When Reality Feels Far Away
- Merritt Millman
- Jun 23
- 6 min read
Understanding Dissociative States and Disorders
Have you ever found yourself staring out of the window on a train and suddenly realised you had no idea how many stops had passed?
Maybe you’ve caught yourself daydreaming in class, rereading the same sentence five times, or performing familiar tasks on autopilot.
Most of us know what it’s like to experience these mild and temporary mental “check-outs” from time to time. Many of us might not realise that these sorts of feelings or experiences exist on the spectrum of dissociation, a term used to describe a range of experiences involving a disrupted or altered sense of connection to thoughts, memories, emotions, the body, or reality.
While often brief and harmless, these experiences sit on a continuum that, at its more extreme end, can become clinically significant and deeply distressing.
The term dissociation is often thrown around in all sorts of contexts, to describe many different things, from ordinary distraction to severe psychological distress. In reality, dissociation is not one single experience, but a range of experiences that can look very different from person to person.
My own interest in dissociation comes from both personal curiosity and academic work. With a background spanning science and art, including embodied practices like dance, where connection to and with the body is central, I became fascinated by what happens when this connection feels disrupted, distant, or absent altogether. This paved the way for my PhD research exploring bodily awareness in depersonalisation-derealisation disorder (DDD), and continues into work in the Neurological, Affective and Dissociative Symptoms (NEUROADS) Lab led by Dr Susannah Pick at King’s College London, where I am currently based as a postdoctoral researcher.
Here, we will unpack what dissociation is, look at why the mind sometimes disconnects in the first place, and examine the relationship between dissociation and the body.
So, What Actually is Dissociation?
At its core, dissociation involves a disruption in the normal integration of experience. This might mean feeling detached from thoughts, emotions, memories, surroundings, identity, or even from the sense of being fully present in your own body. Put simply, the mind’s usual sense of unity or continuity becomes altered.
Dissociation can be difficult to define because it does not look the same for everyone. Two people might both describe feeling “disconnected” while referring to experiences that feel completely different internally. In many ways, dissociation is less a single symptom and more a broad collection of ways the mind can distance itself under certain circumstances.
Because dissociation can take many forms, people often use different words to describe it: detachment, disruption, separation, fragmentation, depersonalisation, derealisation, and compartmentalisation. These terms overlap, but each captures slightly different aspects of dissociative experience.
For some people, dissociation can feel like emotional numbness. For others, it may feel dreamlike, foggy, distant, or unreal, as though the world around them has lost its familiarity. Some people describe watching themselves from the outside or feeling strangely absent from their own body, almost like observing their own life rather than fully participating in it. Others experience gaps in memory, visual distortions, or a blurry and uncertain sense of self or identity.
Importantly, dissociation exists on a spectrum.
The mild and temporary mental “check outs” mentioned earlier are relatively common, especially during periods of stress, anxiety, exhaustion, overwhelm, or emotional strain.
For some people, however, these experiences can become more persistent and disruptive to daily life. They may interfere with memory, emotional regulation, relationships, work, identity, or the ability to feel connected to reality and to oneself. This is where dissociation may move beyond an occasional experience and into the territory of dissociative disorders.
In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), dissociative disorders include:
Dissociative identity disorder (DID) – involves disruptions in identity and significant gaps in memory.
Dissociative amnesia, including dissociative fugue – involves periods where someone is unable to remember information about themselves or life events.
Depersonalisation/derealisation disorder (DDD) – involves persistent, recurring feelings of detachment from the self (depersonalisation), surroundings (derealisation), or both.
Even within psychiatry and psychology, however, the boundaries within dissociation are not always clear.
For example, functional neurological disorder (FND), which can include a range of symptoms from non-epileptic seizures, to tremors, to sensory changes, that are not explained by an identifiable neurological cause, is classified differently across diagnostic systems. In the DSM-5 it falls under Conversion Disorders, while the International Classification of Diseases-11 (ICD-11), groups it under dissociative disorders, reflective of the elevated dissociative symptoms often reported in FND.
This reflects a broader challenge within the field: dissociation is complex, multi-layered, and often difficult to neatly categorise.
Why Might Someone Dissociate?
One of the most important things to understand about dissociation is that the brain is usually trying to do something when it happens.
Although dissociation can feel strange or unsettling, we might generally understand it as serving some kind of psychological or protective function, rather than occurring for no reason. Current theories suggest dissociation is often linked to the brain’s attempts to cope with experiences that feel overwhelming, threatening, emotionally intense, or impossible to escape.
Importantly, dissociation is not always linked to trauma, although trauma is an often cited contributor. Dissociative experiences can also occur during periods of high stress or anxiety, alongside other mental health difficulties, due to exhaustion or burnout, emotional conflict, or in response to alcohol and drugs.
Dissociation might be understood as a survival response, something the mind may do when experiences become too overwhelming, stressful, or emotionally intense to fully process in the moment. In traumatic situations, this response can genuinely help someone survive, reducing pain, fear, or emotional overload in the moment.
You have probably heard of the “fight or flight” response, but the nervous system can also react to threat by freezing or shutting down. Dissociation is often thought to be closely linked to these states. Rather than confronting danger directly, the mind may create distance from it through numbness, detachment, memory gaps, or feelings of unreality.
Dissociation tends to happen automatically, almost like the brain pulling an emergency brake behind the scenes.
For some people, particularly those exposed to repeated or early-life trauma, dissociation can become a learned coping strategy. If mentally “checking out” once helped somebody get through overwhelming situations, the brain may continue to use the same strategy long after the original danger has passed, in situations that are quite ordinary.
Understanding dissociation as a protective response can help make these types of experience feel a little less mysterious.
Dissociation and the Body
When it comes to treatment, there is no universal one-size-fits-all approach. However, because dissociation often involves feeling disconnected from the self or body, there has been increasing interest in the development of interventions that aim to rebuild a sense of bodily safety and connection.
In the case of depersonalisation/derealisation disorder (DDD) specifically, experiences of disembodiment and detachment from one's body could be reflective of alterations in the processing, sensing, or awareness of bodily signals and sensations (otherwise known as interoception). Some studies have indeed found differences in interoception/bodily self-perception and mindfulness in people experiencing DDD.
Building on this, in my PhD research, I examined the relationship between dissociation and the body itself, exploring interventions that aim to strengthen one’s bodily connection. In both online and in-person studies examining the use of dance/movement tasks to reduce dissociative symptoms in DDD, participants reported less bodily detachment after task completion, with greater body awareness during the tasks also linked to lower levels of symptoms.
Direct work with the body allows for the generation of bodily experiences, rather than thinking about their absence. This research highlights the possible therapeutic value of dance/movement practices as a complementary approach for symptom reduction, and the development of greater body awareness, in dissociative and related disorders.
While there is still much left to be understood, these findings point toward a more integrated way of thinking about dissociation, one that includes both psychological and bodily experience.
Ultimately, feeling ‘present’ or ‘in the here and now’ is something that is continuously constructed, shaped through the interaction of mind, body, and surroundings. In this sense, presence is not a fixed state, but something we continually return to.
