Dissociation in Adults: Feeling Detached From Reality and How to Cope
Dissociation is a broad and complex experience with varying sub-symptoms and intensities. Impacting thought, body, emotion, and sense of time, dissociation can disrupt functions that are fundamental to the human experience.1
Feelings of detachment from reality or one’s sense of self can be extremely distressing, often causing second-hand anxiety on top. Plus, the experience can be tremendously difficult to put into words and may even cause people to question their sanity.
Dissociation in adults may arise from things like abuse, trauma, drug use, and intense stress. Though it isn’t a rare experience, there isn’t a clear-cut treatment for dissociation. However, there are many techniques and approaches available that could help people cope with dissociation and treat its root causes.
If dissociation is something you experience, a mental health professional can advise on the best treatment approaches for your needs. This page can also help you further understand dissociation in adults, as it explores:
- What dissociation is and the different types
- Causes of dissociation
- Ways of coping with and treating dissociation
- Where to find professional support
What Is Dissociation?
“Dissociation” describes a very broad set of experiences in which there is a disruption to someone’s normal experience of consciousness, memory, emotion, identity, perception, behavior, motor control, or body representation. Often, those who experience dissociation struggle to articulate it accurately, as it can feel too “strange” or all-encompassing to describe.1
Additionally, two people can have completely different experiences of dissociation. For instance, sub-symptoms may include emotional numbing or a disconnect from someone’s sense of identity. Yet further, more intense sub-symptoms can also include things like amnesia, flashbacks of traumatic events, and the development of alternate personalities.1
Since dissociation can vary so much in severity, it can be helpful to think of it as a spectrum. But what would a spectrum of dissociation look like?
The Spectrum of Dissociation
Dissociation can emerge in several ways, ranging from the harmless to the extremely serious.
On one end of the spectrum are experiences like daydreaming or “highway hypnosis.” In these situations, our mental energy is focused on a particular task, like driving, while our other thoughts or perceptions fade into the background. This sort of dissociation is not typically deemed problematic.2
On the other end of the spectrum are forms of dissociation connected with trauma. For instance, some may describe a sense of leaving their bodies during an assault. Plus, other people might have gaps in their memory or “alter” personalities. These types of dissociation are more concerning and often interrupt day to day life.2
The middle of the spectrum includes experiences like depersonalization/derealization, in which someone may have symptoms that are quite disorienting. However, these experiences are transient and do not impact daily life in a significant way. We explore depersonalization/derealization and other dissociative conditions further in the following sections.
The Types of Dissociation
The different types of dissociation reflect how the phenomenon exists on a spectrum – ranging from more mild to severe symptoms – and include the following conditions:
Depersonalization/Derealization (DPDR)
Depersonalization/derealization involves persistent feelings of detachment from the world, oneself, or both.3 It can either be temporary or more continuous.4
While depersonalization (DP) is inward-focused, derealization (DR) is outward-focused. For example:
Depersonalization refers to a detachment from one’s sense of self. People describe feeling like observers of their own body movements and sensations or disconnected from their personal identity. They may not even be able to recognize their reflection in mirrors.4
Derealization is a disconnection from the outside world. It may feel as though the world is dreamlike or strange, even in locations that are familiar. Some people report visual distortions, describing things as “flat,” “colorless,” or objects seeming oddly large or small.4
A secondary symptom of DPDR is existential thoughts and questions, with symptoms driving people to question the nature of their reality and their true identities. For instance, they may have a strong sense that life is a simulation or that the concept of identity isn’t real.4
It’s important to note that DPDR is not a symptom of psychosis or detachment from reality. In fact, those who experience it know something is wrong and are not having any delusions or hallucinations. One psychiatrist, Oscar Janiger, actually described DPDR as the opposite of insanity, saying “It’s like being ‘too’ sane, you become hypervigilant of your existence and the things around you.”4
Aside from trauma, DPDR can be triggered by things like:4
- Fatigue
- Stress
- Alcohol
- Jet lag
- Psychoactive drugs
Dissociative PTSD
Alongside nightmares and physical anxiety, some people with PTSD may also experience dissociative symptoms, such as flashbacks or depersonalization.5
In fact, 14% of people with PTSD have persistent symptoms of depersonalization and derealization. This was termed “dissociative PTSD” by the American Psychiatric Association in 2013, labelling a new subtype of the condition.2
Dissociative Amnesia
Dissociative Identity Disorder (DID)
Formerly known as “multiple personality disorder,” dissociative identity disorder is characterized by the presence of more than one personality or “alter.” Often, each alter has their own names, memories, and styles of expressing themselves.6
DID is an extremely serious and rare condition, often emerging as a result of significant trauma, such as childhood abuse. Those with DID commonly have gaps in their memory, around both daily events and traumatic experiences.6
Why Do We Dissociate?
There are many causes of dissociation, but it broadly serves to protect our brains from trauma, stress, and intensely painful emotions.7 The following are some of the different causes of dissociation.
Short and Long-Term Protection From Trauma
By enabling people to “disconnect,” dissociation can be understood as a shield against trauma that’s happening in the present moment.7
However, many people continue to experience dissociation beyond the initial trauma. For instance, between 25-53% of people who have experienced interpersonal abuse will experience DPDR.3
Dissociation in this sense is similar to how PTSD operates. Though the brain’s initial protective instinct in response to a threat is helpful, it can cause problems if it continues to react as though the threat is still present long-term.
Overwhelming Emotions
As well as protecting us from traumatic events, our brains may also perceive emotional pain as a trigger. For instance, we may dissociate from situations or feelings that remind us of unmet needs or cause overwhelming emotions.7
Periods of intense stress or anxiety could also trigger something like DPDR, such as a panic attack or emotional stress combined with physical illness. Further, poor sleep quality is a significant risk factor for worsening dissociative symptoms, so this could be a compounding influence.8
Additionally, research into dissociation caused by PTSD finds that people who struggle to emotionally regulate are more likely to experience dissociation. For example, not recognizing the need for social support or failing to reappraise an automatic response to a perceived threat. Those with alexithymia (difficulty identifying, understanding, and describing emotions) may also be at greater risk of dissociating.9
In these cases of dissociation, developing emotional regulation skills tends to be highly important in treatment.
Other Mental Health Conditions
DPDR is more common in people with other mental health disorders, such as anxiety, depression, borderline personality disorder (BPD), schizophrenia, and substance use disorders.3
It’s not clear whether there’s a biological link between these mental health conditions and dissociation. However, we do know that childhood trauma increases the risk of developing mental health conditions in adulthood. Therefore, it could be the case that people develop multiple conditions as a result of adverse experiences.2
Psychoactive Drug Use
Episodes of dissociation can also be triggered by the use of psychoactive drugs, including alcohol.4 Drugs such as cannabis, LSD, and ketamine are notably common in reports from people experiencing DPDR.8
To sum up, the main risk factors for dissociation are childhood abuse, trauma, drug use, and poor mental health. Further, symptoms can be classified as “dissociative disorders” when they do not disappear after a short time. While they may be temporary in people who experience acute stress, dissociative disorders occur when symptoms are persistent and interfere with daily life.8
Treating and Coping with Dissociation
With no specific medication or therapy type designed to specifically treat it, dissociation can be tricky to manage. However, we are able to provide the following guidance for overcoming dissociation, informed by what we know about it.
Do Not Ruminate on Existential Thoughts
One of the most common dissociation recovery strategies focuses on the idea that you cannot think your way out of dissociation. Although DPDR symptoms can lead you to some very compelling thoughts about the nature of your true self, reality, and other people, ruminating on them will likely not reveal answers.
Instead, if you find yourself feeling disconnected and questioning the nature of your reality, it can be helpful to move back into your body. This brings us to our next piece of advice.
Strengthen Your Mind-Body Connection
Somatic therapies (such as yoga, tai chi, progressive muscle relaxation, or somatic counseling) may be extremely helpful for those who dissociate.7 This is because dissociation is a state of disconnection; it’s the opposite of being grounded. Therefore, strong physical sensations can bring you back into your body.
Although distraction can be an unhealthy coping mechanism in itself, it can play a helpful role in managing DPDR. For instance, if you’re plagued by existential thoughts and ruminations, distractions could help bring you back into the present moment, your body, and your character. Physical exercise may be your preferred choice of distraction, but seeing a friend or cooking a meal from scratch could be equally immersive.
Develop Emotional Regulation Strategies
Not only are emotional regulation difficulties strongly linked with childhood trauma, but they’re also associated with the perpetuation of dissociative symptoms.9
Learning about your emotions may be extremely beneficial in healing from both trauma and dissociative experiences. This involves reconnecting with your feelings, learning to identify and explore them, and practicing expressing them.9
Emotional regulation may also involve learning to practice mindful acceptance, reframing emotional situations, or working through unhelpful beliefs about negative emotions.10
Theoretically, if you improve your ability to regulate emotions, your brain will receive fewer signals of threat and be less likely to dissociate on a regular basis.
Reduce Risky Behaviors
With such a clear link between dissociation and psychoactive drug use, if someone is taking substances, it’s important that they stop as soon as possible. Even if they’re engaging in other approaches for recovering from dissociation, continued drug use may cause symptoms to persist.
If you have a substance use dependency, it’s crucial that you receive specialized support for this. Plus, even if your use is recreational, dissociative symptoms may continue without sobriety.
Tend to Other Mental Health Conditions
Since dissociation is connected to things like stress and fatigue, it’s worth tending to these elements of your life to indirectly treat your dissociation. Getting treatment for co-occurring conditions can lower your overall stress levels, thus reducing your risk of dissociating. Therefore, although this may be an indirect approach, it can nonetheless be highly effective.
Seek Treatment for Trauma
With such a clear connection between dissociation and trauma, many people affected by this symptom could benefit from seeking specialized trauma treatment. Trauma-focused therapy for dissociation can help people process and integrate their traumatic memories and cultivate coping strategies so that they no longer need to dissociate.
For example, you may be interested in EMDR, an evidence-based approach to reducing the emotional impact of distressing memories.7
Mission Connection: Get Support for Dissociation Today
If the information in this article has resonated with you and you’d like to get mental health support for yourself or a loved one, get in touch with the team here at Mission Connection. We treat a range of mental health conditions and have several facilities across the country, offering many types of therapy.
Further, if you simply want to understand more about your symptoms, you can take a self-test or make a free, confidential enquiry with us.
Alternatively, feel free to browse our other articles on cognitive symptoms, which explain things like intrusive and racing thoughts, memory problems, and indecisiveness.
References
- Lanius, R. A. (2015). Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research. European Journal of Psychotraumatology, 6(1), 27905. https://doi.org/10.3402/ejpt.v6.27905
- Boyer, S. M., Caplan, J. E., & Edwards, L. K. (2022). Trauma-related dissociation and the dissociative disorders: Neglected symptoms with severe public health consequences. Delaware Journal of Public Health, 8(2), 78–84. https://doi.org/10.32481/djph.2022.05.010
- Yang, J., Millman, L. S. M., David, A. S., & Hunter, E. C. M. (2022). The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review. Journal of Trauma & Dissociation, 24(1), 1–34. https://doi.org/10.1080/15299732.2022.2079796
- Murphy, R. J. (2023). Depersonalization/Derealization disorder and neural correlates of trauma-related pathology: A critical review. Innovations in Clinical Neuroscience, 20(1-3), 53–59. https://pmc.ncbi.nlm.nih.gov/articles/PMC10132272/
- Mann, S. K., Marwaha, R., & Torrico, T. J. (2024, February 25). Posttraumatic stress disorder (PTSD). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559129/
- National Alliance on Mental Illness. (2024). Dissociative Disorders. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Dissociative-Disorders/
- Psychology Today. (2024). Inside Dissociation. https://www.psychologytoday.com/gb/blog/an-interpersonal-lens/202412/inside-dissociation
- Psychology Today UK. (n.d.). Depersonalization / Derealization Disorder. https://www.psychologytoday.com/gb/conditions/depersonalizationderealization-disorder
- Powers, A., Cross, D., Fani, N., & Bradley, B. (2015). PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample. Journal of Psychiatric Research, 61, 174–179. https://doi.org/10.1016/j.jpsychires.2014.12.011
- Psychology Today UK (n.d.). Emotional Regulation. https://www.psychologytoday.com/gb/basics/emotion-regulation
