PTSD What Is Dissociation? By 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 Matthew Tull, PhD Reviewed by Reviewed by Amy Morin, LCSW on July 19, 2020 facebook twitter linkedin instagram Amy Morin, LCSW, is the Editor-in-Chief of Verywell Mind. She's also a psychotherapist, the author of the bestselling book "13 Things Mentally Strong People Don't Do," and the host of the Mentally Strong People podcast. Learn about our Review Board Amy Morin, LCSW on July 19, 2020 Print JGI / Jamie Grill / Getty Images Table of Contents View All What Is Dissociation? Types Symptoms Causes Diagnosis Treatment Coping 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: ConsciousnessIdentityMemorySelf-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 disorderAffective disordersBorderline personality disorder (BPD)DepressionEpilepsyMigrainesObsessive-compulsive disorder (OCD)PhobiasPost-traumatic stress disorder (PTSD)SchizophreniaSubstance 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 eventsFeeling 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 timeMemory loss about certain events, people, information, or time periodsA distorted or blurred sense of realityFeeling disconnected or detached from your emotionsFeeling that the world around you is unreal and distortedFeeling numb or distant from yourself and your surroundingsAn 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 DissociationClinician-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 behaviorsDialectical behavioral therapy (DBT), which helps people learn skills that allow them to better manage emotions and stop harmful behaviorsEye 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 nightUsing relaxation strategies to help you cope with stressGetting regular physical exerciseEating a healthy dietIdentifying and avoiding or managing triggersPracticing 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. 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, 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. Was this page helpful? Thanks for your feedback! Learn the best ways to manage stress and negativity in your life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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. 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. doi:10.3402/ejpt.v6.27905 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 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 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). Schiavone FL, Frewen P, McKinnon M, Lanius RA. The dissociative subtype of PTSD: An update of the literature. PTSD Research Quarterly. 2018;29(3):