How to stop dissociating

What is dissociation?

Dissociation is the experience of feeling disconnected or detached from reality or the self. It can cause memory loss or a feeling that things are unreal or dream-like. Many people experience mild or brief dissociation occasionally, but some experience severe or long-term dissociation, which can be caused by trauma and severe mental health conditions ^[1].

In many cases, dissociation can be managed without professional intervention, particularly if it is brief and does not cause a risk of harm. However, treatment may be necessary for individuals with a dissociative disorder or additional symptoms that cause a risk of harm or impair quality of life ^[2].

Signs and symptoms of dissociation

Dissociation can cause several signs and symptoms that vary from person to person. Common terms used to describe some of these symptoms include ^[3]:

• Depersonalization: the feeling of being disconnected from one’s own body, thoughts, and emotions.
• Derealization: the feeling that the world or surroundings are not real.

Signs and symptoms of dissociation can include ^[1][2][4][5]:

• Feeling detached from your own thoughts or body, as though you are watching yourself from outside your body or on a screen.
• Feeling as though life feels like a dream or does not seem real, as though you are disconnected from reality.
• Feeling that others are unaware of your presence or that you do not exist.
• Feeling as though other people are not real.
• Forgetting things that have happened or having blank spots in your memory.
• Forgetting details about yourself.
• Being unable to remember how you got somewhere or obtained a specific item.
• Struggling with a sense of identity, such as not knowing what you believe or enjoy.
• Behaving like an entirely different person sometimes, switching between these personas.
• Having several different personalities or identities.
• Using different voices or accents.
• Issues with cognitive functions such as concentration.
• Feeling regularly overwhelmed by negative emotions.
• Experiencing symptoms of depression or anxiety.

What causes dissociation?

Mild dissociation can happen to anyone at any time. For example, it is common to ‘zone out’ while driving or when becoming engrossed in a book or film. However, more severe instances of dissociation are often a result of exposure to trauma and are used as a coping strategy or defense mechanism ^[1].

Dissociation can occur during a traumatic event, such as witnessing war or conflict, being involved in a life-threatening circumstance, or experiencing sexual or physical abuse. In these situations, individuals may experience dissociation as a coping mechanism to protect themselves from severe physical or emotional distress by disconnecting from reality ^[3].

It can be common for people to experience this type of dissociation short-term, returning to a sense of reality once the danger or distressing situation has passed. Others may experience dissociation as a long-term condition if it occurs repeatedly following the traumatic event ^[5].

For example, a child exposed to sexual or physical abuse may dissociate during these experiences. As children cannot process or understand these types of traumas, dissociation becomes a vital and necessary tool to cope with their distress ^[1][2].

This can contribute to an inability to develop other coping strategies, leading to prolonged and repeated dissociation when exposed to any stressful or distressing situation. This can potentially lead to dissociative disorders, such as dissociative amnesia, dissociative identity disorder, and depersonalization-derealization disorder ^[1].

Dissociative amnesia

The memory of the traumatic event becomes inaccessible to the individual, so distress is not experienced in the moment or by remembering the event.

This memory loss can be associated with a specific traumatic event, the details of which may be forgotten for a brief time or up to several years. However, it may also relate to the loss of extensive periods or significant details unrelated to trauma, such as personal details or information about others ^[2][5].

Dissociative identity disorder (DID)

The brain separates the traumatic experience from the individual's thoughts, emotions, and reality, leading to a splitting of their personalities and a feeling that the trauma was experienced by someone else.

DID, which was previously referred to as multiple personality disorder (MPD), is characterized by several identities, known as alters, who may have various genders, ages, nationalities, and personalities. It is common for people with DID also to experience amnesia, forgetting what happened while a different alter was being shown ^[1][3].

Depersonalization-derealization disorder

This disorder is characterized by a potentially consistent feeling of being disconnected or detached from reality or the self. It may cause the individual to feel they are experiencing their life as though in a movie or dream. It can cause cognitive impairments with concentration or memory and feeling out of control or slowed down ^[5].

Other circumstances

Dissociation can also occur in the context of various other mental health conditions and situations, such as ^[1][3]:

• Borderline personality disorder (BPD)
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
• Bipolar disorder
• Major depressive disorder
• Anxiety disorders
• Stressful or traumatic situations
• Intoxication or withdrawal from alcohol, medication, or illicit substances

How to stop dissociation

It may not be possible to stop dissociation from occurring, particularly for individuals with a severe dissociative disorder. However, several strategies can be used to help in coping with or reducing the impact of dissociation, such as ^[1][4][6]:

• Keeping a diary: It might be helpful to keep a journal or diary of your experiences, including details of situations that triggered a dissociative episode or techniques you used to help you cope with dissociation. This could help you to understand what improves or worsens your symptoms,so you feel more able to manage in the future.
• Using grounding or mindfulness techniques: These techniques can bring your awareness back to the present moment and distract from or help to cope with emotional distress. This can involve bringing into awareness any of the five senses: touch, taste, sight, hearing, andsmell. It could also include ice diving, lighting incense or scented candles, and walking barefoot on grass.
• Breathing exercises: Breathing exercises can be used as a grounding technique and can also help to manage feelings of anxiety and stress by reducing physical symptoms,such as increased heart rate. 
• Relaxation: Engaging in relaxing activities, such as reading, walking, taking a bath, body scanning, or meditation, can help to reduce feelings of stress and anxiety that may precede a dissociative episode or occur in the context of associated mental health conditions.
• Practical help: If you experience memory loss because of dissociative episodes, it may be helpful to use practical strategies to help you manage, such as regularly using clocks and alarms, having written lists or reminders, and using a calendar to keep track of important dates and appointments.
• Taking care of physical well-being: Ensuring you look after your physical health can help reduce the impact of dissociative episodes and other associated mental health conditions. This can include using a sleep schedule, eating a healthy diet, and exercising regularly.
• Attending groups or talking to others: Learning from others with similar experiences can help you with advice and support in managing your condition. This may be through support groups, online groups, or reading about the experiences of others.

When to seek professional help

It is vital to seek professional help if you experience dissociative episodes regularly that impact your quality of life, reduce your social or professional functioning, cause emotional distress, put you at risk of harm, or worsen symptoms of other mental health conditions ^[1][6].

Therapies

People with a dissociative disorder, a history of trauma, or a mental health condition in which dissociation occurs, may be recommended to utilize talk therapy to help with their symptoms. Various types of therapy are available that can help reduce the impact of past trauma and teach positive coping strategies to help manage emotional distress, such as ^[3][4]:

• Trauma-informed therapy
• Psychodynamic therapy
• Cognitive behavioral therapy (CBT)

Eye movement desensitization and reprocessing (EMDR) is a specialized type of therapy used to treat PTSD and other trauma-related conditions, such as dissociative disorders. It involves revisiting trauma memories and can be potentially harmful if not administered at a time when the individual can cope with this or by a well-trained professional ^[1][5].

Medication

Although there are no evidence-based medications for dissociation and dissociative disorders, various medications could potentially be beneficial in managing the condition or co-existing symptoms and conditions, such as low mood, anxiety, self-harming behaviors, or insomnia. This could include antidepressants, anti-anxiety medications, antipsychotics, or mood stabilizers ^[1][3].