What Dissociation Means Chemically, Neurologically, and Experientially.

If you search the internet these days for the subject of dissociation, you can find a lot of writings about dissociation. However, few who write about it have actually worked with it as long as I have, for over 35 years. Ive worked in Prison, mental hospitals in the US and abroad, addictions, and I also spent six years as a Buddhist monastic studying dissociation through meditating eight hours a day. When you meditate eight hours a day, you are quite literally studying the subconscious mind, and you are studying what dissociation is through your concentration and amplified consciousness. The whole teaching of Zen Buddhism is based upon understanding that everyone is living in a kind of dissociated state at different levels. Awakening consciousness is about accepting your reality and coming out of dissociative states. Mindfulness is the polar opposite of dissociation. Dissociation is a very interesting thing. It is a very tricky thing. It is very hard to see, because the nature of it is that it is a defense mechanism that tries to help you avoid being conscious of something. That something could be you or sensations or memories about you. It is, in many ways, a defense mechanism that makes you unconscious of what you are conscious of.

If you are reading this, you may have come here because dissociation is a central part of your life. Perhaps parts of you disappear in moments of stress. Perhaps memories blur, emotions numb, or you feel a lot of internal conflict in your thinking. Maybe you have tried talk therapy, telling your story over and over and over seeking understanding, and it helped in some ways but…. it did not heal what you feel is the core wound. It is important to understand that dissociation is not a defect in you, as it often arises from overwhelming experiences that the nervous system could not fully process.

Trauma does not lodge itself only in thoughts or memories. It embeds itself in brain circuits, in bodily states, in survival responses that predate language. Dr. Bessel van der Kolk, has put it this way:

“From my vantage point as a researcher we know that the impact of trauma is upon the survival or animal part of the brain. That means that our automatic danger signals are disturbed, and we become hyper or hypo active, aroused or numbed out. We become like frightened animals. We cannot reason ourselves out of being frightened or upset.” (psychotherapy.net)

Dr. Vander Kolk tells us something very important here. That reasoning, narrative, and talking are prefrontal cortex functions. But in many states of dissociation, parts of the brain, especially those involved in survival, alarm, and automatic regulation, override or shut down the capacities for reasoning and verbal coherence. What remains may be fragmented, sensory, and visceral.

What Dissociation Means Chemically, Neurologically, and Experientially

If you go to the VA hospital and you talk to veterans almost any day of the week, and you ask them how they are enjoying their trauma groups, they will often tell you that when they first came to the trauma group, it was great. They felt really heard. They felt really understood. They felt really seen by other veterans. But after coming week after week, month after month, and telling their story over and over again, they started to feel worse. They started to feel more angry. The panic attacks came back. They started to feel worse and worse. In fact, there is significant evidence to support the reality that PTSD symptoms can worsen through repeated verbal retelling, and the experience of many veterans at the VA demonstrates this.

This is because trauma does not simply live in narrative memory. It alters brain functioning and nervous system regulation at levels that talking alone cannot touch. To see why talk alone often fails, it helps to consider what the scientific literature says about how trauma and dissociation change the brain:

• Structure and function disruption: Trauma changes how brain regions communicate. In dissociative conditions, there is often reduced integration between the prefrontal cortex, responsible for planning, self reflection, and language, and deeper brain structures, such as the amygdala, hippocampus, and brainstem, that manage emotion, memory, and autonomic regulation.
• Traumatic activation overrides cognition: Dr. Daniel Amen’s work with SPECT, Single Photon Emission Computed Tomography, imaging demonstrates that in people with PTSD or high levels of emotional trauma, subcortical regions, especially the amygdala, basal ganglia, anterior cingulate gyrus, and deep limbic systems, are hyperactive. Meanwhile, regions of the brain involved in reasoning, inhibition, and planning often show lower or disrupted activity. For instance, Amen Clinics describes how emotional trauma produces a “diamond pattern” of overactivity, in the anterior cingulate gyrus, which helps shift attention, in basal ganglia and amygdala, fear and alarm centers, and in the thalamus, which functions as relay and sensory flood control. (amenclinics.com)
  • Another study by Dr. Daniel Amen and colleagues (2015, PLOS ONE) found that SPECT imaging can distinguish people with PTSD from those with traumatic brain injury, TBI, because of different patterns of brain perfusion, or blood flow. The PTSD group showed high activity in deep limbic areas, whereas the TBI group had different abnormalities. This supports the idea that emotional trauma activates subcortical circuits that can drown out or hinder the prefrontal cortex’s ability to interpret or integrate. (pmc.ncbi.nlm.nih.gov)
• Memory storage that evades narrative: Traumatic memories often are not stored as linear stories but as body sensations, images, smells, and fragmented emotional states. The hippocampus, which helps contextualize memory, is often impaired in trauma, making coherent recall difficult.
• Experience of self and identity altered: Dissociation may lead to identity confusion, emotional disconnection, depersonalization, or derealization. Sensations, time, and even body awareness can seem strangely distorted.

Why Talk therapy Frequently Falls Short with Dissociation.

• Language requires regulation. To speak about trauma safely, the nervous system must be regulated enough so that the threat circuits are not flooding. But in dissociation, those circuits overrun, shutting down regulation, prefrontal cortex, speech, and logical reflection, because the body is responding first.
• Narrative demands coherence. Talk therapy assumes a continuous, coherent self. But dissociation fragments memory and identity, making coherence difficult.
• Risk of re traumatization. Talking without regulation can reawaken trauma physiology, heart racing, shallow breathing, dissociative collapse, without offering integration.
• Insufficiency for sensory and autonomic memory. Much of trauma memory is sensory, implicit, and procedural. Talking does not reach those levels.

The Internal Experience: What Dissociation Often Feels Like

• Disconnection from the body- hard to feel your body at times.
• Blank spots in memory
• Emotional numbness or by contrast, overwhelming floods of emotions unexpectedly
• Watching yourself from outside, or confusion over who “I” am
• Different internal states or parts with conflicting emotions and memories

Dissociation is not simply a symptom to eliminate, it is a survival adaptation that deserves respect. Healing it requires more than words, it calls for safety, regulation, and reconnection across mind, body, and self. In the sections that follow, we will explore formal definitions of dissociation, why traditional talk therapy often fails, two case vignettes, and therapeutic pathways that can reconnect what has been fragmented.

Defining Dissociation

Dissociation is not a vague concept, it has a clear clinical definition and an equally real lived experience. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), dissociation is described as a disruption in the normal integration of consciousness, memory, identity, emotion, perception, and body representation (American Psychiatric Association, 2022). Dissociation even has different levels, such as, depersonalization, derealization, amnesia, identity confusion, or identity fragmentation, among others.

Yet these diagnostic terms often do not capture what dissociation feels like to those who live with it, nor how it arises in the first place. Dissociation is best understood as a defense mechanism, one that protects the mind from experiences that would otherwise overwhelm it. This is seen clearly in the stories of those who have experienced religious trauma and childhood sexual abuse.

Dissociation and Religious Trauma

I once worked with a man in his early forties who had grown up in a highly authoritarian religious environment. From childhood onward, sermons focused on sin, hell, and divine punishment. Even normal childhood curiosity or anger was shamed as rebellion against God. His parents, devoted members of their church, often told him that questioning leadership was “Satan working through him.”

By the time he reached adolescence, he had learned to suppress nearly every “unacceptable” emotion. When fear or anger arose, he felt himself go numb, as though a heavy curtain dropped inside. He described it later as though “the real me had to vanish, so God wouldn’t see what I was feeling.” Then he added, “I was really scared that Satan was really working through me, and I had to push away or dissociate from those feelings in order to make sure that Satan wasn’t working through me, It was very confusing.”

As an adult, he sought help after years of struggling with anxiety and panic attacks. In conversations he could articulate beliefs, but whenever he tried to speak about the fear of hell or punishment endured at home, his voice would trail off, his gaze drift, and his body collapse into silence. He recognized these moments later as dissociation. Talking about doctrine or reasoning through beliefs did not touch the deeper wound, because the nervous system had encoded fear and shame so deeply that words alone could not bridge the gap.

Attachment research helps explain his pattern. When parental and spiritual authority figures are fused, the attachment to God can function both as comfort and as a source of terror. Granqvist and Shaver (2010) note that religion often mirrors attachment patterns: secure caregiving fosters a benevolent God-image, whereas punitive caregiving fosters an authoritarian God-image, one that can instill chronic fear and dissociation. For this person, dissociation was the only way to survive the impossible bind of needing love from a God who seemed to punish his every feeling.

Surviving Childhood Sexual Abuse

Another client, a woman in her thirties, sought therapy for chronic depression, migraines, and “losing time.” Over many years, she revealed that from ages seven to ten she had been sexually abused by a trusted family member. When the abuse began, she felt trapped, voiceless, and unable to fight back. To cope, she left her body, she described floating above the room, watching events from outside herself. Sometimes she would focus intently on a crack in the ceiling or the ticking of a clock, anything to separate from what was happening.

As an adult, these patterns persisted. She often reported gaps in memory, sudden emotional shifts, and a sense of unreality. In therapy, when she tried to recall the abuse, she would either freeze or feel as if she were no longer in her own body. Panic attacks, nightmares, and intrusive body sensations haunted her despite years of talk therapy.

When we explored further, we discovered that at times when she tried to be intimate with her partner at home, it was going well. They would be having a very good sexual connection, but then unexpectedly a certain touch or smell would suddenly trigger a series of physical memories and physical associations that would cause her to recoil, feel tremendous fear and panic, and go into a freeze state, dissociating and leaving her body. She would have to stop sexual activity immediately and apologize to her partner, later going into a shame spiral, feeling terrible about depriving her partner of sexual pleasure and intimacy, and feeling terrible about herself for not understanding why this was happening.

It became clear that dissociation had been her body’s brilliant survival strategy. By disconnecting from unbearable sensations, she had preserved some part of herself, but the long-term cost was steep: fragmented memory, disconnection from her body, difficulty sustaining relationships.

Research confirms her experience. Survivors of childhood sexual abuse are at high risk for dissociative disorders, especially when the abuse is chronic and involves betrayal by trusted caregivers. Studies also show that shame plays a central role in maintaining dissociation. In individualist cultures survivors often internalize the abuse as their fault, silencing themselves and reinforcing the need to split off painful emotions (Boiger et al., 2013). For this person, shame and dissociation worked hand in hand to protect in childhood but to imprison in adulthood.

Dissociation as Disconnection from the Self

These real-life examples are meant to illustrate that dissociation is not random, it is an instinctive survival strategy that happens when our fear begins to train our consciousness to be less conscious. Dr. Gabor Maté often emphasizes that trauma is not simply what happens to us, but what happens inside us as a result. Dissociation is that inner happening, the psyche’s way of cutting connections, between feelings and thoughts, between body and mind, between self and self. We often want to subconsciously disown a part of ourselves that is too painful to be with and accept. This will obviously have an impact on how we form relationships with others, and therefore why we often chose relationships with people who are not safe for us. We are not acting consciously. We are not living in open hearted discernment; we are living in a highly defensive dissociated state. Unable to recognize emotions as information. Living like this we don’t always make the best decisions for ourselves. How can we?  

 “Attachment is a very powerful aspect hidden in the background in adult relationships, for example … The child has an absolute need to belong to the parents and to be cared for by the parents. That drive to be close to somebody in order to be taken care of, or to take care of the other, for that matter, is called attachment. And mammals are creatures of attachment, They can’t survive without attachment; without the caring relationship, obviously, the young cannot survive. So attachment, that’s fine, But then we have this other need that’s also determined by evolution, which I call authenticity … being in touch with ourselves, being in touch with our feelings and our bodies and our emotions … Gut feelings are essential for survival … What happens is if, for the sake of fitting in with the family or with a culture that doesn’t particularly support our authenticity, we have to give up our connection to ourselves, our authenticity, for the sake of attachment? Then being inauthentic, being out of touch with ourselves, is how we survive … Something happened between the day you were born and a few years later when you no longer listened to your gut feelings, because you couldn’t afford to.’ ” (Dr. Gabor Maté, Authenticity Can Heal Trauma) (Mad In America)

What Research Says: Why Somatic and Body-Based Therapies Are More Effective for Dissociation

For many trauma survivors, especially those living with dissociative symptoms, the promise of healing through traditional talk therapy often falls flat. Clients frequently arrive in our offices frustrated: they’ve done “the work,” seen multiple therapists, talked about their trauma, and still find themselves dissociating, spacing out, going numb, feeling unreal, or disconnected from their bodies. For these individuals, the very structure of talk therapy can replicate the sense of being split off from experience. This is not a failure of will, effort, or insight. It is a neurobiological mismatch between the treatment and the part of the brain-body system holding the trauma.

Recent research has increasingly demonstrated that somatic and body-based therapies often outperform traditional cognitive or talk-based approaches for those living with dissociation. These modalities, like Somatic Experiencing, Sensorimotor Psychotherapy, Trauma Release Exercises (TRE), and others, engage the body’s own memory systems and regulatory capacities. They do not require a client to articulate what happened in words right away. Instead, they start with the part of the trauma that was never stored in language to begin with: the body.

Let’s look at what the science is actually showing us, and why this shift toward somatic therapies is not just a trend, it’s a necessity for effective trauma care.

When people experience traumatic events, particularly overwhelming or inescapable events like sexual assault, childhood abuse, or combat, the brain can switch into survival states. Dissociation is one such survival response. It involves a disconnection from sensation, emotion, memory, or identity, often as a last-ditch effort to escape something that the person could not physically escape.

As Judith Herman writes in Trauma and Recovery, traumatic events overwhelm ordinary adaptations to life. They fracture time and sense of self. The survivor may be unable to organize the experience on a narrative level because the brain wasn’t encoding the event in language to begin with. Instead, trauma is often encoded in fragmented sensory impressions: smells, body sensations, or emotional flashes. These are stored not in the prefrontal cortex, the brain’s narrative center, but in the amygdala, brainstem, and other subcortical areas.

This explains why talking about trauma doesn’t always resolve its impact. If the trauma was never encoded in language, asking someone to talk about it often fails. Worse, pushing too hard to “talk through it” can lead to re-traumatization or more dissociation. The person may leave the session feeling worse, not better, and may even drop out of therapy.

Evidence from Somatic Experiencing (SE)

Somatic Experiencing (SE) is a therapeutic approach developed by Peter Levine that focuses on helping individuals track bodily sensations and release the physiological energy of trauma. Rather than diving into the traumatic narrative, SE gently helps clients build awareness of internal sensations, which are the building blocks of traumatic memory.

A 2021 study by Kuhfuß et al. in the European Journal of Psychotraumatology found that participants undergoing SE showed significant improvements in PTSD symptoms, including reductions in hyperarousal, somatic symptoms, and dissociation. The researchers emphasized that the clients’ ability to stay connected to bodily sensation without becoming overwhelmed was key to the treatment’s success.

This aligns with what we see clinically. Dissociation disrupts the connection between body and mind. SE helps restore this connection not by forcing narrative processing, but by helping the client gently return to sensations that were previously intolerable or inaccessible.

Sensorimotor Psychotherapy and the Reconnection to Self

Sensorimotor Psychotherapy, developed by Pat Ogden and further advanced by clinicians like Janina Fisher, combines body-awareness with cognitive and emotional processing. It operates on the principle that trauma is stored in the body, particularly in muscular tension, posture, movement, and other somatic patterns.

In one pilot randomized controlled trial of a Sensorimotor group therapy for complex trauma, participants demonstrated measurable improvements in affect regulation, bodily awareness, and reductions in dissociation. This is especially important because people with complex PTSD often experience profound identity fragmentation. They may describe themselves as “not here,” “gone,” or having different “parts” of themselves that feel alien or inaccessible. Sensorimotor Psychotherapy helps integrate these parts by working with the body systems that keep them separate.

Janina Fisher (2019) describes how clients often say, “I know what happened, but I don’t feel anything about it.” This gap between knowing and feeling is a hallmark of dissociation. Sensorimotor work closes this gap by helping the body register the safety of the present moment, so that dissociated sensations and emotions can be accessed without overwhelm.

Trauma Release Exercises (TRE) and Neurogenic Tremoring

Another approach supported by clinicians at Seattle Trauma Counseling is Trauma Release Exercises (TRE). TRE uses a series of physical movements to induce a natural shaking mechanism in the body called neurogenic tremoring. These tremors help discharge stored tension and stress from the nervous system.

While TRE lacks the large-scale randomized controlled trials of SE or Sensorimotor Psychotherapy, emerging evidence and clinical reports suggest it can be especially helpful for those who have learned to shut down body awareness entirely. In cases of freeze-based trauma responses, where clients feel immobilized or numb, TRE provides a structured way to physically “unfreeze” without needing to talk.

By letting the body release trauma directly, clients often experience reductions in anxiety, better sleep, and a restored sense of embodiment. These gains are particularly crucial for people with dissociation, who often struggle with feeling disembodied or unreal.

Phase-Oriented Treatment and Stabilization

Trauma treatment models such as those endorsed by the International Society for the Study of Trauma and Dissociation (ISSTD) recommend a phase-based approach: (1) stabilization, (2) trauma processing, and (3) reintegration. Somatic therapies excel in Phase 1: helping clients regulate their autonomic nervous systems, develop present-moment awareness, and tolerate bodily sensation.

A 2023 mixed-methods study by Salvesen et al. published in the Journal of Trauma & Dissociation showed that trauma-sensitive interventions with somatic components significantly reduced dissociation, complex PTSD symptoms, and self-hatred. These approaches emphasized gentle, body-based stabilization techniques over traditional exposure or cognitive interventions.

This is especially relevant for dissociative clients, who may need extensive time in stabilization before any direct trauma processing is attempted. For them, somatic work is not optional,it is foundational.

The Problem of Dropout: When Talk Therapy Fails

One of the clearest signs that traditional talk therapies struggle with dissociation is the dropout rate. In a 2022 analysis of U.S. Department of Veterans Affairs data, researchers found that only 9.1% of veterans offered Prolonged Exposure (PE) or Cognitive Processing Therapy (CPT) completed the full protocol. In many studies, dropout rates for exposure-based therapies hover between 38% and 50%.

Why are people dropping out? For many, the answer is dissociation. When trauma memories are fragmented, when arousal is too high, and when verbal recall is dysregulated, exposure simply doesn’t work. As Resick et al. (2012) note, the mechanism of exposure therapy depends on emotional engagement. But dissociation shuts that engagement down. You can repeat the story, but if the body is frozen or numb, no real integration happens. Many therapists with experience working with PTSD have come to believe that exposure therapies can actually retraumatize people and there are studies that now suggest this.

Somatic therapies offer a way out of this impasse. They work with what’s actually present: sensation, movement, breath, subtle shifts in posture or awareness. These small doorways open into deeper integration, without forcing the system to re-live what it can’t yet tolerate.

Why This Matters: Rebuilding Connection from the Inside Out

Trauma separates. It separates us from our bodies, our feelings, our memories, and sometimes even from our sense of self. Dissociation is not just a symptom; it’s a state of disconnection that lives in the nervous system. To treat it, we must help people reconnect, not just to their pasts, but to their present experience of being alive.

Somatic therapies do not promise quick fixes. They are not always comfortable. But they are aligned with the way trauma actually works. They respect the wisdom of the body and recognize that healing requires more than insight. It requires presence. Sensation. Safety. Slowness.

For clients who dissociate, somatic therapy is often the first kind of therapy that finally makes sense, not because they suddenly remember everything, but because they begin to feel something. And feeling, is the beginning of learning how to recognize whether or not you feel safety in your body; learning how to discern and feel safe in your body is where healing begins.

written by Robert Espiau LMHC

References

American Psychiatric Association. (2022). DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders, Text Revision. Arlington, VA.

Boiger, M., Mesquita, B., Uchida, Y., & Barrett, L. F. (2013). Culturally shared and individual differences in the association of shame and social behavior. Personality and Social Psychology Bulletin, 39(5), 663–676.

Fisher, J. (2019). Sensorimotor Psychotherapy in the Treatment of Trauma. Practice Innovations, 4(3), 156–165. https://janinafisher.com/wp-content/uploads/2023/03/sensorimotor-psychotherapy-trauma.pdf

Granqvist, P., & Shaver, P. R. (2010). Religion as attachment: Normative processes and individual differences. Personality and Social Psychology Review, 14(1), 49–59.

Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror. Basic Books.

Kuhfuß, M., Cropp, C., Knaevelsrud, C., & Rosner, R. (2021). Somatic Experiencing – Effectiveness and key factors of SE on PTSD-related symptoms. European Journal of Psychotraumatology, 12(1). https://doi.org/10.1080/20008198.2021.1929023

Maté, G. (2022, December 11). Authenticity Can Heal Trauma. Mad in the World. https://www.madintheworld.org/2022/12/11/authenticity-can-heal-trauma/

Maté, G. (2022). The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. Knopf Canada.

Salvesen, K. T., et al. (2023). A mixed-methods pilot study of a trauma-sensitive intervention with somatic components: Reducing CPTSD, dissociative symptoms, and self-hatred. Journal of Trauma & Dissociation. https://www.sciencedirect.com/science/article/abs/pii/S2468749923000492

U.S. Department of Veterans Affairs. (2022). Dropout rates in trauma-focused therapies. National Center for PTSD. https://www.ptsd.va.gov/professional/treat/txessentials/therapy_dropout.asp

Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.