What Is Dissociation? What Experts Need You to Know
You may have had that eerie out-of-body feeling from time to time, but with dissociation, it can be severe and long-lasting. Here's what you need to know about its causes and treatments.
You’re in the middle of a meeting and your boss asks for your opinion on the topic at hand. There’s just one problem: You have absolutely no idea what topic that is. Maybe some bad news has caused you to disconnect from the here and now. You may even feel like you’re watching things unfold from outside of your body.
Sound familiar? If so, you’re among the up to 75 percent of people who experience at least one episode of dissociation during the course of their lifetime, according to the National Alliance on Mental Illness (NAMI).
These episodes can happen to anyone at any time regardless of age, race, or background. They can be mundane and short-lasting, such as losing track of time and place when engrossed in a novel, or more severe and chronic.
“These episodes are different than the attention issues seen with a condition like ADHD,” says Tobechukwu Clouden, MD, an adult psychiatrist in Red Bank, New Jersey. “As opposed to just being distracted, it’s really the feeling that you have left your body.”
(Related: How to Know If Your Anxiety Is “Normal”)
When does dissociation occur?
Sometimes dissociation can occur as a side effect of medication or as part of an underlying illness like epilepsy or migraine headache. Drinking too much alcohol may also trigger feelings of dissociation. And stress overload can do the same in otherwise healthy people, says John H. Krystal, MD, professor of translational research and chair of the department of psychiatry at Yale University School of Medicine in New Haven, Connecticut.
“With a certain level of stress, things become sharper and you operate more quickly and efficiently,” says Dr. Krystal, who’s also the chief of psychiatry at Yale-New Haven Hospital. But “with extreme stress, attention gets fragmented and instead of being more in the action, we become detached from what’s going on around us.
“Our ability to process information gets more and more disrupted and slows down instead of speeding up,” he adds. “Such extreme stress may follow a car accident or hearing bad news. This is common and usually transient.”
The more severe, long-lasting dissociative disorders are usually related to some physical, sexual, or psychological trauma, according to NAMI.
Degrees of dissociation
There are ranges of dissociation and its related symptoms.
“Daydreaming can be a very light dissociative state,” says Dr. Clouden. “Your body is physically there, but your mind is off wherever, and people have to bring you back to reality.”
These episodes are not necessarily a cause for concern unless they start happening more frequently and are interfering with your life, Dr. Clouden says. “If you are drifting off all the time and it affects school and work, then it can become a problem,” she says.
Dissociative disorders are far more severe and long-lasting, she adds. “These people can’t recollect who they are, where they are, and how they got there,” she says. “That’s where it becomes a disorder.”
Dissociative disorder causes
While strongly linked to a history of trauma, these disorders tend to travel with other psychiatric conditions such as post-traumatic stress disorder (PTSD) or depression, Dr. Clouden says. Just two percent of people who have an episode of dissociation will develop a dissociative disorder, and women are more likely than men to be diagnosed with one, according to NAMI.
“Trauma is one of the most common denominators we see among recurrent experiences of dissociation,” Dr. Krystal says. Natural disasters and time spent in combat can also trigger dissociative disorders.
Some people have dissociative states without any history of trauma, Dr. Krystal says. “They may be naturally vulnerable to having these states.”
There aren’t many studies looking at the brains of people experiencing dissociative disorders. However, there is a robust body of research looking at what happens in the brain when people take drugs—such as ketamine, angel dust, and nitrous oxide, or “laughing gas”—that cause dissociative symptoms. When taking these drugs, “people experience things happening around them in an unreal way,” says Dr. Krystal.
Based on these studies, “we would expect that the tuning of cortical activity in the brain becomes compromised,” he says.
The brain’s cortex is divided into parts that control sight, hearing, smell, and sensation, as well as speech, thinking, and memory. “We see impaired communication of the higher centers of the cerebral cortex such as the temporal lobe with other parts of the brain,” Dr. Krystal says. The temporal lobe is tasked with creating and preserving memory.
Types of dissociative disorders
The three main types of dissociative disorders are:
Dissociative identity disorder
Once known as multiple personality disorder, dissociative identity disorder usually comes on after extreme abuse, Dr. Clouden says. With this type of dissociative disorder, other personalities emerge to protect you from recalling a traumatic event. These personalities may have their own names and mannerisms that are very different from your own. Memory gaps occur when another personality has taken over.
People with this disorder are more likely to attempt suicide or engage in self-harm, notes NAMI.
Also linked to trauma, dissociative amnesia involves forgetting chunks of your life or sometimes your entire autobiography, Dr. Clouden says.
“This is your mind’s way of protecting you from memories of abuse. It can last a few days, a few weeks, a few months, and some people never retrieve their memories,” she says. “The trigger is usually a traumatic event that has just happened, and all of a sudden they completely forget certain autobiographical information.” This trigger may invoke memories of the past trauma.
With this disorder, you feel like you are looking at yourself from the outside in, says Dr. Clouden. “You may see yourself as a character in a movie,” she adds. These feelings can last minutes and return over time. They tend to first develop when you are in your teens, according to NAMI.
“People may not only have symptoms of dissociative disorders but anxiety or depression symptoms, too,” Dr. Krystal says. “The constellation of symptoms is what brings them to a mental health professional.”
Diagnosing dissociative disorders
Your doctor will rule out any physical causes of the symptoms such as head injury, brain tumors, sleep deprivation, medication, side effects, or intoxication.
If an underlying disease like epilepsy is causing the dissociative symptoms, medication can help treat the seizures and the aura that precedes them, Dr. Krystal says. Aura is marked by visual disturbances and sometimes the feeling of being separated from your body.
It’s important to listen carefully to the symptoms that are described as dissociation, as they can be confused with the hallucinations and delusions of psychosis.
Teasing out the difference matters because the treatments differ. “If the diagnosis is wrong, the patient may get antipsychotic medication as opposed to anti-anxiety medication,” he says. “And they may not get the same intensive psychotherapy that can be helpful for trauma.”
Treatment for dissociative disorders
Talk therapy aimed at unraveling the root cause of trauma is the treatment of choice for dissociative disorders, Dr. Clouden says. There is no medication available to treat dissociative disorders. However, “you can prescribe medication to treat anxiety or depression associated with the disorder,” she adds.
Not all dissociative disorders will require treatment, but many do. “If there is a small period of time that you can’t recall, but you are going forward and living your life, you may not need to address it,” Dr. Clouden says.