What’s the Link Between Trauma and Dissociation?

Dissociation is an escape. It’s an involuntary detachment from reality, often experienced as a disconnect from your sense of self, thoughts, and memory.

Dissociation usually occurs due to trauma, such as:

• abuse
• sexual assault
• a natural disaster
• an accident
• military combat

“Dissociation, believed to be the oldest psychological defense mechanism we can develop, is the ability to disconnect from our thoughts, feelings, body, actions, and surroundings,” explains Alyson Privitera, LCPC, NCC, CCTP, a counselor based in Baltimore, Maryland.

“When human beings are psychologically overwhelmed, a component of trauma, we seek safety. Sometimes that safety cannot be met at that time by our external world, so we shift to seeking safety internally.”

The outside world wasn’t within our control, she explains, but our inner world is more so.

Trauma is, by definition, an overwhelming emotional response to a horrific event. Dissociation can be a critical part of your survival instinct during trauma. When a horrific event happens, your nervous system kicks in to protect you from mental and physical pain.

“Dissociation is part of the fight-or-flight response, which is an involuntary survival network that helps protect us from threats or danger,” says Sabina Mauro, PsyD, who specializes in treating patients living with trauma in Yardley, Pennsylvania.

“During traumatic experiences, the fight-or-flight is activated in order to protect the individual,” she explains. “If fight-or-flight is not a viable option or if fight-or-flight becomes inactive due to the body feeling overwhelmed, the freeze response is activated.”

According to Mauro, it’s during the “freeze response” that you can experience disconnect. Because there aren’t any other options available, you essentially sever contact between your brain and body in order to survive the experience. This is a similar survival response to a mouse “playing dead” when caught by a cat to increase its chances of getting out of there alive.

While dissociation is a helpful strategy at the time, it can also arise long after the trauma is over, causing problems in your daily life. Dissociation might occur when you encounter a situation or object that reminds your nervous system — consciously or subconsciously — of the trauma.

Trauma can actually change the structure and function of the brain, so it’s no wonder that we feel strong mental and physical sensations related to it.

When you dissociate, you may feel disconnected from yourself and from the world around you. You might feel like you are separate from your body, or you might feel like the world around you isn’t real.

Signs and symptoms that you are dissociating include:

• feeling disconnected from your body, like an “out-of-body experience”
• feeling separate from the world around you
• feeling numb or experiencing emotional detachment
• lacking a sense of identity, or a sense of who you are
• forgetting certain events or personal information
• feeling little physical pain
• having clear, different identities, as in dissociative identity disorder

Importantly, everyone’s experience of dissociation is different. The key is to find out what it feels like for you so that you can notice it when it arises.

It’s often helpful to do this with a mental health professional. Parts of your brain “shut down” during dissociation, so it can be difficult to notice when it’s happening. A therapist can help you recognize the signs that you’re dissociating or that an episode is coming on, so that you can take steps to keep yourself safe.

Two forms of dissociation are:

• Depersonalization. This feels as if you’re watching yourself as an actor in a movie. You may feel as though you’re having an out-of-body experience, floating around your actual body.
• Derealization. This feels like the people and things around you are unreal — almost as if you’re in a dream. Sounds may be distorted, or the world may look “unnatural” in some way.

According to the National Alliance on Mental Illness (NAMI), approximately 75% of people experience an episode of depersonalization or derealization at least once in their lives, and only 2% experience chronic episodes linked to dissociative disorders.

While many people may experience dissociation, often related to past trauma, the symptoms don’t always meet the criteria for a mental health disorder.

Episodes of dissociation vary in length; they might last a few hours or days, or they could last much longer, into weeks or months. If you learned to dissociate from a young age, dissociation may be a common experience as an adult, and it might be the main way that you cope with stress. This may signal a dissociative disorder.

As dissociation is the body’s response to extreme stress, research from 2014 suggests it can be present, in some form, in almost all psychiatric disorders. This includes anxiety disorders, panic disorder, and depression.

Below, we look at some mental health conditions that commonly involve dissociation.

Dissociative disorders

If you’re experiencing chronic episodes of dissociation, you may meet the criteria of diagnosis for one of the three types of dissociative disorders:

• Depersonalization/derealization disorder (DPDR). With DPDR you frequently feel as though you’re watching your actions and thoughts from an outside perspective.
• Dissociative identity disorder (DID). If you have DID, you may feel as though you have different selves or that you don’t always have control over your different parts. You may wonder which persona inside you is the “real” you.
• Dissociative amnesia. Dissociate amnesia often involves memory loss around a traumatic event. You may completely forget the trauma, or you may block out things that remind you of the trauma during a regular day. You might forget things like chores, work deadlines, or to pick your dog up from the vet.

If trauma-related dissociation is holding you back in your daily life, help is available. Treatment options exist for all forms of dissociative disorders.

Borderline personality disorder

Dissociation is often a component of borderline personality disorder (BPD). Many people with BPD have a history of early life trauma.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD), and its newer counterpart complex PTSD, both commonly involve dissociation.

Since PTSD is a fear-based diagnosis, dissociation can occur during trauma-related triggers as a way to cope with the physical sensations that occurred at the time of the trauma.

When you’re living with trauma-related dissociation, you may not know how to start the healing process. The first step is to acknowledge and accept that dissociation is happening.

“Accepting and recognizing when we dissociate is the first step, but it can be challenging,” Privitera says. “Notice what you are feeling that you may be wanting to avoid, consciously and unconsciously.”

Trauma-focused therapy can be especially helpful. This means working with a therapist who understands trauma and the way it affects your body and mind. Therapy will help you develop coping skills that will aid you in exploring emotions and memories related to trauma while preventing retraumatization.

Various therapies can help you deal with the mental and physical effects of trauma, including:

• psychodynamic therapy
• cognitive behavioral therapy (CBT), especially cognitive processing therapy
• dialectical behavior therapy (DBT)
• eye movement desensitization and reprocessing (EMDR)
• support groups
• somatic therapy

After you and your mental health professional decide on a treatment plan that suits your needs, there are additional strategies that may help you manage symptoms of dissociation.

Grounding techniques

Privitera says that when you notice you’re dissociating in the moment, you can then begin to
utilize grounding techniques.

Grounding involves connecting with your surroundings. You can do this by putting your hands under running water and noticing the sensations that arise, or touching a familiar object and describing its properties. Is it cold or warm? Smooth or rough?

“For most individuals, simply noticing your feet on the floor or your breath won’t be that helpful, regardless of what Instagram alleges,” she cautions. “I suggest to clients that they practice something less abstract and a bit more challenging.”

She recommends that, for some people, a mental-based approach can help. “Math is an excellent tool for coping with dissociation. Practice your times tables; start at 100 and count backward by 7s or 4s or 5s.”

She also suggests seeing how many countries you can name or finding four blue objects and two round objects in your current space.

Mindfulness

Mindfulness is becoming a valuable resource for mental well-being.

Mindfulness is the practice of being present in the moment. While there are many ways to train this ability, one straightforward method involves focusing on your breath coming in and going out.

“Mindfulness is a powerful tool that can be used to cope with dissociation,” Mauro notes. “In traumatized survivors, the body is unable to recognize that the trauma no longer exists. As such, the body is constantly in stress mode.”

Because the body isn’t capable of understanding time during dissociation (e.g., differentiating past from present), mindfulness can teach your body to be present in the moment.

By teaching your body to be present in the moment, the body recognizes the trauma is not currently happening, and it doesn’t need to be in ongoing survival mode.

Breathing routines

While mindfulness can keep you in the moment, breathing routines can help deescalate severe moments of dissociation that result in anxiety or stress. There are a variety of methods to try.

Mauro explains, “Deep breathing strategies can also teach the body to calm down the fight-or-flight response.”

She adds, by calming down your survival network, dissociation is less likely to occur as you’re able to learn to tolerate any physical sensations, negative emotions, and painful memories associated with the trauma.

Trauma-related dissociation may spare you some memories from past events, but it can severely impact your daily life.

Help exists in the form of treatments such as trauma-focused therapy and grounding techniques. You can start healing from trauma while developing skills to manage symptoms of dissociation.

Trauma is treatable and support is available. You can use the American Psychological Association’s Psychologist Locator to find a therapist who is familiar with trauma. You can also look up support groups near you.

If you’d like to learn more about how trauma affects the mind and body, including dissociation and dissociative disorders, the following books are a good place to start:

• “The Body Keeps the Score” by Bessel van der Kolk, MD
• “Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation” by Janina Fisher, PhD
• “Trauma and Recovery” by Judith Lewis Herman, MD
• “The Complex PTSD Workbook” by Arielle Schwartz, PhD
• “Trauma and the Body” by Pat Ogden, PhD
• “What Happened to You? Conversations on Trauma, Resilience, and Healing” by Bruce D. Perry, MD, PhD, and Oprah Winfrey

Remember, you’re never alone. Many other people have experienced trauma. They understand how trauma-related dissociation can take control over your life, and they are there to help.