You drive to work, park and realize you can't remember a thing about the journey, not the traffic lights, not the roundabouts. Another day, in the middle of an argument, the other person's voice starts to sound far away and you feel as if you're watching the scene from outside, as if you weren't really there. Both experiences have the same name: dissociation.
The first happens to almost everyone and means nothing. The second can also be a one-off, but if it keeps happening, if it wipes out chunks of your day or if it shows up every time something reminds you of a bad moment, it's worth understanding. In this article I explain what dissociation is, how it feels, why some people dissociate far more than others and how it's treated.
What dissociation is
Normally, what you think, feel, remember and notice in your body come together as a single experience that you recognize as yours. Dissociation is a disconnection between those pieces. You might know what happened and feel nothing about it, be somewhere and feel absent, or have a gap in your memory that you can't explain. The American Psychological Association includes the term in its dictionary of psychology, and the NHS describes it as a way the mind copes with too much stress.
Nobody chooses to dissociate. It happens automatically, often before you even notice you're struggling, which is why willpower alone rarely stops it. According to the NHS, periods of dissociation can last hours or days, and sometimes weeks or months.
When switching off is normal
A little dissociation is part of everyone's life. Driving on autopilot is the best-known example, but so is getting so absorbed in a film that you don't hear someone calling you, or drifting off in a boring meeting and coming back with no idea what was being discussed. Psychologists call this absorption, and it's a useful ability, because it lets you focus on one thing and push everything else into the background.
These experiences are more common than you might think. A study of more than a thousand adults in Winnipeg, Canada, found that they were frequent in the general population, that men and women reported them equally and that they became less frequent with age (Ross, Joshi and Currie, 1990). So if it happens to you now and then, it doesn't mean anything.
Things change when the disconnection is frequent, when it erases important events or when it always comes with the same situations, such as shouting, a certain smell or an argument. Then it deserves a closer look, because it starts to cost you things: parts of your day, conversations, trust in your own memory.
Symptoms of dissociation
When a professional assesses dissociation, they usually explore five groups of symptoms, the same ones covered by the SCID-D, a reference clinical interview in this field (Steinberg and colleagues, 1990):
- Memory gaps that go beyond ordinary forgetting, such as conversations you don't remember having, blank stretches of the day or periods of childhood that have almost disappeared. This is known as dissociative amnesia.
- Feeling strange inside your own body or watching yourself from outside, as if your life were playing on a screen (depersonalization).
- Experiencing your surroundings as unreal, distant or flat, like a stage set (derealization).
- Not being sure who you are, what you want or what you think, with a sense of changing a lot from one moment to the next (identity confusion).
- Noticing sudden changes in the way you speak, feel or react that don't feel like yours, or being told you did or said things you can't remember (identity alteration).
You don't need to have all of them. Some people only know the feeling of unreality, while for others the main problem is lost time. Many of these symptoms aren't visible from outside either, and some people hide them for fear of not being believed.
When dissociation shows up in the body
Dissociation can be physical too. Some people stop feeling pain at moments of great tension, have numb areas of the body, find it hard to move or speak under pressure, or feel that their hands or legs don't belong to them. The NHS explains that some people with dissociative disorders have seizures, which can range from fainting to something more like an epileptic seizure. That's why physical symptoms like these always call for a medical check first.
The two forms of dissociation
Many researchers distinguish two ways of dissociating (Holmes and colleagues, 2005), and understanding them helps to work out what kind of help is needed.
The first is detachment. You're there, but as if there were a pane of glass between you and the world. Emotions arrive muffled, your body seems to belong to someone else and your surroundings lose their depth. This is the territory of depersonalization and derealization, and if that's mainly what happens to you, there's a more detailed guide to depersonalization and derealization.
The second is compartmentalization. Here part of your experience is kept out of awareness: memories that aren't there, things you don't remember doing, physical symptoms with no medical cause or reactions that don't feel like your own. The two forms can go together, but they need different things. Detachment usually improves with techniques for coming back to the present and with learning to regulate your body's arousal, whereas compartmentalization needs longer work so that the pieces of experience can reconnect.
Why dissociation happens
Dissociation starts out as protection. When a situation is too intense and you can neither stop it nor get away, the mind turns the volume down. You stop feeling, everything seems far away or the memory never gets stored in full. According to the NHS, switching off from reality is a normal defence mechanism that helps a person cope during a traumatic time, and it becomes a problem when the danger has passed but the person still lives as if it hadn't.
Other things can trigger episodes of dissociation or make them more likely:
- Very intense anxiety and panic attacks, which often bring a sense of unreality.
- Lack of sleep and built-up exhaustion.
- Alcohol and some drugs.
- Some medical and neurological conditions, which need to be ruled out first.
Dissociation and trauma: a protection that stays switched on
The link between dissociation and trauma is very close. The NHS notes that many people with a dissociative disorder went through traumatic experiences in childhood, and the ISSTD, the international society that studies trauma and dissociation, explains that most mental health professionals consider these disorders to be caused by severe trauma, usually early in life.
It makes sense. An adult in danger can fight back or leave. A child can't. And when the danger comes from the very person who should be looking after them, disconnecting is almost the only way out. Research on defence responses (Kozlowska and colleagues, 2015) describes how, when there is no escape, the body moves from fight or flight to immobility and, as a last resort, to collapse. Unlike animals, people can get stuck there.
Years later, the danger has gone, but the alarm system is still on. A tone of voice, a particular smell or an anniversary can set off the same disconnection that once protected you. That's why dissociation is so common in post-traumatic stress disorder (PTSD), to the point that the DSM-5 recognizes a dissociative subtype. And that's why, in therapy, it's treated with respect: at the time, it was the best way the mind found to survive. If you want to understand how what you lived through as a child can weigh on adult life, it may help to read about childhood wounds.
Types of dissociative disorders
When dissociation is intense, persistent and gets in the way of life, it's called a dissociative disorder. The NHS highlights three main types, and the ISSTD adds a fourth group:
- Depersonalization-derealization disorder. The feeling of unreality keeps coming back or never fully goes away. The person knows it's their perception and that the world is real, but it's deeply distressing, and they often hide it so well that nobody notices.
- Dissociative amnesia. Gaps in memory about one's own life that are far greater than normal forgetting and aren't explained by a medical condition. Sometimes people find themselves somewhere without knowing how they got there.
- Dissociative identity disorder (DID). It used to be called multiple personality disorder. There are two or more distinct identities or parts, and recurring memory gaps about everyday events.
- Other specified dissociative disorder. When symptoms cause suffering and limit life but don't fully fit any of the above.
Dissociative identity disorder, far from the movies
Films have done this diagnosis a lot of harm. They show dramatic personality switches, often tied to violence, while the reality is usually much quieter. According to the ISSTD, some people with DID show very few outward signs, and it's uncommon for them to feel in control of switching between parts, although therapy makes that more possible. What they do describe is confusion, lost time and the sense of not always being the same person. Structural dissociation models (van der Hart, Nijenhuis and Steele, 2005) see it as a personality that hasn't been able to come together, with some parts handling daily life and others remaining fixed in the trauma.
Dissociation also often comes with other problems. Among the conditions that can exist alongside it, the NHS mentions PTSD, depression, anxiety and panic attacks, self-harm, eating disorders, OCD and insomnia.
How dissociation is diagnosed
There's no blood test or scan for it. Diagnosis relies on a careful clinical interview, and it often starts with a GP, who may run tests to rule out another illness that could explain the symptoms.
In the consulting room, questionnaires help to guide the assessment. The best known is the DES (Dissociative Experiences Scale), which asks about 28 everyday situations and is designed for adults. It's a screening tool, though, and it doesn't diagnose anything. The Spanish validation study (Icarán, Colom and Orengo García, 1996) found that many patients preferred to answer it as an interview, because they found the scale's percentages confusing, and that's how it recommends using it. The scale's authors also stress asking for an example of every high answer. They describe a man who scored high on the question about finding new clothes he didn't remember buying. The explanation was simple: his wife bought his shirts.
An important part of the assessment is telling dissociation apart from other problems that can look like it or exist alongside it, such as ADHD, epilepsy or psychosis. And when dissociative identity disorder is suspected, diagnosis takes time. According to the ISSTD, the therapist listens, observes and checks that no other condition explains things better.
How dissociation is treated
Dissociation can be treated, and treatment works. The NHS points out that many people with a dissociative disorder make a full recovery with treatment and support. Psychotherapy is the foundation. There's no specific medication for dissociation, although antidepressants are sometimes prescribed for related problems such as depression or panic attacks.
When there's trauma underneath, treatment is usually organized in phases (Steele, van der Hart and Nijenhuis, 2005). In a survey of 50 experts in complex PTSD, 84% preferred this approach (Cloitre and colleagues, 2011), and the ISSTD guidance for patients follows the same line.
First, safety and stability
Before working on memories, the person needs to be stable enough. In this phase you come to understand what dissociation is and what it was for, learn to notice when it starts and how to come back to the present, and work on emotional regulation, sleep and routines, along with a plan for moments of crisis. If there are parts of the personality that act separately, you also start getting to know them, without rushing. The ISSTD warns that in complex trauma this stage can take longer.
Then, the traumatic memories
Once the base is solid enough, the memories that still hurt are worked through, always at a pace the person can manage. EMDR is one of the tools used, with the adaptations that dissociation requires, which Anabel González and Dolores Mosquera set out in their book EMDR y disociación (2012). The aim is for the memory to become something that happened, rather than something that feels as if it's happening now.
Finally, getting back to life
The last phase looks ahead: relationships, work, intimacy, the changes that used to feel frightening. Many people find they can now do things they used to avoid without knowing why. The process is long and doesn't always run in a straight line, but, as the ISSTD itself says, small steps add up.
What you can do when you feel yourself disconnecting
These tools don't replace therapy, but they help you come back to the present when an episode of dissociation begins. They work best if you practise them when you're calm, so that they come naturally when you need them.
- Say out loud where you are, what day it is and how old you are. "I'm in my kitchen, it's Wednesday and I'm 34." Reminding yourself that the danger is over helps too.
- Plant your feet firmly on the floor and notice the weight of your body on the chair.
- Look for a strong sensation, such as cold water on your wrists, an ice cube in your hand, a mint or a strong smell.
- Look around and name five things you can see, in different colours.
- Move. Walk, stretch your arms or push against a wall with your hands.
- Carry an object in your pocket that connects you with the present, such as a stone or a keyring.
Once it has passed, write down what was happening just before. That record is very useful in therapy for spotting triggers. And if it happens often in risky situations, such as while driving, talk to a professional as soon as you can.
How to help someone who dissociates
If you live with someone who dissociates, it can be unsettling. Suddenly they seem absent, don't answer or look at you without seeing you. In those moments it helps to:
- Speak calmly, use their name and remind them where they are and that they're safe.
- Ask before touching them. Sudden contact can frighten them more.
- Offer cold water or something to hold.
- Avoid shouting, rushing them and firing questions at them.
Afterwards, ask what helps and what doesn't, without judging or joking ("you're away with the fairies again"). And if they haven't talked to a professional yet, encourage them to. Understanding what's happening to someone you love is part of the process too.
When to seek help
It's worth asking for an assessment if:
- Episodes are frequent or getting longer.
- You have memory gaps about everyday things, or find objects, messages or purchases you don't remember.
- Other people mention things you did or said that you can't remember.
- You disconnect every time something reminds you of a painful experience.
- You feel unreal for days or weeks.
- You hurt yourself during or after episodes.
On that last point, a meta-analysis found a link between dissociation and both suicide attempts and non-suicidal self-injury (Calati, Bensassi and Courtet, 2017). If this applies to you, there's more information in the article on self-harm. And if at any point you think about hurting yourself or ending your life, call 024 (Spain's suicide helpline), which is free and open 24 hours a day, or 112 in an emergency.
Therapy for dissociation in Igualada and online
At my practice in Igualada and online, I work with people who dissociate, often as part of trauma treatment. We start with a careful assessment, sometimes using questionnaires such as the DES, which I give as an interview, and from there we follow the phases I've described. When there's dissociation, before working on memories with EMDR we spend as much time as needed on stabilization, and we go at your pace. I work in Spanish and Catalan, as a health psychologist. You'll find more information on the page about trauma treatment with EMDR and the one about online PTSD therapy.
If you recognize yourself in what you've read, you don't need to understand it all before asking for help. Get in touch and, in a first conversation with no obligation, we'll look at what's happening and how I can help.