PTSD What Is Dissociation? By Matthew Tull, PhD Matthew Tull, PhD Twitter Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. Learn about our editorial process Updated on August 24, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Amy Morin, LCSW Medically reviewed by Amy Morin, LCSW Facebook LinkedIn Twitter Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk, "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time. Learn about our Medical Review Board Print JGI / Jamie Grill / Getty Images Table of Contents View All Table of Contents Types Symptoms Causes Diagnosis Treatment Complications Coping With Dissociation is a disconnection between a person's sensory experience, thoughts, sense of self, or personal history. If you have trouble remembering a certain period of time in your life, for example, you may be experiencing a type of dissociation called dissociative amnesia. The American Psychological Association (APA) defines dissociation as "a defense mechanism in which conflicting impulses are kept apart or threatening ideas and feelings are separated from the rest of the psyche." This disconnection can occur as part of a dissociation disorder, or it may be a symptom of another mental health issue. For instance, people with borderline personality disorder, post-traumatic stress disorder, and schizophrenia sometimes experience dissociation. What Dissociation Feels Like Someone with dissociation might feel a sense of unreality and lose their connection to time, place, and identity. This is because dissociation disrupts four areas of personal functioning that usually operate together smoothly, automatically, and with few or no problems. These areas are: Consciousness Identity Memory Self-awareness and awareness of surroundings Breaks in this system of automatic functions can cause dissociation symptoms. Dissociation can range from feeling a mild sense of detachment (daydreaming) to experiencing a more severe disconnection from reality (feeling as if the world is unreal). Types of Dissociation The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), a handbook published by the APA to help mental health professionals diagnose mental illnesses, identifies three types of dissociative disorders: Depersonalization-derealization disorder (DPDR): This dissociative condition involves feeling detached from one's own body and thoughts. People with DPDR may feel like they are observing their own life as an outsider, or they might feel disconnected from their surroundings. Dissociative identity disorder: This dissociation disorder was previously known as multiple personality disorder. It is characterized by having two or more persistent personality states, sometimes referred to as "split personalities." Dissociative amnesia: This type of dissociation is characterized by forgetting one's personal information. This includes not being able to recall or "losing" memories of past events. Related Conditions In addition to these dissociative disorders, dissociation may also occur as a symptom of another condition. Conditions in which someone may experience dissociation include: Acute stress disorder Affective disorders, also known as mood disorders Anxiety Attention-deficit/hyperactivity disorder (ADHD) Borderline personality disorder (BPD) Depression Epilepsy Migraines Obsessive-compulsive disorder (OCD) Phobias Post-traumatic stress disorder (PTSD) Schizophrenia Substance use disorders Symptoms of Dissociation If you have a dissociation disorder or a mental health condition involving dissociation, you may sometimes have felt "disconnected" from yourself. Examples of dissociation include: “Blanking out” or being unable to remember anything for a period of time Experiencing a distorted or blurred sense of reality Feeling disconnected or detached from your emotions Feeling like you’re briefly losing touch with events going on around you, similar to daydreaming Feeling numb or distant from yourself and your surroundings Feeling that the world around you is unreal and distorted Having an altered sense of time and place Having flashbacks of traumatic events Memory loss about certain events, people, information, or timeframes It is possible to experience dissociation without being aware of it. Sudden mood changes, difficulty remembering personal details about yourself or your life, and feeling disconnected are all symptoms of dissociation. Related Symptoms Some people with dissociation may experience additional symptoms of depersonalization (feeling as if the self is not real) and derealization (feeling as if the world is not real). Both of these are serious mental health issues. Depersonalization and derealization are often responses to overwhelming traumatic events that cannot be escaped, such as child abuse and the trauma of war. They help the person to keep functioning at the moment of being severely traumatized. An example of depersonalization is an out-of-body experience, where people see themselves from above. This lets them feel that whatever is occurring “is not happening to me.” In states of derealization, people are detached from their surroundings. This lets them feel that their situation isn't real, or that it is “just a dream.” Causes of Dissociation Several factors can play a role in the development of dissociation. Among the potential causes are trauma, drug use, and other mental conditions. Trauma The main cause of dissociative disorders is trauma. In cases such as this, dissociation occurs as a way to keep memories of the traumatic event from feeling overwhelming or too massive to handle. Dissociation also helps the person distance themselves from the 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 even predict the potential for addiction according to a study published in the International Journal of High Risk Behaviors and Addiction. Another study in the Journal of Trauma & Dissociation 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. Three Types of Dissociative Drugs and Their Effects Other Mental Conditions Certain mental health disorders can also cause symptoms of dissociation. PTSD, for example, is often characterized by symptoms of dissociation and detachment. A 2021 study also found a direct connection between dissociation and hallucinations, grandiosity, paranoia, anxiety, and depression. Diagnosis of Dissociation To be diagnosed with dissociation, your healthcare provider will assess your symptoms, take your medical history, perform a physical exam, and possibly order lab tests to rule out any underlying medical conditions. They may also refer you to a mental health professional for diagnosis. A number of assessments can be used to help evaluate and diagnose dissociation. If you are experiencing dissociative symptoms, you may be given: A structured clinical interview for dissociation The Dissociative Experiences Scale (DES) The Clinician-Administered PTSD Scale (CAPS) The CAPS assessment tests for depersonalization by asking questions such 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 for Dissociation If you or someone you love has a dissociative disorder, it's important to know that treatment can be a lengthy and sometimes difficult process. However, several treatment options have been found effective and can include psychotherapy, medication, or a combination of both. Psychotherapy Your health provider may recommend psychotherapy to help treat dissociation. Types of psychotherapy used for dissociation treatment 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 There are no medications specifically approved for the treatment of dissociation. However, there are some medicines that can be prescribed to help manage its symptoms. For example, you may be prescribed antidepressants, sleep aids, or anti-anxiety drugs to help manage dissociation symptoms related to mood, anxiety, and sleep. If the dissociation is due to a psychiatric condition such as schizophrenia, your health provider may prescribe an antipsychotic. Complications of Dissociation If left untreated, symptoms of dissociation can be lifelong. This makes seeking treatment when signs first appear important to recovery. Research has also connected dissociation with worsened psychiatric symptoms in the future. Another complication of dissociation is that it increases a person's vulnerability to abuse since the disconnection leaves them unprotected. Sadly, this abuse sometimes occurs in the form of a therapist sexually abusing a patient with dissociation. This is a form of revictimization known as "sitting duck syndrome." Taking the time to find the right therapist can help avoid this type of situation. It is also helpful to know the signs of a bad therapist and make a switch should any of these become apparent during treatment sessions. Dissociation After Trauma May Indicate Increased Mental Distress in the Future Coping With Dissociation Since stress and anxiety sometimes trigger dissociation, finding ways to deal with these issues can help you better cope with their symptoms. Actions to consider taking include: Eating a healthy diet to lower your stress levels Getting adequate sleep each night Getting regular physical exercise Identifying and avoiding or managing dissociation triggers Practicing grounding techniques to help bring you back to the present moment Using relaxation strategies to reduce your anxiety If you or a loved one are struggling with dissociation, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. A Word From Verywell If you've experienced depersonalization or derealization, 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. Should this happen, 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 not otherwise be possible could expose you to the risk of harm. Talk to your health provider if you think you might be experiencing symptoms of dissociation or a related condition. 12 Tips for Dealing With Trauma 14 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Psychological Association. Dissociation. Seligman R, Kirmayer LJ. Dissociative experience and cultural neuroscience: narrative, metaphor and mechanism. Cult Med Psychiatry. 2008;32(1):31-64. doi:10.1007/s11013-007-9077-8 Valdez CE, Lilly MM. The effects of dissociation on analogue trauma symptoms after trauma processing among women with varying histories of lifespan victimization. J Interpers Violence. 2019;886260519829273. doi:10.1177/0886260519829273 Lanius RA. Trauma-related dissociation and altered states of consciousness: A call for clinical, treatment, and neuroscience research. Eur J Psychotraumatol. 2015;6:27905. doi:10.3402/ejpt.v6.27905 National Alliance on Mental Illness. Dissociative disorders. Sajadi SF, Hajjari Z, Zargar Y, Mehrabizade Honarmand M, Arshadi N. Predicting addiction potential on the basis of early traumatic events, dissociative experiences, and suicide ideation. Int J High Risk Behav Addict. 2014;3(4):e20995. doi:10.5812/ijhrba.20995 Najavits LM, Walsh M. Dissociation, PTSD, and substance abuse: An empirical study. J Trauma Dissociation. 2012;13(1):115‐126. doi:10.1080/15299732.2011.608781 Černis E, Evans R, Ehlers A, Freeman D. Dissociation in relation to other mental health conditions: An exploration using network analysis. J Psychiatr Res. 2021;136:460-467. doi:10.1016/j.jpsychires.2020.08.023 Weathers FW, Bovin MJ, Lee DJ, et al. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess. 2018;30(3):383-395. doi:10.1037/pas0000486 Cleveland Clinic. Dissociative disorders. American Association for Marriage and Family Therapy. Dissociative identity disorder. Lebois L, Harnett N, van Rooij S, et al. Persistent dissociation and its neural correlates in predicting outcomes after trauma exposure. AJP. 2022. doi:10.1176/appi.ajp.21090911 Şar V. The many faces of dissociation: Opportunities for innovative research in psychiatry. Clin Psychopharmacol Neurosci. 2014;12(3):171-179. doi:10.9758/cpn.2014.12.3.171 Schäflein E, Sattel H, Schmidt U, Sack M. The enemy in the mirror: Self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder. Eur J Psychotraumatol. 2018;9(Suppl 3). doi:10.1080/20008198.2018.1472991 Additional Reading Lanius RA, Hopper JW. Re-experiencing/hyperaroused and dissociative states in posttraumatic stress disorder. Psychiatric Times. 2008;25(13):31-36. Schiavone FL, Frewen P, McKinnon M, Lanius RA. The dissociative subtype of PTSD: An update of the literature. PTSD Research Quarterly. National Center for PTSD. By Matthew Tull, PhD Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. 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