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Dissociation

All of us have times when we feel 'disconnected'. It could be that we are having a conversation with someone but our mind is elsewhere, or we arrive at a destination with no recollection of driving there. For most of us, these moments are occasional lapses that bear no impact on our daily lives. For others, however, disconnecting from reality becomes a defence mechanism.

When this happens, being disconnected can quickly turn into dissociation. If left untreated, this can evolve into a dissociative disorder. On this page, we will look at various effects of dissociation including the various disorders associated, such as dissociative identity disorder (DID).

What is dissociation?

The way we perceive the world around us is what determines our reality. Our thoughts, feelings and memories all contribute to help us know who we are and what is real. When these perceptions disconnect, our sense of reality and identity becomes blurred.

If you are experiencing dissociation, you may look at yourself as if you are a stranger - unsure of who the person looking back at you in the mirror is, or indeed what is real. There are several mental health conditions that can cause dissociative symptoms including bipolar disorder, schizophrenia and borderline personality disorder.

For some people though, dissociation is a form of extreme escapism. Escaping reality in a way that is involuntary and potentially unhealthy, someone with a dissociative disorder may create alternative identities or suffer from amnesia.

Symptoms of dissociation

The effects of dissociation and dissociative disorders can be difficult to pinpoint and differ from person to person. It can affect the way you think, feel and behave - so it's important to tell someone as soon as possible if you are experiencing the symptoms listed below.

The following symptoms are examples of what you may experience:

  • feeling detached from your body
  • experiencing gaps in your memory
  • forgetting important information about yourself
  • feeling as if there is more than one person inside of you
  • hearing voices
  • feeling as if the world around you isn't real
  • referring to yourself as 'we' rather than 'I'
  • having out-of-body experiences
  • other people telling you that you have behaved out of character
  • feeling detached from your emotions
  • feeling numb or devoid of emotion

It can be very difficult to diagnose dissociation and dissociative disorders as many of the symptoms can be linked to other mental health issues. The very nature of the condition can also make the sufferer confused and reluctant to seek help, which may explain the low diagnosis rates. If you think you, or someone close to you, may be experiencing dissociative symptoms it is important to speak to your GP who can refer you to a mental health specialist with experience in dissociation.

I no longer felt human. I had lost the two most important people in my life. I became disassociated. I felt like I was watching my life, but I was not in control. I was a passenger in my own body.

- Read Charlotte's story.

Dissociative disorders

Dissociative disorders occur when episodes of dissociation become recurrent and frequent. While cases of dissociation may be mild and go away in time, dissociative disorders tend to be more extreme and are likely to require ongoing treatment. The following are examples of dissociative disorders:

Dissociative amnesia

This happens when you are unable to remember key information about yourself or even a particular time in your life. With this disorder, you may also feel symptoms of depersonalisation and identity confusion.

Dissociative amnesia with fugue

A typical fugue may see you assuming an alternative identity for a certain period of time (this could be days or weeks). To those who don't know you, your actions and behaviours may seem entirely normal. When the memory of your true identity returns, you may experience a range of different emotions including guilt, shame and depression.

Depersonalisation or derealisation disorder

This disorder leads you to feel detached from your own body and you may feel as if your body isn't 'real'. You may feel as if you are watching your body as if it was a movie, or you may have what feel like out-of-body experiences.

Dissociative identity disorder (DID)

One of the most complex disorders, dissociative identity disorder used to be known more commonly as multiple personality disorder. This name led people to believe that it is a personality disorder, but it is not (hence the name change). The overriding symptom of this disorder is change in identity.

Those with dissociative identity disorder may have a range of identities that are in control of the body and mind at different times. You are likely to experience severe amnesia and you may also experience symptoms of depersonalisation disorder. You may become aware of the other identities, or you may lose chunks of time without knowing why.

Other specified dissociative disorder (OSDD) 

This is when you experience dissociative symptoms that don't fit other diagnoses. If the person making your diagnosis can't tell you why your symptoms don't fit any other diagnosis, they may diagnose you with unspecified dissociative disorder (UDD). 

In this video from Mind, four people talk through their experiences of dissociation.

Causes of dissociative disorders

As with many other mental health issues, the causes of dissociation are incredibly complex. Experts have agreed however that the most common cause for dissociative disorders is past trauma such as childhood abuse.

If you were abused as a young child, you may have 'disconnected' from yourself to cope with what was happening to you. Feeling vulnerable may have led you to use dissociation as a coping device, and this can continue even years after the abuse took place.

If there was no adult present to provide comfort, you may have had to become emotionally self-sufficient at a young age. As identity is still forming during this time, this can lead to confusion and the creation of other identities that can cope or escape from what is happening.

While it tends to be abuse that triggers dissociation, physical or emotional trauma as an adult can trigger a similar response.

Treatment for dissociative disorders

Treating dissociative disorders aims to re-connect you with your thoughts, feelings and memories to help you feel more real and complete as a person. If you suspect you have a dissociative disorder your first port of call should be your GP. They will be able to refer you to a specialist who can go through your treatment options.

If you find it difficult to remember what you talk about at appointments like this, you may find it helpful to take someone you trust along with you. They can keep track of appointments and ensure that you attend important meetings.

In terms of the treatment you may be offered, psychotherapy and talk therapies are likely to be at the forefront. Finding out the underlying cause of your dissociation is key, as is learning to recognise your symptoms and deal with stressful situations.

There may be different techniques used during your therapy sessions including hypnosis to help you remember your past better and/or cognitive therapy to help you change negative thought patterns into healthy ones. Creative art therapy can also be helpful for those who have difficulty expressing themselves.

Eye movement desensitisation and reprocessing (EMDR) is often recommended to help those dealing with traumatic memories, however, standard EMDR is not likely to help those with dissociative disorders. EMDR for those with dissociative disorders should be adjusted, often focusing on specific memories for shorter time periods. It should only be used if you're feeling emotionally stable and by professionals who know about dissociative disorders. 

While there is no medication for dissociative disorders, your doctor may recommend medication to help you cope with associated symptoms such as depression. If you have dissociative identity disorder you should only be offered medication like this if the symptoms are experienced by your dominant identity.

When it comes to seeking professional help, it is important that you speak to someone who has experience in dealing with dissociation. The related disorders can be incredibly complex and difficult to treat - and may, therefore, require long-term support. Because of this, finding someone you feel comfortable with and able to trust is essential.

Great counsellors develop a rapport with clients. Through listening and accepting you, they work to establish goals for the therapy. You should be in no doubt that the therapist wants you to achieve your aims. This relationship is key and a good predictor of the successful outcome of therapy.

- Read more on finding a good therapist by counsellor Graeme Orr MBACP (Accred).

How to help yourself

Seeking professional help is a must when dealing with dissociation, however, there are forms of self-help you can utilise to help your recovery process. Carrying out self-help techniques on your own can be difficult, so you may want to ask your trusted friend/relative to help you.

(The following tips have been sourced from Mind)

1. Keep a journal

Keeping a journal can be a really helpful way of improving your connections to reality. If you suffer from dissociative identity disorder, writing in a journal can encourage an awareness and dialogue to form between identities. If you feel comfortable doing so, speak to your therapist about what you write in your journal as it may help you during your sessions.

2. Use grounding techniques

Connecting yourself with the present is helpful during times of stress. This may include breathing slowly, talking to someone you trust, touching something solid or even smelling a strong smell. Certain aspects of mindfulness practice could help in the same way.

3. Allow time for younger identities to take over

If you have dissociative identity disorder, the identities within you may vary in age. If you have one or more that are young, it can be helpful to give them an allocated time and space to 'come out'. You may want to do this with someone else close by to ensure you are safe during this time. Allowing them their own time to play and have control offers them something they may have been denied as a child.

4. Implement everyday coping strategies

Together with your therapist, you should look to implement any strategies that could help you remain in the moment. If you suffer from dissociative amnesia, for example, having a calendar you tick off every day and a working watch may be helpful. If you suffer from depersonalisation, certain techniques such as twanging a rubber band on your arm may help to bring you back to your body.

5. Join a support group and/or online community

You may find it helpful to speak to others who experience similar problems as yourself. Support groups can offer you an emotional outlet and you may be able to learn practical tips from other members of the group. Online communities are ideal for those who don't feel comfortable speaking about their problems face to face. As online forums are rarely regulated and foster anonymity, you should approach this kind of support with caution. Your therapist may be able to suggest an appropriate forum and may also give you tips for staying safe online.

Two people talking

Advice for friends and relatives of those with dissociation

If someone you are close to is diagnosed with dissociation or a dissociative disorder, your role as a friend or family member can be key in their recovery. Being as supportive and understanding as possible can really help the person dealing with dissociation; it may be worth trying the following:

  • Learn as much as you can about their disorder so you understand better what they are going through.
  • Listen to your friend or relative without judgement if they choose to tell you about their experiences.
  • Offer to help with everyday tasks and help them keep track of appointments and eating habits if they are often forgotten.
  • Be wary when it comes to touching and intimacy - always ask if it is OK.

Being responsible for someone in this way can be incredibly tough for you if you become a carer, so ensure you are looking after yourself too.

What should I be looking for in a counsellor or psychotherapist?

Currently, there are no official rules or guidelines in place that stipulate what level of training a counsellor dealing with dissociation needs. However, it is recommended that you check to see if your therapist is experienced in this area.

A Diploma level qualification (or equivalent) in dissociative disorders will provide assurance and peace of mind that your counsellor has developed the necessary skills.

Another way to assure they have undergone this type of specialist training is to check if they belong to a relevant professional organisation representing counsellors dealing with dissociation.


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