Is dissociation a problem among people in the U.S. – and what are the common symptoms of dissociative disorders?
Consider this.
It’s the end of another long, difficult day. You plop down on the couch, grab your phone, and begin to scroll through your favorite social media site.
You planned to spend 20 or 30 minutes online. But when you look at the clock, you discover almost three hours passed.
In 2022, a team of researchers from the University of Washington explored this phenomenon in a study titled I Don’t Even Remember What I Read: How Design Influences Dissociation on Social Media.
“Social media platforms are designed to keep people scrolling,” the study’s lead author, doctoral student Amanda Baughan, said in a UW News article about her team’s research.
“When we are in a dissociative state, we have a diminished sense of agency, which makes us more vulnerable to those designs and we lose track of time,” Baughan added. “These platforms need to create an end-of-use experience, so that people can have it fit in their day with their time-management goals.”
Dissociative episodes like this aren’t limited to social media experiences.
For example, have you ever driven to work, pulled into the parking lot, and discovered you have no memory of your drive? Some people refer to this as highway hypnosis, but it can also be classified as a type of dissociation.
“Dissociation is defined by being completely absorbed in whatever it is you’re doing,” Baughan said. “But people only realize that they’ve dissociated in hindsight. So once you exit dissociation there’s sometimes this feeling of, ‘How did I get here?’”
Sometimes, as the UW team explored, dissociation is a form of advanced daydreaming, fueled partially by the desire for temporary distraction and exacerbated by app designers who equate extended screen time with greater profits.
But dissociation isn’t always as benign as zoning out while staring at a screen or through a windshield. For some people, dissociative episodes are evidence of untreated trauma or signs of a serious mental health disorder.
What Is Dissociation?
In a clinical context, the term dissociation refers to the sense of being disconnected from yourself and/or your environment.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes this experience as follows:
“…a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.”
According to Karl Deisseroth, MD, PhD, of Stanford University, experts estimate that 2%-10% of people will have at least one dissociative episode over the course of their lifetime.
During a dissociative episode, a person may experience depersonalization, derealization, or both.
Depersonalization
Depersonalization is the sensation of being detached from your body, thoughts, emotions, and behaviors. Sometimes, people refer to depersonalization as having an out-of-body experience.
Examples of what depersonalization include:
- Feeling like you’re floating above your immediate environment and observing yourself from afar/above.
- The feeling someone else has control of your thoughts and movements, like you’re a robot or an automaton.
- Feeling numb to both physical and emotional sensations. You know they’re happening, but you can’t feel them.
- You can’t properly judge the passage of time.
In a September 2020 article on the Stanford Medicine website, Deisseroth described this as “the perception of being on the outside looking in at the cockpit of the plane that’s your body or mind – and what you’re seeing, you just don’t consider to be yourself.”
Derealization
Derealization refers to the sensation that you’re separated from your environment.
The Mayo Clinic lists the following common symptoms of derealization:
- Feeling like you’re in a dream, and the people and objects you interact with are not real
- A distinct emotional separation between yourself and others, as though viewing the rest world through a thick fog or a pane of glass.
- The sense that the world is black and white, or flattened into only two dimensions, like a picture.
- Dramatic shifts in perspective, which may include having trouble determining the size and shape of objects or their distance from you.
What Causes Dissociation and/or Dissociative Disorders?
The likelihood that people will experience dissociative episodes in the absence of dissociative disorders is influenced by a variety of factors, including:
- Exposure to overwhelming stress
- Physical and psychological exhaustion
- Misuse of cannabis, PCP, ketamine, and other substances
- Living through or witnessing one or more traumatic events
- Anxiety, depression, post-traumatic stress disorder (PTSD), and other mental health disorders
In addition to anxiety, depression, and PTSD, there’s an entire category of mental illness that list dissociation as primary characteristics: dissociative disorders.
What Are Dissociative Disorders?
One-off or infrequent dissociative experiences are often the result of stress, exhaustion, or substance misuse. They may also be symptomatic of an anxiety disorder or depression. But if someone has frequent periods of dissociation, they may meet clinical criteria for a dissociative disorder.
The dissociative disorders section of the DSM-5 contains entries for multiple conditions, including depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder.
Depersonalization/Derealization Disorder
A person meets criteria for this diagnosis if they show persistent, recurrent episodes of either depersonalization or derealization (or both) not attributable to substance use, a medical problem, or another mental health disorder.
This disorder can cause considerable distress, and impaired functioning in one or more important areas of life.
As noted in the DSM-5, people who have this disorder often fear that they’re going crazy or they have a serious brain injury. In some cases, they need continued reassurance that they actually exist or that what they perceive is truly real.
Dissociative Amnesia
A person with dissociative amnesia can’t recall events or periods from their past associated with stressful or traumatic experiences.
In some cases, dissociative amnesia prevents a person from remembering a single event or a specific day. In other cases, it can cause extensive memory gaps, potentially obscuring several months or years of memories.
Though it’s possible for an individual to lose memory of their entire life and their personal identity, this type of generalized dissociative amnesia is rare.
Dissociative Identity Disorder
Also referred to as DID – and previously known as multiple personality disorder – this is perhaps one of the most misunderstood mental health conditions. Overly dramatic, exploitative portrayals in television shows and films are the source of much of the misunderstanding about this disorder.
In addition to having memory gaps, a person with dissociative identity disorder will also show “two or more distinct personality states.”
People with DID may experience shifts in personality characteristics, including their attitude, affect, preferences, speech patterns, and behaviors. When they shift from one set of characteristics to another, they may feel suddenly awakened, with no memory of how they got to their current location or what they were doing before.
Trauma, Dissociation, and Dissociative Disorders
According to a May 2022 article in the Delaware Journal of Public Health (DJPH), there is “a robust correlation” between trauma and dissociation. This link is particularly strong, the authors reported, among people who report early/childhood trauma.
For these individuals, dissociation may serve two purposes:
- Dissociation can function as a way of distancing the victim from the negative experience. The authors of the DJPH article describe this as “a psychic escape when there is no physical escape.”
- Dissociating can function as a way to prevent additional psychological distress when the individual encounters a situation that might trigger memories of early/childhood trauma.
It’s not difficult to understand how recurring periods of trauma-related dissociation can undermine the ability to enjoy a full, productive, and satisfying life. Adding to the challenges of managing these disruptive symptoms, people with dissociative disorders report difficulty finding appropriate treatment and support.
The Impact of Untreated Dissociation and Dissociative Disorders
The DJPH article cited above notes that people with dissociative disorders typically spend five to 12 years in treatment – and see an average of at least six clinicians – before they receive an accurate diagnosis.
During this period, their symptoms often escalate in severity, which can exacerbate the harmful effects of the symptoms and the disorder.
Research correlates the following negative outcomes with untreated dissociative disorders:
- Difficulty performing typical acts necessary for daily living
- Diminished academic and occupational function
- Elevated rates of diabetes, cardiovascular problems, chronic pain, and other medical issues
- Poor adherence to medical treatment and pharmacological response
- Greater likelihood of revictimization, including being assaulted or abused
- Increased substance misuse and addiction
- Heightened risk of intentional self-harm, suicidal ideation, and suicide attempts
The authors of the DJPH article report that more than 70% of people who receive outpatient care for a dissociative disorder have a history of at least one suicide attempt. Many patients report multiple suicide attempts.
Here’s how the DJPH research team describe the necessity of treatment for dissociative disorders:
“When dissociative symptoms become a pattern or entrenched, they can negatively impact many domains of functioning in a person’s life. To prevent these outcomes, it is imperative that clinicians are trained to assess, recognize, and treat dissociative symptom patterns that have historically been overlooked or disbelieved.”
Gianna Melendez
Jodie Dahl, CpHT