Dissociation, Trauma, and Borderline Personality Disorder
Dissociation is one of the most confusing and distressing experiences linked to Borderline Personality Disorder. A person may suddenly seem far away, emotionally absent, numb, unreal, or unable to remember what has just happened. For carers, these moments can feel frightening and hard to understand. A major 2022 editorial by Dr Annegret Krause-Utz explains that dissociation is not a rare side issue in BPD. It is a central feature for many people, especially during times of stress. The research also shows that dissociation is closely linked to trauma, identity disturbance, emotional overwhelm, and problems in relationships. Understanding this can help carers respond with more calm, compassion, and clarity.
Dissociation is more common in BPD than many people realise
Dissociation affects a very large number of people with Borderline Personality Disorder at some point in their lives. It is not a fringe symptom and it is not something that only happens in extreme cases. For many people with BPD, dissociation appears during moments of intense emotional stress, conflict, fear, or inner overload.
This matters because dissociation can be very easily misunderstood. From the outside, it may look like someone is ignoring you, being rude, withdrawing on purpose, or refusing to engage. In reality, they may be experiencing a genuine shift in awareness, attention, memory, or sense of self. They may not be able to take in what is happening around them in the usual way.
When carers do not know this, these moments can become even more painful. A loved one may seem to disappear emotionally just when support is most needed. That can create fear, frustration, or conflict. But when dissociation is understood as part of the person’s stress response, the picture changes. The behaviour looks less like rejection and more like a mind that has become overwhelmed.
Dissociation in BPD is not usually a choice. It is often a sign that the person’s system has become overwhelmed and has shifted into protection mode.
What dissociation actually means
Dissociation is a state in which parts of a person’s experience become disconnected from each other. Thoughts, feelings, memories, bodily awareness, attention, perception, and identity may no longer feel joined together in the normal way. This can happen on a mild level, such as feeling spaced out or unreal, or on a more severe level, such as memory gaps or feeling disconnected from one’s own body and emotions.
Some people experience derealisation, where the world around them feels strange, distant, dreamlike, or not fully real. Others experience depersonalisation, where they feel detached from themselves, as if they are watching themselves from outside or moving through life without full connection to their own body or mind. Some may experience dissociative amnesia, where they cannot clearly remember conversations, events, or parts of a distressing experience.
For carers, these symptoms can be deeply confusing. A loved one may say, “I don’t feel real,” “I can’t remember,” or “Everything went blank.” At other times, they may not be able to explain what is happening at all. They may just look vacant, frozen, disconnected, or unreachable.
Understanding the language of dissociation helps carers recognise that this is not simply moodiness or avoidance. It is a real alteration in awareness and self-experience.
Trauma helps explain why dissociation develops
Trauma models suggest that dissociation develops as a survival response when experience becomes too overwhelming to process directly. In childhood especially, if a young person faces repeated fear, abuse, neglect, or emotional overwhelm and has no safe way to escape, the mind may protect itself by disconnecting.
Research discussed in the editorial shows strong links between dissociation and early repeated trauma, including emotional, physical, and sexual abuse by caregivers. The earlier the trauma begins and the more severe or chronic it is, the greater the risk of later dissociative symptoms.
This makes sense psychologically. A child who cannot run away, fight back, or fully understand what is happening may survive by mentally going elsewhere. In the moment, that can be protective. It can reduce pain, fear, and awareness of what feels unbearable. But later in life, the same response may become generalised.
In BPD, dissociation may then appear not only during actual danger, but also during interpersonal conflict, rejection, emotional shame, or relational stress. A difficult conversation, a perceived abandonment, or intense emotional pain may trigger the same old protective pattern, even when the person is no longer in the original traumatic situation.
Dissociation often begins as a survival strategy in overwhelming situations, but later it can become a barrier to feeling, thinking, and relating clearly.
Why dissociation can become a problem in everyday life
What begins as protection can eventually interfere with ordinary functioning. According to the editorial, dissociation can block emotional learning and reduce a person’s ability to process information properly. This means it can affect relationships, coping, therapy, and daily decision-making.
If a person dissociates during conflict, they may not take in what was said clearly. If they dissociate during therapy, they may struggle to reflect, learn, or connect emotionally to what is being discussed. If they dissociate during distress, they may be left with confusion, memory gaps, and a sense of being out of control.
This is one reason dissociation is so important to understand in BPD. It does not only create strange experiences in the moment. It can also make recovery harder by interrupting the very processes people need in order to heal, such as emotional awareness, reflection, and learning from experience.
For carers, this can help explain why a conversation that seemed meaningful one day may appear forgotten the next, or why progress can feel inconsistent. Dissociation may be interrupting the person’s ability to stay present enough to integrate what is happening.
The brain and body both seem to shut things down
Neuroscience is beginning to show what dissociation looks like in the brain. Research reviewed in the editorial found that people experiencing dissociation often show increased activity in areas such as the medial prefrontal cortex and inferior frontal gyrus, which are involved in regulation and inhibitory control. At the same time, regions involved in integrating sensory and emotional information, such as the hippocampus and thalamus, may show reduced volume in people with chronic dissociation.
In simpler language, the brain appears to move into a state where feeling and experience are dampened or blocked. Instead of fully processing emotional and sensory information, the system seems to reduce access to it. This helps explain why people can feel numb, unreal, detached, or blank.
The body seems to do something similar. Psychophysiological studies suggest that during dissociative states, people may show blunted physical responses, including slower heart rate, reduced skin conductance, and a weaker startle reaction. The body does not always look as activated as you might expect during distress. Instead, it may appear muted or shut down.
This is important because carers often expect distress to look noisy, dramatic, or obviously emotional. Dissociation can look like the opposite. The person may appear strangely flat, still, or distant while something very intense is happening internally.
In dissociation, the mind and body may both move into a numbed, shut-down state. The person is not necessarily calm. They may be overwhelmed in a different way.
Dissociation is closely linked to self-harm and altered pain
One of the most concerning areas discussed in the research is the connection between dissociation, altered pain perception, and non-suicidal self-injury. When a person is dissociated, they may feel numb, disconnected, unreal, or cut off from their body. In some cases, self-harm may be used to break through that numbness and feel something again.
This does not mean self-harm only happens during dissociation, and it does not mean every act of self-injury has the same purpose. But the link matters. If someone feels emotionally and physically disconnected, pain may be experienced differently. The usual internal warning signals may be weaker. Self-injury may then become tied to an attempt to re-establish feeling, presence, or relief from an unbearable mental state.
For carers, this can be a very important shift in understanding. A loved one may not be self-harming only because emotions are “too much.” Sometimes they may be self-harming because they feel almost nothing at all and need to break through deadness or unreality.
That does not make the behaviour safe, but it does help explain why simple advice like “just calm down” or “think before you act” may completely miss what is happening. Dissociation changes how the person experiences themselves, their body, and the moment they are in.
Identity disturbance and dissociation often go hand in hand
Identity disturbance is one of the central features of Borderline Personality Disorder, and the editorial explains that dissociation is tightly linked to it. People with BPD may describe their sense of self as fragmented, unstable, or incoherent. They may not feel solid inside. Their values, goals, emotional states, and sense of who they are may shift painfully.
Dissociation can deepen that instability. If a person feels disconnected from their memories, emotions, body, or inner continuity, it becomes harder to maintain a steady sense of self. They may not only ask, “Who am I?” but actually feel as if there is no stable “I” to return to.
This can affect every area of life. Relationships become harder when the self feels fragile. Decision-making becomes harder when goals and identity do not hold steady. Recovery becomes harder when emotional setbacks trigger not only pain, but disconnection from self.
For carers, this can help explain why a loved one may seem like a different person at different times, or why their views of themselves can swing so sharply. Dissociation is not the only reason for this, but it can be one important part of the picture.
When dissociation and identity disturbance combine, the person may not simply feel upset. They may feel unsure of who they are, what they feel, or how to stay connected to themselves.
Emotion dysregulation and dissociation feed each other
Emotion dysregulation is another core feature of BPD, and the research shows that it is closely tied to dissociation. Intense shame, fear, rage, panic, or emotional pain may trigger dissociation as a way of escaping what feels unbearable. In that sense, dissociation can act like an emergency psychological brake.
But the relief is costly. Once dissociation occurs, the person may become less able to understand, process, or regulate the original emotion. The feeling has not been resolved. It has been cut off. Later, it may return in confused or intensified form.
This creates a difficult cycle. Strong emotions trigger dissociation. Dissociation blocks emotional processing. Unprocessed emotion then remains in the system and may contribute to future overwhelm. Over time, the person can end up trapped between emotional flooding and emotional disconnection.
The editorial also refers to research showing that women with BPD had lower body awareness and higher body dissociation than healthy participants, and that these difficulties were strongly linked to childhood trauma and problems in emotional regulation. This highlights how deeply connected the emotional, bodily, and traumatic aspects of BPD can be.
Why dissociation is so hard for carers to witness
From a carer’s point of view, dissociation can be one of the hardest symptoms to deal with. A loved one may suddenly go quiet, stare into space, lose track of what is happening, seem emotionally absent, or fail to respond in the usual way. If this happens during or after emotional escalation, it can feel frightening and even alarming.
Many carers understandably misread these moments. Dissociation can look like withdrawal, coldness, defiance, or deliberate avoidance. But when it is understood as a trauma-linked coping mechanism, the meaning changes. The person is not necessarily shutting you out on purpose. Their system may be trying to protect them from overload.
This does not make the experience any easier to witness, but it can reduce blame and help carers respond more calmly. It also protects the relationship. If dissociation is misread as rejection, both people can end up feeling hurt and alone. If it is recognised as distress, there is a better chance of staying connected.
Sometimes the most helpful thing a carer can do is to stop trying to force a normal conversation in that moment and instead focus on safety, steadiness, and gentle grounding.
When a person dissociates, they may look absent, but this does not always mean they are choosing distance. Often they are overwhelmed and no longer fully present in the usual way.
Dissociation can also affect therapy and recovery
The editorial highlights that people with high levels of dissociation often respond less well to traditional BPD treatments. This is not because they do not want help. It may be because dissociation interrupts the emotional learning that therapy depends on.
If a person becomes detached during key moments of treatment, they may not be able to fully absorb, reflect on, or use what is being taught. Therapy can then feel less effective, more fragmented, or harder to sustain.
This is one reason why dissociation deserves careful attention in clinical work. It should not be treated as a minor side issue. It can shape how well a person engages with treatment and how much benefit they are able to get from it.
At the same time, the picture is not hopeless. The editorial notes that promising adaptations exist. Modified forms of Dialectical Behaviour Therapy that monitor and manage dissociation have shown better outcomes than standard approaches. Other evidence-based therapies, including Schema Therapy and Mentalization-Based Treatment, may also reduce dissociation indirectly by helping with emotional regulation, self-understanding, and identity disturbance.
What carers can do in practical terms
Carers cannot stop dissociation from happening by willpower, but they can make their response more helpful. One important step is learning to recognise what dissociation looks like in the person they care for. Sudden blankness, disorientation, emotional absence, staring, slowed response, and memory gaps can all be possible signs.
Grounding can sometimes help. This means gently helping the person reconnect with the present moment through simple sensory or orienting cues. Naming objects in the room, noticing textures, holding something cold, sipping water, or focusing on the feel of feet on the floor may help some people come back.
It is usually not the best moment for confrontation, reasoning, or emotionally loaded discussion. If the person is dissociated, they may not be able to take in complex words or arguments properly. Waiting for some re-engagement can be more effective than trying to force communication.
It can also help to discuss dissociation in advance, during calmer periods. Some people know what helps and what makes things worse. Having a shared plan can reduce fear when dissociation happens again.
Most importantly, compassion matters. A calm and steady presence may help more than anything dramatic. Even when it feels like nothing is getting through, your steadiness may still be reducing threat and helping the person’s system settle.
During dissociation, calm presence often helps more than pressure. Safety, grounding, and patience are usually more useful than arguments or demands.
There is reason for hope
Dissociation can be frightening, strange, and deeply disruptive, but the long-term picture is not without hope. The editorial points out that as people with BPD recover, symptoms such as depersonalisation and derealisation often decrease. This suggests that dissociation is not always permanent at the same intensity.
That is an important message for carers. The symptom may feel overwhelming in the present, but it can improve over time, especially when the person receives support that is trauma-aware, emotionally informed, and adapted to their needs.
Hope is also important because dissociation is so often misunderstood. Once carers understand that it is linked to trauma, stress sensitivity, identity confusion, and emotional overload, they can respond in a way that supports healing rather than increasing shame or conflict.
No carer can remove all distress. But a carer who understands dissociation can become a stabilising force. That matters more than it may seem in the moment.
Conclusion
Dissociation is a central and often misunderstood part of Borderline Personality Disorder. It can involve feeling unreal, disconnected, numb, absent, or unable to remember clearly. For many people with BPD, it is closely tied to trauma, emotional overwhelm, identity disturbance, and difficulties in relationships.
The research reviewed by Dr Annegret Krause-Utz makes it clear that dissociation is not a small side issue. It affects how people feel, how they cope, how they relate, and how they respond to therapy. It may even contribute to self-harm when people try to break through emotional numbness or unreality.
For carers, understanding dissociation can change everything. It can reduce misinterpretation, soften conflict, and make space for calmer, more compassionate support. Instead of seeing the person as switched off by choice, carers can begin to see a nervous system trying to protect itself in an unhelpful but understandable way.
Most importantly, the picture is not hopeless. Dissociation can reduce over time, especially when recovery addresses trauma, emotional regulation, and identity difficulties together. With understanding, patience, and the right support, healing is possible.
Dissociation can feel frightening and confusing, but it is understandable, treatable, and often closely linked to survival responses that made sense in the past.
Source note
This article is based on the following open-access editorial:
Krause-Utz, A. (2022). Dissociation, trauma, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation.
Read the full article here: https://link.springer.com/article/10.1186/s40479-022-00184-y