Dissociation, numbness and
feeling far away.
My therapist said I was ‘dissociating’. I was having an absence seizure.
How to understand experiences of unreality and distance without assuming their cause, especially when pain, medication or neurology may be involved.
What this is: a careful guide to dissociative experiences.
Why it matters: for disabled people, many things can look like dissociation.
The sharpest reframe: stillness isn’t evidence of freezing; patchy memory isn’t evidence of hidden trauma.
One thing to take away: describe before labelling.
The short version
People describe feeling unreal, distant, foggy, cut off, absent, or unable to remember parts of an experience. These can be dissociative experiences, and they can be linked to trauma. They can also have other causes or contributors: pain, sleep problems, medication, neurological conditions, brain injury, seizures, sensory overload, fatigue. For disabled people, these overlaps are common. A disability-informed approach starts by asking what the experience is like and when it happens, considers bodily and medical factors, uses proper assessment, and avoids confident interpretations from outward appearance. Stillness isn’t evidence of freezing, and patchy memory isn’t evidence of hidden trauma.
You might recognise this
Illustrative statementsDrawn together from common experiences. They are not quotes from individual people.
Describe before labelling
Established conceptICD-11 describes depersonalisation as feeling that one’s self is unreal or detached, as if watching oneself from outside, and derealisation as the world or other people seeming unreal, distant or hazy, while the person still knows what is real. For a diagnosis, these experiences must not be better explained by another condition, substance effects, a neurological disease or head injury.
That exclusion matters for disabled people: the same descriptions can arise from causes that aren’t psychological at all.
Two cautions
- A description matters, but doesn’t settle the cause. What the person reports is essential evidence. On its own, it can’t establish whether an episode is dissociative, neurological, medication-related or something else; that may need assessment.
- Emotional numbness is not the same as altered sensation. Feeling emotionally flat or cut off is different from reduced physical sensation, which may be part of an impairment such as a spinal cord injury or neuropathy. The words can overlap; the experiences shouldn’t be confused.
Other possible contributors
Our frameworkPain and sleep
Severe pain or poor sleep can make the world feel distant and memory patchy.
Medication
Many medicines affect alertness, mood or memory.
Neurological conditions
Seizures, brain injury, migraine and other conditions can cause absences, unreality or gaps in recall.
Sensory overload and fatigue
Shutdown after overload, or exhaustion after masking, can look like dissociation from outside.
Trauma
Dissociation linked to trauma, sometimes as a protective response during events that couldn’t be escaped.
Several at once
A person with a brain injury may also dissociate during examinations that remind them of the accident.
Malachy is 40 and has had a brain injury since a fall at work. He describes “blank spells” and feeling that the world is “behind glass” several times a week. A counsellor tells him these are dissociation from the trauma of the fall. His neurologist later finds he is having focal seizures. Malachy also says that during physiotherapy, when someone stands behind him, he goes “somewhere else”, and that this feels different from the blank spells.
Malachy is a fictional teaching example, not a real person.
What therapists can do
Practice- Ask what the experience is like, in the person’s words.
- Explore when it happens: after pain, in particular settings, at particular times, during reminders.
- Consider bodily and medical factors, and liaise with the person’s medical team where appropriate, with consent.
- Use appropriate assessment rather than inference.
- Avoid confident interpretation from appearance. Stillness, quietness or a blank expression can mean many things.
What it might sound like
You’ve described two things: blank spells, and going somewhere else in physio. Are they the same, or different?
Different. The blank spells just happen. I lose minutes. The physio one, I know I’m going. It’s when someone’s behind me.
Thank you. It sounds as though the blank spells need your neurology team, and the physio one might be something we could work on here, if you want. Does that fit?
Yes. I’ve been told for a year it was all trauma.
What changes: Malachy starts seizure medication, and the blank spells become rarer. In therapy, they work on the physio experience: he asks his physiotherapist to stay in his line of sight and to tell him before moving behind him. He says knowing what each thing was made both easier to deal with.
What needs attention here?
An experience is called dissociation from appearance
Possible focus: asking what it is like, and when
Watch for: interpreting stillness or silence
The person has a neurological condition
Possible focus: medical assessment alongside psychological work
Watch for: assuming a psychological cause
Several things may be happening
Possible focus: distinguishing them with the person
Watch for: a single explanation
Memory is patchy
Possible focus: its likely causes, without pressure
Watch for: treating gaps as evidence of hidden trauma
Possible starting points, agreed with the person, not rules.
How you’d know it helped
- The person understands their experiences more clearly.
- Medical and psychological contributors are both considered.
- Nobody has interpreted their body from the outside.
Words you can use
For clientsQuestions worth carrying, as a therapist
Therapist Reflection- Am I naming dissociation from outward appearance?
- Have I considered pain, sleep, medication and neurology?
- Has this person had appropriate assessment?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Depersonalisation and derealisation, including the exclusion of other conditions, neurological disease and head injury: World Health Organization, ICD-11, 6B66.
The list of contributors and the guidance for therapists are this site’s synthesis.
Malachy and the dialogue are constructed for learning. He is not a real person.
We have not located research on how often dissociation is misattributed in disabled people with neurological conditions.
Last reviewed: October 2026.
How to cite this page: Donaghey, C. (2026). Dissociation, Numbness and Feeling Far Away. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/trauma-informed-approaches/dissociation-numbness-and-feeling-far-away/ (Accessed: [date]).