Yes, Bipolar Dissociation Is Real — Here’s What It Is and How to Cope

Do you have bipolar disorder and sometimes feel detached from yourself or your surroundings? You might be experiencing bipolar dissociation. Read on to learn more about this phenomenon.

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Do you ever feel like you’re disconnected from your body, or like your surroundings aren’t totally real? If so, you may have experienced dissociation. 

Dissociation refers to feeling detached from yourself in one way or another. Some people with bipolar disorder experience bipolar dissociation, which is when symptoms of dissociation occur alongside bipolar symptoms. However, dissociation in people with bipolar disorder isn’t always linked to bipolar disorder itself.

Keep reading to learn about bipolar dissociation, bipolar disorder, dissociative disorders, and treatment options.

Introduction to bipolar dissociation 

Bipolar dissociation is not an official diagnosis. Rather, it’s a term used to describe episodes of dissociation that occur in people with bipolar disorder.

What is dissociation? 

To start off, let’s dive into dissociation in general. Anyone can experience dissociation, even if they don’t have a diagnosable mental health condition. Dissociative symptoms can greatly vary in severity.

“I would define dissociation as a disruption of normal integration of a person’s self and their experience,” says Shawnna Punteney, LPC, a Charlie Health Clinical Director. “It can feel like they’re detached, or they’re in a dream-like state. Some people will report memory gaps or that things aren’t real.”

Often, dissociation is the brain’s response to trauma, and dissociation is seen at higher rates in trauma survivors than in the general population.  

What does dissociation feel like? Understanding bipolar dissociation symptoms

Dissociation can feel different for different people, and people often struggle to describe it exactly, but an overarching theme is a sense of detachment. This can be a detachment from your body, thoughts, emotions, or environment. You might simply feel “zoned out,” Punteney says.

One way to explain what a dissociative experience feels like is through an example that many have experienced: highway hypnosis. “You might be driving in your car for a long distance, maybe it’s a three-hour drive, and before you know it, you’re at your destination, but you don’t remember the drive. It’s like you were on autopilot,” Punteney says.

Dissociation mainly falls into two categories:

• Depersonalization: A feeling of being disconnected from yourself.
• Derealization: A feeling of disconnection from your surroundings.

What is a dissociative episode?

A dissociative episode is when someone temporarily loses their sense of connection to themselves or the world around them. During a dissociative episode, you might feel emotionally numb or feel like you’re having an out-of-body experience where things feel strange.

You might also struggle to remember things that happened during a dissociative episode. 

What is bipolar disorder?

Bipolar disorder (also called bipolar depression) is a mood disorder characterized by distinct shifts in mood and mood episodes. These episodes include depression (depressive episodes), mania (manic episodes), and hypomania (hypomanic episodes).

Manic episodes include:

• Very high, elevated mood
• Feeling on top of the world
• Decreased need for sleep
• Irritability
• Increased desire for pleasurable and/or risky behaviors
• Feeling especially powerful or important

Hypomania is a form of mania that tends to be less intense and doesn’t always interfere with daily functioning.

Depressive episodes include:

• Low mood and sadness
• Decreased motivation
• Low energy
• Trouble concentrating
• Loss of interest in activities you used to enjoy
• Thoughts of death or suicide

Although it isn’t one of the most common clinical features, some people who have severe manic and/or depressive episodes may also have psychosis-related symptoms, including hallucinations and delusions. This can sometimes lead to a misdiagnosis of schizophrenia, although schizophrenia can co-occur with bipolar disorder.

Is dissociation a symptom of bipolar disorder?

Dissociation is not one of the diagnostic criteria or clinical features of bipolar disorder listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). However, research shows that some people with bipolar disorder do experience dissociation. 

Dissociation prevalence in bipolar 1 

Based on developing research, it appears that bipolar dissociation is more common in those with bipolar type 1, Punteney says. This could be due to the intensity of manic episodes, which may involve psychotic features or extreme stress that triggers dissociative experiences. 

Dissociation in bipolar I could also be unrelated to a manic episode or psychosis-related symptoms, and rather be due to trauma. 

Dissociation prevalence in bipolar 2 

It is seemingly less likely to experience bipolar dissociation when you have bipolar type 2. Bipolar II is characterized by longer periods of depression and hypomanic episodes rather than manic episodes. Hypomania is a less severe form of mania. Therefore, someone with bipolar II would be less likely to experience psychosis-related symptoms. 

However, that’s not to say you can’t experience dissociation if you have bipolar II. You can certainly still dissociate during a depressive episode, particularly if you’ve experienced trauma. 

What are dissociative disorders?

According to the American Psychiatric Association, a dissociative disorder involves “problems with memory, identity, emotion, perception, behavior, and sense of self.” These psychiatric disorders greatly impact someone’s functioning and quality of life. Experiencing dissociation does not mean you have a dissociative disorder. However, if dissociative symptoms are persistent or severe, it could indicate the presence of a dissociative disorder.

One 2019 study found the prevalence of dissociative disorders in people with bipolar disorder to be 35.4%, suggesting these disorders are more prevalent in people with bipolar disorder than in the general population. Dissociative disorders typically occur in people with a significant trauma history, Punteney says. “That’s the brain trying to take care of the person, trying to keep them safe,” she adds.

Here are three examples of dissociative disorders:

1. Dissociative amnesia

Dissociative amnesia is when you have major memory gaps, where you can’t remember certain information about yourself or parts of your past. This is typically linked to traumatic incidents. Your brain represses these traumatic memories as a defense mechanism to protect you. 

2. Dissociative identity disorder (DID)

Dissociative identity disorder, previously called “multiple personality disorder,” is a rare condition where someone has multiple separate identities (at least two). These separate identities have distinct personalities, memories, and behaviors. People with DID experience gaps in memories
(dissociative amnesia). They may not remember what happened while they were one of their “alters” or alternate identities.

The disorder is highly linked to trauma, particularly severe childhood trauma. There’s also a higher risk of suicide attempts in people with DID.

3. Depersonalization/derealization disorder

Depersonalization/derealization disorder is characterized by persistent depersonalization (feeling detached from yourself) and/or derealization (feeling detached from your surroundings). During depersonalization, you might feel like you are seeing yourself from the outside, or feel disconnected from your own actions or body. During derealization, your surroundings may feel distorted, strange, or even unreal. 

Bipolar disorder and bipolar dissociation treatment

Bipolar disorder is a chronic mental health disorder, but it is manageable with treatment, including therapy and medication. You may find that with treating your overall bipolar disorder, dissociative symptoms can subside. However, you may also need to specifically target dissociation, too.

Some treatment options include the following:

1. Psychoeducation

Psychoeducation is a key part of treatment for any mental health struggle. By understanding your condition (or conditions), you can better understand why you feel the way you do and how to cope. Group psychoeducation is popular for bipolar disorder.

If you experience dissociation, you may feel scared, not knowing what it is, or afraid that you’re “going crazy.” Learning more about it can help you gain power over it.  “I always say, if you can name it, you can tame it,” Punteney says.  “If people understand what’s happening, then they’re more likely to be able to deal with it.”

2. Cognitive-behavioral therapy (CBT)

CBT is a commonly used therapy modality that helps you learn how behaviors, thoughts, and feelings are interconnected. You will learn to address negative thought patterns and create healthier ones, which, in turn, can influence more positive behaviors and emotions.

Trauma-informed CBT is a great option for those who have experienced trauma, as well. CBT is also helpful for dissociative symptoms and people with dissociative disorders.

2. Dialectical behavior therapy (DBT)

DBT is a therapy based on mindfulness and acceptance. It’s usually conducted in both individual and group settings. You will learn how to deal with intense emotions, tolerate distress, improve relationships, and acquire more skills that can help improve both bipolar and dissociative symptoms.

3. Interpersonal and social rhythm therapy (IPSRT)

IPSRT focuses on the importance of your interpersonal relationships and your daily schedule. The premise of this therapy is that improving your relationships and building routine helps improve your mental health. Stability in relationships and routine may help prevent major disruptions that might trigger bipolar episodes.

4. Trauma therapy

Processing trauma is key if your dissociative symptoms are linked to trauma. Plus, addressing trauma can help improve mental health overall. Examples of trauma therapies include prolonged exposure therapy (where you are gradually exposed to triggers related to your trauma), somatic therapy (where you address how trauma is stored in the body), and eye movement desensitization and reprocessing (EMDR), which helps your brain reprocess traumatic memories and store them differently in the brain. 

Experiential therapies are also helpful for dealing with trauma-related and dissociative symptoms, Punteney says. This could include yoga therapy or mindfulness-based therapies that help ground you in the present, she explains. 

5. Medication

Medication is typically a key part of long-term management and treatment for bipolar disorder. Commonly prescribed medications for bipolar disorder include:

• Mood stabilizers
• Antipsychotics
• Combination antidepressant-antipsychotic medications

Everyone’s treatment response is different due to individual clinical variables, and it may take some trial and error to determine which medication (or combination of medications) works best for you. If you have other co-occurring mental health disorders, your provider might prescribe multiple medications to address all psychiatric symptoms.

How Charlie Health can help

If you struggle with bipolar disorder and bipolar dissociation, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for individuals dealing with serious and complex mental disorders, including bipolar disorder, dissociative disorders, and other conditions that may co-occur with bipolar disorder, like borderline personality disorder, schizophrenia, anxiety disorders, or post-traumatic stress disorder.Our trauma-informed mental health professionals use a variety of evidence-based therapy modalities, such as CBT and DBT, in individual therapy, group sessions, and family therapy for bipolar treatment. If needed, you can also get connected with a psychiatrist for medication management. With treatment, managing your bipolar symptoms and dissociative symptoms is absolutely possible. Fill out the form below or give us a call to start your healing journey today.