ADHD Symptoms And Mental Health: Understanding ADHD Dissociation

What is dissociation and how does it relate to ADHD?

Dissociation is a mental state that involves disruptions in memory, identity, awareness, or perception. People can experience mild, temporary dissociation in the general population. Daydreaming, zoning out, or losing track of time can all be considered mild disassociation. 

Clinically significant dissociative symptomatology, however, is more disruptive, intense, and persistent. Examples of this type of dissociation can include feeling as if you are outside of your body or losing your memory. It is often associated with chronic stress, trauma, or other mental health conditions.

While people with ADHD may experience dissociation-like symptoms, like zoning out, the condition generally does not cause true dissociation. Understanding the distinction can help clarify whether someone is experiencing ADHD-like symptoms or signs of a condition that may be more complex.

ADHD affects attention and awareness

ADHD affects attention, making it difficult for people to sustain focus. People with this condition may experience frequent zoning out, especially when engaged in repetitive tasks, but these episodes are situational, short-lived, and reversible. The person can remain aware of their surroundings and identity while experiencing them. True dissociative states may involve more profound disruptions of awareness.

ADHD dissociation vs zoning out

Although zoning out can be considered a mild form of dissociation, they are generally not the same. People with ADHD may experience their attention drifting, but this is not equal to true dissociation. Understanding more about how zoning out and dissociation differ can help clarify when experiences are in line with ADHD symptoms and when they may be a warning sign of something else.

Zoning out, dissociative absorption, and maladaptive daydreaming

In ADHD, someone who is zoning out typically may be less aware of what’s going on around them, but their overall awareness is generally not lost, and they can usually redirect themselves by using external clues rather than entering a dissociative state.

In contrast, dissociative absorption involves deeper immersion in internal imagery, thoughts, or activities, during which one’s surroundings fade. Disassociation can be intense and uncontrollable, and interfere with daily functioning. Maladaptive daydreaming goes further, leading to vivid, prolonged fantasies that significantly interfere with daily functioning.

Memory gaps and loss of time

Another distinction between zoning out and dissociation can be memory. Zoning out may not result in true memory gaps; someone may miss the details of what happened when they were zoned out, but they can generally recall what happened when pressed. 

On the other hand, dissociative experiences can include mild memory loss, lapses in time, or uncertainty about how one finished an activity or arrived at a place. Dissociation may result in a more significant disruption in awareness.

Why people with ADHD dissociate

The causes of dissociation as they relate to ADHD are not yet well known. However, studies have shown that neurological factors related to ADHD may cause an increase in dissociative episodes. Changes in the neural network for individuals with ADHD can make it more challenging to stay present in the moment, which can manifest as dissociation in some cases. 

Nervous system overload and executive functioning

With nervous system overload, executive functioning (that is, the ability to plan, manage multiple tasks, focus, and control impulses) is less efficient. Response inhibition weakens, making it harder for people to pause, filter, and redirect their thoughts. When this happens, the default mode network (the parts of the brain that take over when a person is no longer focused on the world around them) becomes even more active, making it even more difficult to concentrate on tasks.

Trauma responses and protective mechanisms

Dissociative disorders, in general, may also be related to childhood trauma or post-traumatic stress disorder (PTSD). People with ADHD who have also experienced a traumatic life event or who are living with PTSD may experience dissociative episodes more frequently as a protective mechanism. As trauma responses, these episodes can happen consistently or more sporadically, depending on the individual and other factors, such as stress and anxiety. They can become a protective response and a way for survivors to mentally escape emotional pain.

Role of traumatic experiences

Traumatic experiences, like emotional abuse, sexual abuse, and other types of traumatic events, can help shape the brain’s response to stress. For people who have been through trauma, disassociation can develop as a protective response.

ADHD, trauma, and dissociation: where symptoms overlap

ADHD, trauma, and disassociation can have overlapping symptoms, which can make it difficult to identify what is happening accurately. All three of these conditions can result in difficulties with emotional regulation, memory, and attention, though the underlying causes can vary. Understanding how these dissociative and attention deficit symptoms intersect can help people understand why they may not neatly fit into a single diagnosis. 

Overlapping symptom clusters

Both ADHD and dissociative experiences may share similar symptom clusters. For example, they can both involve: 

• Feeling spaced out or distracted
• Experiencing emotional reactivity
• Having memory problems
• Losing track of time
• Struggling to stay present. 

In ADHD, these symptoms may be driven by problems with executive functioning and regulating attention. In dissociation, these experiences can emerge in response to trauma or stress, acting as a coping mechanism rather than a baseline problem with executive function.

ADHD vs dissociative disorders

Distinguishing between ADHD-related dissociative experiences and dissociative disorders may be essential to ensure effective treatment. 

Dissociative disorders, like dissociative identity disorder (previously referred to as multiple personality disorder), depersonalization/derealization disorder, and dissociative amnesia, can have more pronounced disruptions in memory and identity, while ADHD does not cause the same level of identity fragmentation.

What research says about ADHD and dissociation

Research suggests that there is a complex, though meaningful, relationship between ADHD and dissociative experiences. Dissociation appears to be more common among individuals with ADHD, especially in times of stress.

Measurement tools and study designs

Researchers in this area use the Dissociative Experiences Scale (DES), a self-report tool that measures dissociative symptoms. Descriptive statistics and latent profile analysis, based on information gathered from these tools, can help identify clinically significant patterns and participants classified by factors such as symptom severity.

Key studies and authors

Some key studies and authors in this field include: 

• Inattention and Dissociation: Overlapping Constructs? by Allyson Grainger Harrison and Jan Baker Wilson explores the relationship between ADHD inattention, dissociative experiences, and trauma.
• Childhood Trauma and Dissociation Pathway as a Mediator for the Persistence of ADHD Symptoms from Childhood to Adulthood in Nonclinical and Clinical Samples by Ali Kandeğer et al, which suggests that trauma contributes to both dissociation and ongoing attention problems.
• Attention-deficit/hyperactivity disorder in adult patients with posttraumatic stress disorder (PTSD): is ADHD a vulnerability factor? by Adler et al, which found significant associations between PTSD and ADHD.
• Dissociation in posttraumatic stress disorder part I: Definitions and review of research by Carlson et al, which examines how dissociation may be connected to trauma, PTSD symptoms, and the underlying biological factors.

Limitations and future directions

The most significant limitation of studies in this area may be that, while they are able to identify psychological variables and associations between ADHD and dissociation, they are unable to determine precisely how the two may be linked. Further studies that follow participants over years may be needed to make these things clearer.

How ADHD dissociation affects daily life

Dissociation related to ADHD can significantly impact daily life.

Cognitive functioning and attention

ADHD affects attention and cognitive functioning. People may struggle with organization, following directions, or maintaining focus while at work or school. In times of stress, dissociative episodes can exacerbate these challenges, making it difficult to complete tasks or even participate in routine activities.

Social interaction and environmental awareness

Dissociation can also affect social interaction and a person's awareness of their external environment. When people with ADHD are facing drifting attention or dissociation, they may miss social cues, appear distracted or disengaged, or fail to notice their immediate surroundings. In time, this can have a significant impact on their relationships, work performance, and even safety in day-to-day life.

Coping strategies for ADHD dissociation

Managing ADHD and associated dissociation disorders or symptoms can be a complex and multifaceted undertaking. However, by working with a mental health professional to develop coping strategies and lifestyle changes, a person experiencing ADHD dissociation may see a reduction in symptoms for both dissociative episodes and ADHD. Some coping strategies and lifestyle changes are discussed below. 

Grounding exercises to reconnect with the present

Research has shown that improving mindfulness may decrease ADHD symptoms as well as symptoms of dissociation. Mindfulness strategies generally help a person stay grounded and focus on the present rather than the future or the past. Grounding exercises and techniques that improve mindfulness while preventing dissociation and ADHD symptoms can include journaling, meditating, and practicing yoga. These practices may focus the mind on reality and regain control before symptoms start. 

Mindfulness practices can also help a person focus in the moment when they realize that a dissociative episode is beginning or if they sense that their ADHD symptoms are making it hard to focus. These practices can include mindful breathing or deep breathing exercises, as well as exercises that ask a person to identify sensory information, such as naming five things you can see, four you can touch, three you can hear, two you can smell, and one thing you can taste. Performing these mindfulness practices may keep a person in the present moment. 

Emotional regulation and daily coping

The triggers for many people with ADHD dissociation tend to include stress and anxiety. To combat these triggers or reduce their frequency, one way people cope is by having a structured daily routine around maximizing focus and attentiveness and reducing stress. Setting a schedule and developing a routine can reduce the number of choices they must make each day, which can decrease stress and improve one’s overall mental state. 

Therapy and trauma-informed care

Treatment approaches for ADHD and dissociation may focus on prioritizing safety and then understanding individual symptoms and clinical characteristics. Therapists may focus on identifying if they have experienced trauma, avoiding re-traumatization, and helping the individual learn how to cope and build resilience. In some cases, providers may seek guidance from a local ethics committee to ensure treatments are appropriate and evidence-based.

When to seek professional help

If a dissociative state occurs frequently, interferes with daily life, or leads to negative consequences, it may be time to seek professional support and consider ADHD therapy.

Signs dissociation may need clinical support

Specific signs to look for can include: 

• Feeling like you are separated from yourself and your emotions
• Believing that the people and things around you are not real
• Having a blurred sense of your own identity
• Experiencing severe stress or problems in work, school, relationships, or other important areas of your life
• Being unable to cope with emotional or work-related stress
• Experiencing memory loss
• Having other mental health symptoms, including anxiety, depression, or suicidal thoughts and behaviors

Getting support through BetterHelp

Managing trauma responses, ADHD, and dissociative disorders alone can be challenging. By working with a mental health professional, you can focus on learning new coping strategies, grounding exercises, and other ways to reduce ADHD dissociation symptoms and overcome challenges with executive functioning.

How therapy can support ADHD and dissociation

For individuals with ADHD and dissociation symptoms, attending in-person therapy sessions can be challenging. It may mean going to a new office in a new location to talk to a new person, all of which may increase stress and anxiety. However, online therapy typically allows a person to find a therapist who suits their needs from anywhere with an internet connection. In general, this means an individual can attend therapy from a place of comfort and familiarity without needing to drive to a brick-and-mortar office. 

Online therapy can be as effective as in-person therapy at reducing symptoms of ADHD. While not much research yet exists on the efficacy of online therapy for dissociative disorders, current evidence supports the notion that online therapy normally produces the same outcomes as in-person therapy.