What is dissociation? Signs, causes and what helps

What is dissociation?

The NHS puts it simply: “Dissociation is a way the mind copes with too much stress”^[2]. It is not something you choose to do. The World Health Organization (WHO) describes dissociative disorders as an involuntary break in how your identity, senses, feelings, thoughts, memories, movements or behaviour usually fit together. That break is “more commonly partial”, and it “can vary from day to day or even from hour to hour”^[3].

So dissociation on its own is not a disorder. It becomes a dissociative disorder only when symptoms are severe enough to cause “significant impairment” in your personal, family, social, work or study life^[3].

What dissociation can feel like

• Watching yourself from a distance, as if you were in a play^[4]
• Feeling detached from your thoughts, feelings or body^[4]
• Feeling emotionally or physically numb^[4]
• The world seeming dreamlike, distant, foggy or lifeless^[2][4]
• Time seeming distorted^[4]
• Forgetting periods of time, events or personal information^[2]
• Feeling uncertain about who you are^[2]

Is dissociation normal? Everyday dissociation vs a disorder

Yes, mild dissociation is normal. The American Psychiatric Association gives daydreaming, “highway hypnosis” (arriving somewhere with no memory of the drive) and “getting lost” in a book or film as examples. All of them involve “losing touch” with your surroundings^[1]. In a random sample of 1,055 adults in one Canadian city, dissociative experiences were common, and they became less frequent with age^[6].

Brief feelings of unreality can also happen when you are under stress, very emotional, exhausted, physically ill or under the influence of a substance. The WHO says such experiences “typically remit when these emotional or physical states change”^[4]. That is the main line between everyday dissociation and a disorder: whether it passes, and how much it affects your life.

Based on the American Psychiatric Association, the NHS, the WHO’s ICD-11 and a systematic review^{[1][2][3][4][8]}. It is a guide, not a way to diagnose yourself.

Signs and symptoms of dissociation

Dissociation feels different for different people. Doctors group the main experiences into four kinds: feeling detached from yourself, feeling that the world is unreal, memory gaps, and changes in your sense of identity^[1][2].

Depersonalisation

The NHS describes depersonalisation as “the feeling of being outside yourself and observing your actions, feelings or thoughts from a distance”^[2]. You might feel emotionally or physically numb, and time can feel distorted^[4].

Derealisation

Derealisation “is where you feel the world is unreal. People and things around you may seem ‘lifeless’ or ‘foggy’”^[2]. The world can also look dreamlike, distant, colourless or visually distorted^[4].

With both, you still know what is real. The WHO says “reality testing remains intact”^[4], and the American Psychiatric Association notes that the person “is aware of reality and that their experience is unusual”^[1]. Worrying that you are “going crazy” can be part of the experience too^[4]. These feelings “may last only a few moments or come and go over many years”^[2]. When depersonalisation-derealisation disorder develops, it usually starts in the teenage years, at an average age of about 16^[1][4].

Memory gaps (dissociative amnesia)

Dissociative amnesia is “an inability to recall important autobiographical memories, typically of recent traumatic or stressful events, that is inconsistent with ordinary forgetting”^[5]. The NHS says the gaps are “much more severe than normal forgetfulness”, and some people “find themselves in a strange place without knowing how they got there”^[2]. Episodes can last minutes, hours or days, and rarely months or years^[2]. Before this is diagnosed, a doctor will check that the memory loss is not caused by a substance, a condition of the nervous system or a head injury^[5].

Changes in identity, and DID

Feeling unsure who you are is one possible sign^[2]. Much more rarely, a person has two or more distinct identities, or “personality states”, along with ongoing memory gaps. This is dissociative identity disorder (DID), which used to be called multiple personality disorder^[1]. The American Psychiatric Association stresses that “although these alternate states may feel or appear to be very different, they are all manifestations of a single, whole person”^[1]. DID is more closely linked with childhood trauma than depersonalisation is^[4]. Experts warn that social media content about DID is “routinely unreliable and low quality”, which is why a careful, personal assessment matters^[34].

How common is dissociation?

Brief episodes are very common. In population surveys, between 26% and 74% of people say they have felt depersonalised or derealised at some point, and between 31% and 66% at the time of a traumatic event. The range is wide because studies use different definitions and time frames^[7].

The disorder is much rarer. A systematic review puts depersonalisation-derealisation disorder at “around 1% in the general population”, and finds it more common in teenagers and young adults^[8]. A large UK study of people born in 1946 found a similar figure, 0.95%, at age 36^[9]. It affects men and women about equally^[4].

For all dissociative disorders together, estimates vary widely between community studies, which used different interviews, time frames and groups of people^[10][11]. Many cases may go unrecognised: in one study of women in Turkey, fewer than a third of those with a dissociative disorder had ever had psychiatric treatment^[11].

What causes dissociation?

There is no single cause. For depersonalisation, the WHO lists stress, anxiety, low mood, too much sensory input, lack of sleep and substance use as things that can make symptoms stronger^[4].

Stress and trauma

The American Psychiatric Association says: “Dissociative disorders are frequently associated with previous experience of trauma.” During an accident, a disaster or a crime, dissociation “can help a person tolerate what might otherwise be too difficult to bear”^[1]. The NHS calls switching off from reality “a normal defence mechanism”. It “becomes a problem when the environment is no longer traumatic but the person still acts and lives as if it is”^[2]. Across 65 studies, people who were abused or neglected as children reported more dissociation than others. Abuse that started earlier, lasted longer or came from a parent was linked with higher scores^[12].

But it is a link, not a rule. Some researchers see strong evidence that trauma causes dissociation^[13]. Others argue that the studies show a link rather than a cause, and that trauma is one factor among several^[14]. The WHO notes that the link with childhood trauma is weaker for depersonalisation-derealisation disorder, and that some cases begin “out-of-the-blue”, with no trigger anyone can identify^[4]. In the UK study of people born in 1946, childhood anxiety was the only significant predictor of adult depersonalisation; parental death or divorce was not^[9]. Dissociating does not mean that something terrible must have happened to you. For how trauma can echo through families, see intergenerational trauma.

Dissociation and PTSD

Dissociation can be part of post-traumatic stress disorder (PTSD). Flashbacks and dissociative memory loss are counted among the core symptoms of PTSD^[16]. Some people with PTSD also have depersonalisation or derealisation^[15], which the US diagnostic manual (DSM-5) recognises as a “dissociative subtype”^[16].

Estimates of how many people with PTSD have it vary. In World Mental Health Surveys across 16 countries, the figure was 14.4%^[18]. A review of 49 studies found 38.1%, but the studies differed a lot from each other^[17]. People with this subtype tend to struggle more in daily life and have a higher risk of suicidal thoughts and behaviour^[16][18]. Among mental health conditions, dissociation scores are highest in dissociative disorders, followed by PTSD, borderline personality disorder and conversion disorder^[19]. See our page on PTSD therapy.

Anxiety, panic and low mood

Feeling unreal can happen during panic attacks. The WHO says panic attacks may come with marked depersonalisation or derealisation, “which may persist for a time after the panic episode subsides”. It is also common in generalised anxiety, social anxiety and depression^[4]. A review found rates in panic disorder ranging from 7.8% to 82.6%^[7], and the UK birth cohort study found strong links between depersonalisation and anxiety and depression^[9]. If you feel unreal when you panic, it is a recognised part of anxiety. Read more in stress vs anxiety or on our anxiety therapy page.

Lack of sleep, cannabis and other substances

• Sleep. In a small experiment, healthy students kept awake for 36 hours had more dissociative symptoms^[22]. In a study of hospital inpatients, sleep and dissociation were linked, and the authors suggest better sleep habits may help^[23]. These are small studies, so lack of sleep is best seen as something that can make dissociation worse. See therapy for insomnia.
• Cannabis and hallucinogens. The WHO calls them a “common precipitant” of depersonalisation and derealisation^[4]. For some people, the feelings persist after the drug has worn off. That evidence comes from one specialist clinic^[20] and a case series of six young people^[21], so nobody knows how often it happens.
• Substances and medicines. Because they can cause similar symptoms, a doctor will want to rule them out before diagnosing a dissociative disorder^[4].

How to stop dissociating: grounding techniques that may help

You usually cannot switch dissociation off on command. Grounding means using your senses and your body to bring your attention back to the present moment. In clinical settings, grounding is “frequently cited as a primary approach” for dissociative episodes^[24]. Expert guidelines for treating DID include grounding skills^[25], and UK guidance says EMDR for PTSD should include techniques for managing flashbacks, for use within and between sessions^[26].

Over time, it can help to notice what makes episodes more likely, such as stress, lack of sleep or cannabis^[4]. Protecting your sleep may help too, since early research links sleep loss with more dissociation^[22].

Treatment for dissociation

The NHS says “talking therapies are often recommended”. The aim “is to help you cope with the underlying cause of your symptoms, and to learn and practise techniques to manage the periods of feeling disconnected”. It adds that “many people with a dissociative disorder make a full recovery with treatment and support”^[2].

Research on treating dissociation is still limited. A review of 16 studies found treatment was linked with fewer symptoms of dissociation, depression, PTSD and distress, but most studies were small and not randomised^[27]. For depersonalisation-derealisation disorder, a 2024 review of 41 studies found that “the quality and quantity of studies were generally low”^[28].

For depersonalisation and derealisation

One approach is CBT that helps you see the symptoms as less threatening, and cut down on avoiding things and checking how you feel. In an open study of 21 people, symptoms improved, gains lasted six months, and 29% no longer met the criteria for the disorder by the end^[29]. It was small and had no comparison group, so more trials are needed.

When dissociation is linked with trauma

For complex trauma-related conditions, including DID, expert guidelines recommend treatment in stages: first safety, stabilisation and symptom reduction, then working through traumatic memories, then integration and rebuilding life. This is expert agreement, not trial evidence, and treatment for DID usually takes “years, not weeks or months”^[25]. The American Psychiatric Association says CBT and dialectical behaviour therapy (DBT) are commonly used for DID^[1].

When dissociation is part of PTSD, UK guidance recommends trauma-focused therapy, with extra time to build trust and help with barriers such as dissociation^[26]. Does dissociation make PTSD therapy work less well? The evidence is mixed: a review of 21 trials found no link^[30], while a later trial found that women with more dissociation at the start benefited less^[31]. Early research suggests people with PTSD and depersonalisation or derealisation may do better when therapy also teaches skills for managing emotions and relationships^[16]. So your therapist may focus on stabilisation and grounding first. The NHS says EMDR is sometimes used for dissociative disorders^[2].

Medication

There is no specific medicine to treat dissociation. A doctor may prescribe medicine for related problems such as depression, anxiety or panic attacks^[2]. That is a decision to make with your doctor.

Talking about it in your own language

Dissociation can be hard to describe, so it can help to talk about it in the language you feel most at home in. One large, older review found that for people whose first language was not English, therapy in their own language was twice as effective as therapy in English^[32]. Culture matters too: the WHO and the American Psychiatric Association both say that experiences such as trance or possession that are part of an accepted cultural or religious practice are not a disorder^[1][3].

On Bliss Therapy

On Bliss Therapy you choose a therapist who speaks your language, by video, with no waitlist. 35 psychologists and counsellors list trauma, with sessions from €30 (about £25); 29 of them list CBT and 4 list EMDR. Ask any therapist about their experience with dissociation. If you lose time or your dissociation is severe, talk to a doctor first about whether online sessions suit you; UK guidance does not advise self-guided computer CBT for PTSD with severe dissociative symptoms^[26].

Our therapists are based outside the UK and the US, so they are unlikely to be on UK registers or covered by US health insurance. Ask any therapist about their training, including in trauma-focused therapy, and their registration in the country where they practise.

When to get help

Occasional, brief dissociation that passes on its own is not usually a problem. See a doctor or a mental health professional if it keeps happening, worries you, causes memory gaps, or gets in the way of work, study or relationships^[3]. A GP may examine you and do tests to check whether another illness is causing your symptoms, and may refer you to a specialist. The NHS says “it’s important to be honest about your symptoms and not to feel ashamed or embarrassed”^[2].

Get a medical check first if

• It started after a head injury, or comes with fainting, blackouts or seizures. Some people with dissociative disorders have seizures, and nervous-system conditions such as epilepsy need to be ruled out^[2][4].
• It began for the first time later in adult life. Depersonalisation-derealisation disorder very rarely starts after 25, so it is worth checking for other causes^[4].

Get help urgently if

• You have lost time and found yourself somewhere without knowing how you got there^[2].
• It happens while you are driving or in other risky situations. Talk to a doctor soon.
• You are hurting yourself or having thoughts of self-harm or suicide. These can come with dissociative disorders and PTSD, and they always deserve help^[2][16].
• You are no longer sure what is real, or hold unusual beliefs you cannot step back from. These are not part of depersonalisation or derealisation, so they need checking quickly^[4].