Dissociation refers to the phenomenon of feeling disconnected from our thoughts, feelings, behaviors, and surroundings. While dissociation is a common occurrence—one that most of us experience from time to time—in some cases, it can be a sign of a serious and chronic mental health condition. Dissociation can cause an individual to become detached from reality, experience memory loss, or develop alternate personalities, which can lead to serious challenges when it comes to everyday functioning and mental, emotional, and physical well-being. Below, we’re going to discuss the definition, causes, and treatment of dissociation and dissociative disorders.
What Is Dissociation?
Following a distressing event, an individual might compartmentalize their negative emotions and intrusive thoughts in order to avoid difficult feelings.
Dissociation is facilitated by complex processes in the brain. Recent research shows that nerve cells in the posteromedial cortex of the brain start firing to initiate dissociation. Studies on mice illuminated that a specific protein type called an ion channel plays a role in the firing of these nerve cells.
You’ve likely experienced mild forms of dissociation frequently in your life. Perhaps you’ve started daydreaming during a meeting and missed what was being discussed. Or maybe you’ve made it through a few paragraphs of a book before realizing you hadn’t retained any information. While these disruptions may cause frustration, they are likely harmless as long as they do not significantly impair your ability to function or affect your health. For many, though, dissociation can cause severe symptoms that seriously impact their life.
Chronic and severe dissociation can occur in a variety of ways. Some people develop alternate personalities while others lose periods of time. When dissociation becomes persistent and severe, it can be a sign that an individual is experiencing a dissociative disorder.
There are three primary dissociative disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V): dissociative identity disorder, dissociative amnesia, and depersonalization disorder.
The Three Types Of Dissociative Disorders
Dissociative Identity Disorder (DID)
The main symptom of this disorder is the presence of multiple identities within a single individual. Generally, each identity has its own unique characteristics and voices. DID often develops as a coping mechanism after an individual has lived through violent, traumatic, or otherwise distressing events.
The personalities generally do not shift on demand but arise involuntarily and suddenly, which can cause significant confusion and distress in the individual while also impacting the people around them.
For a diagnosis of DID, two or more unique and separate identities have to be present. DID is considered the most serious and severe of the three dissociative disorders, and typically someone living with DID will also have dissociative amnesia.
When someone experiences dissociative amnesia, they may have trouble remembering things about themselves. This is different from someone who just happens to forget something. With dissociative amnesia, the person may have difficulty remembering a stretch of time or an event from their life; and, in some rare cases, they can forget their identity entirely.
Dissociative amnesia can also come about as a result of a specific traumatic event or occurrence. An episode of amnesia can last anywhere from a few minutes to several days—and, in some cases, amnesia can last for years. There are typically no warning signs prior to an episode, which can occur suddenly. It is not uncommon for an individual to have several episodes in their lifetime.
This disorder causes an individual to feel detached from the world and the reality surrounding them. People with depersonalization-derealization disorder report feeling like they are in a fog or a daze and often have difficulty connecting with their own thoughts and emotions. They may frequently feel like they're looking in on their life from the outside. They might watch themselves going to work, doing the dishes, or spending time with their children, but none of these experiences feel real to them. While their physical body is carrying out the actions, emotionally, they may remain detached and removed from the situation.
Depersonalization-derealization symptoms can last for a few minutes or longer. They can occur at any time and come back periodically over the course of a lifetime. Up to 75% of people experience a depersonalization-derealization episode in their lifetimes. Only 2%, however, experience chronic episodes.
Although each type of dissociative disorder has specific symptoms, some general characteristics of dissociative disorders are:
Memory loss and an inability to remember people, places, or events
Depression, anxiety, or other mental health challenges
Feeling disconnected from one’s physical self, as though watching life from the outside (i.e., having an out-of-body experience)
Difficulty with self-identity
As with many mental health concerns, an individual living with a dissociative disorder may not realize they’re dissociating. Often, family, friends, or loved ones may detect the first warning signs. If this is the case, it is advised that family and loved ones approach the topic of mental health in a sensitive, gentle manner while encouraging the individual to seek professional help.
Diagnosis And Treatment
If you're questioning whether you may be experiencing a dissociative disorder but you're unsure of how to approach it, a healthcare professional can provide you with screenings and determine whether further testing, a diagnosis, and treatment are necessary.
The healthcare professional you see may make their diagnosis of dissociative disorder based on the symptoms you are experiencing, along with your family and personal history. Physical tests like blood tests or an MRI might be carried out to make sure some other factor like a brain tumor or burst blood vessel is not at play. Once a physical ailment is ruled out, the professional may refer you to other medical or mental health specialists.
Treating and managing dissociative disorders may involve psychotherapy (e.g., cognitive behavioral therapy, dialectical behavioral therapy), medication, (e.g., antidepressants), or both. While there is currently no way to cure a dissociative disorder, treatment can help you manage your symptoms.
How Online Therapy Can Help
Individuals experiencing symptoms of dissociative disorders may be hesitant to seek out mental health care services in person. Those with anxiety, for instance, may fear going out in public or feel uncomfortable in a clinical setting. Online therapy may be a better option in these cases. Many people feel more comfortable discussing their symptoms in a web-based environment. Plus, online counseling can be reached from home, making it more convenient.
There are a significant number of studies pointing to online therapy as a beneficial method of helping individuals who are seeking to address dissociation-related mental health concerns, such as trauma. In one study, published in the journal Cognitive Behaviour Therapy, researchers examined the effectiveness of online cognitive behavioral therapy (CBT) for PTSD, finding that participants’ symptoms were significantly reduced following treatment. Cognitive behavioral therapy is a widely accepted form of treatment that helps individuals replace negative, intrusive thoughts underlying unwanted behaviors and emotions so that potentially triggering situations can be better managed.
If you or someone you love is living with a dissociative disorder, online therapy platforms can provide useful tools for managing your symptoms. With online therapy through BetterHelp, you can work with a qualified therapist remotely, which may be helpful if dissociation causes you to lose track of time. BetterHelp works with a team of licensed mental health professionals with diverse specialties, so you’ll have a good chance of connecting with someone who can address your specific concerns regarding dissociation, trauma, or other challenges. Continue reading for reviews of BetterHelp therapists from those who have sought help for similar concerns in the past.
“Lynette has a good understanding of my trauma issues and keeps me on track. She is easy to talk to and can explain things to me on my level even on days when it's hard to think straight. We quickly fell into a positive and productive routine. I definitely recommend Lynette Davis.”
“Dr. Becton is a very kind and caring therapist. She's great and I do recommend her, especially if you need PTSD therapy.”
How Do You Know If You Are Dissociating?
A person may not realize if they are dissociating, but this may depend on the type of dissociative disorder. A person who experiences episodes of depersonalization/derealization disorder typically knows when something is off. With other types of dissociation, a person may not know what is happening. A friend or family member may notice dissociative symptoms and take the person to a doctor, who may order tests to rule out a physical cause, such as a brain tumor or head injury. If the doctor rules out physical causes, they may refer them to a psychologist.
What Are The 5 Stages Of Dissociation?
Some people might break down dissociation into five stages of severity, from mild detachment to identity alteration. However, there is no single set of dissociation stages represented in the literature. Each case of dissociation can be unique and can vary in severity.
What Do People Do When Dissociating?
When people dissociate, they may act in ways that are atypical for them. If they experience dissociative identity disorder (previously known as multiple personality disorder), they may behave as if they had a different identity with different personality traits. They may have different preferences and dress differently before shifting back to their other identity. If a person experiences dissociative amnesia, they may behave differently because they forget important parts of their life. Some people experience a symptom called dissociative fugue, during which a person experiences memory loss and ends up somewhere unexpected.
What Does Dissociation Look Like To Others?
Dissociation can look different depending on the type that a person is experiencing. There are three main types of dissociation: dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder. With dissociative identity disorder, a person typically experiences two identities with their own history and traits. Dissociative amnesia typically leads a person to forget important aspects of their life. They may forget specific elements or major parts of their identity. With depersonalization, a person tends to feel detached from their feelings, thoughts, and body, and with derealization, a person typically feels detached from their environment.
Am I Dissociating Or Zoning Out?
While zoning out can be part of dissociation, dissociation tends to involve other symptoms. If a person zones out, it doesn’t necessarily mean they are dissociating. Dissociation is something diagnosed by a mental health professional.
Can I Be Aware I'm Dissociating?
According to the American Psychiatric Association, people who experience dissociative identity disorder “may feel that they have suddenly become observers of their own speech and actions, or their bodies may feel different (e.g., like a small child, like the opposite gender, huge and muscular).” People who live with dissociative amnesia may not be aware that they are experiencing memory loss. Finally, people who experience depersonalization/derealization disorder typically know that something unusual is happening, and it can be distressing, even if they don’t show their distress.
What Triggers Dissociation?
The risk factors for dissociation tend to include a life history that includes traumatic or stressful events during childhood. The American Psychiatric Association states that childhood trauma, such as emotional abuse or neglect, is common among people with dissociative identity disorder. This may include ongoing traumatic events, such as sexual abuse. Dissociation may be a way for a person to cope with memories of these overwhelming events.
How Do You Snap Out Of Dissociation Fast?
With dissociative identity disorder, the shifts in identity tend to happen involuntarily. However, there may be some strategies that help with some cases of dissociation, including grounding strategies. For example, you can try to focus on your five senses and name something you can see, something you can hear, something you can smell, something you can touch, and something you can taste. It may also help to engage in breathing exercises to ground yourself in the present moment.
Do People Talk To Themselves When Dissociating?
Some people may talk to themselves when dissociating, but it may depend on the type of dissociation and the dissociative process. Someone with dissociative identity disorder may experience a sudden shift in identity, which may lead them to talk to themselves. However, talking to oneself doesn’t necessarily mean someone is dissociating. They could have another mental health problem, such as acute stress disorder, or they may not have any mental health conditions at all. For more information on identity confusion and dissociation, examples of dissociative behavior, or information on traumatic stress and dissociative experiences, you might consider speaking with a licensed mental health professional, whether in person or online.
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