Dissociation Isn't Always a Trauma Response

As a child, I'd often have an unpleasant feeling sweep over me, where all of a sudden I'd feel as if I was in a dream. I'd tug on my mom's arm and ask her if this was real life, or sometimes I'd pinch myself to test it. It happened most often in busy places, like grocery stores or crowded rooms, anywhere the lights were bright and 100 things were making noise at once.

I didn't have a word for it until adulthood. The word is dissociation. Even after studying dissociation in graduate school, it took me a while to connect it to the experience I'd been having. Once I did, I spent several years in therapy trying to work out why it happened to me so often, and whether it meant I had repressed trauma.

What I was having, it turns out, was a fairly ordinary version of it for an AuDHD human.

Dissociation isn't good or bad

Most people dissociate to some degree. Dissociation can be neutral, like numbing out on the drive home. It can even be positive, like when we get absorbed into a song, a good book, or an interesting project. It can also be an unpleasant experience. It is often protective, and a response to the world around us being too much.

Most conversations about dissociation start at the severe end (trauma, losing time) and work backward. So when we fog out in the middle of an ordinary conversation, it's easy to conclude something is wrong with us. But dissociation is more nuanced than this, especially when we look at autistic and ADHD experiences.

Dissociation is often talked about as a spectrum. It covers a range of experiences from out-of-body experiences to low-grade fogging out to times when memory gets disrupted. Essentially, when our awareness, memory, sense of self or our sense of the world splinter in some way, that's dissociation. Dissociative experiences tend to cluster around three different kinds of experiences:

• Depersonalization and derealization. This is when we feel detached from our own bodies or sense of self (depersonalization), or when the world around you feels less real, like you're in a dream (derealization).
• Absorption. This is when we get so pulled into one thing—a book, a film, a daydream, an inner world—that the rest of reality drops away.
• Amnesia. This is when we have gaps in memory. It could be mild, like not remembering the drive home, or having a conversation, or it can look like losing awareness of larger gaps of time.

Brief episodes of dissociation are common. One systematic review put the lifetime rate of a passing episode somewhere between a quarter and three-quarters of people. The chronic version of this (depersonalization-derealization disorder) is much rarer.

Autistic shutdown, sensory overload, and dissociation

Too much unpredictable sensory input can create a great deal of strain on an autistic or ADHD nervous system. While sensory diversity has long been a well-known feature of autism, the ADHD research is only recently catching up. When sensory input surpasses what the system can hold, it tends to go one of two places:

• A sensory meltdown, where the alarm system fires up and our bodies mobilize. This looks like agitation, and a surge of hyperarousal.
• Or toward shutdown. Speech might get harder or go entirely, movement might slow, or everything feels slowed-down and foggy.

In a study of how autistic adults describe shutdowns, the metaphors people reached for included being frozen, going inside themselves, and a computer crashing. Others, like me, used the word dissociation to describe the experience.

That is what a shutdown feels like to me: like I'm in a dream, foggy, not present, distant. However, these words come from two different fields that barely speak to each other. Shutdown comes largely from the autistic community and a small amount of qualitative research. Dissociation grew up in trauma psychiatry, and is most widely talked about in relation to mental health concerns, and no one has systematically mapped these two experiences onto each other.

I suspect a lot of autistic and AuDHD people are describing sensory shutdowns to their therapists without either of them realizing it. The therapist hears it through a trauma-informed dissociative lens, and so the sensory-based dissociation never gets considered.

For me, one of the most painful parts of sensory-based dissociation is that the times I most want to be present—a child's birthday, or holiday gatherings—are the times I often feel the least present. And the things that would actually help me be present, like taking breaks or listening to one song on repeat through my earbuds, can read to other people as disengagement.

What helps with dissociation

We will respond differently to trauma-based dissociation than to sensory-based dissociation because fundamentally they are responses to different underlying needs.

• When trauma is part of the picture: working with a trauma-focused therapist to address dissociation closer to its root tends to be most helpful.
• When the pathway is sensory: grounding alone won't typically be enough. We want to reduce unpredictable input and increase predictable input that is within our control: removing yourself from a busy room, putting in headphones and listening to a stim song, pacing, or going on a walk. Or simply having an exit plan can help. Just knowing we can leave removes some of the stress our bodies are often carrying in high-pressure environments. An OT or a neurodivergent-affirming therapist can also help you map your sensory profile and build out accommodations.
• When it's absorption: if getting lost in projects or daydreaming is causing problems, we can think in terms of guardrails, like setting an alarm (I recommend a soft sound) that reminds you to check in with yourself.

Living with the fog

Somewhere in my 30s, I stopped pinching my skin and wondering whether or not I was in a dream and started asking what my body was trying to tell me. It’s certainly a less mystical question, but it turns out to be a useful one.

I have started to treat the fog as information rather than an unpleasant experience to power through. Sometimes it means the room is too much. Other times it means I’m absorbing other people’s emotions too intensely, or picking up on someone else’s dissociation and feeling it in my own body. And sometimes it just means a book or a project has captured my attention.

Learning to tell the difference is slow work, and I don’t think we ever get fully fluent in it. But we can start with simple check-ins. Does this feel good, neutral, or bad? Is there an underlying need I’m not addressing? Over time, we can get better at reading these complex bodies of ours and learning what they need.

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