It can be hard to find words for. The day seems to happen behind glass. You run on autopilot. You know you love someone and cannot feel it. These are everyday images, not clinical terms, for experiences that clinicians call dissociation and emotional numbing.
This article explains what those terms mean, what official sources say about them after trauma, and when an assessment makes sense. It cannot tell you what you have. Only a clinician who has talked with you can do that.
What is dissociation?
Dissociation is a kind of disconnection, and in mild forms it is ordinary. The American Psychiatric Association's patient page quotes this definition: "Dissociation is a disconnection between a person's thoughts, memories, feelings, actions or sense of who he or she is. This is a normal process that everyone has experienced." Its examples of mild, common dissociation are daydreaming, highway hypnosis, and getting lost in a book or movie.
The same page describes what dissociation can do during a trauma: "During a traumatic experience such as an accident, disaster or crime victimization, dissociation can help a person tolerate what might otherwise be too difficult to bear."
It can also follow the event. The National Institute of Mental Health (NIMH) says: "After a dangerous event, it is natural to have some symptoms. For example, some people may feel detached from the experience, as though they are observing things as an outsider rather than experiencing them."
What do depersonalization and derealization mean?
They are the two dissociative symptoms that the American Psychiatric Association names in its description of post-traumatic stress disorder (PTSD). It defines them this way:
- Derealization: "The feeling that life is not real. Individual may describe feeling like they are in a movie or in a dream."
- Depersonalization: "The feeling that one is outside of their body."
It says that some individuals with PTSD will have these symptoms, and adds: "These symptoms are not required for a PTSD diagnosis."
Is feeling numb a trauma reaction?
It can be. The VA's National Center for PTSD includes "Feeling shocked, numb, or not able to feel love or joy" among common reactions after trauma. In describing PTSD, it says you may feel numb, unable to have positive or loving feelings toward other people, and lose interest in things you used to enjoy. NIMH's list of PTSD symptoms includes "Difficulty feeling positive emotions, such as happiness or satisfaction."
Numbness is easy to mistake for not caring. The VA's coping page speaks to that directly: "Remember that this is a common reaction to trauma. You are not doing this on purpose."
Loss of interest is not unique to trauma. The VA notes that "trouble concentrating or feeling less interested in things you used to enjoy can be signs of both depression and PTSD," and that different problems have different treatments. That is one reason to have lasting numbness assessed instead of guessing at its cause.
What is the dissociative subtype of PTSD?
It is a form of PTSD in which depersonalization and derealization are prominent. A VA page for clinicians says research "has suggested that there is a dissociative subtype of PTSD," defined primarily by those two symptoms. In the studies it summarizes, of veteran and civilian samples, roughly 15 to 30% of people with PTSD reported them.
The VA page reports that, compared with people with PTSD alone, people with the subtype showed repeated traumatization and early adverse experience before the onset of PTSD, "Increased functional impairment," and "Increased suicidality (including suicidal ideation, plans, and attempts)." The study it cites for the suicidality finding analyzed World Health Organization surveys in which 25,018 people in 16 countries were interviewed. Among respondents who had PTSD in the past 12 months, 14.4% had dissociative symptoms, and those symptoms were associated with suicidality. That is an association found in population surveys, in which dissociation was measured with a few items from a checklist of general distress. It is not a prediction for any one person. If you are having thoughts of suicide, call or text 988, or call 911 in an emergency.
The subtype is something clinicians assess in an interview, with questions about times when surroundings seemed unreal or unfamiliar. It is not something to work out from a list. Dissociative disorders are separate diagnoses. The American Psychiatric Association lists three (dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder) and says they "are frequently associated with previous experience of trauma."
Does dissociation get in the way of treatment?
The sources give two readings, and both are reported here.
The VA's page for clinicians says that for people with the dissociative subtype, "exposure treatment can lead to further dissociation." It describes preliminary evidence that people with depersonalization and derealization responded better to treatments that also included cognitive restructuring and skills training in managing emotions and relationships than to exposure-based therapies alone.
A later meta-analysis, published in 2020, looked across 21 trials (nine of them randomized) with 1,714 patients. It found that dissociation before treatment was not related to how well psychotherapy for PTSD worked (correlation 0.04, 95% confidence interval -0.04 to 0.13). The authors wrote: "We found no evidence that dissociation moderates the effectiveness of psychotherapy for PTSD. The quality of some of the included studies was relatively low."
On PTSD treatment in general, the 2023 guideline from the Departments of Veterans Affairs and Defense (VA/DoD) and the American Psychological Association's 2025 guideline give their strongest recommendations to specific trauma-focused psychotherapies, such as cognitive processing therapy and prolonged exposure. Psychodynamic therapy has been studied much less for PTSD, and both guidelines list it as having insufficient evidence to recommend for or against. Types of trauma therapy sets out the research.
When should you seek an assessment?
No official source reviewed for this article gives a threshold specific to dissociation. The VA's general rule for trauma reactions is to talk to a doctor or mental health care provider if your symptoms last longer than a month, are very upsetting, or disrupt your daily life.
The American Psychiatric Association lists loss of memory among dissociative symptoms. If you notice gaps in your memory, or if these experiences frighten you, that is reason enough to ask for an assessment. You do not have to reach any threshold first. If you are thinking about harming yourself, call or text 988, or call 911 in an emergency.
The VA says: "Only a mental health provider can diagnose PTSD." PTSD symptoms: what clinicians look for describes the wider picture, and Do I need trauma therapy? may help you decide on a next step.
How does Dr. Rabin work with trauma?
Dr. Rabin's page on trauma therapy speaks of numbness and disconnection. Her approach is psychodynamic, attachment-based, trauma-informed and mindfulness-based, guided by safety, pacing and the therapeutic relationship. The work moves at your pace and builds trust and stability before approaching painful material. You decide what is discussed and when.
If you are looking for a particular method, ask on a consultation call whether she offers it or would refer you. She sees clients in Brookline and by secure telehealth anywhere in Massachusetts. You can read about her psychodynamic approach or request a free consultation of about 15 minutes through the contact page.
Keep reading
Sources
- American Psychiatric Association, What Are Dissociative Disorders? (physician review October 2024)
- American Psychiatric Association, What is Posttraumatic Stress Disorder (PTSD)? (physician review March 2025)
- National Institute of Mental Health, Post-Traumatic Stress Disorder, NIH Publication No. 23-MH-8124 (revised 2023)
- VA National Center for PTSD, PTSD Basics (page header: Last Updated October 2026)
- VA National Center for PTSD, Common Reactions After Trauma (last updated September 25, 2026)
- VA National Center for PTSD, Coping with Traumatic Stress Reactions (last updated March 26, 2025)
- VA National Center for PTSD, Dissociative Subtype of PTSD (last updated December 9, 2025)
- Hoeboer CM, De Kleine RA, Molendijk ML et al., Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis. BJPsych Open (2020)
- U.S. Department of Veterans Affairs and Department of Defense, VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder (June 2023)
- American Psychological Association, Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults (2025)
- Stein DJ, Koenen KC, Friedman MJ et al., Dissociation in posttraumatic stress disorder: evidence from the world mental health surveys. Biol Psychiatry (2013)
- VA National Center for PTSD, Do I Have PTSD? (last updated September 25, 2026)
Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis or thinking about harming yourself, call or text 988, or call 911 in an emergency.
