What is Dissociation?

Dissociation is the separation from sensory experiences, sense of self, or personal history resulting in feelings of being disconnected, alienated or existing within an alternate reality. Dissociation is a common practice in everyday life and can be a normal way of coping through daily stress or boredom, such as daydreaming or “zoning out”. It can become problematic, however, when it affects one’s integrated consciousness, memory, identity or perception functions.

Disassociation is often a survival strategy that is used in response to trauma. The limbic system in the brain helps us respond quickly to survive trauma, choosing between “flight, fight, or freeze.” If we are unable to escape through “flight” or defeat a predator through “fight,” we may become numb or “freeze.” These practices are adaptive at the time of trauma but may create the symptom of dissociation after the danger of the initial trauma has passed, when something triggers us i.e., reminds us of the original trauma or in response to an increase in stress.

Dissociation is formally defined by The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) as a disruption, interruption and/or discontinuity of the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. There are four main types of dissociation:

• Depersonalization: experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions.
• De-realization: experiences of unreality or detachment with respect to surroundings.
• Dissociative amnesia: inability to remember important autobiographical information, usually of a traumatic or stressful nature that is inconsistent with ordinary forgetting.
• Dissociative identity disorder: disruption of identity characterized by two or more distinct personality states, repeated gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

For example, some signs of dissociation that you or others around you may notice include a sense of numbing, an interruption in one’s daily activity or function (such as losing memory for hours or days), feeling outside of one’s self or life or entering other personalities.

If you or someone you know is struggling after experiencing a traumatic event, showing signs of dissociation or other symptoms that cause them distress, it may be time to reach out to a mental health professional. Treatment may include counseling, coping skills (such as grounding techniques) and a safe place to learn to better manage symptoms. In the meantime, if you are concerned about a loved one, give them support and space during their dissociative episodes. Try to reassure and validate their feelings, and let them know they are safe.

Dr. Pamela Denison is a Clinical Psychologist at Centerstone, a non-profit health system specializing in mental health and substance use disorder services.