Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

When this happens, are you choosing to get away from something, or do you feel unreal, absent, detached, or missing time?

Most useful distinction

Avoidance usually preserves awareness while the person escapes or narrows activity; dissociation changes presence, memory, body experience, or awareness.

Common confusion

Both can look like disengagement, shutdown, or being hard to reach in the room.

Treatment difference

Avoidance often points to graded approach or behavioural experiments; dissociation first needs grounding, pacing, and orientation.

Avoidance

Avoidance reduces distress in the short term but commonly maintains anxiety, trauma responses, functional impairment, and interpersonal narrowing.

BehaviourCognitionTrauma+1

Dissociation

Dissociation can reduce overwhelming distress during threat but may later impair memory integration, presence, agency, and relational engagement.

TraumaAffectBehaviour+1

Definition

AA pattern of keeping away from internal experiences, situations, people, or tasks that trigger distress or perceived threat.

BA disruption or disconnection in memory, identity, emotion, perception, behaviour, body experience, or sense of self.

Core process

AThreat appraisal activates escape, safety behaviour, suppression, or disengagement, which prevents corrective learning and narrows coping options.

BOverwhelming arousal or threat is managed by disconnection, detachment, numbing, derealisation, depersonalisation, or memory compartmentalisation.

Look for

AMissed appointments · Safety behaviours

BTime loss · Spacing out

Patient language

A“I just avoid it”

B“I was not really there”

Maintaining cycle

AThreat cue -> anxiety -> avoidance -> relief -> threat belief remains untested

BThreat cue -> overwhelm -> dissociation -> reduced processing -> cue remains potent

Treatment leverage

ATarget the relief-maintenance loop and build tolerable approach behaviours.

BIncrease present-moment orientation and safety before intensive processing.

Check before using

AWithdrawal is mainly due to low energy, cognitive impairment, environmental barriers, or lack of opportunity.

BThe person is deliberately avoiding while awareness and memory remain intact.

Formulation language

Avoidance appears to reduce distress briefly, but it also prevents corrective experience and maintains the threat appraisal.

Open full guide

Formulation language

Dissociation appears to protect against overwhelming affect, but it may also interrupt integration and reduce present-moment agency.

Open full guide

Browse the map Use both hypotheses

Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

When this happens, are you choosing to get away from something, or do you feel unreal, absent, detached, or missing time?

Most useful distinction

Avoidance usually preserves awareness while the person escapes or narrows activity; dissociation changes presence, memory, body experience, or awareness.

Common confusion

Both can look like disengagement, shutdown, or being hard to reach in the room.

Treatment difference

Avoidance often points to graded approach or behavioural experiments; dissociation first needs grounding, pacing, and orientation.

Avoidance

Avoidance reduces distress in the short term but commonly maintains anxiety, trauma responses, functional impairment, and interpersonal narrowing.

BehaviourCognitionTrauma+1

Dissociation

Dissociation can reduce overwhelming distress during threat but may later impair memory integration, presence, agency, and relational engagement.

TraumaAffectBehaviour+1

Definition

AA pattern of keeping away from internal experiences, situations, people, or tasks that trigger distress or perceived threat.

BA disruption or disconnection in memory, identity, emotion, perception, behaviour, body experience, or sense of self.

Core process

AThreat appraisal activates escape, safety behaviour, suppression, or disengagement, which prevents corrective learning and narrows coping options.

BOverwhelming arousal or threat is managed by disconnection, detachment, numbing, derealisation, depersonalisation, or memory compartmentalisation.

Look for

AMissed appointments · Safety behaviours

BTime loss · Spacing out

Patient language

A“I just avoid it”

B“I was not really there”

Maintaining cycle

AThreat cue -> anxiety -> avoidance -> relief -> threat belief remains untested

BThreat cue -> overwhelm -> dissociation -> reduced processing -> cue remains potent

Treatment leverage

ATarget the relief-maintenance loop and build tolerable approach behaviours.

BIncrease present-moment orientation and safety before intensive processing.

Check before using

AWithdrawal is mainly due to low energy, cognitive impairment, environmental barriers, or lack of opportunity.

BThe person is deliberately avoiding while awareness and memory remain intact.

Formulation language

Avoidance appears to reduce distress briefly, but it also prevents corrective experience and maintains the threat appraisal.

Open full guide

Formulation language

Dissociation appears to protect against overwhelming affect, but it may also interrupt integration and reduce present-moment agency.

Open full guide

Browse the map Use both hypotheses