What is dissociation?

Dissociation is when a person feels detached from their own thoughts, emotions or sense of identity. It’s like an automatic escape from reality, often triggered by overwhelming stress or traumatic experiences. This disconnection can affect one’s perception of time, memory and self-awareness. Dissociation itself is not a disorder, but it can be a symptom of various mental health conditions. 

What are dissociative disorders?

In contrast to typical dissociation, dissociative disorders are mental health conditions involving severe and chronic dissociation. Dissociation becomes a ‘disorder’ when it becomes disruptive to your daily life.

Examples of these disorders include:

Dissociative Amnesia

Characterised by an inability to recall important personal information, usually following a traumatic event like being bullied. 

Dissociative Identity Disorder (DID)

Previously known as multiple personality disorder, DID involves a person exhibiting two or more distinct identities or personalities. 

Depersonalisation-Derealisation Disorder

Involves persistent or recurrent experiences of feeling detached from one’s body (depersonalisation) or feeling that the external world is unreal (derealisation). 

Causes of dissociation

Dissociation can result from various factors, including: 

• Trauma (e.g., childhood abuse, combat, accidents) 
• Severe stress 
• Psychological conflict 
• Substance misuse 
• Certain medications, such as those for depression

Symptoms of dissociation

Dissociation can be hard to diagnose. The symptoms can vary but may include:

• Memory loss (amnesia) for certain time periods, events and people 
• Feeling disconnected from oneself (depersonalisation) 
• Perception of the people and things around as unreal (derealisation) 
• A blurred sense of identity 
• Significant stress or problems in relationships, work or other important areas of life 

Why are dissociative disorders hard to diagnose?

The biggest reason is that it frequently co-occurs with other mental health issues, such as anxiety, bipolar, schizophrenia, borderline personality disorder (BPD) and most notably Post-Traumatic Stress Disorder (PTSD). This overlap can complicate diagnosis, as the symptoms might be mistaken for symptoms of other conditions. 

The subjective nature of dissociation also means it can be hard to describe and quantify. Patients may struggle to talk about their experiences, and standard diagnostic tools might not capture the nature of dissociative episodes. Therefore, it is very important to make sure that you seek professional help to make sure that you or your loved one are getting diagnosed correctly. 

PTSD vs. Dissociation 

While research shows that PTSD and dissociative disorders often occur together, they are distinct conditions. Recognising the differences and signs of both PTSD and dissociative disorders is crucial for treatment. 

Both PTSD and dissociative disorders are triggered by experiencing or witnessing traumatic events such as war, natural disasters or serious accidents. However, people with PTSD frequently relive their trauma through flashbacks or nightmares. Those with dissociative disorders involve a disconnection between thoughts, identity, consciousness and memory.  

Dissociation can be a symptom of PTSD but it is a core feature of specific dissociative disorders, which can occur separately of PTSD. For those with PTSD, dissociation serves as a coping mechanism to escape from overwhelming memories and emotions temporarily. However, when dissociative symptoms are severe and persistent, they may indicate a dissociative disorder rather than PTSD. 

What can I do?

If you think you are experiencing dissociation, it’s important to take steps to manage its effects. Here are strategies you can consider: 

Seek professional help: Consulting with a therapist or psychologist who specialises in dissociation and trauma can provide you with the necessary tools and support to understand and manage your symptoms. 

Practise grounding techniques: Techniques such as mindfulness, deep breathing exercises and physical grounding activities (like holding a cold object or planting your feet firmly on the ground) can help bring you back to the present moment. 

Set clear boundaries: Establishing personal boundaries can help you feel more in control and reduce stressors that may trigger dissociation. 

Engage in physical workouts: Regular exercise, such as yoga or aerobic activities, can reduce stress, improve mood and enhance your connection with your body. It can also improve your physical health, which directly impacts your overall wellbeing.

Create a supportive environment: Arrange your living and working spaces to be calming and stress-free. A stable and safe environment can significantly reduce the likelihood of dissociative episodes. 

How can I help others?

Supporting someone experiencing dissociation requires patience, understanding and a willingness to learn. Here are some ways you can offer effective support: 

Be patient and understanding

Recognise that dissociation is a coping mechanism for dealing with stress or trauma. Avoid being judgemental or dismissive of their experiences, as this can worsen their symptoms. 

Encourage professional help

Gently suggest that they seek help from a therapist or mental health professional who can provide them with specialised care. 

Respect their boundaries

Understand and respect their need for personal space and boundaries. This can help them feel safe and in control.

Offer grounding techniques

Learn and share grounding techniques that can help them stay connected to the present moment when they start to dissociate.