What Is Dissociation?

What Is Dissociation?

Dissociation is a disconnection between a person's sensory experience, thoughts, sense of self, or personal history. People may feel a sense of unreality and lose their connection to time, place, and identity.

Dissociation disrupts four areas of personal functioning that usually operate together smoothly, automatically, and with few or no problems:

• Consciousness
• Identity
• Memory
• Self-awareness and awareness of surroundings

Breaks in this system of automatic functions cause the symptoms of dissociation. Dissociation can range from a mild sense of detachment to a more severe disconnection from reality.

Types

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies three types of dissociative disorders:

• Depersonalization-derealization disorder: This condition involves feeling detached from one's own body and thoughts. People may feel that they are observing their own life as an outsider or feel disconnected from their surroundings.
• Dissociative identity disorder: Previously known as multiple personality disorder, this condition is marked by having two or more persistent personality states.
• Dissociative amnesia: This condition is characterized by forgetting personal information and memories of events.

In addition to these dissociative disorders, dissociation may also occur as a symptom of other conditions including:

• Acute stress disorder
• Affective disorders
• Borderline personality disorder (BPD)
• Depression
• Epilepsy
• Migraines
• Obsessive-compulsive disorder (OCD)
• Phobias
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
• Substance use disorders

Symptoms

If you have a condition such as PTSD or a dissociative disorder, you may sometimes have felt "disconnected" from yourself. If so, you may have experienced common but distressing incidents like these:

• Having flashbacks to traumatic events
• Feeling that you’re briefly losing touch with events going on around you (similar to daydreaming)
• “Blanking out” or being unable to remember anything for a period of time
• Memory loss about certain events, people, information, or time periods
• A distorted or blurred sense of reality
• Feeling disconnected or detached from your emotions
• Feeling that the world around you is unreal and distorted
• Feeling numb or distant from yourself and your surroundings
• An altered sense of time and place

Related Symptoms

People who are experiencing dissociation may also experience additional symptoms called depersonalization (feeling as if the self is not real) and derealization (feeling as if the world is not real). Having either of these symptoms is a serious health problem.

Depersonalization and derealization are often responses to overwhelming traumatic events that cannot be escaped, such as child abuse and war trauma. They arise in order for the person to keep on functioning at the moment of being severely traumatized.

Examples of depersonalization include out-of-body experiences, where people see themselves from above. This lets them feel that “This is not happening to me.” In states of derealization, people experience events that aren’t real. This lets them feel that “This isn’t real; it’s just a dream.”

Causes

The exact causes of dissociation are not clear, but there are several factors that may play a role.

Trauma

Dissociation often occurs as a reaction to trauma, possibly as a way of helping a person distance themselves from the traumatic 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 predict the potential for addiction, according to a study published in 2014.

Another study 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 disorders can also cause symptoms of dissociation. PTSD, for example, is often characterized by symptoms of dissociation and detachment.

Diagnosis

In order to be diagnosed, your doctor will need to assess your symptoms and rule out other conditions that may be the cause. Your doctor may also refer you to a mental health professional. Your doctor will take a medical history, perform a physical exam, and possibly order lab tests to rule out any underlying medical conditions.

There are a number of assessments that may be used to help evaluate dissociation. If you are experiencing dissociative symptoms, you may be given:

• Dissociative Experiences Scale (DES)
• Structured Clinical Interview for Dissociation
• Clinician-Administered PTSD Scale (CAPS)

The CAPS assessment tests for depersonalization by asking you to respond to such questions 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

There is no medication specifically approved for the treatment of dissociation. Your doctor may recommend psychotherapy and medication to help manage associated symptoms.

Psychotherapy

Types of psychotherapy that may be used to treat dissociation 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

Your doctor may also prescribe medications such as antidepressants, sleep aids, and anti-anxiety drugs to help you manage problems with mood, anxiety, or sleep. If your dissociation is due to a psychiatric condition such as schizophrenia, your doctor may also prescribe an antipsychotic medication.

Coping

Some strategies that you can use to help cope with stress and anxiety that might trigger dissociation include:

• Getting adequate sleep each night
• Using relaxation strategies to help you cope with stress
• Getting regular physical exercise
• Eating a healthy diet
• Identifying and avoiding or managing triggers
• Practicing grounding techniques that can help bring you back to the present moment

Watch for signs of dissociation, since it is possible to experience this without being aware of it. Sudden mood changes, difficulty remembering personal details about yourself or your life, and feeling disconnected are all signs that you might be experiencing dissociation. 

A Word From Verywell

If you've experienced depersonalization or derealization, you should 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. If this happens, 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 otherwise be possible could expose you to the risk of harm. Talk to your doctor if you think you might be experiencing symptoms of dissociation or a related condition.