Understanding Mental Health Blackouts
A mental health blackout, sometimes referred to as a psychological or psychogenic blackout, is a temporary loss of consciousness, awareness, or memory that is caused by psychological factors rather than physical conditions like head injuries, seizures, or substance use. These episodes can be frightening and disorienting for the person experiencing them, as well as for those who witness them. Understanding what mental health blackouts look like, what causes them, and how they differ from other types of blackouts is an important step toward getting appropriate help and support.
It's crucial to note from the outset that the term "blackout" in the context of mental health encompasses a range of experiences that vary in severity, duration, and manifestation. For some people, a mental health blackout may involve a complete loss of consciousness where they fall to the ground and appear unconscious. For others, it may manifest as a period of time for which they have no memory, even though they appeared to be functioning normally during the episode. Still others may experience a dissociative state where they feel disconnected from their body, surroundings, or sense of identity without actually losing consciousness. All of these experiences can be classified as mental health blackouts, and each requires appropriate attention and care.
What a Dissociative Blackout Looks Like
Dissociation is one of the most common psychological mechanisms behind mental health blackouts. During a dissociative episode, a person may appear to "check out" or become unresponsive to their surroundings. To an observer, the person might stare blankly into space, become unresponsive to their name being called, or seem to be "somewhere else" mentally. The person may not react to questions, physical contact, or environmental stimuli that would normally get their attention. These episodes can last from a few seconds to several hours, and in severe cases, even longer.
From the inside, a person experiencing a dissociative blackout may feel as though they are watching themselves from outside their body, as though the world around them has become unreal or dreamlike, or they may simply have no awareness of the episode at all—experiencing it as a gap in their memory. When the episode ends, the person may feel confused, disoriented, and exhausted. They may not remember what happened during the blackout period, or they may have fragmented, dreamlike memories that feel distant and unreal. Some people describe the experience as similar to suddenly "waking up" in the middle of an activity they don't remember starting.
Psychogenic Non-Epileptic Seizures (PNES)
Psychogenic non-epileptic seizures, or PNES, are a specific type of mental health blackout that can closely resemble epileptic seizures but have psychological rather than neurological causes. During a PNES episode, a person may experience involuntary movements such as shaking, jerking, or convulsions; they may fall to the ground, become unresponsive, or display other seizure-like behaviors. However, unlike epileptic seizures, PNES episodes do not involve the abnormal electrical brain activity that characterizes epilepsy, and they will not show seizure patterns on an electroencephalogram (EEG).
PNES can be extremely difficult to distinguish from epileptic seizures based on observation alone, which is why proper medical evaluation is essential. Studies have shown that even experienced healthcare professionals cannot reliably distinguish PNES from epileptic seizures without EEG monitoring. This means that anyone experiencing seizure-like episodes should undergo thorough medical evaluation, including EEG monitoring, to determine whether the episodes are epileptic or psychogenic in nature. Correct diagnosis is crucial because the treatments for epilepsy and PNES are fundamentally different, and treating PNES with anti-epileptic medications is both ineffective and potentially harmful.
Common Causes and Triggers
Mental health blackouts can be triggered by a variety of psychological factors, with stress, trauma, and anxiety being among the most common. People who have experienced traumatic events, particularly in childhood, are more susceptible to dissociative episodes and other forms of mental health blackouts. The blackout may serve as an unconscious protective mechanism, where the mind "shuts down" to protect itself from overwhelming emotional pain, fear, or stress. This connection between trauma and dissociation is well-established in psychological research and is a central feature of several mental health conditions.
Extreme stress and emotional overwhelm can trigger blackout episodes even in people without a history of trauma. Panic attacks, for example, can sometimes involve brief periods of dissociation or altered consciousness. Grief, major life transitions, relationship conflicts, and workplace stress can all contribute to blackout-like episodes, particularly in individuals who tend to internalize rather than express their emotions. Some people are also more prone to dissociative experiences due to personality traits, sleep deprivation, or other vulnerability factors that lower their threshold for psychological coping.
Associated Mental Health Conditions
Several mental health conditions are associated with an increased risk of experiencing blackouts. Dissociative disorders, including Dissociative Identity Disorder (DID), Dissociative Amnesia, and Depersonalization-Derealization Disorder, are characterized by significant disruptions in consciousness, memory, identity, or perception. People with these conditions may experience frequent blackout episodes as a core feature of their disorder. Post-Traumatic Stress Disorder (PTSD) is another condition strongly associated with dissociative blackouts, particularly when the PTSD is severe or involves childhood trauma.
Anxiety disorders, particularly panic disorder and generalized anxiety disorder, can also involve blackout-like symptoms. During severe panic attacks, some people experience depersonalization (feeling detached from themselves) or derealization (feeling that the world is unreal), which can be experienced as a type of blackout. Depression, particularly when severe, can involve periods of dissociation or memory impairment that function similarly to blackouts. Borderline Personality Disorder is another condition frequently associated with dissociative episodes, particularly during periods of intense emotional distress.
How to Recognize the Signs
Recognizing mental health blackouts can be challenging because they may not always involve dramatic visible symptoms. Some signs that someone may be experiencing a mental health blackout include suddenly becoming unresponsive or "zoning out" for extended periods, appearing confused about where they are or what they've been doing, having gaps in their memory that they can't explain, finding evidence of activities they don't remember performing, and receiving reports from others about behavior they have no recollection of.
People who experience mental health blackouts may also show more subtle signs between episodes. They may express confusion about time, feeling as though hours have passed when only minutes have gone by, or vice versa. They may discover writings, drawings, or purchases that they don't remember making. They may seem to shift in personality, demeanor, or behavior in ways that seem inconsistent with their usual character. If you notice these patterns in yourself or someone you care about, it's important to seek professional evaluation, as these symptoms can indicate underlying conditions that benefit from treatment.
What to Do During and After a Blackout
If you witness someone experiencing what appears to be a mental health blackout, the most important thing is to ensure their physical safety. If the person has fallen, make sure they are in a safe position away from sharp objects, stairs, or traffic. Speak calmly and reassuringly, as the person may be able to hear you even if they appear unresponsive. Do not shake, slap, or attempt to forcibly "wake" the person, as this can increase their distress and potentially make the episode worse. If the person is having convulsions, do not attempt to restrain them or put anything in their mouth.
After a blackout episode, the person may feel confused, exhausted, and emotionally fragile. Give them time and space to reorient themselves, and offer simple, clear information about what happened during the episode. Encourage them to drink water and rest if needed. Most importantly, encourage them to seek professional help if they haven't already done so. Mental health blackouts are treatable conditions, and with appropriate psychological support, most people experience significant improvement in the frequency and severity of their episodes.
Treatment and Support
The treatment of mental health blackouts depends on their underlying cause and typically involves psychotherapy as the primary intervention. Trauma-focused therapies, such as Eye Movement Desensitization and Reprocessing (EMDR) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), have shown effectiveness in treating dissociative symptoms associated with trauma. These therapies help individuals process traumatic memories in a safe, controlled environment, reducing the need for the protective dissociative responses that cause blackouts.
Grounding techniques are practical skills that can help individuals manage dissociative episodes in the moment. These techniques work by redirecting attention to the present moment and physical environment, counteracting the disconnection that characterizes dissociation. Common grounding techniques include the 5-4-3-2-1 method (identifying five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste), holding ice cubes, stomping your feet, or focusing on slow, deep breathing. Learning and practicing these techniques regularly can help reduce the frequency and duration of blackout episodes.
When to Seek Emergency Help
While mental health blackouts are generally not life-threatening in themselves, certain situations require emergency medical attention. Seek immediate medical help if a blackout episode lasts longer than usual, if the person sustains an injury during the episode, if the episode is accompanied by symptoms such as chest pain, difficulty breathing, or one-sided weakness, or if the episode occurs in a dangerous situation such as while driving. It's also important to seek emergency evaluation for a first-time blackout episode, as medical professionals need to rule out physical causes such as cardiac arrhythmias, epilepsy, hypoglycemia, or other medical conditions that can cause loss of consciousness.
Remember that experiencing mental health blackouts is not a sign of weakness, and there is no reason to feel ashamed or embarrassed. These episodes are the mind's attempt to cope with overwhelming circumstances, and they respond well to appropriate treatment. If you or someone you know is experiencing mental health blackouts, reaching out to a mental health professional is the most important step toward understanding and managing these episodes. With proper support, most people can develop effective coping strategies that significantly reduce the impact of blackouts on their daily lives.
