When Chronic Illness, Chronic Pain, and Dissociation Cross Paths: What to do

By Krista Boncheff LCSW, ADC on June 6, 2026.

As someone living with multiple chronic illnesses myself, I know how exhausting it can be just to make it through lunch—whether that's at work, with a friend, or quietly by yourself. Chronic illness affects far more than the body. Over time, many people find themselves coping not only with symptoms, but also with medical trauma, grief, loneliness, uncertainty, and the loss of activities they once enjoyed.

In this context, dissociation often becomes a survival strategy.

When our bodies repeatedly signal pain, danger, or discomfort, it can become difficult to feel safe in our own skin. Chronic pain and illness can leave us feeling trapped inside a body that no longer feels predictable or trustworthy. And when there is no obvious escape from the pain, the mind may do what it was designed to do: protect us.

We numb.

We disconnect.

We check out.

For some people, dissociation may look like spacing out, feeling detached from their body, losing track of time, or feeling disconnected from their emotions. For others, particularly those whose chronic illness or pain began in childhood and was severe, prolonged, or traumatic, dissociation may become more complex and can contribute to the development of dissociative disorders.

The challenge is that chronic pain and dissociation often reinforce one another in a vicious cycle.

Many people with chronic pain have had this experience. Traditional grounding techniques can sometimes feel overwhelming because they direct attention toward the very sensations the nervous system has been trying to avoid.

So what do we do?

The answer often lies in helping the body discover moments of ease, comfort, or neutrality before asking it to fully engage with painful sensations (what we call titration).

Neutrality is enough. And if you can't find it in your body, we'll work with you until you can.

For example, imagine your lower back is screaming at you. It's tight, tense, and painful. You feel the urge to check out because staying present feels overwhelming.

Then I ask you a strange question:

"Is there anywhere in your body that feels neutral right now?"

Not good. Not relaxed. Just neutral.

Maybe it's your hands.

Maybe it's your feet.

Maybe it's your eyelids or the tip of your nose.

We're simply looking for a place that feels okay enough.

Once we find that place, we can begin gently moving attention between the painful sensation and the neutral sensation. In therapy, this process is often called somatic pendulation. We will talk about that some more in the next blog post.

Afterward, I might ask:

"How does the pain feel now?"

"Any different?"

"Better, worse, or about the same?"

There is no right answer.

The goal isn't to make the pain disappear.

The goal is to help your nervous system learn that it can notice discomfort without becoming completely overwhelmed by it.

 Somatic pendulation gradually expands your capacity to stay connected to the present moment while experiencing difficult body sensations. Rather than forcing yourself to stay in pain or forcing yourself to stay grounded, you're learning to move flexibly between discomfort and safety.

That flexibility is what helps reduce reliance on dissociation over time.

Maintaining connection to the present while living with chronic pain is a genuine skill—one that deserves far more recognition than it often receives.

And if you dissociate because you're hurting, that makes sense.

Your nervous system is not failing.

It's adapting - it's trying to protect you. The goal isn't to get rid of dissociation overnight. The goal is to slowly build enough safety, flexibility, and support that your body no longer has to work quite so hard to protect you from what hurts.

Because when chronic pain and dissociation intersect, healing doesn't begin with forcing yourself to feel more. It begins with helping your nervous system discover that moments of safety and ease still exist, even in the midst of pain.

The goal isn't to ignore pain. It's to remember that pain is not the only thing present.