distinct identities.
- Help them find an advocate and support them to meet with different therapists.
- Offer extra support and understanding before and after therapy sessions.
- Help them make a crisis plan if they think it would be helpful.
The four dissociative disorders are: Dissociative Amnesia, Dissociative Fugue, Dissociative Identity Disorder, and Depersonalization Disorder (American Psychiatric Association, 2000; Frey, 2001; Spiegel & Cardeña, 1991).
How long does dissociation last? ›Dissociation and dissociative behaviors may last for hours, days, weeks and even months. Individuals who dissociate over a long time may develop a mental health condition called a dissociative disorder or dissociative identity disorder.
How do people get out of dissociation? ›
The best treatment for dissociation is to go to therapy. An inpatient adult psychiatric program can be especially effective if your symptoms of dissociation are particularly intense, or if they are the result of sexual abuse.
Can you do things while dissociating? ›Include writing and artwork you do at different times. If you have DID, you may write or make different kinds of art while experiencing different identity states. Help you become more aware of the different parts of your identity. Help you remember more about what happened in the gaps in your memory.
Is dissociation a trauma response? ›Dissociation can occur in response to traumatic events, and/or in response to prolonged exposure to trauma (for example, trauma that occurs in the context of people's relationships). Dissociation can affect memory, sense of identity, the way the world is perceived and the connection to the physical body 3.