What does it really mean to dissociate?

Have you ever zoned out?

Maybe you have experienced highway hypnosis, with no recollection of having driven from Point A to Point B. Or maybe you have zero memory of something you just read.

These are mild forms of dissociation, which is the ability to disconnect from our thoughts, feelings, environment or actions.

Dissociation can even help athletes do their jobs, for instance, because it “allows people to focus on the most salient or life-preserving aspects of a situation” without mental interference, said Janina Fisher, a psychologist who has been treating dissociative disorders for decades.

But sometimes people experience a major form of dissociation, often in the aftermath of overwhelming trauma. In this case, the dissociative symptoms become more extreme and frequent.

Public fascination with dissociation and its disorders has endured for many years — examples include the books Sybil and The Three Faces of Eve, both adapted into wildly popular feature films, each about a woman with “multiple personalities.”

Now people are capturing their experiences with dissociation and posting them on social media. TikTok videos hashtagged #dissociativeidentitydisorder, or DID, have been viewed more than 1.7 billion times and #dissociation has drawn more than 775 million views. Some show what it looks like to dissociate, or use visual effects to explain the eerie feeling of living outside your body. In others, people describe their different identities, also called alters or parts.

Celebrities such as “Saturday Night Live” cast member Bowen Yang have also openly described struggles with dissociative disorders, as conversations about mental health continue to migrate into public forums.

But research suggests that much of this content isn’t providing reliable information. We asked several mental health providers to explain more about dissociation.

What are the dissociative disorders?

Rather than fight or flee in a stressful or threatening situation, some people “freeze,” said Dr. Frank Putnam, a professor of clinical psychiatry at the University of North Carolina School of Medicine and an expert on dissociative disorders. “That’s the dissociative state where you shut down and you kind of go away.”

Although dissociation can help a person mentally escape during a threat, it can interfere with daily life when people continue to dissociate during benign situations. Some people might find themselves in a new location without knowing how they got there, for example.

Frequent experiences like that make dissociation pathological, Putnam said. It becomes a disorder when you space out and “lose time” long enough that it interferes with your life in a significant way, he added.

The three most common and well-known dissociative disorders are: dissociative identity disorder, depersonalization/derealization disorder and dissociative amnesia.

The common thread in each is a disruption of identity.

The most severe is dissociative identity disorder, formerly known as multiple personality disorder. Those who experience DID report having two or more identities. Studies indicate that about 1 per cent to 1.5 per cent of the population has DID. But some say the prevalence could be higher.

“I think it’s way underdiagnosed,” said Dr. Judith Herman, a psychiatrist and pioneer in the field of trauma studies. That’s largely because “you still hear people in my field saying they don’t ‘believe in DID.’”

Despite the inclusion of DID in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, known as DSM-5., the American Psychiatric Association’s official manual of mental disorders, some psychiatrists and psychologists think that patients with symptoms of DID actually have borderline personality disorder. Others think it is a fad or that it can be induced by a provider.

Experiencing severe early childhood trauma, such as sexual abuse, is a predictor of developing DID, several experts said.

Fisher acknowledged that “it’s a hard-to-believe diagnosis unless you’ve seen it.” Patients show changes in body language, facial expression and cognitive ability, she added. “It is sort of dramatic and sounds almost fantastical.”

Depersonalization/derealization disorder is thought to occur in about 1 per cent to 2 per cent of the population and is often associated with a history of verbal abuse, such as shaming, that drives someone to want to disconnect from an emotionally traumatizing environment, Putnam said.

According to the APA, those who experience depersonalization can feel at times as if they are detached from their mind or body — estranged from themselves — like they are watching events happen to them. Derealization, on the other hand, refers to feeling detached from the environment as if the people and things in the world are not real, in some cases appearing like cardboard cutouts.

The prevalence of dissociative amnesia is not well established. It occurs in response to a variety of different types of trauma, and involves having blocks of time where you lose your identity and are not able to recall important information about your life, such as your own name.

Both dissociative amnesia and depersonalization/derealization symptoms commonly accompany DID.

Why are dissociative disorders attracting so much attention?

“I had thought that the internet and app-based world would bring us all closer together. And it’s had exactly the opposite effect,” said Dr. David Spiegel, a Stanford University psychiatry professor who has worked with patients with DID for about 50 years. “It has fragmented us.”

What he means, he explained, is that many of us have retreated into our own online echo chambers. Some people truly have DID, or any number of mental health disorders, but others might be incorrectly labeling themselves because they are locked into a DID information loop — either by choice or via an aggressive social media algorithm.

The idea of having alternate realities or different identities is one that may especially resonate during adolescence, experts said, a time when many teenagers struggle with the question “Who am I?”

Dr. David Rettew, a child and adolescent psychiatrist and the medical director of Lane County Behavioral Health in Eugene, Oregon, has worked with many adolescents who learned about dissociative disorders on social media and are questioning whether they have them.

Rettew encouraged anyone curious about a specific disorder to speak with an attentive and thoughtful health care provider, particularly one who understands trauma, to tease out what might be going on.

“Just about everything in mental health is dimensional. It exists on a spectrum,” he said. “And that doesn’t make our conditions less real, but it does make them more complicated.”