Tag: CBT

When people use the word dissociation, it can sound alarming. You may have seen it on social media, heard your child mention it, or noticed your child seeming “checked out” and wondered if that’s what’s happening. Dissociation can be confusing because it exists on a spectrum — from everyday experiences like daydreaming to more serious symptoms that may signal that a child is overwhelmed or struggling. The good news is that dissociation is often a temporary coping mechanism, and when it does become a problem, there are effective ways to help.

In simple terms, dissociation is a kind of mental disconnection. “When I think of dissociation, I think of there being some sort of disconnect between an individual and their sense of self, or a period of time that you later can’t recall, or feeling like you’re disconnected from your body,” says Lauren Allerhand, PsyD, a clinical psychologist at the Child Mind Institute and co-director of its DBT program.

Some kids describe dissociation as feeling spaced out, numb, or disconnected from their body or surroundings. Others say they feel like they’re watching themselves from outside their body, or that the world around them doesn’t feel real. “There’s some period of time where your normal sense of flow is disrupted,” Dr. Allerhand explains.

In its mildest form, dissociation is a commonplace occurrence. Kids might daydream in class, zone out during something boring like a long car trip, or feel detached when they are overwhelmed in some way. These experiences are usually not a cause for concern. “Our brains do a really good job of protecting ourselves,” Dr. Allerhand says. “Sometimes our brains develop strategies to protect us that are healthy, and other times they develop strategies that might work in short bursts but become less helpful if they happen too much.”

When dissociation happens often, or interferes with daily life, it may signal that a child is struggling with something more serious than ordinary, intermittent stress. “If it’s happening all the time, it’s less effective as a coping mechanism” because of the toll it can take when there is memory loss, confusion, and feeling disconnected to the self, she explains.

Children and teens may describe dissociation differently. Some say they feel:

• Like they’re in a dream
• Emotionally numb
• Detached from their body
• Like they’re watching themselves in a movie
• Like things around them aren’t real

“Kids might say they feel like a robot. Everything feels fake around them,” Dr. Allerhand says. “Younger children may not have the words to describe what they’re experiencing. Instead, parents might notice their child seems unusually quiet, unresponsive, or ‘not themselves.’”

Dissociation is often linked to stress or overwhelming emotions — kids may dissociate when they feel unable to cope with what’s happening around them. “This could be a response to any sort of highly intense emotion or experience,” Dr. Allerhand says, such as:

• Trauma
• Anxiety or panic
• Intense emotions
• Depression
• Major life changes
• Overwhelming stress

“It’s another way of coping with stress or trauma,” says Tanvi Bahuguna, PsyD, a clinical psychologist at the Child Mind Institute who specializes in trauma and mood disorders. “There’s this psychological process that helps them disconnect from overwhelming pain.” Some kids dissociate during panic attacks or periods of intense anxiety. Children who have experienced significant adversity may be more likely to dissociate. These experiences can include:

• Abuse
• Neglect
• Family instability (housing instability, domestic violence, addiction)
• Loss of a family member, especially through violence or suicide

Still, experts are quick to note that dissociation doesn’t automatically mean a child has experienced trauma or has a serious disorder. “There are lots of exits on this highway before we’re at a dissociative disorder,” Dr. Allerhand says, adding that a full-blown dissociative disorder is very rare in children.

It can be hard to recognize when a child is experiencing more serious dissociation because it doesn’t always look different from daydreaming or inattention. One key difference is distress. “Spacing out or not paying attention is not often experienced as distressing,” Dr. Allerhand says. Moderate or serious dissociation “is often somewhat distressing.” Kids who are daydreaming are still connected to themselves and their surroundings; kids who are experiencing more serious dissociation may feel cut off from their body, emotions, or reality altogether.

If you think your child may be dissociating, the most important thing you can do is not panic or try to get your child to “snap out of it.”  “The number one thing a parent can do is stay as calm as possible,” Dr. Bahuguna says. Speak gently, use short sentences, and reassure your child that they’re safe. Saying your child’s name and reminding them you’re there can help them reconnect.

Grounding techniques can also bring kids back into the present moment. One common method is called the 5-4-3-2-1 technique: Ask the child to name five things they can see, four things they can feel, three things they can hear, two things they can smell, one thing they can taste or imagine tasting. Other grounding strategies include:

• Deep breathing
• Squeezing a stress ball
• Holding something cold
• Gently moving the body

If you find your child often dissociates, Dr. Allerhand recommends helping them make a plan for it. During a calm moment, talk with your child about what they find helpful. “I noticed that this is happening. How can I help you when this is happening?” she suggests asking. Having a plan in advance makes it easier to respond in the moment — and in the meantime, stay nearby and make sure your child is safe until the episode passes.

If dissociation is frequent, distressing, or associated with changes in your child’s functioning, seeking professional support is appropriate. “If something dissociative happens, and there’s a really big change in your child’s functioning, then I would be concerned,” Dr. Allerhand says.

Signs it may be time to reach out include:

• Memory gaps after the episode
• Noticeable personality changes
• Difficulty at school
• Withdrawal from friends or activities
• Significant distress or confusion

A good place to start would be talking to your pediatrician, who may refer you to a mental health professional. “If your child is displaying behaviors that seem out of the ordinary, you should trust your instincts,” Dr. Allerhand says.

To determine whether a child is dissociating, a mental health professional gathers information from multiple sources, including parents, the child, and sometimes teachers, asking about the child’s behaviors, history, and any recent stressors or changes in behavior.

“The first thing would be a structured diagnostic interview with a qualified clinician,” Dr. Allerhand explains. “Parents bring the history and describe the behavior, and then the clinician meets with the child.” Clinicians also consider whether dissociation might be a symptom of another condition, such as post-traumatic stress disorder, borderline personality disorder, anxiety (especially panic disorder), and depression.

“It’s really gathering history, meeting the child, observing the child, and figuring out what this cluster of behaviors leads to,” she says. It’s more frequent to find that dissociation is a result of another disorder than an actual dissociative disorder.

Treatment depends on what’s driving the dissociation. If trauma is involved, therapy may focus on helping the child process difficult experiences and build coping skills. Evidence-based approaches include trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR).

If anxiety or emotional overwhelm is the primary cause, treatment may focus on emotion regulation, grounding techniques, and identifying triggers and early warning signs. Therapy, such as dialectical behavior therapy (DBT), typically involves both children and parents, helping families recognize patterns and respond in supportive ways.

For more severe or persistent dissociation, treatment may happen in phases — beginning with safety and stabilization, then skill-building, and eventually, when appropriate, processing difficult experiences. “The goal is helping the child learn to cope with their experience and stay in their body,” Dr. Allerhand says.

In children and teens, dissociation is usually a symptom of another condition. But in cases of very serious early trauma, abuse, or neglect, it can progress into a full-blown disorder. There are a number of dissociative disorders, including:

• Dissociative identity disorder (what was once called multiple personality disorder) involves two or more distinct personality states and gaps in memory and is typically linked to significant early trauma. Parents who search online may find alarming information, but Dr. Allerhand says this condition is very rare in kids.
• Dissociative amnesia involves gaps in memory that can’t be explained by ordinary forgetfulness — such as not remembering important personal information or periods of time — and is often associated with stressful or traumatic experiences.
• Depersonalization/derealization disorder involves feeling detached from oneself, as though watching yourself from outside your body, or feeling that the world around you isn’t real.

These disorders sometimes attract media attention, but they are extremely rare in children. What’s important for parents to know is that if you see dissociative behavior in a child, it’s most likely a normal coping mechanism for a child experiencing some stress or intense emotion. If it persists, is causing distress, or is interfering with a child’s life, it’s time to consult a pediatrician or mental health professional. Identifying what might be causing the behavior is the first step to getting appropriate treatment.

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