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Dissociation: Symptoms, causes, types, and treatments

Reviewed by Kirsten Davin, OTD, OTR/L, ATP, SMS

Cutout of a white paper brain on a jumbled collection of pink cutouts

What Is Dissociation?

Dissociation is a mental process that involves feeling disconnected from reality. One may feel like they are watching themselves from above or see themselves and others as unreal. Dissociation can range in severity, from daydreaming to loss of memory and identity. 

Is Dissociation a Mental Disorder?

Dissociation itself is not a mental health disorder. However, it is a sensation or experience that can be a symptom of a disorder. In its most severe form, dissociation may be a sign of dissociative disorders, such as depersonalization/derealization disorder or dissociative identity disorder (DID).

Dissociation vs. Derealization vs. Depersonalization

Although the terms dissociation, derealization, and depersonalization have common threads, each carries a distinct meaning:

  • Dissociation: A general term that covers many ways in which a person can feel disconnected from their thoughts, memories, and the world around them
  • Derealization: A specific feeling that the world is not real, causing everything to look foggy, far away, or as if the world is a movie
  • Depersonalization: An experience in which a person feels “out of body” or detached from their physical body; may be triggered by looking in a mirror or thinking about their body

Dissociation Symptoms

Dissociation can include many different symptoms ranging in severity. Common symptoms of dissociation include:

  • Altered senses
  • Emotional changes
  • Sudden and unanticipated shifts in mood
  • Feeling “out-of-body” or as if floating above the physical body
  • A sense of disconnect and lack of bodily control 
  • Seeing life as dreamlike or others as unreal
  • Gaps in memory and an inability to recall certain people, places, or events 
  • Identity issues and confusion

What Does Dissociation Feel Like?

Dissociation can present differently depending on the severity. Mild dissociation may consist of  daydreaming, forgetting one’s surroundings while lost in a book, or driving down a familiar road without being able to recall the last several miles. Severe dissociation can involve dissociative amnesia with significant gaps in memory, the emergence of multiple identities, and other dissociative disorder symptoms.

Because dissociation can range in severity and may be a symptom of a more serious mental illness, it’s important to see a therapist for a formal diagnosis. 

What Causes Dissociation?

While the exact cause of dissociation is unknown, studies suggest it may be a coping mechanism in an effort to “disconnect” from reality during times of immense stress. 

Risk Factors

There are many risk factors that may increase one’s chance of experiencing dissociation, including:

  • Trauma, especially childhood abuse
  • Extreme stress
  • Emotional abuse or neglect
  • Substance abuse
  • History of self-harm and/or suicidal ideation
  • Traumatic brain injury (TBI), neurological diseases, or chronic migraines

Having a history of a mental health disorder may also increase one’s risk for dissociation. Mental health disorders associated with dissociation include:

Types of Dissociative Disorders

Depersonalization/Derealization Disorder

Depersonalization/derealization disorder involves dissociation where one might experience feeling “out-of-body,” feeling unreal, or being unable to recognize one’s own reflection. Those with depersonalization/derealization disorder may also experience changes to their senses and struggle to react to their emotional changes. 

Dissociative Amnesia

While experiencing dissociative amnesia, a person might forget certain personal information or events they have experienced. This goes beyond normal forgetfulness and can involve forgetting entire conversations with others or even traumatic events that have happened. 

Dissociative Fugue

Dissociative fugue (meaning “flight” or “to flee”) is a rare form of dissociative amnesia. A person with dissociative fugue may lose some or all of their memories, leading to extreme confusion. They may struggle to hold a job, remain in relationships, or maintain a stable environment due to severe dissociation and memory loss. 

Dissociative Identity Disorder (DID)

Dissociative identity disorder (DID) involves the emergence of multiple different identities within the same person. Someone who suffers from DID may feel like a stranger to themselves and behave very differently at different times, depending on which identity is coming through. This often leads to confusion, loss of memory, and social difficulties. 

Is Multiple Personality Disorder Real?

Multiple personality disorder is the former term for dissociative identity disorder. Although rare, affecting 0.1-2% of the population, DID is a very real disorder, but is often inaccurately portrayed and overly sensationalized in the media. 

DID is a known coping mechanism, which can develop after severe trauma or abuse in childhood. The “personality states” or identities that emerge with DID are distinctly different. The intricacies of each personality state are significant, in such a way that someone who has dissociative identity disorder may even exhibit different handwriting with each identity. DID always requires professional diagnosis and care, including a series of diagnostic testing via a therapist to acquire a formal diagnosis. 

Dissociation Treatment 

Treatment for dissociation is determined by the severity of symptoms and the presence of an underlying disorder(s). Dissociation treatment might include:

  • Cognitive behavioral therapy (CBT): CBT focuses on changing thought and behavior patterns by using coping strategies, problem-solving, and emotional regulation. 
  • Eye movement desensitization and reprocessing (EMDR): In certain cases, EMDR can help ease distress caused by traumatic events or memories that may be triggering episodes of dissociation. 
  • Electroconvulsive therapy (ECT): ECT is a procedure that passes electrical currents through the brain in an attempt to reverse certain symptoms related to a mental health disorder. More research is needed to determine the effectiveness of ECT for dissociation.
  • Transcranial magnetic stimulation (TMS): TMS uses magnetic fields to stimulate the brain, potentially improving symptoms of depression and other mental health conditions. However, like ECT, more research is needed on TMS for treating dissociation. 
  • Medication: While medication may not directly impact dissociative identity disorder, they can be prescribed to help with other co-occurring symptoms and disorders, such as anxiety or depression. 

Which Types of Therapy Can Make Dissociation Worse?

Some types of therapy, including hypnotherapy, may not be recommended for people struggling with dissociation. While EMDR helps some people with dissociation, it can worsen symptoms in others. 

If you have been experiencing symptoms of dissociation, schedule an appointment with a therapist. They can offer a professional diagnosis and discuss the right course of treatment for you. With the appropriate treatment plan, you can find relief from dissociation and begin living a happier, more fulfilling life.  

Find a dissociation therapist near you today. 

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