Many people have mildly dissociated for brief moments during their lives. Maybe you space out during a meeting or drive to a familiar location, but don’t remember how you got there. You might get lost in a book and not pay attention to the time or what’s going on around you.

However, if your dissociation is persistent, disruptive, or linked to significant distress, it may be time to reach out for help.

What is Dissociation?

Dissociation is a mental process where you separate or disconnect from your thoughts, feelings, memories, or sense of identity. Think of it as a temporary mental escape from reality. You may feel detached from your surroundings, emotions, or even your own body. This can happen in response to stress, trauma, or other overwhelming situations. You might feel like you’re watching yourself from outside your body or that your experiences aren’t real. It's a defense mechanism the mind uses to cope with distress.

Mild dissociation, such as daydreaming or getting lost in thought isn’t uncommon during times of stress, anxiety, or intense emotions. It’s a natural and often adaptive way to deal with challenging experiences.

However, dissociative experiences are unique to each individual. Some may experience dissociation infrequently and in response to specific stressors. Others may have more regular or pronounced episodes linked to mental health conditions or trauma. It's important to differentiate between mild, adaptive dissociation and episodes that negatively impact your life.

Signs of Dissociation

The way a person dissociates can vary widely in specific type, frequency, duration, and intensity. It’s not always a sign of a mental health condition. Mildly dissociating can serve as an adaptive coping skill. However, if dissociation becomes more frequent and interferes with daily life, it might be a sign of underlying mental health issues that need attention and support.  Common signs of dissociation include:

• Depersonalization:
  • Feeling detached from yourself.
  • The sense that your body or actions are not your own.
  • Feeling as though you’re observing yourself from outside or above your body.
• Derealization:
  • The external world doesn’t seem real or it appears distorted.
  • Your surroundings feel foggy, dreamlike, or distant. -mnesia:
  • Gaps in memory, especially concerning specific events or periods.
  • Forgetting important personal information.
  • Memory loss related to traumatic experiences.
• Identity Disturbances:
  • Drastic shifts in self-perception or identity.
  • Feeling as if you have different identities or personalities.
  • Confusion about personal identity or values.
• Emotional Numbness:
  • Feeling emotionally numb or detached.
  • Difficulty experiencing or expressing emotions.
  • A sense of being "numb" to both positive and negative feelings.
• Flashbacks:
  • Re-experiencing traumatic events as if they are happening in the present.
  • Vivid and intrusive memories accompanied by strong emotions.
  • Loss of awareness of the current surroundings during a flashback.
• Spacing Out:
  • Periods of zoning out or being mentally absent.
  • Inability to concentrate or focus on the present moment.
  • Feeling disconnected from ongoing activities.
• Alterations in Perceived Time:
  • Distorted sense of time. Events feel longer or shorter than they actually are.
  • Losing track of time during dissociative episodes. -utomatic Behaviors:
  • Engaging in activities without conscious awareness.
  • Completing tasks without a clear memory of doing so.
  • Behaving in an automatic or robotic manner.
• Sensory Disconnection:
  • Feeling disconnected from your senses.
  • Experiencing a lack of sensory input or heightened sensitivity.
  • A sense of numbness or detachment from physical sensations.

What Causes Dissociation?

There isn’t one specific experience or health condition that causes dissociation. Some factors that can increase the risk of having more intense or frequent dissociative episodes include:

• History of trauma: Dissociating can be a trauma response. It may result from either a one-time traumatic event or continuous experiences. This is especially true for those who endure abuse or other forms of trauma during childhood.
• Mental health conditions: Severe and chronic dissociation is often seen in individuals with specific mental health conditions, such as post-traumatic stress disorder (PTSD), dissociative disorders, anxiety, depression, schizophrenia, bipolar disorder, or borderline personality disorder
• Chronic or high levels of stress: A person may dissociate to cope with distress.
• Cultural or religious practices: In some cases, dissociation might be a part of specific cultural or religious practices.
• Substance use and medication: Dissociation may occur as a side effect of substance use (such as alcohol, cannabis, or hallucinogens) or certain medications. It can also occur during the withdrawal from certain medications.

Conditions Associated with Dissociation

Different mental health conditions can show dissociative symptoms. Recognizing these can help with accurate diagnosis and effective treatment.

Dissociation and Anxiety

High levels of anxiety may lead to dissociation as a way to cope. It can make a person feel detached from reality like they're watching their own life from a distance.

Dissociation and Depression

Depression is characterized by persistent feelings of sadness, hopelessness, and a lack of interest in activities. Dissociation can present as emotional numbness or a sense of being emotionally disconnected from one's own experiences. This detachment can contribute to the sense of emptiness associated with depression.

Dissociation and PTSD

Post-traumatic stress disorder (PTSD) is closely linked to dissociation. Traumatic events can overwhelm the mind's ability to process information. This can lead to dissociative symptoms such as flashbacks, amnesia, and a feeling of being "spaced out." These episodes may act as a shield from the full impact of distressing memories.

Dissociation and Trauma

Dissociation can be a survival strategy in response to trauma. Individuals may dissociate to distance themselves from emotional and physical pain. Episodes may range from mild detachment to intense states where a person loses touch with their surroundings and self.

Dissociation and Schizophrenia

Schizophrenia is characterized by disruptions in thinking, perception, and emotional regulation. Dissociation isn't a primary feature of the condition. However, some individuals with schizophrenia may experience dissociative symptoms, such as depersonalization or derealization.

Dissociation and Bipolar Disorder

Individuals with bipolar disorder may experience dissociative symptoms during manic or depressive states. These symptoms can include feelings of detachment or altered perceptions of reality.

Dissociation and Borderline Personality Disorder (BPD)

Dissociation is commonly associated with borderline personality disorder (BPD). Individuals may use it as a way to cope with distress triggered by perceived abandonment or rejection. Dissociative symptoms in BPD can include depersonalization, derealization, and even brief identity disturbances.

Dissociative Disorders

Dissociative disorders involve more severe and chronic forms of dissociation. They’re identified by disruptions in a person's memory, identity, consciousness, or perception of the environment.

Dissociative Identity Disorder (DID)

Formerly known as multiple personality disorder, DID involves disruption of a person’s identity characterized by two or more distinct personality states. These states may control the person's behavior and consciousness at different times. They can be accompanied by separate memories, behaviors, and experiences, creating a complex and fragmented sense of self.

Dissociative Amnesia

In dissociative amnesia, individuals experience memory gaps or loss, typically related to traumatic events. This memory loss is more extensive than ordinary forgetfulness and cannot be explained by a medical condition.

Depersonalization-Derealization Disorder

Depersonalization involves a persistent feeling of detachment or estrangement from one's own body, thoughts, or sensations. Derealization involves a similar sense of detachment from the external world, making it seem unreal or distorted. Depersonalization-derealization disorder often involves both experiences.

Other Specified Dissociative Disorder (OSDD)

OSDD involves significant dissociative symptoms. However, the symptoms aren't enough to meet the criteria for one of the other dissociative disorders.

Examples of Dissociation

Workplace Stress

Denise is under a lot of pressure at work and has a major deadline approaching. Recently she has been finding herself staring blankly at the computer screen, unable to focus or engage with her tasks. This mental fog serves as a temporary escape from the stress, disconnecting her from the overwhelming demands.

Conflict in Relationships

During intense arguments with his partner, Rick tends to withdraw mentally and emotionally. Detaching from the conflict creates an emotional shield for himself. However, it's hindering the couple's communication and relationship.

Traumatic Flashbacks

Dominic has been having vivid flashbacks to the violence he witnessed while on active duty. Certain loud noises trigger him and transport him back to the battlefield momentarily.

Debunking Myths Surrounding Dissociation

Myth #1: Dissociation is Always a Sign of Severe Mental Illness

Dissociating doesn't automatically mean you have a mental health condition. It's often an adaptive response to stress. Common mild dissociative experiences include daydreaming or getting lost in thought.

Myth #2: Dissociation is Synonymous with "Split Personality"

While dissociative identity disorder (DID) is a specific dissociative disorder characterized by the presence of distinct personality states, most dissociative experiences do not involve significant discontinuity in sense of self or agency. Dissociation exists on a spectrum, and not everyone who dissociates has DID.

Myth #3: Dissociation is Always Conscious and Deliberate

Dissociation can be both conscious and unconscious. While some individuals may intentionally dissociate as a coping mechanism, others may experience dissociation involuntarily in response to overwhelming stress.

Treatment for Dissociation

When dissociation interferes with daily functioning or relationships, reach out to a qualified mental health professional for support. Treatment options may include a combination of psychotherapy, mindfulness-based approaches, or medication. Therapy aims to help you understand and manage symptoms, develop coping strategies, and process traumatic memories. Medication may be prescribed to treat an associated mental health condition, such as anxiety or depression.

Mindfulness practices and grounding techniques can be valuable in bringing individuals back to the present moment. Techniques such as deep breathing, sensory awareness, and mindfulness meditation can help individuals reconnect with their surroundings and regain a sense of control.

Dissociation Treatment | Seattle

If you or someone you know is experiencing dissociation or related issues, Existential Psychiatry can help. Dr. David Zacharias provides tailored and trauma-informed support. With over 20 years of experience in patient care, he’ll collaborate with you to create a personalized treatment that works for you. Reach out today for a free consultation.

Written by Existential Psychiatry Staff

Sources

• Černis, E., et al. “Dissociation in Relation to Other Mental Health Conditions: An Exploration Using Network Analysis.” Journal of Psychiatric Research, April 13, 2021. Accessed January 10, 2024.
• NHS. “Dissociative Disorders.” NHS, August 10, 2020. Accessed January 10, 2024.