Dissociation vs Other Experiences: Understanding the Differences

Why Understanding Differences Matters

Grounding Check-In

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Dissociation is often confused with other mental health experiences, which can lead to misunderstanding, misdiagnosis, and inappropriate treatment approaches. Understanding the distinctions between dissociation and similar experiences is crucial for several reasons (Steinberg & Schnall, 2000):

Accurate Self-Understanding: Knowing what you’re experiencing helps you better understand your own mental health and needs

Appropriate Treatment: Different experiences require different therapeutic approaches, and accurate identification leads to more effective help

Reduced Confusion: Many people feel confused about their symptoms, and clarity can reduce distress and self-doubt

Better Communication: Understanding differences helps you communicate more effectively with healthcare providers, family, and friends

Validation: Recognizing that your experiences have specific names and characteristics can be deeply validating

This article will explore how dissociation differs from anxiety, depression, psychosis, substance-related experiences, attention difficulties, and other conditions that share some similar features.

Dissociation vs. Anxiety and Panic

Key Similarities

Both dissociation and anxiety can involve feelings of unreality, physical sensations, and distress (Sierra & David, 2011):

Shared Symptoms:

• Feeling “unreal” or detached
• Physical sensations like dizziness or lightheadedness
• Racing heart or breathing changes
• Feeling like you’re observing yourself from outside
• Difficulty concentrating

Overlapping Triggers:

• Stressful situations
• Crowded or overwhelming environments
• Interpersonal conflicts
• Medical procedures or health concerns

Critical Differences

Anxiety and Panic Attacks:

• Emotional State: Usually involves intense fear, worry, or dread
• Physical Activation: Body feels “revved up” with racing heart, sweating, trembling
• Thought Content: Mind races with fearful thoughts about danger or catastrophe
• Duration: Often brief (minutes to an hour) but intense
• Awareness: Usually maintain awareness of surroundings and identity
• Response to Reassurance: May respond to calming techniques or reassurance

Dissociation:

• Emotional State: Often involves emotional numbing or detachment rather than intense fear
• Physical Experience: May feel disconnected from body or like body isn’t real
• Thought Content: May involve confusion about identity, time, or reality
• Duration: Can last minutes, hours, or even days
• Awareness: May lose awareness of surroundings, time, or sense of self
• Response to Reassurance: May not respond to typical calming techniques; grounding exercises often more helpful

When They Co-Occur

Many people experience both anxiety and dissociation, sometimes simultaneously:

• Anxiety-Triggered Dissociation: Severe anxiety or panic may trigger dissociative responses as a protective mechanism
• Dissociation-Triggered Anxiety: Becoming aware of dissociative symptoms may cause anxiety about losing control
• Comorbid Conditions: Some people have both anxiety disorders and dissociative disorders

Dissociation vs. Depression

Overlapping Features

Depression and dissociation share several characteristics that can make them difficult to distinguish (Michal et al., 2005):

Common Experiences:

• Emotional numbing or feeling “empty”
• Disconnection from previously enjoyed activities
• Feeling like life is “unreal” or meaningless
• Difficulty with memory and concentration
• Social withdrawal and isolation
• Sleep disturbances

Distinguishing Features

Depression:

• Primary Mood: Persistent sadness, hopelessness, or emptiness
• Self-Worth: Feelings of worthlessness, guilt, or self-criticism
• Energy: Fatigue and decreased motivation for activities
• Cognitive Style: Negative thinking patterns about self, world, and future
• Anhedonia: Loss of pleasure in activities once enjoyed
• Physical Symptoms: Changes in appetite, sleep, and energy levels

Dissociation:

• Primary Experience: Disconnection from thoughts, feelings, memories, or identity
• Reality Perception: Feeling that self or world is unreal or dreamlike
• Memory Issues: Gaps in memory or difficulty forming new memories
• Identity Confusion: Uncertainty about who you are or feeling like different people
• Embodiment: Feeling disconnected from physical body or bodily sensations
• Time Perception: Losing time or feeling confused about when things happened

The Complexity of Comorbidity

Many trauma survivors experience both depression and dissociation:

• Trauma-Related Depression: Depression resulting from traumatic experiences
• Dissociative Depression: Depression characterized by significant dissociative symptoms
• Sequential Presentation: Sometimes depression develops after dissociative symptoms, or vice versa

Dissociation vs. Psychosis

Critical Distinctions

This is one of the most important distinctions because the treatments are very different (Steinberg et al., 1993):

Psychosis:

• Reality Testing: Genuinely believes false things are true (delusions)
• Perceptual Experiences: Sees or hears things that aren’t there (hallucinations)
• Insight: Usually lacks awareness that experiences aren’t real
• Thinking Patterns: May have disorganized or illogical thought processes
• Response to Reality: Doesn’t typically respond when others point out unreality of experiences

Dissociation:

• Reality Testing: Usually knows that feelings of unreality aren’t actually real
• Perceptual Experiences: Feels disconnected but doesn’t typically see or hear things that aren’t there
• Insight: Often maintains awareness that experiences feel strange or unreal
• Thinking Patterns: Thinking may be confused but follows logical patterns
• Response to Reality: Often responds to grounding techniques and external reality checks

Areas of Potential Confusion

Voices in Dissociative Identity Disorder:

• These are internal experiences, not external hallucinations
• Usually recognized as coming from within, not from outside sources
• Often have personal meaning and connection to the individual’s life

Reality Confusion:

• In dissociation, people often say “I feel like” things are unreal
• In psychosis, people typically believe things actually are different from reality

Dissociation vs. Substance-Related Experiences

Drug-Induced Dissociation

Certain substances can produce dissociative-like experiences (Krystal et al., 1994):

Substances That May Cause Dissociation:

• Alcohol (especially during blackouts)
• Marijuana (particularly high-THC varieties)
• Hallucinogens (LSD, psilocybin, PCP)
• Dissociative anesthetics (ketamine, PCP)
• Some prescription medications

Key Differences

Substance-Induced:

• Timing: Directly related to substance use
• Duration: Usually resolves as substance leaves the system
• Controllability: Often chosen and expected
• Context: Occurs in context of recreational or medical use
• Memory: May remember taking the substance even if experience is altered

Spontaneous Dissociation:

• Timing: Can occur without substance use
• Duration: May persist long after any substance use
• Controllability: Usually involuntary and unexpected
• Context: Often triggered by stress, trauma reminders, or emotions
• Memory: May have no memory of what triggered the episode

Withdrawal and Dissociation

Some people experience dissociative symptoms during withdrawal from substances:

• Alcohol Withdrawal: Can include confusion, disorientation, and feeling unreal
• Benzodiazepine Withdrawal: May cause depersonalization and derealization
• Stimulant Withdrawal: Can involve emotional numbing and disconnection

Dissociation vs. Attention Difficulties (ADHD)

Overlapping Challenges

Both conditions can affect concentration and awareness, leading to potential confusion (Kozlowska et al., 2015):

Shared Difficulties:

• Problems with sustained attention
• Difficulty completing tasks
• Appearing “spaced out” or inattentive
• Memory difficulties
• Distractibility

Distinguishing Characteristics

ADHD:

• Attention Pattern: Difficulty sustaining attention on most tasks, not just during specific triggers
• Hyperactivity: May include physical restlessness or mental hyperactivity
• Impulsivity: Tendency to act without thinking
• Consistency: Symptoms present across different settings and situations
• Developmental History: Usually evident from early childhood
• Response to Stimulants: Often improves with stimulant medications

Dissociation:

• Attention Pattern: May have normal attention except during dissociative episodes
• Disconnection: Feels separated from thoughts, emotions, or surroundings
• Triggers: Often triggered by specific stressors or trauma reminders
• Episodic Nature: Comes and goes rather than being constant
• Trauma History: Often associated with traumatic experiences
• Response to Stimulants: Stimulants may worsen dissociative symptoms

When Both Are Present

Some individuals, particularly trauma survivors, may have both ADHD and dissociative symptoms:

• Trauma-Related ADHD: Trauma can create ADHD-like symptoms
• Comorbid Conditions: Some people genuinely have both conditions
• Misdiagnosis: ADHD may be diagnosed when dissociative symptoms are the primary issue

Dissociation vs. Memory Problems

Types of Memory Issues

Various conditions can cause memory problems that might be confused with dissociative amnesia (Brand & Chasson, 2015):

Medical Causes:

• Dementia or Alzheimer’s disease
• Brain injuries or concussions
• Seizure disorders
• Medication side effects
• Thyroid or other hormonal issues

Psychological Causes:

• Depression-related memory problems
• Anxiety-related concentration difficulties
• PTSD-related memory fragmentation
• Normal stress-related forgetfulness

Dissociative Amnesia Characteristics

• Selective Nature: Usually affects specific types of memories (often traumatic)
• Preservation of Skills: General knowledge and skills usually remain intact
• Emotional Connection: Missing memories often have strong emotional significance
• Reversibility: Memories may return suddenly or with therapeutic work
• Awareness: Often aware that memory is missing
• Context: Usually occurs in context of trauma or extreme stress

Dissociation vs. Spiritual or Mystical Experiences

Cultural and Spiritual Context

Many cultures have normative dissociative experiences that aren’t pathological (Castillo, 1997):

Spiritual Practices:

• Meditation-induced altered states
• Religious trance or ecstasy
• Shamanic journeying
• Prayer-induced mystical experiences

Key Differences

Spiritual Dissociation:

• Voluntary: Usually intentionally induced
• Meaningful: Experienced as spiritually significant
• Controlled: Can usually be ended when desired
• Cultural Support: Supported and understood within cultural context
• Integration: Experience is integrated into spiritual beliefs and practices

Trauma-Related Dissociation:

• Involuntary: Usually happens without conscious control
• Distressing: Often experienced as frightening or confusing
• Uncontrolled: Difficult to start or stop at will
• Isolation: May feel alone or misunderstood
• Fragmentation: May create further disconnection rather than integration

Simplified Version for Difficult Moments: If you’re confused about what you’re experiencing, that’s normal and understandable. Many conditions share similar symptoms. The key is that dissociation usually involves feeling disconnected from yourself, your surroundings, or your memories, often in response to stress or trauma. Professional help can clarify what you’re experiencing.

Getting Accurate Assessment

When to Seek Professional Help

Consider professional evaluation if you:

• Are unsure what you’re experiencing
• Have symptoms that interfere with daily life
• Experience multiple types of symptoms
• Have a history of trauma
• Notice symptoms getting worse over time
• Feel distressed about your experiences

What to Expect in Assessment

A thorough evaluation might include:

• Clinical Interview: Detailed discussion of your symptoms and history
• Standardized Questionnaires: Specific tools to assess dissociation and other conditions
• Medical Evaluation: Rule out medical causes of symptoms
• Psychological Testing: Comprehensive assessment of mental health
• Trauma History: Careful exploration of potentially traumatic experiences

Preparing for Assessment

To get the most accurate assessment:

• Keep a Symptom Journal: Track when, where, and how symptoms occur
• List Triggers: Note what seems to trigger different experiences
• Prepare Your History: Think about when symptoms started and how they’ve changed
• Bring Support: Consider bringing a trusted person if helpful
• Be Honest: Share all symptoms, even if they seem strange or embarrassing

Grounding Practice

Take a moment to check in with yourself right now. How are you feeling after learning about these different experiences? Remember that having any of these experiences doesn’t define you, and understanding what you’re going through is the first step toward getting appropriate help and support.

Further Reading & Recommended Books

For Beginners:

• “The Stranger in the Mirror” by Marlene Steinberg – Expert guide to distinguishing dissociation from other mental health conditions. Essential reading for understanding the diagnostic criteria and recognising symptoms.
• “Trauma and Recovery” by Judith Herman – Foundational text on understanding trauma’s impact on the mind. Provides crucial context for how dissociation develops as a protective mechanism.
• “The Body Keeps the Score” by Bessel van der Kolk – Accessible introduction to how trauma affects the brain and body. Excellent for understanding the neurobiological basis of dissociative experiences.

For Deeper Understanding:

• “Dissociation and the Dissociative Disorders” by Paul F. Dell & John A. O’Neil – Comprehensive clinical reference covering all aspects of dissociative conditions. Advanced but thorough.
• “Coping with Trauma-Related Dissociation” by Suzette Boon, Kathy Steele & Onno van der Hart – Practical skills-based approach to managing dissociative symptoms. Written for both clients and therapists.

Support Resources:

• International Society for the Study of Trauma and Dissociation (ISSTD) – Professional organisation with educational resources and therapist directory
• Mind UK – Mental health charity with information sheets and local support services
• Samaritans – 24/7 emotional support: 116 123 (free from any phone)