What Is Dissociation?

A plain definition

Mental Health America describes dissociation as a mental process that causes a lack of connection in a person's thoughts, memory and sense of identity. Researchers put it in a similar way: disconnections between thoughts, feelings, behaviors, sensations and other mental processes that would normally be connected.

Put simply, the usual links between what you think, what you feel and what you sense come apart for a while. That can last a moment or much longer, and it can be barely noticeable or very unsettling.

Everyday dissociation and the distressing kind

Dissociation sits on a continuum of severity. At the mild end are experiences nearly everyone knows: daydreaming, getting lost in a book, or driving a familiar stretch of road and realizing you do not remember the last several miles. These are not a sign that something is wrong.

Further along the range, the experience is stronger and less welcome. Two common forms have names. Depersonalization is feeling detached from your own actions, feelings, thoughts and sensations, as if you were watching a movie of yourself. Derealization is when other people and things around you seem unreal. A person can have one or both.

The National Alliance on Mental Illness notes that many people have at least one episode like this in their lives, and that only a small share go on to have chronic episodes. Signs that dissociation has moved past the everyday kind can include:

• Gaps in memory for specific times, people or events
• Out-of-body experiences, such as watching yourself from a distance
• Feeling detached from your emotions, or emotionally numb
• A shaky or missing sense of who you are
• Episodes that get in the way of work, school, relationships or daily tasks

Why it happens: the link with trauma

Dissociative symptoms usually first develop as a response to a traumatic event, as a way of keeping painful memories under control. Researchers report a strong link between dissociative symptoms and exposure to trauma, especially early childhood trauma.

Seen this way, dissociation is not a weakness. One research review describes it as a psychic escape when there is no physical escape. The mind does what it can to get a person through something unbearable. The difficulty comes later, when the same response becomes automatic and shows up in situations that are stressful but not dangerous.

Dissociation is also part of some trauma diagnoses. There is a dissociative subtype of PTSD, marked by persistent depersonalization and derealization. Stressful periods can make symptoms worse. Not everyone who dissociates has a trauma history, and only a qualified professional can say what is going on for one person.

Grounding: coming back to the present

Grounding is a general name for techniques that use the senses to guide yourself back to the here and now. They can be useful when you feel out of your body or pulled into a painful memory. They are simple on purpose.

• Touch: hold or rub a piece of fabric and notice its texture.
• Smell: sniff something with a strong scent.
• Breath: focus on breathing slowly and deeply.
• Writing: keep a journal, which can help build awareness of when episodes happen.

When to seek help

It is worth talking with a professional if episodes are frequent, last a long time, frighten you, leave gaps in your memory, or interfere with daily life. A doctor may first check for physical causes of memory loss or a sense of unreality, such as a head injury or sleep deprivation.

Psychotherapy is the primary treatment for dissociative disorders. Approaches that are used include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT) and Eye Movement Desensitization and Reprocessing (EMDR). Researchers describe the work as phased: safety, stability and coping skills come first, and work on traumatic memories comes later, at a pace that is manageable.

If you are in crisis or thinking about harming yourself, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page lists more options.

How we can help

Locascio Wellness is an all-virtual practice. Sessions are by secure video, and you need to be physically located in Pennsylvania, West Virginia or Arizona during each session. Everyone on our team is trained in trauma-sensitive care, and members of the team use CBT, DBT skills and EMDR. Not every therapist uses every approach, so we match you with someone who fits your needs and is licensed in your state.

Many people who dissociate find it hard to describe. You do not need the right words to begin. You can read about trauma and PTSD therapy, anxiety therapy and depression therapy, check coverage on our insurance and fees page, and book a free 15-minute consultation when you are ready.