Dissociation and Mental Health
Jessica Chang, MHC-LP
Dissociation, not to be confused with disassociation (a conscious separation or detachment from an entity) or cognitive dissonance (when one exhibits conflicting attitudes, beliefs, or behaviors), is an involuntary experience involving disconnection from one’s self or environment. This can include a disconnect from thoughts, sensory experience, sense of self, emotions, or surroundings.
What is dissociation?
Dissociation is a coping mechanism that serves to protect people while dealing with overwhelming or traumatic experiences. It is defined by the American Psychological Association (APA) as “a defense mechanism in which conflicting impulses are kept apart or threatening ideas and feelings are separated from the rest of the psyche.” Dissociation can manifest in many forms, from daydreaming to dissociative identity disorder. It is common for people to experience dissociation during their lifetime, as it is a way for the mind to handle overwhelming stress. Dissociation may become the primary way someone copes with stressful experiences, and dissociative disorders may develop if an individual dissociates for a long time. The disconnect that occurs during dissociation may occur as part of a dissociation disorder, or it could be a symptom of another mental health issue such as borderline personality disorder, post-traumatic stress disorder (PTSD), or schizophrenia.
What does dissociation feel like?
Experiencing dissociation may feel like loss of connection to time, place, and identity, or existing in a non-reality. These symptoms occur due to disruption of four areas of functioning that usually work together automatically: consciousness, identity, memory, and awareness (of self and surroundings). It is a possibility that one may experience dissociation without being aware of it.
Examples of dissociation symptoms include:
“Blanking out” or lack of memory throughout a period of time
Briefly losing touch with events happening around you, similar to daydreaming
Sensing that your environment is unreal and distorted
Having an out-of-body experience
Having an altered sense of time and place
Feeling like a different person at times
Feeling emotionally or physically numb or detached
Memory loss about specific people, events, timeframes, or personal details
Sudden mood changes
Derealization and depersonalization - Some people with dissociation may experience the serious mental health issues of depersonalization, feeling as if the self is not real, and derealization, feeling as if the world is not real. These are survival mechanisms that help the person continue to function in the moment of being severely traumatized.These traumatic events are completely overwhelming to the psyche and often cannot be escaped, such as child abuse and war.
In states of depersonalization, people detach from themselves, like an out-of-body experience, in which they can feel as though whatever is occurring “is not happening to me.” In states of derealization, people detach from their surroundings, allowing them to feel that their situation is not real, as if living in a movie, or is “just a dream.”
Dissociation Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) identifies three types of dissociative disorders, including depersonalization-derealization disorder (DPDR), dissociative identity disorder, and dissociative amnesia. Only a professional should diagnose a dissociative disorder. There are 5 core components of dissociative disorders: amnesia, depersonalization, derealization, identity confusion, and identity alteration. If a person is experiencing any of the core components of dissociation in a persistent manner which causes significant distress, disrupts important areas of functioning, and cannot be explained by other means (e.g., alcohol or mind-altering drugs), it may be an indication of a dissociative disorder.
A dissociation diagnosis often involves a primary care provider and mental health professional such as a psychiatrist, psychologist, or psychiatric social worker. These healthcare providers will document symptoms, record medical histories, conduct a physical exam, and potentially order lab tests to rule out an illness or any underlying medical conditions as the cause of dissociative symptoms. Other assessments which may be helpful for evaluating and diagnosing dissociation include a structured clinical interview for dissociation, the Dissociative Experiences Scale (DES), and the Clinician-Administered PTSD Scale (CAPS).
Causes of Dissociation
Trauma, stress, substance use, and other mental health conditions are all potential causes of dissociation, with trauma being the leading cause of dissociative disorders, especially severe and ongoing trauma during childhood.
Trauma
When one psychologically disconnects from the present moment in which something really bad is happening to them, it is called peritraumatic dissociation. Dissociation as a result of trauma occurs as a way to manage memories of the traumatic event from being overwhelming and to create distance from oneself and the traumatic situation.
Examples of sources of trauma that can cause dissociation:
Sexual or physical assault, childhood abuse, witnessing domestic violence between parents, motor vehicle accidents, death of a close family member, injuries and medical procedures, surviving a natural disaster, military combat or survival training, torture or capture, etc.
Stress
Experiencing high levels of emotional stress may also lead to dissociation. Although a human’s natural bodily response to a stressor or perceived threat is to activate the “fight or flight” response, if the stressor is ongoing and inescapable, the body may enter a state of freeze or shutdown, i.e. dissociation. When normal coping mechanisms fail, dissociation serves as an emergency coping response. This could occur if a person is experiencing intense and persistent work stress and feeling overwhelmed and powerless, leading to detachment from self.
Other examples of severe life stressors that could overwhelm a person’s coping capacities:
Divorce, financial pressures, loss of a loved one, job loss or instability, physical illness, bullying, a difficult breakup, etc.
Substance Use
Substance use and dissociation and trauma are intricately connected, with more research needed on the interactions of substance use disorder, PTSD, and dissociation amongst various populations. Some recreational drugs may also cause feelings of dissociation, such as ecstasy and Ketamine.
Mental Health and Dissociation
Other Mental Health Conditions and Dissociation
Dissociation is also often linked with autism spectrum disorder, anxiety, depression, and sleep deprivation. Dissociation may be a response to autism symptoms, such as sensory challenges and overwhelm and difficulties with feeling emotions. The rich inner worlds and daydreaming tendencies of autistic people may also be confused for dissociation. In relation to anxiety and depression, dissociation may occur as a response to alleviate one from feeling ongoing difficult and intense emotions. Disruption of cognitive and emotional functioning and processes from lack of sleep often leads to dissociation as a coping mechanism as well.
Risks to Mental Health and Wellbeing
Additionally, dissociation leaves one vulnerable to self-harm and suicidal behaviors, revictimization, employment and relationship issues, and increased engagement in sexual risk-taking behaviors. If left unmanaged or untreated, dissociation can lead to worsened mental health and wellbeing. It is important to seek professional help if symptoms of dissociation are persistent and interfering with daily functioning.
Dissociation Treatment and Management
Depending on the underlying cause and severity of symptoms, there are various appropriate management and treatment strategies for dissociation. These typically include a combination of self-care (e.g., grounding exercises and stress reduction), psychotherapy (talk therapy, cognitive behavioral therapy, dialectical behavior therapy, creative therapies, etc.), and/or medication. It is important to speak with a trusted professional to receive personalized care that meets the needs of each individual.
Sources
Guy-Evans, O. (2023). What Is Dissociation? Types, Causes, Symptoms & Treatment. SimplyPsychology.
Tull, M. (2024). What is Dissociation? Verywell Mind.
Wiginton, K., Amandolare, S., Mitchell, K. (2024). What is Dissociation? WebMD.