What Is Dissociation?

While dissociation can be unsettling, experts say that it is the brain’s way of protecting itself when something feels too overwhelming to process in real time.

“You know how you’re driving in your car, and you drive this path every day, and all of a sudden you’re at home. You don’t remember the light. You don’t remember the stop sign. You don’t remember any of the turns you made. That’s a form of dissociation. It’s like checking out,” says Chivonna Childs, PhD, a psychologist at Cleveland Clinic who specializes in treating people with anxiety, depression disorders, trauma, and PTSD.

“It really is your brain’s way of going into survival mode, it’s taking a time-out. It’s not due to your brain having some sort of malfunction; it’s your brain’s way of protecting itself in the face of what it perceives to be a threat,” Dr. Crawford says.

Dissociation can look different depending on the person and the severity of the episode. In milder cases, someone may feel spacey, foggy, or emotionally disconnected. In more severe cases, they may have memory gaps or feel completely detached from themselves or their surroundings, Crawford says.

• Encounter significant gaps in memory or lose track of time
• Have an out-of-body experience, like they’re watching themselves on a movie screen
• Feel detached from emotions or emotional numbing
• Have mental health problems, such as depression, anxiety, or suicidal thoughts
• Grapple with severe stress or difficulties in relationships, work, or other major areas of life

Dissociative episodes can interfere with daily life in ways that aren’t always obvious. “You can be sitting in a room and having a conversation, and to everyone else you seem present. But internally, your mind has completely checked out — and afterward, you may not remember any of it,” Dr. Childs says.

Dissociation is most often tied to trauma, especially trauma that’s chronic, severe, or began in childhood. But it can also happen during periods of intense stress, anxiety, panic, or even significant sleep deprivation, Crawford says.

• A single episode of or ongoing physical, mental, or sexual abuse
• An accident or medical emergency
• A natural disaster
• Military service
• Being a victim of crime

“In those moments, someone who’s experiencing really intense anxiety can find themselves in this shutdown mode in which they have this dissociative episode,” Crawford says. And for people with a history of trauma, something small in everyday life can trigger memories of the past, bringing them back to a place of feeling threatened or overwhelmed.

It’s a coping mechanism, Childs says. “When something traumatic happens to us, if our mind cannot deal with it effectively, the mind is going to protect you at all costs.”

• Anxiety or depression
• PTSD
• Borderline personality disorder
• Substance abuse disorders

Bear in mind that having a dissociative episode doesn’t mean someone has a dissociative disorder. Crawford says that dissociation can happen with acute, one-time stressors, too, like childbirth or a panic attack.

“It can happen in people who don't have an underlying psychiatric condition or underlying history of trauma. It's just your brain's way of responding to a really intense emotional experience in which you’re too overwhelmed to fully process what is happening in that moment in time,” she says.

What Are Dissociative Disorders?

• Dissociative Amnesia With this condition, you can’t remember essential information about your life, especially during a time when you were in shock, distress, or pain — and the memory loss can’t be explained by a medical condition. Dissociative amnesia is often associated with experiences of childhood trauma, particularly emotional abuse or neglect. In some cases, it can look like confused wandering or traveling without knowing how you got somewhere, called dissociative fugue.

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• Dissociative Identity Disorder This condition, which used to be called multiple personality disorder, involves having two or more distinct identity states emerge. When something traumatic happens, our core identity can be pushed back and another identity can come forward as a protective force. “It’s really a defense mechanism that has stepped up because the main character can no longer cope,” Childs says.
• Depersonalization/Derealization Disorder This disorder involves ongoing feelings of being detached from yourself, like you’re observing yourself outside of your body (depersonalization) or feeling as if the world or environment around you isn’t real (derealization).

Dissociation is typically diagnosed through a clinical assessment by a mental health professional, including psychologists, psychiatrists, licensed therapists, and clinical social workers.

While there isn’t a standard test to make a diagnosis, assessments can help determine the presence and severity of dissociation, Childs says. Clinicians look at the full picture, including symptoms, mental health history, trauma history, and day-to-day functioning.

Crawford says that dissociation often comes up during evaluations for PTSD, since it can be one of the condition’s core features.

But many people do not have the language to describe what they’re experiencing on their own. “They might think to themselves, I feel lost. I don’t really feel like I’m fully present. I feel disconnected or things aren’t real,” she says. That is why being asked about dissociation directly during a mental health assessment can be so important.

Dissociative states also co-occur with conditions like anxiety disorders, trauma disorders, or mental health disorders that have psychosis as a feature, so clinicians may ask about dissociative episodes or symptoms, Childs says.

Treatment depends on how severe the dissociation is and what’s driving it, but the goal is to reduce how often it happens, how intense it feels, and how much it disrupts daily life, Childs says.

“The best treatment is a combination of medication and therapy. That's the sweet spot of being able to sit with somebody, help them manage their medication, and help them develop a plan of what to do the next time they feel anxious, depressed, or triggered,” she says.

Treatment strategies include different ways of working with the mind and body to remain in the here and now.

Grounding Techniques

These grounding techniques can help bring you back to the present moment, especially during milder episodes of dissociation:

• Box Breathing Inhale for four counts, hold for four counts, exhale for four counts, and hold for four counts. Repeat for several minutes to calm yourself down.

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  “Pretty quickly, it helps to slow your heart rate, it helps to slow down your thoughts, and it helps to make you feel more present because your brain isn't going a mile a minute,” Crawford says.
• Cold Exposure Splash cold water on your face between your eyes and the tops of your cheekbones, or use ice cubes or a cold washcloth to induce the mammalian dive reflex, which can help snap the body out of an overwhelmed state, Crawford says. It’s typically used for milder cases of dissociation.

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• 5-4-3-2-1 Method Name five things you can see, four things you can hear, three things you can feel, two things you can smell, and one thing you can taste to reorient your senses. It takes your mind off whatever's stressing you and turns your focus to something else so your system can regulate, Childs says.
• Physical Grounding Put your feet on the floor or stand barefoot outside — “literally ground yourself to remind yourself that you’re here now,” Childs says.

Therapy

• Trauma-focused cognitive behavioral therapy (TF-CBT) is short term, typically six to nine months. It incorporates psychoeducation, relaxation techniques, tactics to help you work with emotions and change negative or distorted thoughts, and exposure therapy.

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• Dialectical behavior therapy (DBT) focuses on mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation through acceptance and working toward changing beliefs and behaviors.

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• Eye movement desensitization and reprocessing therapy (EMDR) uses bilateral stimulation (eye movements, tapping, tools that vibrate or light up) while focusing on a traumatic memory to reprocess the memory and reduce its vividness and emotional impact.

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• Talk therapy is one of a variety of therapies that help people try to change distressing emotions, thoughts, and behaviors.

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Medication

• Selective serotonin reuptake inhibitors and other types of antidepressants
• Antianxiety medications
• Antipsychotic medications

• Dissociation is a disconnection from your thoughts, feelings, body, memory, or surroundings. It’s a coping mechanism when the brain feels overwhelmed or threatened by a traumatic event or the memory of one.
• Dissociation occurs on a spectrum that can range from mild checking out to more severe experiences like memory gaps, losing track of time, or feeling detached from reality, especially in people who have experienced trauma or who have PTSD.
• Treatment includes grounding techniques, therapy like trauma-related cognitive behavioral therapy or dialectical behavioral therapy, and medication for underlying conditions like PTSD, depression, or anxiety, with the goal of reducing how often dissociation happens and how much it disrupts daily life.