What Is Dissociation?

Most people daydream now and then, and if that happens to you, it's perfectly normal. But if you have a mental health problem called "dissociation," your sense of disconnect from the world around you is often a lot more complicated than that.

Dissociation is a break in how your mind handles information. You may feel disconnected from your thoughts, feelings, memories, and surroundings. It can affect your sense of identity and your perception of time.

The symptoms often go away on their own. It may take hours, days, or weeks. You may need treatment, though, if your dissociation is happening because you've had an extremely troubling experience or you have a mental health disorder like schizophrenia.

What Are Symptoms of Dissociation?

When you have dissociation, you may forget things or have gaps in your memory. You may think the physical world isn't real or that you aren't real.

You may notice other changes in the way you feel, such as:

  • Have an out-of-body experience
  • Feel like you are a different person sometimes
  • Feel like your heart is pounding or you're light-headed
  • Feel emotionally numb or detached
  • Feel little or no pain

Other symptoms you can get are:

  • Have an altered sense of time
  • Not remember how you got somewhere
  • Have tunnel vision
  • Hear voices in your head
  • Have intense flashbacks that feel real
  • Become immobile
  • Get absorbed in a fantasy world that seems real

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Causes of Dissociation

Trauma. You may psychologically disconnect from the present moment if something really bad happens to you. This is called peritraumatic dissociation. Experts believe this is a technique your mind uses to protect you from the full impact of the upsetting experience you had.

Peritraumatic dissociation can happen when you've been through things like:

  • Sexual or physical assault
  • Childhood abuse
  • Combat
  • Torture or capture
  • Motor vehicle accidents
  • Natural disasters

If you've had disturbing experiences over and over, you may get severe forms of dissociation known as dissociative disorders. You may leave your normal consciousness, forget things, or form different identities within your mind.

Hypnosis. When you daydream or let your mind wander, you are in a type of "auto-hypnotic state." You may no longer have a strong awareness of your body. Other types of hypnosis may put you in a deeper dissociated state. A trained professional may use therapeutic hypnotherapy to help you manage pain, anxiety, addictive behaviors, or posttraumatic stress disorder (PTSD).

Certain drugs. You may lose your sense of identity or reality if you drink alcohol or take illicit drugs. Research shows that people who take psychedelics, like psilocybin and LSD, report briefly losing their sense of self.

Meditation. Like daydreaming, you may become less aware of the here and now while you meditate. Some expert meditators say they lose an awareness of their self or body during certain mindfulness meditation practices.

Related Mental Health Conditions

You may have dissociation with certain mental health disorders. Besides schizophrenia and PTSD, dissociation is also linked to:

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Warning Signs

It's possible to have dissociation and not know it. If you have a dissociative disorder, for example, you may keep your symptoms hidden or explain them another way.

Common signs you or a loved one should watch out for include:

  • Rapid mood swings
  • Trouble remembering personal details
  • Forgetfulness about things you've said or done
  • Behavior or abilities that change (altered identities)
  • Depression, anxiety, or panic attacks
  • Thoughts of suicide or self-harm
  • Substance abuse
  • Failed treatments or hospitalizations for mood disorders

Children with a dissociation disorder may:

  • Seem spacey
  • Stare out the window a lot
  • Have imaginary friends
  • Forget they've said or done something
  • Have ADHD or other learning disabilities

Diagnosis of Dissociation

Your doctor will give you a physical exam and ask about any past physical or mental health issues. You should let them know if you take illicit drugs or any medication. They may check a sample of your blood or run other tests to rule out an illness or other medical condition as the cause of your dissociation. They may also order an electroencephalogram (EEG), a painless test that measures brain waves, to rule out certain types of seizure disorders that can sometimes cause dissociation.

Your doctor may then refer you to a mental health specialist. You might see a psychiatrist, psychologist, or psychiatric social worker. They will want to know about any severely troubling events you've had in the past.

They may give you other tests, including:

  • Dissociative Experiences Scale (DES)
  • Structured Clinical Interview for Dissociation

Treatment for Dissociation

There is no specific drug to treat dissociation, but it's possible to get better with a mix of medication and counseling. Your doctor will tailor your care based on how severe your symptoms are and their cause.

Your treatment may include:

Psychotherapy. This kind of treatment may help you find the cause of your dissociation. But the goal is to help you manage or get rid of your symptoms.

Types of psychotherapy may include:

  • Cognitive behavioral therapy. It's designed to help you see and change negative thoughts and behaviors.
  • Hypnotherapy. You may find it easier to explore and process your memories when you are in a relaxed state. You should only do this with a professional certified in hypnosis who is trained in dissociative disorders and PTSD.
  • Phasic trauma treatment. This treatment aims to help you stop suicidal thoughts or self-destructive behavior first. Then your psychotherapist will slowly help you process any traumatic memories and re-integrate your identities, if necessary.
  • Family treatment. You may find it helpful to get support from a spouse, partner, or other loved one.
  • Dialectical behavioral therapy. It may help you learn skills to control your emotions and stop harmful behavior. This is a common treatment for borderline personality disorder.
  • Eye movement desensitization and reprocessing. It uses techniques from cognitive behavioral therapy along with visual exercises to help you work through memories of severely troubling events. It may help stop your nightmares, flashbacks, or other PTSD symptoms.

Add-on medication. Your doctor may give you antidepressants, a mood stabilizer, or other drugs to help with anxiety or sleep problems. If you have schizophrenia, you may need an antipsychotic.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on August 26, 2019

Sources

SOURCES:

Richard J. Loewenstein, senior psychiatrist; medical director, The Trauma Disorders Program, Sheppard Pratt Health System; clinical professor of psychiatry, University of Maryland Medical School.

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