Dissociation: Definition, Symptoms, Causes, & Treatments

What Is Dissociation?

Dissociation is a state in which one feels disconnected from themselves and their surroundings. In a dissociative state, individuals cannot identify their thoughts, feelings, actions, memories, or even identities.^1,2 The person may have no recollection of what occurred during an episode.

Dissociation is a common and expected part of life. A person could experience dissociative states throughout an average week. For example, daydreaming, highway hypnosis (feeling disconnected to self and the environment while driving), and becoming engrossed in a book can represent dissociative episodes.

Dissociation is not necessarily a problem. In fact, dissociation as a coping skill can provide some level of safety and support. High stress from a car accident, natural disaster, or form of abuse may be too overwhelming for a person to experience, so dissociation serves as a shield from the situation.³

Symptoms of Dissociation

Dissociation is a mental health symptom that can create multiple effects. Feeling dissociated means sensing a disconnect from self, past experiences, and present environment.¹

Some dissociating may only experience one or two of these symptoms, while another could note all signs of the condition at different times. Dissociation ranges from mild and benign to severe and debilitating. Someone with severe dissociation could find maintaining relationships, employment, or other life responsibilities impossible.³

Symptoms of dissociation include:^{1, 3}

• Loss of memory related to periods of time, situations, important people, or personal information
• Disconnection from emotions and feelings
• Feeling people and surroundings are fake, unreal, distorted, or odd
• Having an unclear sense of 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
• Having an out-of-body experience
• Feeling like a different person
• Experiencing an altered sense of time
• Tunnel vision
• Immobility
• Becoming entranced in a fantasy world
• Intense flashbacks that appear real
• Hearing voices

Signs of Dissociation

Dissociation is a response to stress through which individuals separate from their environments to protect their well-being. When they dissociate from reality, many may lose the ability to communicate or experience emotions, thoughts, or core memories. Emotional dissociation may also present as numbness.

Below are common signs of dissociation:

• Tunnel vision
• Forgetting details about yourself or events
• Rapid mood swings
• Feeling disconnected from your sense of self or your body
• Feeling disconnected from others or the world around you
• Depersonalization
• Distortions in time or perception
• Trance-like experiences
• Feelings of disorientation
• Derealization

Types of Dissociative Disorders

There are a variety of dissociative disorders where the experience of dissociation can present differently. Certain conditions may be lifelong, whereas other episodes of dissociation may be brief or treated with a combination of medication and therapy.

The types of dissociative disorders include:

• Dissociative identity disorder (DID): DID is a condition marked by two or more separate personality states. When switching between these identities, a person will change their presentation, behavior, thinking matters, speech, and memory. They often cannot recall periods of time and personal information.
• Depersonalization-derealization disorder: DPDR refers to frequent 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 refers to feeling disconnected from the environment, meaning surrounding people, animals, and objects seem unreal or distorted.
• Dissociative amnesia: Dissociative amnesia occurs when a person cannot remember or recall detailed information about their life, like where they live, what they do for work, or even their name (sometimes resulting in a dissociative fugue episode). People with this condition may wander or travel without a destination in mind.
• Other specified dissociative disorder (OSDD):OSDD encompasses chronic dissociative symptoms that do not match the full criteria of any specified disorder.
• Unspecified dissociative disorder (UDD):Clinicians may diagnose UDD when they know a dissociative disorder is present, but the current symptoms do not match any diagnosable disorder.

Dissociation & Related Conditions

Dissociation is a trans-diagnostic phenomenon and appears alongside various diagnosable mental health and neurological conditions.⁴ Dissociation may serve as an adaptive function to protect an individual from painful trauma. With neurological disorders or traumatic brain injuries, dissociation may stem from structural changes or brain damage.

Conditions associated with dissociation include:^1,3,4

• PTSD
• Acute stress disorder
• Somatic symptom disorder
• Schizophrenia or other psychotic disorders
• Panic disorder
• Major depressive disorder
• Eating disorders
• Obsessive-compulsive disorder (OCD)
• Epilepsy/seizure disorder
• Global amnesia
• Traumatic brain injury (TBI)
• Brain tumors
• Neurological conditions
• Migraine
• Extreme sleep deprivation

What Causes Dissociation?

Dissociation causes and risk factors vary but share common connections, like trauma, frightening experiences, and unpredictable upbringings. Not everyone who endures these situations will experience dissociation, but many report experiencing this disconnection and separation from self.³

Some people become accustomed to dissociating and can disconnect at will, while others will experience dissociation unintentionally. Once a person uses dissociation to escape trauma, this behavior may happen more often when presented with stressful, scary, or uncertain situations.³

Possible causes of dissociation include:³

• Experiencing abuse: Experts believe children may use dissociation as a coping skill or defense mechanism to help them survive and tolerate abusive situations. Dissociating throughout these experiences can be their way to disconnect from the act.³
• Trauma: Dissociation can present as a self-protective response against trauma or threats to the psyche.⁶
• Hypnosis: Some evidence states hypnosis can create nonpathological forms of dissociation. Hypnosis involves unconscious states of suggestibility, which may leave individuals more vulnerable to dissociative episodes.⁷
• Substance use:Certain substances can change perceptions of time, reality, and self-identity. These can leave an individual at a higher risk of experiencing dissociation.
• Coping mechanisms: Dissociation, like daydreaming, can be an adaptive coping mechanism.
• Underlying mental health illness:Certain underlying mental health conditions can cause episodes of dissociation. For example, rapid identity shifts associated with BPD can prompt or worsen dissociative episodes.
• Meditation: Some individuals may experience dissociation during meditation because of changes in mind-body perceptions.
• Stress: The body may use dissociation as a defense against prolonged stress.
• Emotional neglect: Emotional neglect in childhood can be a painful experience. Children may enter a “freeze state” to cope with chronic experiences of interpersonal trauma.

How Long Does Dissociation Last?

Dissociative episodes may be brief or prolonged, depending on the underlying condition. For example, DID episodes can last days, months, or years. Others experiencing dissociation report brief occurrences lasting a few minutes.

Complications of Dissociation

Untreated dissociation can worsen with time. Seeking professional help after recognizing the early warning signs can reduce the risk of long-term impacts. Therapists and other mental health providers can help you identify the cause and create a unique, individualized treatment plan.

Possible impacts of severe dissociation may include:

• Drug use or alcohol use
• Depressive episodes
• Anxiety disorders or symptoms
• Insomnia or hypersomnia
• Disordered eating
• Issues with sexual performance
• Instances of self-harm
• Suicidal ideation or attempts

How Is Dissociation Diagnosed?

Only a professional can determine the root cause of dissociative episodes. Severe dissociation can stem from structural brain injuries, meaning a medical professional may be necessary for diagnosis.

Professionals may utilize various tests to diagnose a dissociative disorder. They may issue a self-reported exam, such as the Dissociative Experiences Scale, to understand your symptoms. Formal assessments, including the Clinician-Administered PTSD Scale or Structured Clinical Interview for Dissociative Disorders, can assess for additional depersonalization and derealization symptoms.

Dissociation Treatments

Determining how to treat dissociation requires professional guidance. Dissociating can stem from underlying mental health conditions, and utilizing a combined approach of psychotherapy, support, and medications can improve symptoms. Through treatment for dissociation, individuals can gain control over their experiences and lives.

Therapy

Therapy can help individuals struggling with dissociation address the trauma or chaotic situations that underlie their symptoms. Being in a safe environment is an essential element of treatment, so clients should actively seek ways to remove themselves from toxic environments contributing to dissociation.

Starting therapy and finding the right therapist can seem daunting. However, help is available for those ready to recover. Post-traumatic growth is possible with the right support and guidance. Consider searching for a mental health provider in an online therapist directory or asking loved ones for recommendations.

Therapy for dissociation and dissociative disorders may include:

• Cognitive behavioral therapy (CBT): CBT focuses on the notion that thoughts, feelings, and behavior affect each other. A CBT therapist may help the person by encouraging them to monitor their periods of dissociation and identify common themes. They can also teach alternative coping skills to help manage high-stress situations.
• Dialectical behavior therapy (DBT): DBT is an offshoot of CBT that focuses on teaching clients valuable aspects of mindfulness, emotional regulation, distress tolerance, and communication skills. A person with dissociation can rely on these coping skills to address the cause of their symptoms and their reactions to stress.
• Eye movement desensitization and reprocessing (EMDR): EMDR can help individuals cope with residual trauma and emotional distress that may contribute to dissociative episodes.
• Hypnotherapy: Hypnosis conducted by a trusted mental health professional could be another helpful treatment for dissociation. Some evidence supports this method as an effective treatment, especially for dissociative identity disorder.^1,2,3

Medication

No medications specifically treat dissociation. However, prescribers may recommend medications to alleviate symptoms of co-occurring conditions. Anti-anxiety, antipsychotic, or antidepressant medications may yield good results and reduce dissociation frequency, intensity, or duration.^{2, 3}

Coping With Dissociation & Dissociative Disorders

Dissociative disorders and episodes can be frustrating, affecting your day-to-day functioning, relationships, or ability to reach personal or professional goals. Coping with dissociation often starts by implementing effective relaxation or grounding skills to help you ease stress and remain attuned to your reality.

Below are tips for coping with dissociation:

• Keep a journal: Journaling can help you document triggers and process your feelings before, during, and after dissociative episodes.
• Practice grounding techniques: Grounding techniques can prevent or reduce the experience of episodes. These methods help you feel safe in the present moment through sensory engagement.
• Make a crisis plan: Making a safety plan pre-crisis can help keep you safe if a dissociative episode occurs. These often include information about your treatment plan, care time, and identity so professionals can best assist you.
• Take care of yourself: Developing routine self-care practices can help prevent or mitigate symptoms of dissociation. Caring for your mind and body is essential for maintaining overall well-being.
• Seek social support: Social support pre- or post-episode can help you prevent or lessen the effects of dissociation. Some people may experience shame or sadness after an episode, and loved ones can provide much-needed assurance and comfort.
• Implement preventative measures: Preventative measures often look different for everyone, but brain-storming can help you put “life rafts” in place pre-episode.
• Maintain healthy sleep routines: Good sleep hygiene keeps your brain and body in sync, helping reduce stress associated with dissociation.
• Identify your triggers: Knowing your triggers can help you prepare for situations that often lead to dissociation. Keep track of people, places, or situations that leave you vulnerable to dissociative attacks.
• Stay physically active: Find a form of movement you enjoy to foster a healthy mind-body connection.
• Practice relaxation techniques: Dissociative episodes occur when the body is under severe and chronic stress. Relaxation techniques can help you prevent or lessen the long-term effects.

Final Thoughts

Dealing with dissociation is no easy task. Fortunately, mental health professionals understand how dissociative episodes affect people and what treatment options can effectively combat the issue. The journey toward health can be challenging but is worth the struggle.