Dissociation

What is it?

Dissociation is a break in how your mind handles information. You may feel disconnected from your thoughts, feelings, memories, and surroundings. It can affect your sense of identity and your perception of time. Dissociation vs. Disassociation: Dissociation is an involuntary experience that occurs when you feel disconnected from yourself or your environment. Disassociation is used in contexts outside of mental health but can also be used to describe a mental process. It is a conscious separation or detachment from something or someone and can be a coping mechanism.

Symptoms:

• Have an out-of-body experience

• Feel like you are a different person sometimes

• Feel like your heart is pounding or you’re lightheaded

• Feel emotionally numb or detached

• Feel little or no pain

• Have an altered sense of time

• Not remember how you got somewhere

• Have tunnel vision

• Hear voices in your head

• Have intense flashbacks that feel real

• Become immobile

• Get absorbed in a fantasy world that seems real

What does it feel like?

You may feel outside of your body, as if you’re watching yourself. You might also feel detached from your emotions and identity. Some people suddenly realize that they can’t remember something. They might wander while dissociating and forget how they arrived at a certain place. They might also forget especially distressing or shocking experiences. Some people with dissociation hear voices in their head or feel overtaken by alternate identities.

Dissociation Anxiety

Dissociation is linked to anxiety. You might experience anxiety or panic because of how disorienting dissociation feels. Dissociation is also a symptom of some anxiety disorders, including acute stress disorder and posttraumatic stress disorder (PTSD). People who have experienced trauma may dissociate to avoid returning to the experience in their minds.

Causes

• Sexual or physical assault

• Childhood abuse

• Combat or military survival training

• Torture or capture

• Motor vehicle accidents

• Natural disasters

• Hypnosis

When you daydream or let your mind wander, you are in a type of “auto-hypnotic state.” You may no longer have a strong awareness of your body. Other types of hypnosis may put you in a deeper dissociated state. A trained professional may use therapeutic hypnotherapy to help you manage pain, anxiety, addictive behaviors, or PTSD.

• Certain drugs. You may lose your sense of identity or reality if you drink alcohol or take illicit drugs. Research shows that people who take psychedelics, like psilocybin and LSD, report briefly losing their sense of self.

• Meditation. Like daydreaming, you may become less aware of the here and now while you meditate. Some expert meditators say they lose an awareness of their self or body during certain mindfulness meditation practices.

Types

• Depersonalization disorder. This can feel out of body or like separating from yourself.

• Derealization disorder. The world seems dreamlike and separate from you. Your sense of time could be affected, creating a sense that time is speeding up or slowing down.

• Dissociative amnesia. Usually occurring suddenly, this type of memory loss can last only minutes or hours, or in rare cases months or years. You may forget traumatic experiences or basic information about your life.

• Dissociative identity disorder. This disorder used to be known as multiple personality disorder. It may feel like people are living inside your mind, interfering with your sense of self. You may switch identities.

• Albuminocytologic dissociation refers to cerebrospinal fluid with a high protein level and normal cell count. It is used to help diagnose Guillain-Barré syndrome, a condition where nerve cells are attacked by the immune system, causing weakness and sometimes paralysis

Related Mental Health Conditions

• Acute stress disorder

• Borderline personality disorder

• Affective disorders

• Obsessive-compulsive disorder

• Depression

• Eating disorders

Autism

People on the autism spectrum may be prone to dissociate. Experiences that can trigger dissociation, like anxiety and trauma, are common among people with autism. Autism symptoms, such as sensory challenges and problems with feeling emotions, can be intertwined with dissociation. Dissociation may be a way for people with autism to cope with sensory overload, feeling overwhelmed by noise or touch, or changes in surroundings. It can be tricky to recognize dissociative identity disorder in people who mask (hide) their autism spectrum disorder. Masking can cause identity confusion and a feeling of being disconnected from your true self. Many people on the autism spectrum have rich inner worlds and are prone to daydreaming, which can be confused for dissociation. Depression: If you have frequent episodes of dissociation, you’re also more likely to have chronic depression. Most people who have dissociative identity disorder also have depression. There’s no specific medication for dissociation, but your doctor may prescribe antidepressants to treat your connected symptoms, like depression and anxiety.

Examples

• Being in a car accident

• Being the victim of a crime

• Being sexually or physically assaulted

• Experiencing childhood trauma or abuse

• Being a combat veteran

• Surviving a natural disaster, like a hurricane or tornado

Common Warning Signs

• Rapid mood swings

• Trouble remembering personal details

• Forgetfulness about things you’ve said or done

• Behavior or abilities that change (altered identities)

• Depression, anxiety, or panic attacks

• Thoughts of suicide or self-harm

• Substance abuse

• Failed treatments or hospitalizations for mood disorders

Warning Signs in Children

• Seem absent-minded

• Stare out the window a lot

• Have imaginary friends

• Forget they’ve said or done something

• Have ADHD or other learning disabilities

Diagnosis

Your doctor will give you a physical exam and ask about any past physical or mental health issues. You should let them know if you take illicit drugs or any medication. They may check a sample of your blood or run other tests to rule out an illness or other medical condition as the cause of your dissociation. They may also order an electroencephalogram, a painless test that measures brain waves, to rule out certain types of seizure disorders that can sometimes cause dissociation. A mental health specialist may give you other tests, including:

• Dissociative Experiences Scale

• Structured Clinical Interview for Dissociation Treatment

• Psychotherapy. This kind of treatment may help you find the cause of your dissociation. But the goal is to help you manage or get rid of your symptoms.

Types of Psychotherapy May Include

Cognitive behavioral therapy. It’s designed to help you see and change negative thoughts and behaviors.

Hypnotherapy. You may find it easier to explore and process your memories when you are in a relaxed state. You should only do this with a professional certified in hypnosis who is trained in dissociative disorders and PTSD.

Phasic trauma treatment. This treatment aims to help you stop suicidal thoughts or self-destructive behavior first. Then your psychotherapist will slowly help you process any traumatic memories and reintegrate your identities, if necessary.

Family treatment. You may find it helpful to get support from a spouse, partner, or other loved one.

Dialectical behavioral therapy. It may help you learn skills to control your emotions and stop harmful behavior. This is a common treatment for borderline personality disorder.

Eye movement desensitization and reprocessing. It uses techniques from cognitive behavioral therapy along with visual exercises to help you work through memories of severely troubling events. It may help stop your nightmares, flashbacks, or other PTSD symptoms.

Add-on medication. Your doctor may give you antidepressants, a mood stabilizer, or other drugs to help with anxiety or sleep problems. If you have schizophrenia, you may need an antipsychotic.