Dissociation is a mental process where a person disconnects from their thoughts, feelings, memories or sense of identity. It involves a disruption in consciousness, memory, identity, or perception that is not better explained by another medical or psychiatric disorder.
Dissociation can be thought of as a defense mechanism that helps a person cope with trauma or intense emotions by mentally escaping from the situation. The dissociated part of the mind is able to split off and compartmentalize memories or emotions that are too much for the conscious mind to handle.
Dissociative behavior occurs along a spectrum, ranging from mild detachment from immediate surroundings to more severe detachment from physical and emotional experience. Most people experience minor dissociative episodes, such as daydreaming or highway hypnosis.
More severe dissociative behavior includes:
- Feeling detached from one’s body, thoughts, or emotions
- Losing awareness of one’s identity or sense of self
- Inability to recall important personal information
Severe, chronic dissociative behavior may be diagnosed as a dissociative disorder.
Understanding Dissociative Disorders
Dissociative disorders involve ongoing dissociative behavior that negatively impacts daily functioning. People with dissociative disorders exhibit disturbances of identity, memory, consciousness, emotion, perception, behavior, and sense of self.
There are three major dissociative disorders in the DSM-5:
- Dissociative amnesia
- Depersonalization/derealization disorder
- Dissociative identity disorder
Identity confusion is a key aspect of dissociative disorders. Those with dissociative disorders report feeling detached from themselves, experiencing different personality states, or not recognizing themselves in the mirror.
Types of Dissociative Disorders
Dissociative amnesia involves an inability to recall important autobiographical information that is too extensive to be explained by ordinary forgetfulness. The amnesia is not caused by a medical condition and is usually centered around traumatic or stressful events. There are four subtypes of dissociative amnesia:
- Localized amnesia – gaps in memory for a specific traumatic event
- Selective amnesia – partial or fragmentary recall for a period of time
- Generalized amnesia – memory gaps for identity and life history
- Systematized amnesia – loss of memory related to a specific person or category
Depersonalization disorder involves persistent feelings of detachment or estrangement from oneself. Individuals may report feeling like an outside observer of their own thoughts, feelings, or body. They may complain that the world feels unreal or dreamlike. Depersonalization often causes significant distress and impairment.
Derealization disorder involves persistent feelings that the external world is strange or unreal. Individuals feel detached and emotionally disconnected from their surroundings. Similar to depersonalization, derealization can cause significant distress and functional impairment.
Dissociative identity disorder
Previously known as multiple personality disorder, dissociative identity disorder (DID) involves alternating between two or more distinct personality states. Each identity or persona has its own pattern of thinking, relating, and perceiving the world. Transitions between identities are associated with gaps in memory or sense of self.
Dissociative fugue involves sudden, unexpected travel away from home, along with confusion about one’s identity. Individuals seem to enter a fugue state in which they assume a new identity, often for days, weeks, or even months. They are unable to recall important autobiographical information during the fugue state.
Link between post-traumatic stress disorder (PTSD) and dissociative disorders
There is a strong link between PTSD and dissociative disorders, as dissociation is often a response to trauma. Those with PTSD often experience dissociative symptoms like depersonalization or derealization during flashbacks. However, dissociative disorders require that dissociative behavior be pervasive, ongoing, and significantly impair functioning.
Experiences of Dissociative Behavior
Those experiencing depersonalization and derealization often describe feeling detached, distant, or “not really here.” The world may seem foggy, dreamlike, or visually distorted. Individuals may describe the experience as being in a movie, behind a glass wall, or watching themselves from outside their body. Things seem unreal or two-dimensional.
Some common descriptions:
- Feeling like a robot just going through the motions
- Emotional and physical numbness
- Body feels foreign or unfamiliar
These experiences of detachment from self and surroundings can cause significant distress.
Along with depersonalization and derealization, numbness and emotional detachment are common in dissociative disorders. Individuals describe feeling empty, hollow, blank, or “zoned out.” They may have difficulty experiencing emotions or physical sensations. The world appears colorless and mundane.
Some describe feeling like a stone statue – completely frozen and detached from the world. Daily activities may seem mechanical and robotic. Individuals report profound disconnection from loved ones – people seem like strangers or cardboard cutouts.
In severe cases, dissociative disorders may involve feeling separated from one’s own body or watching oneself from outside the body. This is known as an out of body experience.
Individuals may visualize themselves floating above their physical body. They describe seeing their body from the outside, as though it is a separate being. Out of body experiences reinforce the profound sense of detachment from one’s physical being.
Causes and Triggers of Dissociative Disorders
Most mental health professionals believe dissociative disorders are caused by severe, repetitive trauma during childhood. Examples include:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Witnessing violence
Dissociation allows the child to compartmentalize unbearable trauma. By seeing themselves as separate from the abuse, children are able to mentally detach from intolerably painful events.
Studies indicate a strong correlation between adverse childhood experiences and dissociative disorders. The greater the trauma, the more severe the dissociation tends to be.
Key points about childhood trauma and dissociation:
- Develops as an escape when children cannot fight or flee abuse
- Allows compartmentalization of overwhelming trauma
- More severe trauma predicts greater dissociation
- Earlier trauma onset is linked to worse dissociation
The theory is that dissociation becomes ingrained as a maladaptive coping mechanism if trauma is severe and repetitive in childhood.
Symptoms Associated with Dissociative Disorders
Individuals with dissociative disorders suffer from distortions in consciousness and perception. This includes:
- Out of body experiences
- Identity confusion or amnesia
- Truncated senses of time
They describe perceiving themselves, others, and the world in a detached, altered way. Things seem hazy, dreamlike, or unreal.
Dissociative disorders involve different types of memory loss:
- Generalized amnesia for childhood events
- Lacunae for certain time periods or events
- Fugue states with identity loss
Those with dissociative amnesia cannot recall autobiographical information beyond normal forgetfulness. Fugue states involve loss of identity and unexpected travel.
A core symptom of dissociative disorders is emotional numbing, disconnect, and detachment. Individuals cannot fully experience emotions and lose motivation, excitement, or affection for life.
Other symptoms of emotional detachment include:
- Feeling like a robot, zombie, or on autopilot
- Reduction in positive emotions like happiness
- Inability to connect with loved ones
- Lack of motivation or interest in activities
This emotional numbing and loss of connectedness can be profoundly distressing.
Treatment and Intervention for Dissociative Disorders
First-line treatment for dissociative disorders is psychotherapy, such as:
- Cognitive behavioral therapy (CBT) to challenge unhelpful thought patterns
- Eye movement desensitization and reprocessing (EMDR) to process traumatic memories
- Dialectic behavior therapy (DBT) for distress tolerance and emotion regulation skills
- Family/group therapy for additional support
Medications like antidepressants and anti-anxiety drugs may help control symptoms. However, there are no medications that specifically treat dissociative disorders.
Other interventions include:
- Building a safe and trusting therapeutic relationship as a base
- Stress management and coping techniques
- Creative therapies like art or music to aid expression
- Teaching grounding strategies to stay present
Coping strategies for individuals experiencing dissociative behavior
Those experiencing dissociative symptoms can try coping strategies like:
- Grounding techniques – Describe your surroundings in detail using all five senses to stay present.
- Mindfulness meditation – Observe thoughts and feelings in a nonjudgmental way instead of disconnectedness.
- Crafts or hobbies – Express emotions through creative activities.
- Time with pets or loved ones – Interact with emotional support animals or trusted people.
- Exercise – Release endorphins and connect with your body.
Having a strong social support system aids recovery. Many find joining a dissociative disorder support group helpful.
- Dissociation involves disconnection from thoughts, feelings, identity or memory.
- Dissociative disorders are chronic, severe dissociative conditions that disrupt functioning.
- Dissociative disorders often stem from overwhelming childhood trauma.
- Key symptoms are identity confusion, amnesia, depersonalization, derealization, and emotional numbing.
- Psychotherapy is the primary treatment approach. Medications can help secondary symptoms.
Dissociation exists on a spectrum from mild to severe. While transient, mild dissociation is common, chronic dissociative disorders require professional treatment. Proper diagnosis can be complicated, as symptoms overlap other disorders. With compassionate, trauma-informed therapy, individuals can recover and reconnect with themselves and the world around them.