Dissociation is a mental health symptom associated with a person feeling disconnected from their thoughts, feelings, and identity. This symptom, which often stems from trauma, can exist independently or as part of a dissociative disorder like dissociative identity disorder (DID). Controversy and misunderstandings confuse clinical pictures of dissociation, which may complicate therapy and other treatment options.
What Is Dissociation?
When used in the context of mental health, dissociation refers to a state in which a person is feeling disconnected from themselves. In a dissociative state, the person will have no ability to identify their thoughts, feelings, actions, memories, or even their own identity.1,2 The person may have no recollection of what occurred during the dissociative state. A period of dissociation can last anywhere from a few seconds, a few minutes, or even longer, depending on the individual and their situation.
Significant physical, mental, or emotional trauma frequently triggers a state of dissociation, but dissociations, especially mild cases, are a common and expected part of life. A person could experience harmless dissociative states throughout an average week. Mild dissociations may seem jarring, but they are typically harmless.
Some situations or activities associated with dissociation include: 2
- Daydreaming for children or adults
- Highway hypnosis – the feeling of being disconnected to self and the environment while driving
- Becoming really engrossed in a book, movie, or video game
Dissociation is not necessarily a problem. In fact, dissociation could provide some level of safety and support as a coping skill. High stress from a car accident, a natural disaster, or a form of abuse may be too overwhelming for a person to experience, so dissociation serves as a shield from the situation.3
Types of Dissociative Disorders
Dissociative disorders (DDs) are a group of mental health conditions linked by the common symptom of dissociation. These disorders typically occur after a major life trauma, and though they may share many similarities with post-traumatic stress disorder (PTSD), dissociative disorders represent a separate group of disorders.4 DDs are challenging to diagnose and treat because there is so much misinformation and confusion regarding the diagnoses.5
The three types of dissociative disorders are:4
- Dissociative Identity Disorder: A condition marked by two or more separate personality states with the person switching between these identities. When switching between identities, the person will display a change in their presentation, behavior, thinking matters, speech, and memory. They will have an inability to remember or recall large amounts of time and personal information.
- Depersonalization-Derealization Disorder: A concern evident when a person experiences periods of depersonalization and derealization. Depersonalization occurs when the person feels detached from their body and experiences their thoughts, feelings, and actions as if they were happening to someone else. Derealization occurs when someone feels detached to their environment, so that other people, animals, and objects around seem unreal or distorted.
- Dissociative Amnesia: A diagnosis given when a person has an inability to remember or recall detailed information about their life, like where they live, what they do for work, or even what their name is. Often, the information they forget is connected to high stress or traumatic situations. People with this condition may wander or travel without really having a destination in mind.
It is important to note that all of these conditions must occur without the influence of alcohol or other drugs. If someone is feeling detached or dissociated while using a hallucinogenic drug, they do not have a dissociative disorder. Some people may actually use certain drugs, like ketamine, for their ability to produce dissociative effects.4
Dissociation Is Common in Other Disorders & Health Conditions
Dissociative disorders also cannot stem from other mental health disorders. However, some disorders produce symptoms that may interact with dissociative disorders.
Some psychological conditions that may produce symptoms that overlap with dissociative disorders include:4
- PTSD
- Acute stress disorder
- Somatic symptom disorder
- Schizophrenia or other psychotic disorders
- Panic disorder
- Major depressive disorder
Mental health experts will not diagnose someone with a dissociative disorder if there is a physical health condition producing the symptom.
Dissociation may occur as a symptom of the following physical health conditions or states:1,3,4
- Epilepsy/seizure disorder
- Global amnesia
- Traumatic brain injury (TBI)
- Brain tumors
- Neurological conditions
- Migraine
- Extreme sleep deprivation
In these situations, dissociation remains a significant and worrisome symptom, but it may only improve with treatment of the underlying conditions.
Symptoms of Dissociation
By itself, dissociation is a mental health symptom, but since the symptom is so complex, it can create multiple effects. All dissociation symptoms will orbit around the idea that a person is disconnected from their sense of self, past experiences, and present environment.1
Symptoms of dissociation include: 1,3
- Loss of memory, related to periods of time, situations, important people, or personal information
- Disconnection from one’s emotions and feelings
- Feeling that the people and things in one’s proximity are fake, unreal, distorted, or odd
- Having an unclear sense of one’s own identity
- Sudden and unexpected mood changes
- Problems managing intense emotional changes
- Concentration and attention problems
- Feeling driven to behave in a specific way
- Acting or speaking in ways that seem one would normally find offensive
A person with dissociation may only experience one or two of these symptoms, while another could note all signs of the condition at different times. Again, dissociation ranges from mild and benign to severe and debilitating. Someone with severe dissociation could find it impossible to maintain relationships, employment, or other life responsibilities.3
Causes of Dissociation
The causes and risk factors linked to dissociation will vary between people, but there are some common connections, like trauma, frightening experiences, and unpredictable upbringings. Not everyone who endures these situations will experience dissociation, but many will feel the disconnection and separation from self.3
Possible causes and risk factors for dissociation include:3
- Long-term sexual, physical, or emotional abuse
- Dangerous environments and unpredictable parental figures
- Experiences related to war and social unrest
- Natural disasters like earthquakes, tornadoes, floods, wildfires, hurricanes, tsunamis, and blizzards
- Kidnapping
- Medical procedures during early life
It seems that long-term abuse is strongly related to dissociation. If a child is being harmed by a parent, family member, or another adult, the physical, sexual, or emotional abuse can lead directly to dissociation. Being subjected to war, dangerous living conditions, and natural disasters can also produce the symptoms of dissociation.
Experts believe that for children in these terrible situations, dissociation becomes a coping skill or defense mechanism that helps them survive and tolerate their situation. For a young child suffering persisting abuse, dissociating throughout the experience can be their way to disconnect from the act.3
Some people may become so used to dissociating that they can do it at will, while others will experience dissociation unintentionally. Once a person uses dissociation to escape trauma, the act of dissociation may happen more often when presented with stressful, scary, or uncertain situations.3
Possible Outcomes of Dissociation
Dissociation can create a heavy burden for a person to carry. The symptom may grow, spread, and begin affecting various aspects of a person’s life and well-being.
Over time, dissociation may put someone at increased risk of new issues and associated disorders like:3
- Alcohol and other substance use
- Depression
- Anxiety
- Post-traumatic stress disorder
- Personality disorders like borderline personality disorder or narcissistic personality disorder
- Sleep disorders
- Eating disorders
- Sexual dysfunction
- Self-harm and nonsuicidal self-injurious behaviors
- Suicidal thoughts and attempts
As illustrated, dissociation, when severe, can begin to negatively influence nearly every aspect of a person’s life.
Treatment for Dissociation
To stem the influence of dissociation, professional treatment will be the best option. By utilizing a combined approach that offers psychotherapy, support, and medications, a person can gain control over their symptoms and experience life without the influence of dissociation.
Therapy
Therapy is the primary option for those with dissociation, with cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) used most commonly by therapists.2
CBT is based on the notion that thoughts, feelings, and behavior all affect and are affected by each other. A therapist using CBT may help the person by encouraging them to monitor their periods of dissociation. During these episodes, the therapist will ask the individual to become aware of common themes linked to the dissociative symptoms to find the people, places, and things that seem to trigger the disconnection. A CBT therapist can also teach alternative coping skills to help manage high stress situations.
DBT is an offshoot of CBT that focuses on teaching the client valuable aspects of mindfulness, emotional regulation, distress tolerance, and relationship/communication skills. A person with dissociation can hopefully rely on these coping skills to address the cause of their symptoms and their reactions to stress.
Therapy may also address the trauma or chaotic situations that underlie the dissociation. For this reason, though, therapy could be less effective if the person cannot remove themselves from their unsafe and unsupportive environment. Being in a safe environment is an essential element of treatment for dissociation.1
Medication
There are currently no medications specifically used for dissociation, but since the symptom is linked to so many other mental health concerns, prescribers may recommend medications to alleviate co-occurring conditions. Anti-anxiety, antipsychotic, or antidepressant medications may yield good results and reduce the frequency, intensity, or duration of dissociation.2,3
Hypnosis
Hypnosis conducted by a trusted mental health professional could be another helpful treatment for dissociation. Although this treatment may seem controversial, there is good evidence to support this as an effective treatment, especially for dissociative identity disorder.1,2,3
Finding Treatment for Dissociation
Dissociation may be a common mental health symptom, but not all therapists will be experienced and educated in treatment, so anyone seeking treatment should be willing to search for a competent provider. Even though the process could be frustrating, professional treatment is immensely important for recovery.
Talking to your personal medical provider or searching an online directory of available therapists is a great way to start the search. People needing more information about finding therapy can refer to the choosing a therapist article for guidance and directions.
Along the way, be sure to acknowledge how much dissociation is impacting life, and if the symptom stems from mental or physical health concerns. This information will direct the treatment plan.
Final Thoughts
Dealing with dissociation is no easy task, but it is a symptom people experience on a regular basis. Fortunately, mental health professionals now have a better understanding of what dissociation is, how it affects people, and what treatment options can effectively combat the issue. The journey towards health could be challenging, but it is completely worth the struggle.
Dissociation Infographics
