What Is Dissociation?

Medically reviewed by Kathleen Daly, MD

Dissociation refers to an out-of-body experience that can make you feel detached from yourself or from reality. This may involve feeling disconnected from your body, mind, surroundings, loved ones, or past experiences and memories. A dissociative episode could last anywhere from a few minutes to several days, depending on the underlying cause.

For many people, dissociation is an involuntary response to trauma or stress. Having an out-of-body experience may be more common than you think. In fact, about 75% of people experience at least one dissociative episode at some point in their life. However, if you're experiencing episodes frequently, your symptoms may be due to an underlying mental health condition. Fortunately, going to therapy and using prevention strategies can help improve dissociation.

Symptoms

The most common symptom of dissociation is a feeling of detachment from yourself and your environment. While it’s not a complete break from reality, dissociation can distort your perception of reality. As a result, you may have one or more of the following symptoms:

• Feeling like you’re outside of, looking down at, or floating above your own body

• Apathy

• Emotional numbness

• Disconnection from those around you

• Feeling like your surroundings aren’t real

• Time feels like it's moving too fast or too slow

• Memory loss

• Not remembering how you got to a specific place

• Having flashbacks that feel like you're living them in the present moment

• Being absorbed in a fantasy-like world that feels real

• Hearing muffled voices or seeing bright lights

• Depressive moods

• Anxious thoughts

Causes

Dissociation can often be an underlying symptom of a variety of mental health conditions. Though less common, sometimes physical health conditions that affect your brain can also cause dissociation. Research suggests that dissociation can happen for the following reasons:

• Dissociative identity disorder (DID): Multiple and distinct identities or "alters" that take over your consciousness at separate times

• Depersonalization/derealization disorder (DPDD): Experiences of both depersonalization (a sense of detachment from your own body) and derealization (a sense of detachment from your environment)

• Dissociative amnesia: Inability to remember significant (and often traumatic) events in your life

• Borderline personality disorder (BPD): Long-standing patterns of unstable emotions that can cause feelings of emptiness, fear of abandonment, trouble maintaining relationships, and concerns with self-image

• Schizophrenia: Extreme hallucinations and delusions that affect your ability to process and remember information, communicate with others, and adhere to social norms

• Post-traumatic stress disorder (PTSD): Occurs after experiencing a shocking or life-threatening traumatic event, such as sexual assault, emotional abuse, childhood neglect, war, domestic violence, car accident, miscarriage, or death of a loved one, among other traumas

• Depression: Extreme mood disorder that causes a deep sense of sadness, worthlessness, and a loss of interest in activities you previously enjoyed

• Panic disorder: Unexpected feelings of fear or discomfort, even if there is no threat or danger

• Anxiety: Persistent or excessive worry that you might have when exposed to a stressful trigger

• Traumatic brain injury (TBI): An injury that affects the structure and functioning of your brain, usually caused by a forceful blow to the head

• Epilepsy: Brain disorder that causes frequent and unexpected seizures

• Migraine: Recurrent and severe headaches that cause throbbing pain and sensitivity to light and sound

• Substance use: Using drugs including, but not limited to alcohol, marijuana, cocaine, and methamphetamine

• Sleep deprivation: Not getting enough sleep can often blur the line between what is and what's not reality

• Stress: Daily issues (like being in traffic or feeling nervous about a presentation) and major life stressors (like getting a divorce or having financial troubles) can both lead to being overwhelmed and dissociated
  

Diagnosis

If you're having dissociative episodes, it's a good idea to see your primary care provider. They'll likely refer you to a psychiatrist or psychologist to learn more about your symptoms, perform a psychiatric evaluation, and rule out or diagnose you with a mental health condition that may be causing your symptoms. If your care team suspects that you may be dissociative due to a brain disorder or injury, they can also work with a neurologist (a doctor who specializes in the brain and spinal cord).

During your diagnostic process, you can expect your provider to:

• Ask you about your medical history

• Learn about your lifestyle habits

• Inquire about any traumas or stressors you're dealing with

• Perform a physical exam

• Conduct a mental health assessment

• Order brain imaging scans, if necessary

Treatment

Psychotherapy is typically the first-line treatment for dissociation. Available treatment options for dissociation include:

• Dialectical behavior therapy (DBT): Originally developed to treat BPD, DBT is a form of psychotherapy that can help you become more mindful of your thoughts, develop healthier coping mechanisms, and deal with emotional distress more effectively.

• Eye movement desensitization and reprocessing therapy (EMDR): EMDR therapy allows people with PTSD and other mental health conditions to heal from trauma and process traumatic memories, making it potentially effective in treating symptoms of dissociation.

• Hypnotherapy: Some studies indicate that hypnotherapy may help people who experience dissociative episodes to process trauma and return to a more mindful state of reality.
  

How to Prevent Dissociation

You can’t always stop yourself from experiencing dissociation. However, you may be able to prevent some dissociative episodes by:

• Journaling or talking about your experiences in order to become more aware of your emotions and deal with them head-on

• Adopting healthier ways to “zone out” and cope with stress, such as exercising or engaging in hobbies

• Limiting your substance use

• Prioritizing sleep and getting enough rest each night

• Socializing on a regular basis to gain support and tap into your connections with others

• Practicing mindfulness techniques, like meditation and yoga

• Learning to self-soothe through relaxing activities like deep breathing exercises, coloring, and listening to music

• Writing down positive affirmations to develop more self-compassion

• Tracking your triggers (such as work-related stress) and avoiding them if possible

Complications

People with dissociative disorders have an increased risk of substance use, suicidal thoughts, and self-harm. This may be because of the strong link between dissociation and a history of trauma. If you or someone else is experiencing thoughts of self-harm or suicide, seek emergency medical help right away. In the U.S., call 911, go to a hospital, or contact the Suicide & Crisis Lifeline at 988.

A Quick Review

Dissociation involves feeling an out-of-body experience that causes detachment from yourself, other people, and your surroundings. During a dissociative episode, you may feel like your identity is fragmented, which can cause symptoms like forgetting important details or feeling numb.

Many people experience dissociation for a short period of time at some point, especially when faced with stress or trauma. If you experience dissociation on a more frequent basis, it may be a symptom of an underlying mental health or neurological condition. Don’t be afraid to reach out to a healthcare provider for support, as this can help reduce the frequency of episodes and improve your quality of life.

Frequently Asked Questions

Is dissociation a form of anxiety?

Dissociation is not a form of anxiety in and of itself. However, it may be a symptom of certain anxiety disorders. Some people may experience dissociation as an unconscious coping mechanism to deal with anxiety during a stress-inducing situation.

Is dissociation the same as zoning out?

Everyone zones out or daydreams from time to time. Sometimes, dissociation may feel like an extreme version of “spacing out,” in which you feel completely disconnected from reality. While they aren’t exactly the same thing, people with severe trauma histories are more likely to daydream frequently and to dissociate on a regular basis.

How do you end a dissociative episode?

It’s not always possible to end a dissociative episode. However, you can try to tap into your surroundings and ground yourself in reality using mindfulness techniques. For example, try becoming more aware of what’s happening around you by breathing deeply, taking a walk, or identifying several things you can currently see, touch, hear, or smell.

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