Have you ever been in the middle of a conversation and suddenly realized you have no idea what the other person just said?
Or driven somewhere and not remembered all or part of the drive?
Missed a turn on a familiar drive?
Lost track of time?
Gotten lost in your thoughts?
Become so absorbed in a book or movie?
Forgotten if you did something or just thought about doing that thing?
This is dissociation.
Learn more from Carol in her The Elephant in the Room Podcast:
What does it mean to dissociate?
To associate means to connect, link or join something together, so to dis-associate, or dissociate, means to disconnect, sever, or separate.
In Psychology, dissociation is talked about as a separation within oneself. You can disconnect from your mind, body, thoughts, feelings, memories, awareness or identity and sense of self.
Do you dissociate?
Everyone dissociates. Dissociation is a spectrum of consciousness. We are all on the spectrum, and on the mild end, everyone dissociates.
It would be impossible to always be conscious of everything around and within you. You slip out of conscious awareness and lose track of yourself, time, space, the present moment or physical reality.
You know when you look at the clock and you have 10 minutes before a meeting, so you check your email and suddenly it’s 30 minutes later and you realize you are late!
Time warps when you are distracted.
Dissociation is distraction.
Dissociation diverts your attention or awareness and draws away your mind.
Dissociation is not bad. Did you know even the ‘flow’ state is a form of dissociation?
Society simply considers flow to be a positive state of immersion in work or art or an activity where you can lose conscious awareness of time and your surroundings – that’s dissociation.
What are mild signs and symptoms of dissociation?
Zoning out
Staring into space
Going on autopilot
Feeling numb
Daydreaming
Feeling distant or detached
Forgetting events or memory gaps
Losing time
Talking out loud to yourself
What are more significant signs and symptoms of dissociation?
Not recognizing yourself in a mirror
Feeling like other people, objects or the world aren’t real
Feeling disconnected from your own body
Out of body experiences
Hearing voices in your head
Ignoring pain
Amnesia
Identity confusion
Fragmented identity
What is the difference between healthy dissociation and unhealthy dissociation?
Dissociation is not healthy or unhealthy, it is simply adaptive and helpful at certain times in certain places, and maladaptive at others.
Dissociation can cause distress or relieve distress.
Daydreaming is a fantastical state of imagination where you can explore your goals and dreams and wishes, but even daydreaming isn’t always harmless. If you are daydreaming half of your work or school day, it is interfering in your engagement and meaningful participation in life.
Daydreaming can also be distressing if it turns anxious, when you get lost in an imaginary crisis or you catastrophize bad things happening to you. These are daymares, like a nightmare during the day.
Mild but frequent dissociation can also separate you from connecting in meaningful relationships with partners, family, friends, or community.
On the other hand, even severe forms of dissociation can be helpful or adaptive in extreme or chronic trauma and abuse, if it helps keeps you alive until you can find safety.
It’s important to consider the function, quality and quantity (time, frequency and duration) of the dissociation, and whether it is maladaptive and causes you stress, or it is adaptive and relieves stress.
What causes dissociation?
Dissociation is a response to trauma or pain.
Trauma is anything that overwhelms a person’s internal capacity to cope. Trauma can include all forms of fear, stress, abuse, neglect, violence, accidents, natural disasters, or war.
Dissociation is most often learned in childhood, and it can be adopted over time (imagine a child with chronic pain who learns to disconnect from the pain), or it can be an automatic and involuntary sudden response to trauma.
Dissociation is a defense mechanism for protection from pain.
The mind can dissociate and drift, distract, or pull away, or the brain can dissociate through fascinating neurobiological mechanisms.
Dissociation is a natural anesthetic.
In moments of unbearable pain, the brain produces natural opioids and cannabinoids as a painkiller to numb your senses, so you do not feel the pain you are in. It can save you from dying.
Dissociation during a trauma or physical or sexual assault protects the mind and body from the experience of pain or death.
How does trauma affect the body?
Trauma impacts your nervous system, triggering the body’s defense mechanisms. Dissociation from painful feelings is a common survival mechanism.
But when you dissociate, even if your mind does not feel the pain, your body feels and remembers everything.
If after a trauma, you are cared for by a safe caregiver in a way that allows you to process the experience and reintegrate the dissociated feelings, sensations, memory or part of self, you can continue to heal and live without repeating the dissociation.
If not, you unconsciously hold on to the trauma, and you will continue to cope with the unprocessed pain in your body, through dissociation or other defense mechanisms.
When you numb from pain in your body, it results in you not feeling safe in your body, because when you go back into your body, the pain is there waiting for you.
So, you continue to respond with dissociation. Sometimes you choose to distract, numb, or escape, and sometimes your body chooses for you.
How does trauma affect emotions and the ability to feel or express those emotions?
Emotions happen in the body. You feel emotions as sensations in the body.
Numbing from your feelings because of stress, trauma, or dissociation impairs your capacity to feel emotions in your body because it hurts to feel anything at all.
Emotions are waves of energy moving through your body, and in a state of fear, every emotion feels like a threat.
You can enter a state of heightened sensitivity and emotional overwhelm, or your body can shut down and block emotions entirely.
Sometimes you can’t feel any emotion at all. You feel numb, empty or an absence of feeling.
Trauma and dissociation impact your ability to feel, recognize and express emotions.
How does dissociation serve as a coping mechanism for those who have faced trauma?
Dissociation protects you from ongoing trauma or the consequences of past trauma.
Without dissociation, a human body could die from trauma. You separate to survive.
You dissociate to survive.
You can dissociate anytime your body perceives you are in a state of death or stress. To a young child, neglect and abuse are the same as death - their brains do not know the difference.
Children’s brains are likely to dissociate to cope with trauma, abuse, neglect or pain, and the cycle continues into adulthood in many subtle ways.
What is the relationship between childhood trauma and dissociative symptoms in adulthood?
Trauma changes your brain.
Trauma changes your brain structure, function, and chemistry in ways that affect every area of your life – emotions, memory, learning, stress, hormones, communication, regulation, executive functioning and decision making.
In childhood, trauma is incredibly disruptive to a developing brain, especially relational trauma.
Our brains are not built for human-to-human harm.
Children do not have the capacity to cope with abuse or neglect, and they dissociate to survive, creating patterns of detachment as protection. This persists into adulthood as a default response to stress.
While you may have first dissociated because of extreme stress or trauma, you continue to dissociate in response to other stressors, whenever you feel the feeling of fear or pain.
When you dissociate as an adult, you are commonly repeating defense mechanisms learned in childhood, but you can get really good at functioning through dissociation.
Many adults are unaware of their dissociation.
What challenges can exist for people who dissociate when it comes to therapy?
There are many challenges.
Therapy is not going to be very helpful if you are not present in the session, you zone out or answer on autopilot. Or if you’re not conscious and present when you are home after therapy, you won’t practice or integrate what you learned.
Dissociation serves to separate you from painful thoughts, emotions, sensations, and memories, and therapy is all about talking about stress, feelings, working through struggles, and being present in the moment in a relationship with your therapist.
Dissociation covers trauma and protects you so you can function and survive.
Relationships lift dissociation because when you are relating to someone, you can become present, aware, attuned, and feeling in your body. Care and nurturing also lift dissociation.
When you engage in a relationship with a therapist and that dissociation lifts, you can have strong and unexpected reactions because you feel the trauma and pain that is underneath.
Therapy is relationally based, and being in a relationship is hard when you dissociate to cope with trauma. It can feel painful and unsafe to be with someone who triggers your pain.
If a client or therapist are not aware of dissociation, therapy can increase distress.
You do not want to lift dissociation until you have something to rely on to cope with the pain or trauma – this is where rapport, safety, stabilization, and psychoeducation in therapy are necessary and helpful.
What types of therapy are helpful for people who dissociate?
If you have mild dissociation, any type of therapy can be good, but it’s most if you or your therapist are able to identify and bring attention to the signs of dissociation.
If you disconnect from your body when you talk about a certain topic, avoid specific issues, answer questions on autopilot, can’t feel your emotions in your body, zone out every time your therapist starts to teach you something, or you can’t remember all or part of your session, tell your therapist and open the space for curiosity and self-discovery.
If dissociation is interfering with your life or therapy, it is important to access trauma-sensitive therapy that is focused on safety and stabilization with a therapist who is specially trained in dissociation.
There is no quick fix - reconnecting your mind and body and healing dissociation takes time, patience and good therapy.
Some specific recommended therapies for dissociation include Sensorimotor Psychotherapy, Somatic Experiencing, and Internal Family Systems. EMDR can be safe if the therapist is trained specifically in EMDR for dissociation, but there are additional risks.
How do therapists recognize dissociation?
Therapists can look for these signs of dissociation in sessions:
Blank stare or glazed eyes, staring off into space
Yawning
Rigid posture
Restlessness or fidgeting
Forgetfulness in session
Emotionally cold
Abrupt shifts in presentation or mood
Disorientation
Therapists can also listen for dissociative language in speech:
Floaty, Foggy, Frozen, Drifting
Switch off
Shut down
2nd person language (client says “you” instead of “I” when talking about themself)
Client refers to self as “we”
Therapists can also feel for signs within themselves in session with clients who are dissociating. Therapists might feel:
Cold
Numb
Distant
Detached
Pulling away
Noticing these cues gives the therapist an opportunity to ground and come back into their own body, to coregulate with the client, help the client ground, bring attention to the signs in session, or discuss dissociation with their client.
Therapists can consult with another therapist or supervisor and receive training for best practice in working with dissociation.
What are common misconceptions about dissociation?
Common misconceptions are that dissociation is extreme, rare or a conscious choice, and that people who dissociate are faking it, dangerous, seeking attention, or can’t heal. None of these are valid but they seriously affect people living with dissociation.
Dissociation is a frequent response to childhood sexual trauma and brings in the difficult realms of law, politics and abusers, with a very controversial history.
When you normalize dissociation, you can have more empathy, compassion and understanding for people who have more severe forms of dissociation.
What resources can you recommend for anyone who wants to learn more about this topic?
ISSTD (the International Society for the Study of Trauma and Dissociation) is the primary source for both professionals and the public. They offer training and guidelines for therapists working with dissociation and they link to lots of different fact sheets and websites offering information and resources for people with dissociation, their loved ones, and professionals.
Any favorite resources on trauma you like to recommend?
Meditation is a frequently recommended tool but difficult for folks with trauma. Insight Timer is an app that offers many ways to be guided through meditations and visualizations for breathing, sleep, and regulation: https://insighttimer.com/
A favorite resource to recommend is a weighted blanket to give you a daily sense of safety and security.
Any final thoughts?
Remember the goal is to have compassion for self, not to remove dissociation from your life.
Ask yourself where you need support, acceptance, or resources. Reflect on what is working for you in your life now and what is not working.
Trust your own intuition, and the feeling you get when something doesn’t feel good. Take the risk to be vulnerable and share the feeling with someone who cares.
Trust yourself and trust your body – your body is just trying to protect you.
Dissociation is not bad. Dissociation saves people from suicide. Use it where it is helpful and get help where you need it.
Carol Korenowski is a psychologist and the founder of Therapy Alberta, a private group practice with psychologists, social workers, and counsellors offering trauma-informed individual, couples, teen and family therapy in Calgary and across Alberta.