Dissociating is the experience of detaching from reality. Dissociation encompasses the feeling of daydreaming or being intensely focused, as well as the distressing experience of being disconnected from reality. In this state, consciousness, identity , memory , and perception are no longer naturally integrated. Dissociation often occurs as a result of stress or trauma , and it may be indicative of a dissociative disorder or other mental health condition.
Symptoms and Diagnosis
There are three main dissociative disorders, as listed in the DSM-5 . They are Dissociative Identity Disorder, Dissociative Amnesia, and Depersonalization/Derealization Disorder.
Dissociative Identity Disorder is when someone’s identity is characterized by two or more distinct personality states. This discontinuity leads to a disrupted sense of self. The person may not be able to recall personal information, everyday events, or a traumatic incident. These symptoms cause significant distress in work, school, relationships, or other aspects of daily functioning. This condition was previously called Multiple Personality Disorder.
Dissociative Amnesia is when a person is suddenly unable to remember important biographical information about themselves, outside of the realm of normal forgetting. The event they can’t recall is often a stressful or traumatic one, and the experience leads to significant distress in the person’s life.
Depersonalization/Derealization Disorder is when persistent episodes of depersonalization occur—feeling a sense of unreality, detachment, or being an outside observer of one’s thoughts, feelings, sensations, or actions—and/or derealization—a sense of unreality or detachment regarding one’s surroundings, such as individuals or objects seeming unreal, foggy, or visually distorted. These experiences lead to distress and impairment in the person’s life.
Causes and Risk Factors
Trauma is one of the central reasons why dissociation and dissociative disorders emerge. When faced with tremendous physical or emotional pain, an individual may unconsciously distance themself from the experience.
For example, dissociation is a common response to child sexual abuse . Among those with Dissociative Identity Disorder, the prevalence of childhood abuse and neglect is about 90 percent according to the DSM-5. Stress and trauma can trigger dissociation in adulthood as well, such as in the case of physical assault or military combat.
Dissociation may also be a symptom of several other conditions, including acute stress disorder, post-traumatic stress disorder, depressive disorders, bipolar disorder, schizophrenia spectrum disorders, personality disorders , seizure disorders, and substance or alcohol use.
Trauma is often a precursor to dissociation. The overwhelming force of traumatic events can overpower existing coping mechanisms. For those unable to physically escape, dissociation provides a psychological exit from the horror of the event. Once the traumatic experience has been dissociated from the sense of “who one is,” it is no longer considered as a self-narrative. For example, someone who was sexually abused as a child may have feelings of overwhelming shame and anger that could not be processed consciously at the time.
Treatment and Support
Dissociation is often treated through a combination of therapy and medication . Therapy can allow people to gradually access and consciously process the experiences during which they have dissociated. Coming to terms with that pain can liberate dissociated feelings and fully integrate one’s identity. Therapy can also help people identify and change harmful patterns of thinking and develop healthy coping skills, such as through cognitive behavioral therapy or dialectical behavior therapy.
No medications are specifically approved to treat dissociation, but antidepressants and anti- anxiety drugs can help with accompanying symptoms.
With support and treatment, individuals can manage dissociation and greatly improve their daily lives.
It can be very frightening to witness a loved one become disconnected from their identity or memory . Stay with them throughout the episode, and try to help them feel grounded, such as by asking them to state where they are and what they hear, or focusing on sensory experiences such as holding a warm or cold object. Some people report that skin-brushing is particularly helpful in staying connected to their body and reducing dissociation.
Explore More About Dissociation
For a comprehensive understanding of dissociation, read our complete guide: