Dissociation: Definition, Symptoms, Causes, and Treatment

What Is Dissociation?

Dissociation is the separation of a person's sensory experiences, 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.

APA Definition of Dissociation

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

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.6

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.

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)

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.

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

The Bottom Line

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.

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