Being Mindful of Mindfulness –Why Physios May Benefit From Understanding Dissociation:

In essence, dissociation is a disconnection from yourself or the world around you. Physiotherapy often encourages mind–body connection—whether that’s activating specific muscles, focusing on breathing, or engaging in exercises that naturally increase bodily awareness through pain, stretch, or lactic acid.

But for people with dissociative traits, the safest place hasn’t always been in the body. For them, disconnecting has been an intelligent, protective strategy. It’s part of the freeze or “play dead” response:
if you can’t outrun the threat or outfight the threat, the nervous system takes the only option left—shut everything down.

It makes sense when you think about it. If you’re backed into a cave about to be attacked by a dinosaur, being fully present in your body isn’t helpful. Feeling every sensation—especially pain—would only add to the overwhelm. Dissociation, in this context, is a brilliant short-term solution that may become a long-term strategy.

Dissociation by diagnosis and in research:

Dissociation is a relatively recent addition to the DSM-5 and ICD-10. The umbrella includes:

• unspecified dissociative disorder
  
• specified dissociative disorder
  
• dissociative amnesia
  
• depersonalisation/derealisation disorder
  
• dissociative identity disorder
  

It’s estimated that around 10% of the population has dissociative traits—more than many clinicians realise.

Traditionally, dissociation has been associated with complex PTSD (cPTSD), often linked with early childhood or attachment trauma (usually indicated by scoring >2 on the ACEs questionnaire). Interestingly, recent research has shown that people who exhibit autistic traits also score clinically on measures of dissociation without high ACEs scores.

This suggests possibly navigating a neurotypical world with a neurodivergent brain may create the same levels of overwhelm seen in complex trauma—and therefore similar dissociative patterns.

Why Physiotherapists may care:

If our profession regularly invites people back into their bodies—a place that may have historically felt unsafe—then it’s worth doing so carefully.

This might even explain why certain evidence-based breathing techniques intended to calm the nervous system can have a very different (and unexpected) effect for some individuals. Reports of people experiencing panic attacks, nightmares, emotional flooding, or even psychotic-like symptoms after practices that are typically considered harmless and regulating.

It’s not that the technique is wrong. It’s that the person’s relationship with their own body is complex. Dissociation continues to be a contentious topic within psychology, partly because it is fairly new to diagnostic systems and partly because it crosses the borders of complex trauma and neurodivergence.

But if 1 in 10 people experience dissociative traits, chances are we’re all working with these clients already—often without realising it. I’d genuinely love to hear your thoughts. If you’re curious or want to explore this further, pop your questions below. I’m hoping to write more about this in 2026.

*Edited with AI.