What is dissociation? What experts need to know

You may have had that creepy out-of-body experience from time to time, but with dissociation, it can be severe and long-lasting. Here’s what you need to know about its causes and treatments.

What is dissociation?

You’re in the middle of a meeting and your boss asks your opinion on the topic at hand. There’s just one problem: you have absolutely no idea what that topic is. Maybe bad news has caused you to disconnect from the here and now. You may even feel like you are seeing things happening outside your body.

Sounds familiar? If so, according to the National Alliance on Mental Illness (NAMI), you are among the 75 percent of people who experience at least one episode of dissociation in their lifetime.

These episodes can happen to anyone at any time, regardless of age, race or background. They can be mundane and short-lived, like losing track of time and place when engrossed in a novel, or more serious and chronic.

“These episodes are different from the attention problems seen in a condition like ADHD,” says Tobechukwu Clouden, MD, an adult psychiatrist in Red Bank, New Jersey. “As opposed to just being distracted, it’s really the feeling that you’ve left your body.”

(Here’s when and how to talk about mental illness at work.)

When does dissociation occur?

Sometimes dissociation can occur as a side effect of medication or as part of an underlying illness such as epilepsy or migraine headaches. Drinking too much alcohol can also cause feelings of dissociation. And stress overload can do the same in otherwise healthy people, says John H. Krystal, MD, professor of translational research and chair of the division of psychiatry at Yale University School of Medicine in New Haven, Connecticut.

“With a certain amount of stress, things get sharper and you work faster and more efficiently,” says Dr. Krystal, also chief of psychiatry at Yale-New Haven Hospital. But “with extreme stress, attention becomes fragmented and instead of being more in the action, we become disconnected from what is going on around us.

“Our ability to process information is increasingly disrupted and slows down instead of speeding up,” he adds. “Such extreme stress can follow a car accident or hearing bad news. This is common and usually transient.”

(Here are some stress management tips for relief.)

The more severe, long-term dissociative disorders are usually related to physical, sexual, or psychological trauma, according to NAMI.

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Degrees of Dissociation

There are ranges of dissociation and associated symptoms.

“Daydreaming can be a very mild dissociative state,” says Dr. cloud. “Your body is there physically, but your mind is off everywhere and people have to bring you back to reality.”

These episodes aren’t necessarily a cause for concern unless they become more frequent and disrupt your life, says Dr. cloud. “If you wander all the time and it affects school and work, then it can become a problem,” she says.

Dissociative disorders are much more serious and long-lasting, she adds. “These people can’t remember who they are, where they are, and how they got there,” she says. “That’s where it becomes a disorder.”

Dissociative Disorder Causes

While strongly linked to a history of trauma, these disorders tend to travel with other psychiatric conditions such as post-traumatic stress disorder (PTSD) or depression, Dr. cloud. Only two percent of people who have a dissociation episode will develop a dissociative disorder, and according to NAMI, women are more likely than men to have one. (This is what your brain looks like with PTSD.)

“Trauma is one of the most common denominators we see in recurrent experiences of dissociation,” says Dr. crystal. Natural disasters and time spent in combat can also cause dissociative disorders.

Some people have dissociative states without any history of trauma, says Dr. crystal. “They can be naturally vulnerable to having these states.”

There aren’t many studies on the brains of people with dissociative disorders. However, much research has been done on what happens in the brain when people take drugs — such as ketamine, angel dust, and nitrous oxide, or “laughing gas” — that cause dissociative symptoms. When they take these drugs, “people experience things around them in an unreal way,” says Dr. crystal.

Based on these studies, we would expect the tuning of cortical activity in the brain to be compromised, he says.

The cortex of the brain is divided into parts that control sight, hearing, smell and sensation, as well as speech, thinking and memory. “We see reduced communication from the higher centers of the cerebral cortex, such as the temporal lobe, with other parts of the brain,” says Dr. crystal. The temporal lobe is in charge of creating and storing memory.

Types of Dissociative Disorders

The three main types of dissociative disorders are:

Dissociative identity disorder

Once known as multiple personality disorder, dissociative identity disorder usually occurs after extreme abuse, says Dr. cloud. With this type of dissociative disorder, other personalities come forward to protect you from remembering a traumatic event. These personalities may have their own names and ways that are very different from yours. Memory gaps occur when another personality takes over.

People with this condition are more likely to commit suicide or self-harm, notes NAMI.

(Also, read more about the signs of borderline personality disorder.)

Dissociative amnesia

Also linked to trauma, dissociative amnesia involves forgetting bits of your life or sometimes your entire autobiography, says Dr. cloud.

“This is your mind’s way of protecting you from memories of abuse. It can last a few days, a few weeks, a few months, and some people never reminisce,” she says. “The trigger is usually a traumatic event that just happened, and all of a sudden they completely forget some autobiographical information. This trigger can evoke memories of the past trauma.

Depersonalization/Derealization Disorder

With this condition, you feel like you’re looking in from the outside, Dr. Clouden says. “Maybe you see yourself as a character in a movie,” she adds. These feelings can last for minutes and return over time. They tend to first develop when you’re in your teens, according to NAMI.

“People can have not only symptoms of dissociative disorder, but also anxiety or depression symptoms,” says Dr. crystal. “The constellation of symptoms is what brings them to a mental health professional.”

Diagnosis of Dissociative Disorders

Your doctor will rule out physical causes of the symptoms, such as head injuries, brain tumors, sleep deprivation, medications, side effects, or intoxication.

If an underlying illness such as epilepsy is causing the dissociative symptoms, medication can help treat the seizures and the aura that precedes them, says Dr. crystal. Aura is characterized by visual disturbances and sometimes a feeling of being separated from your body.

It is important to listen carefully to the symptoms described as dissociation, as they can be confused with the hallucinations and delusions of psychosis.

The difference teasing is important because the treatments are different. “If the diagnosis is wrong, the patient may be given antipsychotic medication instead of anti-anxiety medication,” he says. “And they may not receive the same intensive psychotherapy that can be helpful for trauma.”

Treatment for Dissociative Disorders

Talk therapy aimed at unraveling the root cause of trauma is the treatment of choice for dissociative disorders, says Dr. cloud. There are no medications available to treat dissociative disorders. “However, you can prescribe medications to treat anxiety or depression associated with the condition,” she adds.

Not all dissociative disorders need treatment, but many do. “If there’s a short period of time that you can’t remember, but you’re moving forward and living your life, you may not have to deal with it,” says Dr. cloud.

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