Feeling Detached or Unreal? Understanding Dissociation and How to Cope
- Julie Brownley, MD, PhD
- Oct 18
- 6 min read
Based on “Dissociation debates: everything you know is wrong” by Richard J. Loewenstein, Dialogues in Clinical Neuroscience (2018).
The short version
Dissociation is a way the mind copes with overwhelming stress or trauma. It can look like spacing out, feeling detached from your body, losing time, or having important memory gaps. Dissociative disorders are real, common, and treatable—and they’re strongly linked to trauma, especially early or repeated trauma. Popular myths (that dissociation is just fantasy, or “made up by therapy or media”) don’t hold up against decades of research.
What dissociation actually means
The DSM-5 defines dissociation as a disruption in how we usually experience memory, identity, emotions, perception, body awareness, and control of movement. Think of it as the brain’s emergency “circuit breaker”: when experiences are too much, the mind temporarily disconnects parts that would otherwise overwhelm us.
There’s a spectrum:
Everyday dissociation: highway hypnosis, intense absorption in a book or game.
Problematic dissociation: repeated depersonalization (“I feel unreal”), derealization (“the world feels unreal”), losing time, or not recalling key parts of your own life.
Dissociative disorders (DD): when these symptoms are frequent, severe, and interfering with life.
The DSM-5 dissociative disorders include:
Dissociative Identity Disorder (DID)
Dissociative Amnesia (includes “fugue” as a subtype)
Depersonalization/Derealization Disorder (DPDR)
Other/Unspecified Dissociative Disorders
PTSD can also have a dissociative subtype—people still meet criteria for PTSD, but instead of being stuck in “fight/flight,” they swing into numbing and detachment when triggered.
Myth vs. fact
Myth 1: “Dissociation makes people imagine trauma that never happened.”
Fact: Across cultures and age groups, higher dissociation is repeatedly linked to documented trauma—including childhood abuse/neglect, sexual assault, war, torture, and disasters. These findings show up in large community studies and in clinics, not just in therapy rooms.
Myth 2: “Therapists create dissociative disorders.”
Fact: People with DD turn up in places with little exposure to DID in media and often long before any specialized therapy. Careful interviews and standardized measures, not suggestion, identify these conditions.
Myth 3: “Dissociation is a 1980s fad.”
Fact: Descriptions go back to the 18th and 19th centuries, surged during wartime (think “shell shock”), and persist today because they reflect a real, repeatable response to trauma.
Myth 4: “Traumatic memories are always crystal clear.”
Fact: Amnesia for trauma (especially interpersonal and early-life trauma) is well documented. Delayed recall does not automatically mean false memory; studies don’t find lower accuracy just because a memory was recovered later.
A survival response—explained simply
When danger hits, our bodies try fight or flight. If neither is possible, many people flip into freeze—still, numb, detached. That’s dissociation. Brain imaging shows something striking during dissociative reactions: frontal “control” regions ramp up while emotion centers (like the amygdala) quiet down. Heart rate and blood pressure may even stay the same or drop. In other words, the system shuts feelings off to get through the moment.
How common is this?
Numbers vary by study, but a few helpful anchors:
Pathological (problematic) dissociation: about 3–4% of people at any given time.
Dissociative Identity Disorder (DID): roughly ~1% of the general population.
Depersonalization/Derealization Disorder (DPDR): up to ~2–3% over a lifetime.
In mental health settings (hospitals, clinics), dissociative disorders are much more common than most people realize—yet often missed unless clinicians look for them.
What Dissociative Identity Disorder (DID) is—and isn’t
DID isn’t “many people in one body.” A clearer way to think about it: in early, unsafe environments, the child’s developing sense of self never knits together smoothly. The result is distinct self-states with different memories, feelings, and roles—parts of one mind that don’t always share information.
Media portrayals focus on dramatic, theatrical switching. In real life, DID is often subtle and covert: inner voices, time loss, unexpected actions or purchases you don’t remember, or feeling pushed by an internal “other” rather than visible, Hollywood-style flips.
Importantly, DID strongly tracks with early, repeated trauma (often before age 6), and with high rates of PTSD, depression, and self-harm—not with therapist suggestion.
A quick note on Depersonalization Derealization Disorder (DPDR)
Depersonalization/derealization can be chronic and disabling, and it’s frequently tied to childhood emotional abuse. Many people with DPDR are only treated for anxiety or depression while the core dissociation goes unaddressed. There’s no single medication proven to cure DPDR; care usually blends psychotherapy, skills to reduce numbness and avoidance, and careful treatment of co-occurring conditions.
Does treatment help?
Yes. The most evidence-supported approach is phase-based trauma therapy:
Safety & stabilization: reduce self-harm, manage crises, build grounding skills, and learn to recognize and regulate dissociative shifts.
Processing traumatic memories (carefully, at the right pace, and only once the person is stable enough).
Integration & reconnection: strengthen a cohesive sense of self, daily functioning, and relationships.
Large, real-world studies of people with dissociative disorders show less suicidal behavior, fewer hospitalizations, fewer PTSD/depression symptoms, and lower overall costs when they get appropriate care.
One caveat: jumping straight into graphic trauma work often makes symptoms worse—skilled pacing matters.
How do I know if dissociation might be an issue?
Common red flags:
Losing time or finding items, messages, or purchases you don’t recall.
Feeling unreal, or like the world is a movie set.
Autobiographical gaps you can’t explain (beyond normal forgetfulness).
Strong reactions to reminders of past events—followed by numbness or confusion.
A sense of parts or “other sides of me” that take over under stress.
Self-screens (like the Dissociative Experiences Scale) exist, but they’re just starting points. Only a trained clinician can evaluate for a dissociative disorder.
If this is you (or someone you love)
You’re not “making it up.” Dissociation is a documented human response to overwhelming experiences.
Get trauma-informed help. Look for clinicians familiar with dissociation, PTSD, and phase-based therapy.
Stabilization is treatment. Grounding skills, sleep routines, safer coping, and crisis planning are real progress, not stalling.
Safety first. If there’s active self-harm or suicidal thoughts, seek urgent help (call your local crisis line or emergency services).
Why the debate persists—and why awareness matters
Dissociation challenges our assumptions about memory, identity, and willpower. It’s been misunderstood for centuries and sensationalized in media. But the research picture is remarkably consistent: trauma—especially early and repeated—raises the risk for dissociation; dissociative disorders are not rare; and outcomes improve with the right care. The bigger problem today isn’t “false memories”—it’s missed diagnoses and people going untreated for years.
Key takeaways
Dissociation = survival strategy that can become a disorder when it’s frequent, severe, and disruptive.
Trauma link is strong; “it’s all suggestion/fantasy” isn’t supported by data.
DID and DPDR are real and more common than you think.
Treatment works, especially when it starts with safety and stabilization.
Awareness saves lives, reducing self-harm, hospitalizations, and long-term disability.
Grounding Techniques You Can Try Today
These skills help you re-anchor to the present when you feel unreal, numb, or “far away.” Practice when calm so they’re ready during spikes. Pick 2–3 favorites to start.
1) 5-4-3-2-1 Senses Reset (1–2 minutes)
Name 5 things you see, 4 feel, 3 hear, 2 smell, 1 taste. Move slowly. Look for textures and colors. If taste/smell aren’t available, swap in two more “hear.”
2) Temperature Shift
Hold an ice cube or splash cool water on your face/neck. Temperature jolts the nervous system toward “here and now.” Dry hands fully, then notice sensations fade.
3) Paced (Nasal) Breathing
Inhale 4, exhale 6 through the nose, 1–3 minutes. Exhale longer than inhale to nudge the vagus nerve and reduce adrenaline. (If lightheaded, shorten counts.)
4) Box Breathing
Inhale 4 → hold 4 → exhale 4 → hold 4. Trace a mental square with each side. Repeat 4–6 rounds.
5) Orienting + Naming
Turn your head gently—left, center, right—naming objects: “blue chair, window, lamp.” Add a reality cue: “I’m in my kitchen, it’s Saturday, 3 p.m., I’m safe enough.”
6) Categories Game
Pick a category (dog breeds, green foods, songs from the 90s). List items alphabetically or by initials. Cognitive load = less room for spiraling.
7) Bilateral Tapping (Butterfly Hug)
Cross arms over chest, hands on shoulders. Tap left–right–left at a comfortable pace while breathing slowly. Keep eyes open and oriented to the room.
8) Ground-to-Body Scan
Press feet into the floor; feel heel, arch, toes. Then calves, thighs, seat, back. Name each area and a sensation (“warm,” “pressure,” “neutral”).
9) Anchor Object
Carry a small textured item (stone, key, fabric square). Describe it aloud for 30–60 seconds: weight, edges, temperature, color shifts.
10) Scent Snap
Open peppermint, citrus, or eucalyptus. Inhale near (not inside) the nostrils for 3 slow breaths. Close and describe the scent.
11) Move & Place
Stand, stretch arms overhead, name 3 objects, then walk to one and touch it. Gentle rhythmic movement (rocking, slow walking) helps.
12) Micro-Plan
Write the next two steps only: “1) Drink water. 2) Text my sister an emoji.” Do them, then choose the next two.
Build a Personal Grounding Kit
Senses: gum or mints, textured card, mini lotion, essential-oil inhaler
Visuals: two safe photos (nature, pets)
Words: a 3-line reality script (“My name is . I’m in . I’m safe enough right now.”)
Plan: your top three grounding techniques on an index card
Crisis cues: local urgent care/ER, therapist number, 988 (US) or your country’s equivalent
Super informative 👌! Thanx.