You might feel at home in your mind most of the time — and then suddenly, in a moment of intimacy, find yourself somewhere else entirely. Watching from the ceiling, not being emotionally or physically present with your partner. Numb. Gone. Or maybe it’s not during sex at all, but in the middle of a conversation with someone you love, and you realise you have no memory of the last ten minutes. Or perhaps there’s a part of you that feels furious in situations where the rest of you feels calm, and you can’t quite reconcile the two.

These experiences have a name. And they are far more common than most people realise.

In my practice, I work with people who carry the weight of past trauma in ways that show up most painfully in two places: in how they experience their own identity, and in how they experience intimacy and sexuality. This article is for anyone who suspects that their inner world is more fragmented than they’ve been told is normal — and who wants to understand what that means and what can actually help.

What Is Dissociation, Really?

Dissociation is what happens when the mind disconnects — from memories, feelings, thoughts, the body, or a sense of continuous identity. It is not a flaw or a weakness. The DSM-5-TR defines it as a disruption of the normal integration of consciousness, memory, identity, emotion, perception, and behaviour (American Psychiatric Association, 2022). It is a strategy. When something happens that is too overwhelming to process, the mind’s way of surviving is to create distance from it.

“Dissociation provides the illusion that everything is okay.”  — Colin Ross (2022, as cited in Kate, 2026)

There are five core dissociative experiences: amnesia, depersonalisation, derealisation, identity confusion, and identity alteration (Steinberg, 1994). Most people have some experience of mild dissociation — daydreaming, losing track of time. But when it is chronic and rooted in trauma, it shapes daily life, relationships, and sense of self in ways that are hard to name and even harder to get help for.

Importantly, dissociation appears as a hidden layer beneath many common presentations. Australia’s leading researcher Dr. Mary-Anne Kate’s work has shown that people with clinically significant dissociation have a 5.9-fold increased risk of physiological anxiety, a 4.4-fold risk of depression, and elevated risks across disordered eating, ADHD presentations, and autistic traits (Hill et al., 2025; Watson, 2025; Hennah, 2024, as cited in Kate, 2026). It is one reason dissociation so often goes unrecognised for years — and why those with complex dissociative disorders wait, on average, seven to ten years for an accurate diagnosis (Loewenstein, 2018; Kate, 2026).

Standard treatments also struggle when dissociation is unaddressed. Research shows that individuals with higher dissociation respond less effectively to CBT and have higher dropout rates, and that in exposure therapy, dissociation impairs the emotional learning central to therapeutic success (Cloitre et al., 2012; Lanius et al., 2014; van der Kolk, 2014).

Dissociative Disorders: What You Need to Know

Roughly one in ten people will meet the criteria for a dissociative disorder at some point in their lifetime (Kate et al., 2020; Loewenstein, 2018). Despite this, most go undiagnosed for years — partly because clinicians don’t routinely screen for dissociation, and partly because many dissociative people have learned to hide their symptoms out of shame or fear of not being believed.

Dissociative Identity Disorder (DID)

DID is when the mind’s division becomes so complete that a person has two or more distinct identity states — often called parts or alters — that carry different memories, emotions, ways of seeing the world, and sometimes different names, ages, or genders (American Psychiatric Association, 2022). A defining feature is amnesia between parts: one part may have no memory of what another part has said, done, or experienced.

DID does not look like the dramatic Hollywood version. Most people with DID do not switch visibly in public (Loewenstein, 2018). What they carry internally, however, can be exhausting: noise, confusion, lost time, and a persistent sense of not quite being one person. The mental health burden is substantial — 72% attempt suicide, 96% have a history of significant self-harm, and more than 90% also have PTSD or major depression (Brand et al., 2016; Foote et al., 2008; Middleton & Butler, 1998).

Partial DID / OSDD-1

Other Specified Dissociative Disorder Type 1 (OSDD-1), also called Partial DID, is three times more common than DID (Privette et al., 2023; Kate, 2026). Distinct internal parts exist — with their own emotions, voices, or ways of responding — but they don’t fully take over daily life. Instead, they intrude: a sudden flood of anger that doesn’t feel like yours, a harsh critical voice, a wave of fear with no clear cause (Kate, 2026). “A useful way to understand the difference: in DID, parts can fully step into the driving seat. In Partial DID, they press on the steering wheel from the back seat. You still feel them, and they still affect where you end up” (Kate, 2026).

Where It Comes From

Clinical dissociation is almost always rooted in severe and repeated childhood trauma — and particularly in sexual abuse (Kate et al., 2021). Research by Dr. Kate and colleagues found that having experienced six or more distinct types of abuse across childhood, or fifty or more sexual abuse episodes, increases the risk of a dissociative disorder by approximately fourteen to eighteen times (Kate et al., 2021).

But trauma alone doesn’t tell the whole story. Dr. Kate’s research found that the single strongest predictor of clinical dissociation in women was the inability to seek comfort from another person, even a trusted one, when hurt or upset — a 20.5-fold increase in odds (Kate et al., 2023). It wasn’t only what was done to these children. It was that they had nowhere safe to go with it afterwards.

The research confirmed Professor Jennifer Freyd’s betrayal trauma theory (Freyd, 1996): a mother’s negative role or reaction to abuse produced a 45-fold increase in the risk of clinical dissociation (Kate, 2018). Longitudinal studies also demonstrate that disorganised attachment predicts dissociation — when the person who is supposed to be your safe haven is also the source of your fear, the mind learns to manage alone (Main & Hesse, 1990; Lyons-Ruth, 2003, as cited in Kate, 2026). It splits, compartmentalises, and endures. That capacity for survival is remarkable. And it is also the thing that can make intimacy feel so dangerous, or so out of reach, years later.

Dissociation, Identity, and Sexuality

One of the most disorienting things about dissociative disorders is their impact on identity — including gender identity and sexual orientation. Research has documented that people with DID frequently experience bewilderment or confusion because different alters hold different genders and different attractions (Soldati et al., 2022). A 2025 linguistic study found that gender identity was expressed meaningfully and consistently in behaviour and language across alter states (Zhang et al., 2025) — each part carries its own sense of who it is.

It is important to distinguish DID’s global identity disturbance from gender dysphoria’s more specific gender incongruence (Soldati et al., 2022; Colizzi et al., 2015), though the two can co-occur (Hasler et al., 2023). Clinicians at Australia’s Monash Health Gender Clinic have noted that psychotherapy improving dissociation sometimes changed a person’s desire for gender-affirming medical treatment — a finding with significant ethical and clinical implications (Robards et al., 2025).

In my practice, I approach gender and sexuality with genuine openness and without assumptions. I don’t rush to label, I don’t presume what is fixed, and I have no agenda about where someone should land. For anyone navigating questions of gender or sexuality alongside dissociation and trauma, I hold safety first — emotional, psychological, and physical. That means taking the time to understand the whole person, staying curious rather than conclusive, and holding space for identity to be fluid, uncertain, or still finding its shape. In my view, identity doesn’t need to be resolved to be respected. This is not about gatekeeping — it is about making sure that whatever decisions someone makes about themselves are made from a place of genuine clarity, and not from within the fog of unprocessed trauma.

When Sex Becomes the Place Dissociation Shows Up Most

“Only 7 of 57 survivors of childhood sexual abuse reported never dissociating during sex.”  — Hansen et al. (2012)

For many survivors of sexual trauma, intimacy is where the past returns most insistently. PTSD diagnosis, intimate partner rape, earlier onset of abuse, and greater number of perpetrators all predicted higher rates of dissociation during sex (Hansen et al., 2012). Depersonalisation and derealisation during sex are also clinically distinct: depersonalisation is associated with lower arousal, while derealisation is associated with higher — a nuance that matters for understanding what is actually happening for a person (Bird et al., 2014).

There are six dimensions through which trauma shapes sexuality: dissociation during sex, intrusive memories, shame and guilt, prioritising the other person’s experience over one’s own, interpersonal distress, and hypervigilance during intimacy (Gewirtz-Meydan & Godbout, 2023). These are not character flaws. They are the entirely predictable legacy of experiences that happened when someone had no way to protect themselves.

My work with clients reveals another dimension worth naming: the profound difficulty in recognising when a boundary is being crossed in the first place. For many survivors, past trauma disrupts the very signals that would ordinarily alert them to danger — the felt sense in the body, the instinct to pull back, the words to say stop or no. When those internal warning systems have been overridden so many times, it becomes deeply challenging to notice, in real time, that a limit is being violated at all. There is often a disorienting confusion in its wake — is this real? is this actually happening? — leaving many clients questioning their own experience, wondering if what they are feeling is normal, when it is not.

“Standard PTSD treatment has no measurable effect on sexual problems.”  — O’Driscoll & Flanagan (2016)

This finding is important for anyone who has already been in therapy. Many treatments conclude once trauma is processed, without ever helping clients establish a sexual life on their own terms (Landmark et al., 2021). Addressing sexuality is not an optional extra in trauma recovery. It is part of what healing looks like.

Understanding Your Inner World Through Parts Work

If you’ve ever caught yourself thinking “part of me wants this, but another part of me is terrified” — you already understand the basic premise of Internal Family Systems therapy, or IFS (Schwartz & Sweezy, 2020). This approach starts from the idea that the mind is naturally plural. Not in a disordered way — in a deeply human way. We all have parts of ourselves that want different things, feel different feelings, and respond to the world differently depending on what’s happening.

For people who have experienced trauma, those parts often become more entrenched and more at war with each other. Some parts work overtime to keep you functioning — the ones that push through, achieve, stay busy, stay numb. Others show up suddenly and take the wheel: the rage that comes from nowhere, the impulse to drink or disappear, the part that shuts down completely during sex. And somewhere underneath all of it are the parts carrying the original pain — often young, often ashamed, often convinced they are still back there in the middle of what happened.

“92% of participants no longer met PTSD diagnostic criteria after 16 weeks of IFS therapy.”  — Hodgdon et al. (2022)

Parts work offers is a way to turn towards all of these parts with curiosity rather than fear — to understand what each one is trying to do for you, even the ones whose behaviour has been causing harm. A 2025 scoping review of 27 studies described IFS as a promising approach for PTSD, depression, and chronic pain (Buys, 2025), with significant reductions in dissociation and affect dysregulation (Hodgdon et al., 2022).

For sexuality specifically, this kind of work can be quietly transformative. When you start to understand that the part of you that freezes during intimacy isn’t broken — it’s protecting you the only way it knows how, for some people something shifts. You can begin to negotiate with it rather than fight it. You can start to bring more of yourself into the room, rather than abandoning yourself at the bedroom door.

For people with DID or Partial DID, this kind of approach is particularly resonant because the inner world is already plural in a very real sense. The amnestic barriers between parts have blocked the usual web of inner relationships (Schwartz & Sweezy, 2020). This work can help those barriers soften over time, in a paced and safe way. It has also been specifically adapted for sexual trauma (Wilkins, 2007) and for couples  partners learn to speak from a deeper, less defended place rather than from their most wounded parts (Jones & Devlin, 2021).

Making Room for What’s Hard and Psychological Flexibility

One of the painful ironies of trauma is that the strategies we use to cope — pushing feelings away, avoiding certain situations, staying numb — often end up shrinking our lives.

Therapy with me doesn’t ask you to think positively, or to challenge whether your fears are rational. Instead, it asks: what would your life look like if you didn’t have to fight so hard against what you’re feeling? I invite you to make room for difficult experiences — not because they’re okay, but because struggling against them is costing you more than it’s protecting you (Szabo et al., 2021).

For those who have experienced trauma working with the avoidance, shame, and guilt that keep people locked out of their own experience is really important (McLean & Follette, 2016; Lonergan et al., 2022). In the context of sexuality, it helps people build the capacity to stay present with complexity rather than fleeing it — to begin moving, however slowly, towards a sexual life that actually belongs to them.

Some therapeutic approaches are particularly well-suited to LGBTQI+ clients, offering a framework that buffers the effects of minority stress and reduces internalised shame around sexuality and gender identity (Flaherty et al., 2024). For someone navigating both trauma and questions of identity, working within an approach that holds both with acceptance rather than judgement matters enormously.

In my practice, I draw on parts work and acceptance-based approaches — not as the centrepiece, but as quiet scaffolding. Parts work invites clients to understand and relate to their inner world with curiosity rather than criticism; acceptance-based approaches build the willingness to move through experience rather than around it. But what I find most important to my clients is something more immediate than any named method — having a safe therapeutic space to feel again, to notice the subtle shifts within themselves, and to locate the parts that have long been hidden or silenced.

What Healing Actually Looks Like

Healing from dissociation and sexual trauma is not a straight line, and it doesn’t follow a tidy timeline. But it is real, and it happens.

It might look like noticing you are dissociating during sex and, for the first time, being able to gently come back rather than white-knuckling through. It might look like the critical inner voice losing its grip, because you’ve come to understand it as a part of you that’s trying — in its own misguided way — to keep you safe. It might look like saying something honest to a partner about what you need, without the shame spiralling out of control afterwards. It might look like realising you are allowed to have a sexual life that belongs to you. It might be knowing what a touch avoidance part has been protecting you from. It might look like why a self soothing part seeks our unwanted sexual experiences that don’t align with your values. These are just a few examples.

Integration doesn’t mean that all your parts disappear or that you become a single, seamless person. It means the parts are less at war with each other, the wounded ones are less isolated, and a steadier, more compassionate part of you can lead with more consistency (Schwartz & Sweezy, 2020). Many people describe this not as becoming someone different, but as finally becoming more fully themselves.

There is clinical evidence that supports this healing possibility. A study examining the impact of intensive trauma-focused treatment found significant improvements in sexual function among people with PTSD who completed treatment (van Woudenberg et al., 2023). It is absolutely possible to move from a place where intimacy feels frightening, dissociative, or numb, to a place where it is a genuine expression of who you are. Healing and change is possible, it takes time and trauma informed care to get there.

Working With Me

I offer individual therapy sessions from my practice in Goodwood, Adelaide — accessible to clients across Adelaide, South, North, West and the rest of the state. Online sessions are also available.

I bring a trauma-informed, psychotherapeutic approach to all areas of sex therapy. That means I’m not always handing out worksheets or running through techniques in isolation.  I’m interested in the whole of you: your history, your nervous system, your relational patterns, and what has shaped your experience of intimacy, your childhood, and the unwanted experiences.  Sessions are confidential, non-judgmental, and genuinely collaborative.

You don’t need a referral. If you’d like to get a feel for whether working with me might be right for you, then maybe its time to book your first session with me.

To book your first session with me [click here].

Kai is a sex therapist, psychotherapist and counsellor, and the founder of Polysoma — a specialist private practice in Goodwood, Adelaide. Kai holds a Bachelor of Clinical Practice, a Master of Counselling, and a Graduate Certificate in Sexology, and is a Professional Member of the Australian Counselling Association and a member of the Society of Australian Sexologists. Kai’s training spans trauma practice, psychosexual therapy, affirming care and beyond — underpinned by an ongoing and deep commitment to professional development across counselling, sex therapy and sexology. This breadth of training, combined with lived experience, shapes every aspect of the work at Polysoma. In-person sessions in Goodwood, Adelaide and virtual sessions worldwide.

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