Dissociation refers to a sense of disconnect from yourself, your surroundings, and your external experiences. It’s often associated with trauma, and it can occur at any point in your life. Dissociation itself is not a mental illness, however, it can be a hallmark symptom of conditions like acute stress disorder, PTSD, personality disorders, and psychotic disorders.
Dissociation often happens as a stress response. When the mind and body feel overwhelmed, dissociation acts as a way to ‘shield oneself’ away from truly experiencing the situation.
In an extremely mild form, you may read a few pages of a book- only to then realize that you didn’t actually register anything you read. Or, you might drive your car to work and make it to your office without really remembering anything you thought about or experienced during the commute.
It’s important to consider that dissociation exists on a continuum. For example, at times, you may feel detached or even ‘in denial’ about parts of yourself. This is a more mild and normative form of dissociation. In severe cases, people may entirely split off and develop multiple personalities (known as dissociative identity disorder).
Some of the clear signs and symptoms of dissociation include:
- Brief or sustained memory lapses
- Feeling detached from yourself and your feelings
- Blurred or unclear sense of self
- Inability to cope with stress
- Heightened depression and anxiety
- Somatic complaints (headaches, muscle tension, body aches)
- Feeling ‘stuck’ in past trauma
- Feeling disconnected in body-based activities (sex, exercise)
- Persistent sense of numbness
What Causes Dissociation?
There isn’t a single cause of dissociation. Instead, mental health experts have pinpointed a variety of risk factors that may increase someone’s likelihood of experiencing it.
Trauma underlies most cases of dissociation, and traumatic events can include:
- Sexual abuse
- Physical violence and assault
- Torture or capture
- Medical injuries
- Natural disasters
- War and terror
Keep in mind that trauma isn’t always easy to define. However, disturbing events can take a toll on both your physical and mental health. Even if you don’t outwardly identify as having trauma, your body may be holding onto adverse experiences from your past without you realizing it.
Types of Dissociation
Dissociation is a symptom, but it can be a core feature in several mental health conditions. Below are the four main types of dissociation a person can experience.
Someone experiencing dissociative amnesia can’t recall certain parts of themselves or their past. They may forget basic details like their name, address, or phone number. Or they may experience complete memory loss about specific events. For example, someone who can’t really remember their childhood or only sees events from a hazy, fuzzy perspective may have dissociative amnesia.
Dissociative amnesia is not intentional, but it can be highly distressing. The individual experiencing it may feel enormous shame and guilt over their inability to remember particular details. They may feel angry when asked about those details.
Dissociative amnesia presents numerous legal implications. A jury, for instance, may be less trusting of a defendant who cannot remember specific events. Lawyers, judges, and juries alike want hard facts, and when someone cannot provide them, it makes resolutions challenging.
Likewise, there are complications with some criminals feigning amnesia for their crimes, making the issue even more convoluted. Because people can and do lie in court, law enforcement and legal personnel may wrongfully assume that someone who doesn’t remember details must be lying about them.
It’s important to consider that forgetting about the trauma doesn’t mean the trauma doesn’t affect you. In fact, amnesia is one of the core symptoms indicating the presence of trauma. It may also coincide with other symptoms like nightmares, panic attacks, hypervigilance, and avoidance behaviors. Sometimes, individuals experience these symptoms without fully registering their impact.
Dissociative fugue refers to a temporary lapse in memory, resulting in someone ending up in an unexpected location. The person literally “wanders off” and ends up confused about their new surroundings.
Fugue is incredibly rare, but the state can last anywhere from a few hours to several months. When the states are short and periodic, other people may dismiss them altogether (as it can look like the person is just chronically late, disorganized, or absent). Sometimes people also misinterpret dissociative fugue for psychotic episodes or substance use.
Someone experiencing dissociative fugue does not lose their basic skills and capabilities. For example, they can and do drive cars, pay for hotel rooms, eat food, and even converse with other people. However, they often present as confused or disoriented. They may appear entirely out of place, and they have no recollection as to how they ended up somewhere.
Dissociative Identity Disorder (DID)
Dissociative identity disorder (formally known as multiple personality disorder) refers to someone having two or more distinct personalities. These personalities (known as alters) are fully developed- they come with their own age, ethnicity, preferences, values, and motives.
The prevalence of DID is extremely rare with research estimating that it affects anywhere from 0.01-1% of the population. Women tend to be more affected than men.
Experts still aren’t exactly sure what causes DID, but almost all cases report severe cases of complex childhood trauma. It’s theorized that DID acts as a way to fully detach from those adverse experiences.
DID is particularly challenging because the symptoms are often entangled with other mental health conditions like personality disorders, psychotic disorders, and substance use disorders. Furthermore, there are many controversial discussions about DID not existing at all and that people exaggerate these symptoms to seek attention or mask other problems.
Depersonalization-derealization disorder refers to a persistent sense of observing yourself from outside of yourself. This coincides with having difficulties distinguishing true reality. This experience may mimic being in a trance, and it can feel highly disturbing.
Sometimes episodes of depersonalization can be brief and mild. But other times, the symptoms can be so intense that they affect how someone functions and interacts in daily life. The person might feel riddled with fear that they’re literally ‘going crazy.’ This can result in seeking excessive reassurance about what is and isn’t real.
Depersonalization can also be highly somatic. People may have a strong sense that certain body parts are distorted, shrunken, or enlarged. They may have sensations that aren’t real (similar to tactile hallucinations). In general, there’s often a sense of numbness to the world around them. Therefore, they may present as apathetic or disinterested in daily life.
People with depersonalization may also struggle to trust themselves. They may doubt their memories or relationships because they can’t determine the legitimate truth. This can make all forms of vulnerability- especially in intimate relationships- challenging.
Dissociation can be distressing for both individuals and their loved ones. Therapy is the main treatment for dissociation, and while there isn’t a single cure for this symptom, treatment can help.
Ruling out other medical issues: Substance use, traumatic brain injuries, and other medical problems may cause or exacerbate dissociation- especially if it emerges suddenly. For this reason, it’s essential to receive a comprehensive evaluation from a primary care physician or psychiatrist.
Talk therapy: Talk therapy is an umbrella term for processing, exploring, and receiving support for various emotional experiences. If seeking therapy for dissociation, it’s important to consider finding a trauma-informed provider.
Cognitive-behavioral therapy (CBT): CBT focuses on the interaction between thoughts, feelings, and behaviors. A CBT therapist can help clients understand the triggers behind their dissociative symptoms. They can also explore alternative coping strategies rooted in challenging problematic thinking patterns.
Eye movement desensitization and reprocessing (EMDR): EMDR is one of the gold-standard treatment methods for trauma. Resolving traumatic memories may reduce the frequency and intensity of dissociation. EMDR offers structured support for safely discussing trauma.
Mindfulness therapy: Mindfulness therapy can include tenants of CBT, DBT, and other integrative therapies. Mindfulness focuses on accepting your current thoughts, sensations, and needs. In doing this work, you will become more aware of your dissociative patterns.
Psychiatric medication: There isn’t a specific medication intended to treat or cure dissociation. However, people with comorbid anxiety or depression may benefit from certain medications that reduce those symptoms. The collective effect of such medication may also decrease dissociative experiences.
Hypnosis: Some research shows that hypnosis can help people experiencing dissociation. Hypnosis acts as a method for exerting influence and control over dissociation. Over time, this results in changed perceptions of thoughts and sensations.
Coping Strategies for Dissociation
It is possible to improve or reduce dissociation by implementing grounding techniques in your daily life. Here are some strategies to consider:
Slow down your breathing: The next time you start feeling overwhelmed or detached, consider drawing into your breath. Take several deep breaths (inhale for five counts and exhale for five counts). Repeat at least five times. This exercise can signal the central nervous system to slow down, helping you feel less anxious.
Shock your senses: Rub ice on your hands. Eat a spicy food. Spray fragrance around a room. These simple strategies can offer a sense of grounding, as they bring you back to the here and now by awakening your five senses.
Count to a certain number or read something aloud: Although it may sound simplistic, you can ground yourself by focusing on something tangible. Count in multiples of five, read a favorite poem, or sing the words to your favorite song.
Label what’s happening: As you become more aware of your dissociation tendencies, you may become more cognizant of the situations that trigger these states. As much as possible, try to identify what’s happening as it’s happening. This requires attuning to your feelings, thoughts, and bodily sensations. The more you practice this skill, the more natural it will become.
Talking to a trusted loved one: Dissociation can make you feel detached from the people you care about. However, if you can reach out during these vulnerable times, you may feel more supported and safe until the symptoms dissipate.
Dissociation acts as a defense mechanism. It’s your body’s attempt to keep you safe and protect you from future harm. That said, untreated dissociation can worsen progressively (particularly during times of stress), and it can exacerbate other mental health issues. If you are struggling, reach out for support. The right treatment can make a significant difference in how you feel.