Understanding Different Types of Dissociation

Cheyenne Bowman, LCPC

Everyone experiences dissociation at some point in their life, to varying degrees. Dissociation is a complex and unique response that our brain has to trauma. If a client is coming to you with this as a presenting concern, their dissociative symptoms may be interfering with important areas of functioning. That does not mean, however, that dissociation is not a powerful coping skill that may have served them at some point in life. The more we can understand dissociation and what causes it, the better able we can spot it happening, work to ground ourselves, and even begin to use it as an intentional coping skill that we can control.

If you’re curious about whether dissociation has become a problem for you, ask yourself: Is it interfering with important areas of my life such as relationships, free time, or work? Is it disturbing or upsetting to me? If the answer is yes to any of these, consider seeking help from a mental health professional.

It is important to be familiar with different types of dissociation, even if you have trouble grasping what it may feel like to have the experience yourself. If you begin working with clients who struggle with dissociation, take note of which of these types of dissociation feel like they match their experience. You will soon notice how differently these types of dissociation can present. 

**Important disclaimer** all of the following experiences must not be attributed to the influence of a drug, neurological issue, or medical condition.

Derealization

Derealization can feel like having a disconnect between yourself and the world around you. One may feel that the world around them appears blurry or like they are in a fog. Sometimes people describe their experience like they are living in a movie or a dream. When this happens, people can also feel distant from loved ones, as if they were physically separated by something or that they don’t exist to them. Keep in mind that dissociation is not always a constant experience, so these may show up as “moments” that feel like this.

Depersonalization

Depersonalization can feel like a disconnect between your body and mind. This is often explained as seeing yourself in third person, or like an outsider looking into your life. You may look in the mirror and not recognize yourself, or feel that your body does not belong to you. This can also present as feeling like your memories or emotions do not belong to you. One may also feel like they are not in control of their physical movements or what they are saying.

Dissociative Amnesia

Dissociative amnesia means that a person does not remember things that the average person would. This lack of memory is different than “normal forgetting”, and may include autobiographical information, important events that have occurred in our life, or could be specific to a traumatic event that has occurred that a person cannot remember. In my experience as a clinician, I often see this in the therapy room as someone saying “I don’t have any proof of this, but I just know it happened. It must have happened”. Your client may also not even have a “hunch” that something occurred. 

Dissociative Fugue

 Dissociative fugue is a psychological condition in which a person becomes unaware of their identity or autobiographical information. Those experiencing a fugue state are often unaware that it is happening, and may be undetectable by those who do not know the person. This differs from dissociative amnesia because the person may travel away from home with a purpose, very suddenly, and pursue something that may relate to their past or assume a new identity. This must occur for more than a few days to be considered dissociative fugue.

Absorption

Dissociative absorption is when we become “absorbed” in an external stimulus, keeping us from experiencing the present. This may look like reading a book, watching a movie, or scrolling through social media mindlessly to a point that we are not really aware of our surroundings and do not have as much self-awareness. We all engage in entertainment or some sort, but it can become a problem when we are engaging in these things deeply as a way to escape discomfort or distress.

Influence of ego states, identify alterations

An ego state refers to a specific way of thinking, feeling, and behaving that contributes to our personality at a particular moment. Have you ever surprised yourself by the way you acted in a situation? Or felt that you were acting out of character? This could be the influence of an ego state. For example: If you’ve ever traveled back home to your family after a long time of being away and felt like you and a sibling were acting like your “kid selves” again, this can help to understand younger parts of self. I know for myself that when I go home for a big holiday, there are usually some disagreements that pop up and have me acting like I’m a teenager again. Bickering and not having the same amount of patience as I do normally. What makes this an aspect of dissociation is that it is an alteration from who we are on a regular basis (some people call this our ‘going about daily life’ part). Our parts of self are usually integrated and we can learn to communicate with all of our parts of self.These parts of self are usually covert and not recognized by other people. Read more on ego state therapy and internal family systems if you’re interested in learning more about this.

Dissociative Identity Disorder

 We all experience different ego states, or "parts of self," throughout our lives, which help us cope with challenges and may resurface in response to reminders of past trauma. While this is common, some individuals develop distinct parts, as seen in Dissociative Identity Disorder (DID), where these parts exhibit unique behaviors, personalities, and mannerisms. This can lead to observable changes that others notice. Conflicts arise when these parts hold different memories, causing distress when one part is unaware of what another has experienced. Often, these parts may embody different genders or traits that the person doesn't possess. They serve as coping mechanisms for past trauma, but can become unhelpful in situations that are not truly dangerous but perceived as such by the traumatized brain. For instance, someone who faced early abuse might develop a protective part that appears unapproachable. While this trait may have provided safety, it can hinder the ability to form relationships when one is ready to connect with others in the present. For those with DID, shifting out of these ego states can be particularly challenging.

As you continue to work with clients who experience high levels of dissociation, you may start to be able to observe what it may look like when it is happening. A highly attuned therapist may be able to see a shift in body language or expression. For me, I can often see a change in a client’s eyes. They may seem very engaged in a conversation with me, seeming to really “see me”, and then suddenly shift to a vacant expression with a less engaged gaze. You may learn how it looks for a specific client and be able to use this to help bring your client back within their window of tolerance.