PTSD Dissociation: Why It Happens & How to Heal

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic, life-changing, or frightening event. These situations can involve physical injury, the threat of harm, or death. Other times, individuals can develop trauma symptoms from exposure to natural disasters, combat, sexual assault, accidents, or abuse.

Common symptoms of PTSD include:

• PTSD flashbacks
• Hypervigilance
• PTSD intrusive thoughts
• Nightmares
• Intense distress or emotional reactions to trauma triggers
• Avoiding trauma reminders
• Feeling on edge or constantly on guard
• Difficulty sleeping
• Mood swings
• Negative changes in thoughts and beliefs

Dissociation & Dissociative Disorders

Dissociation describes a disconnect between a sense of self and thought processes. Mild experiences are common, frequently occurring as daydreams or mindless mind-wandering. However, severe cases can impact memory, awareness, and identity, thus limiting the ability to work and interact with the world.¹

Dissociative disorders differ from “zoning out” as they interfere with daily functioning. Reminders of previous trauma can trigger these disorders, and individuals may engage in unhealthy and involuntary dissociations to escape reality.

The types of dissociative disorders include:

• Dissociative identity disorder (DID): DID is a disorder in which individuals develop several unique personalities. During dissociation, the alternate identities can take control, allowing the original person to disconnect from reality.
• Dissociative amnesia: This disorder leads to memory lapses relating to trauma experiences or reminders.
• Depersonalization/derealization disorder (DPDR): DPDR involves feeling detached from the body, environment, and thoughts as if living as an outside observer.

PTSD & Dissociation: What Is the Connection?

While developing PTSD and dissociative disorders independently is possible, these conditions more commonly occur together. Dissociative techniques allow individuals to cope with prolonged exposure to trauma experiences. Additionally, chronic trauma can further ingrain dissociative tendencies into automatic brain responses, making these tendencies harder to combat and treat.¹

Dissociation as a Coping Strategy

The brain uses dissociation to protect itself from traumatic emotional experiences, allowing individuals to override their emotions to survive perceived threats. Some may feel like maintaining daily responsibilities is overwhelming or impossible without this coping mechanism. Dissociation tendencies may go away with time but can become debilitating if left untreated.

Age of Trauma & Developing a Dissociative Disorder

The brain is still developing during childhood, meaning those who experience trauma at a young age are more susceptible to dissociative disorders.² Children who are abused or neglected—specifically between the ages of four and nine—are not mentally equipped to handle these stress levels.³ As they continuously encounter adverse situations, childhood trauma can groom and condition someone to operate in true dysfunction.

PTSD Brain Changes

Research has indicated individuals with PTSD experience distinct changes in brain functioning and structure. One study found altered activation in areas such as the amygdala, hippocampus, and prefrontal cortex, which are involved in emotional processing and regulation.⁴ These findings suggest PTSD is associated with a dysregulated fear response and difficulties in cognitive control.

Symptoms of PTSD Dissociation

PTSD with dissociative symptoms can significantly impact daily functioning. Individuals may struggle with depersonalization and derealization, meaning they feel disconnected from themselves and/or their environments. Dissociation allows survivors to distance themselves from overwhelming emotions but can ultimately interfere with daily functioning and overall well-being.

Symptoms of dissociation seen in those with PTSD include:

• Depersonalization: Depersonalization is a sense of detachment or feeling outside your body, as if observing yourself from a distance. People with depersonalization may feel their thoughts, emotions, and sensations are not their own, leading to a disconnection from their sense of self and identity.
• Derealization: PTSD derealization involves a sense of detachment from one’s surroundings. Individuals may perceive the world as distorted, dreamlike, or foggy.

Long-Term Effects of PTSD Dissociation

Dissociation as a coping strategy can be effective momentarily but can wreak havoc if left unaddressed. Eventually, people may enter dissociative states without exposure to potential threats or environmental triggers. This unpredictable disconnection can become problematic for relationships, work, and other commitments.

Potential long-term effects of PTSD-related dissociation include:³

• Having “blackout” periods of amnesia: Individuals with PTSD-related dissociation may experience periods where they have no memory or recollection of certain events, leading to gaps in their memory and difficulties in recalling specific details or experiences.
• Loss of self-identity: Dissociation can disrupt the sense of self, resulting in a diminished or fragmented sense of identity. Individuals may struggle with maintaining a coherent and stable understanding of themselves, their values, and their beliefs.
• Multiple personas or personality disorders: In some cases, chronic dissociation in PTSD can lead to the development of dissociative identity disorder (DID). This condition involves the presence of different identities or personalities that may have distinct characteristics, memories, and behaviors.
• Memory loss: PTSD-related dissociation can cause difficulties with memory, including problems with both short- and long-term memory. Individuals may struggle to recall important events, experiences, or even personal details.
• Difficulties with emotional regulation: Individuals with PTSD-related dissociation may struggle to regulate their emotions effectively, leading to intense mood swings, emotional outbursts, or difficulty expressing and managing their feelings.
• Disrupted relationships: Chronic dissociation can create barriers to forming and maintaining healthy relationships. Individuals may have difficulty trusting others, communicating their needs, or engaging in meaningful connections.
• Difficulties maintaining a consistent sense of self: Individuals may experience shifts in how they view themselves, their values, and their beliefs.
• Challenges in forming and sustaining personal and professional connections: Difficulties in communication, trust issues, and emotional dysregulation may lead to struggles in building and maintaining meaningful connections.

How Is PTSD Dissociative Subtype Diagnosed?

Diagnosing dissociative PTSD involves a comprehensive assessment conducted by a mental health professional. A physician bases their diagnosis on the criteria outlined in the DSM-5, which include exposure to a traumatic event and the presence of specific symptoms.

The dissociative subtype specifier is applied when individuals exhibit depersonalization and/or derealization.

Treatment for PTSD & Dissociation

Therapy and medication are effective for treating trauma-related conditions, including PTSD and dissociation. Finding a safe space in which you can uncover the root cause of your trauma is the first step toward recovery.

Therapy

Therapy is a crucial component in the treatment of PTSD and dissociation, as individuals have a safe space to explore and process their traumatic experiences. Through therapy, trauma survivors can gain insight into unhealthy thoughts, emotions, and behaviors and learn healthy coping strategies to manage distress.

Therapy for treating dissociation & PTSD may include:

• Dialectal behavioral therapy (DBT): DBT helps reduce self-harm behaviors, such as suicide ideations, unsafe sexual practices, and substance misuse. DBT sessions focus on mindfulness, distress tolerance, emotional regulation, and interpersonal skills to assist in acknowledging and accepting feelings without judgment.⁵
• Cognitive behavioral therapy (CBT): CBT for PTSD aims to help people identify and replace patterns of negative thoughts. With CBT, patients learn to combat difficult emotions and behaviors in realistic and constructive ways.⁶
• Eye movement desensitization and reprocessing (EMDR): EMDR for PTSD involves guided eye movements or other forms of bilateral stimulation to help individuals process traumatic memories and reduce distressing symptoms associated with PTSD.
• Cognitive processing therapy (CPT): CPT focuses on addressing and challenging unhelpful beliefs and thoughts related to the traumatic event. This approach aims to help individuals develop a more balanced and realistic perspective.
• Psychodynamic therapy: Psychodynamic therapy explores unconscious thoughts and feelings, childhood experiences, and relationship patterns to help individuals gain insight into their emotions and develop healthier coping strategies.

Medication

PTSD Medications can be helpful when treating dissociations related to trauma. Medication can allow you to manage symptoms more effectively so you can focus on healing. Consider all available options with a qualified and licensed physician before starting a prescription regimen.

How to Cope With Trauma-Related Dissociation

Recovering from PTSD is possible but takes time and support. Understanding the underlying causes of your episodes allows you to address them healthily. Practicing restorative coping techniques can be valuable to your treatment plan when combating negative emotions that can lead to dissociation.

Here are 12 healthy coping strategies for PTSD dissociation:

• Maintain a sleep routine: Maintaining a consistent sleep routine can help manage PTSD dissociation by promoting stability, mental rejuvenation, and a sense of grounding.
• Get regular exercise: Physical activity can reduce anxiety, improve mood, and boost endorphins to improve overall mental well-being.
• Eat nutritious foods: A healthy diet can provide the necessary nutrients for brain function and overall physical health, which in turn can contribute to improved PTSD symptoms.
• Have regular social interaction: A positive social network can help combat feelings of isolation and offer validation when overcoming PTSD dissociation.
• Journal about trauma: Journaling can serve as a therapeutic outlet for processing emotions and experiences related to dissociation.
• Practice mindfulness: Mindfulness exercises can help trauma survivors stay present and grounded in the moment, thus reducing dissociative symptoms.
• Engage in meditation for PTSD: Regular meditation can help regulate stress levels and promote relaxation.
• Practice yoga: Trauma-informed yoga can help with body awareness and grounding to reduce dissociative symptoms.
• Identify your triggers: Knowing your triggers can help you anticipate and prepare for situations that may lead to dissociation, allowing you to implement coping strategies proactively.
• Use grounding techniques: Deep breathing, focusing on physical sensations, or using sensory objects can help you stay connected to the present moment when experiencing dissociation.
• Prioritize emotional self-care: Emotional self-care involves recognizing and meeting your needs, seeking support, and engaging in activities that promote well-being. These activities are essential when coping with and healing from trauma.
• Follow your treatment plan: Stick to your therapy and medication routine. These supports can provide you with the boost you need to manage dissociation and PTSD symptoms.