What Is Dissociation?

Dissociation is a disconnection or detachment from one's sense of self (depersonalization) or one's surroundings (derealization). Symptoms can interfere with every aspect of mental functioning, including memory, identity, emotion, perception, and behavior.

There are different types and varying degrees of dissociation, meaning the symptoms may or may not be obvious to yourself or others. 

Types

Distinct types of dissociative disorders are outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Dissociative Amnesia

People with dissociative amnesia experience memory gaps in autobiographical information (information about themselves), usually of stressful or traumatic memories.

Depersonalization-Derealization Disorder

People with depersonalization-derealization disorder experience a persistent and significantly altered sense of identity or external surroundings (or both). It can look like daydreaming, spacing out, or having an out-of-body experience, such as feeling like floating above one’s body.

Dissociative Identity Disorder

Formerly known as multiple personality disorder, dissociative identity disorder (DID) affects a person’s sense of self and splits their identity into at least two distinct personality states.

Dissociative Fugue

Dissociative fugue (psychogenic fugue) is a rare psychiatric disorder characterized by episodes of memory loss where the person wanders from home and cannot remember what happened. It is a type of dissociative amnesia. Its onset is generally associated with trauma and other stressful life events. 

Episodes of dissociative fugue can last weeks and even months, leaving significant autobiographical memory gaps and disrupting daily functioning. They can also suddenly stop or gradually stop over time.

Symptoms

Dissociative disorders can seriously affect a person’s mental functioning, including their consciousness, perception, memory, identity, behavior, motor control, and emotions.

Depersonalization

Depersonalization is characterized by feelings of detachment, distance, or disconnect from one’s self, body or mind. It makes it feel like what’s happening is not happening to them. 

People experiencing depersonalization are cut off from their thoughts and feelings, sensations, and actions, leading to some of the following symptoms:

• Perceptual alterations
• Distorted sense of time and space
• Unreal, unstable, or absent self
• Emotional or physical numbing
• A feeling of watching a movie of your life

Derealization

Derealization, on the other hand, is characterized by feelings of unreality relating to other people, places, or objects. It lets a person feel that what is happening in the world is not really happening.

People experiencing derealization are prone to feeling that their surroundings are:

• Unreal
• Dreamlike
• Foggy
• Lifeless or static
• Visually distorted or blurry

Causes

Brain imaging in those experiencing dissociation as a manifestation of borderline personality disorder (BPD) have shown a link between dissociative behavior and altered brain function and structure in areas involved in emotional processing and memory. These brain structures include the amygdala and hippocampus, which is associated with emotion regulation.

The cause of dissociative disorders is not clear, but some theorized that they develop as a way of coping with trauma, especially prolonged childhood trauma.

Disorders that may be associated with dissociation include:

• Post-traumatic stress disorder (PTSD)
• Acute stress disorder
• BPD
• Substance use disorder
• Depression
• Anxiety disorders

Complications 

The complications from dissociation and dissociative disorders can be severe. Not only can symptoms become persistent, but they can also lead to serious interpersonal issues. Without help, a person can find themselves grasping at unhealthy ways to cope with the underlying pain. 

Complications can include:

• Lack of resilience to minor or major stressors 
• Codependency or unhealthy interpersonal attachment
• Feelings of self-harm or suicidal ideation
• Addiction
• Personality disorders
• Eating disorders
• Sleep disorders, including nightmares and insomnia
• Career issues
• Isolation
• Sexual dysfunction 

Warning Signs

If you or someone you know has the following signs, seek help from a mental health professional:

• Negative sleep, appetite, or personal hygiene changes: People with dissociation may show a stark difference in their usual routine or appearance.
• Rapid or dramatic mood shifts: Their mood doesn’t match their normal temperament or reaction.
• Social withdrawal or avoidance: They may give up social responsibilities, change the way they speak about their relationships, or avoid certain people and places.
• Impaired functioning at school, work, or in social activities: They may see their grades dropping, lose or quit their job, or remove themselves from activities.
• Concentration, memory, and logic problems: They may seem lost, confused, disoriented, or overly forgetful.
• Heightened sensitivity to or avoidance of overstimulating situations: Minor inconveniences or small triggers can cause exaggerated reactions.
• Feeling of disconnection: They may say things like “No one understands,” “No one really knows me,” or “I don’t have anyone."
• Loss of motivation or passion: Momentum in personal or other projects can drop, and they may feel like they have no idea why they started or should continue.
• Unusual behaviors: They may travel far from home, saying things that cannot be true, or discussing seeing things that are not there. 
• Increased substance use: They may spend more on substances, have increased adverse consequences, or experience conflict with others arising from the substance use.

Signs in Children

Children experiencing dissociation may not be aware of what is happening. Adults should pay attention to the following warning signs of dissociation in children and teens:

• Loss of memory of important or traumatic events known to have occurred
• Frequent dazed or trance-like states
• Perplexing forgetfulness (e.g., the child knows facts or skills one day and not the next)
• Rapid, profound age regression
• Difficulties seeing cause-and-effect consequences from life experiences
• Lying or denying responsibility for misbehavior despite obvious evidence to the contrary
• Repeatedly referring to themselves in the third person
• Unexplained injuries or recurrent self-injurious behavior
• Auditory and visual hallucinations

If dissociation becomes a way to cope with life stressors, the child or teenager can grow up without a stable sense of self. 

Diagnosis

To diagnose a dissociative disorder, you and your doctor will discuss your symptoms and medical history, including a family history of dissociative disorders.

Your doctor will likely perform a physical exam and run some tests to rule out other potential medical contributions to your symptoms, such as brain damage or head trauma, sleep deprivation, or substance use.

If your symptoms cannot be better explained by a physical or another condition, your doctor may ask you to complete the following assessments:

• Dissociative experiences scale (DES), a questionnaire with questions about your experiences in your daily life
• Clinician-administered PTSD scale for DSM-5 (CAPS-5), a structured interview that corresponds to the DSM-5 criteria for PTSD

Depending on your answers, your doctor may begin discussing treatment or may refer you to a mental health professional for further evaluation.

Treatment

Your doctor may recommend prescription medications for managing symptoms of dissociation or for treating any underlying psychiatric conditions.

Medications used to treat dissociative disorders may include:

• Antipsychotics
• Antidepressants like selective serotonin reuptake inhibitors
• Anti-anxiety drugs like benzodiazepines
• Sleep aids like melatonin

Therapy

There are several forms of therapy that may be helpful in treating dissociation, including:

• Cognitive behavioral therapy (CBT), which focuses on helping people develop greater self-awareness and change negative thoughts or behavior patterns
• Dialectical behavior therapy, a form of CBT that helps people develop emotional regulation strategies and healthier coping mechanisms
• Eye movement desensitization and reprocessing (EMDR), which can help reduce negative reactions to triggering stimuli. In one study of 36 PTSD patients, EMDR resulted in changes in brain areas associated with fear and affected by dissociation.

Management 

Coping with dissociation can be difficult, but it gets easier if you practice daily steps to reduce associated or triggering stress in healthy ways. 

Strategies you can try include:

• Make sleep a priority by keeping a set sleep schedule even on weekends.
• Use grounding techniques when faced with overwhelming sensations or emotions, such as checking in with your five senses and deep breathing.
• Identify and understand your triggers.
• Focus on eating a balanced diet with a variety of nutrients and staying hydrated.
• Eliminate substance use that can mimic symptoms, such as cannabis, alcohol, and hallucinogens.
• Have ongoing conversations about the condition with your support system, including your doctor and loved ones

It may also be helpful to ask someone close to you to keep an eye out for any dissociative signs. This is because it can be difficult to be objective with yourself and determine if you’re experiencing dissociation.

Outlook

There are no cures for dissociative disorders, but you can still live a normal and happy life when your symptoms are treated. With help, you can regain a sense of self and learn to manage your emotions and behaviors, as well as cope with daily stressors. You can improve your functioning in a variety of settings— from work to school to home—with treatment over time.

Summary

Dissociation occurs when you separate yourself from your surroundings and even your own body. You may feel like you are watching your own life as if it's a movie. There are many types of dissociation, but they all affect your experience. It may be difficult to recognize the symptoms of dissociation in yourself. With the right treatment, you can still have a high quality of life.

Frequently Asked Questions

What does dissociation look like?

Dissociation can look like someone daydreaming, ignoring you, spacing out, or being totally disconnected from the conversation or their surroundings. The person may seem different than their usual self.

How do you help someone with dissociation?

Being aware of what's happening to your loved one and providing support can be helpful. Do not take it personally and remember that when a person experiences dissociation, they may need help remembering grounding techniques. They may also need empathy to get through the episodes.

How common is dissociation?

Dissociation happens to nearly everyone at some time or another, but 7% of the population may suffer from a dissociative disorder at some point in their lives, although these experiences tend to go under- and undiagnosed.

A Word From Verywell

Living with a dissociative disorder can be scary, confusing, and frustrating. They often reflect a coping mechanism that you have developed to deal with overwhelming stress and trauma. With the right treatment, you can still live a normal and happy life.

The dissociative symptoms can make it difficult for you to feel grounded or even seen. Reach out for help if you notice that you have symptoms of dissociation. If you think someone you know is showing symptoms, it's important to offer support and encourage them to get help.