Dissociation is a sense of disconnection from the self, the body, the surroundings or memory. The NHS describes it as a way the mind copes with too much stress. A dissociative disorder is diagnosed only when the disconnection is involuntary, repeated and interferes with daily life.
Key points
- Dissociation is a sense of disconnection from the self, the body, the surroundings or memory.
- Everyday dissociation, dissociation as a symptom, and a dissociative disorder are three different things.
- Depersonalisation is detachment from the self. Derealisation is detachment from the surroundings. They often occur together.
- Dissociation is not psychosis: reality testing stays intact, so the person knows the unreal feeling is a feeling.
- No NICE guideline covers dissociative disorders; treatment usually addresses the underlying trauma or anxiety.
Symptoms
- Depersonalisation: feeling like an observer of one's own actions; emotions feeling flattened or switched off.
- Derealisation: the world looking unreal, flat or foggy; familiar places or faces seeming strange or lifeless.
- Gaps in memory for personal events, beyond ordinary forgetting; reduced sensitivity to pain, or seizures and blackouts that are not epilepsy.
Causes and risk factors
- Physical, sexual or emotional abuse in childhood is the background named most often, alongside war or invasive medical procedures.
- Depersonalisation-derealisation disorder was found in around 17% of people with borderline personality disorder, and in survivors of interpersonal abuse.
- ICD-11 defines these experiences as involuntary and unwanted, not attention seeking.
Treatment
- Talking therapy addressing what sits underneath the dissociation, often longer-term than standard NHS courses.
- Where PTSD is present, trauma-focused CBT or EMDR, adapted for dissociative symptoms.
- No medicine is licensed for dissociation itself; antidepressants may be prescribed for co-occurring depression or anxiety.
When to speak to a professional
- Dissociation is happening often, lasting longer, or affecting work, study, relationships or your ability to keep safe.
- See a GP promptly if you have blackouts, seizures, weakness or changes in vision or speech, so physical causes can be checked.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.