Am I Dissociating? A Guide for Austinites

Dissociation is a defense mechanism that our minds can use to protect ourselves from stress or a traumatic event. It can look different for different people. Some describe dissociation as feeling outside of their body (depersonalization). Others may feel that the world around them is not real (derealization).

Mild dissociation can be best described as daydreaming or spacing out, while on the other end of the spectrum, you can have full-on dissociative disorders that include memory loss, disruptions in consciousness, or identity confusion.

Dissociation Symptoms

Symptoms of depersonalization may include one or more of the following:

• Not feeling your emotions, but observing them
• Feels as though you are watching yourself in a movie rather than living your life
• Feelings of floating or drifting
• Feeling disconnected from parts of your body or from your emotions
• Unsure of the boundaries between yourself and other people

Symptoms of derealization may include one or more of the following:

• You feel that the world is muted or void of life
• You feel separate from the world
• Feel as though you are living in a dream
• Feel that you are observing the world through a pane of glass

Some of the more severe symptoms of dissociation include the following:

• Identity confusion
• Altered perception of time
• Gaps in memory or memory loss (dissociative amnesia)

Most people who dissociate aren't experiencing it at an extreme level. Everyone dissociates at one time or another, typically in the form of daydreaming or finding that their "mind wandered."

Types of Dissociative Disorders

According to the diagnostic and statistical manual of mental disorders, there are five different types of dissociative disorders, with three major dissociative disorders and two categories that capture the diagnoses that don't quite fit the three.

Dissociation and Dissociative Identity Disorder (DID)

This rare dissociative disorder used to be known as multiple personality disorder, and it affects around 1.5% of people worldwide. Those who experience dissociative identity disorder experience two or more distinct identities that are often uncontrollable by the person who has them.

People with dissociative identity disorder also experience gaps in memory, intense dissociation from self, memory, agency, motor functioning, and perception. Family members and other loved ones may notice extreme behavior changes due to dissociation.

People with dissociative identity disorder often experience intense distress that affects their home life, school, or work. They are also at risk for self-harm or suicidal thoughts.

Depersonalization Derealization Disorder

While short periods of derealization or depersonalization can be rather common, in the case of those with depersonalization derealization disorder, they are ongoing and can be disruptive to daily life and relationships.

People with this mental health condition have difficulty determining what is real, and may feel as though they are "going crazy". During bouts of dissociation, they may describe feeling disconnected from their body or feeling that the world isn't real.

Dissociative Amnesia

One of the dissociative disorders, dissociative amnesia, causes memory loss, which creates gaps in a person's life. Individuals with dissociative amnesia are often unable to have a full understanding of themselves or their current lives due to losing key elements of their lives.

A form of dissociative amnesia known as dissociative fugue is when a person loses awareness of important information about themselves or their identity altogether. A person who experiences a dissociative fugue may find themselves in an area and have no idea how they got there. As far as symptoms of dissociation go, this one is rare and is most often used as a defense mechanism for mentally escaping a severe traumatic event.

Unspecified Dissociative Disorder

This diagnosis applies to severe cases of dissociation that do not meet the criteria for the main three dissociative disorders: dissociative identity disorder, depersonalization derealization disorder, or dissociative amnesia, but the reason the criteria are unmet is not given by the clinician who diagnosed it.

Other Specified Dissociative Disorders

This diagnosis refers to cases of severe dissociation that do not meet the criteria of the other dissociative disorders, but the reasons are given by the diagnosing clinician. This is the most common of dissociative disorders, and it is often comorbid with other mental illness related to a traumatic or stressful event, such as complex post-traumatic stress disorder, personality disorders like borderline personality disorder, substance use disorders, major depressive disorder, and generalized anxiety disorder.

Causes of Dissociation and Dissociative Disorders

Almost all severe dissociation and dissociative disorders are caused by a traumatic event or series of traumatic events, such as physical or emotional abuse, traumatic stress, sexual abuse, childhood abuse, or physical pain. Childhood trauma is a common cause of dissociative disorder. Dissociation can also be a symptom of other mental health conditions related to severe trauma, like post-traumatic stress disorder.

How are dissociation and dissociative disorders treated?

Severe forms of dissociation found in dissociative disorders such as dissociative identity disorder (aka multiple personality disorder) can be treated with a combination of therapy, prescription medications, and healthy lifestyle behaviors.

Psychosocial Treatments

A mental health professional working with someone with a dissociative disorder will treat the disorder by creating a safe space to stabilize symptoms of dissociation, partnering with the client to work through the traumatic event or traumatic memories, and helping them to reintegrate their identity by reestablishing them in their environment and addressing their relationship with themselves.

The most effective therapy frameworks to address dissociative disorders are:

• Dialectical behavioral therapy (DBT)
• Trauma-focused cognitive behavioral therapy (TF-CBT)
• Eye movement desensitization and reprocessing (EMDR)
• Psychodynamic theory
• Hypnosis

Medical Treatments

While there are no medications that are approved for the specific treatment of dissociative disorders, many medical professionals will prescribe medications to treat symptoms of comorbid conditions such as depression, PTSD symptoms, or anxiety.

Self-Care and Management Skills

People experiencing dissociative disorders such as dissociative identity disorder or dissociative amnesia are often under a lot of stress, and a therapist may recommend certain lifestyle habits to help manage that stress and decrease the occurrence of symptoms. Some lifestyle habits recommended to those with dissociative disorders may include:

• Establishing healthy sleep patterns
• Eating a balanced diet
• Getting regular exercise
• Maintaining positive relationships

What To Do If You Think You Or a Loved One Has a Dissociative Disorder

Dissociative experiences can be scary. But remember, periods of dissociation are not uncommon and may be experienced by anyone. Sometimes, when we're under stress or experiencing anxiety, dissociative symptoms may occur. For people with anxiety disorders, dissociation may happen during a panic attack.

However, if you notice that dissociative symptoms are negatively impacting your life, relationships, or mental health or notice bouts of dissociative amnesia, then you may have a dissociative disorder, and you should reach out to a mental health care practitioner. They can treat dissociation with evidence-based therapy. To find a therapist in your area, you can get a referral from your primary care physician or use an online resource like Mental Health America (MHA) or the American Psychiatric Association (APA) to search for therapists who treat dissociative disorders.

If you or a loved one is experiencing one of the dissociative disorders, you are not alone. Reach out to our doctoral-level therapists for dissociation in Austin and get the treatment you deserve.