All about dissociative disorders
Let’s look at what dissociation is, and explore the different types of dissociative disorders.
What are dissociative disorders?
Dissociation is a change in perception or a ‘disconnect’ between thoughts, feelings, memories, actions or your sense of identity/who you are. This disconnect happens outside of your control; it is automatic and involuntary.
Dissociation is often triggered by trauma. It is a normal physiological response – meaning it makes changes in your brain and body.
In most cases dissociation is temporary, but some people may keep feeling disconnected for a few hours, days or weeks after a trauma.
Some people experience long lasting or recurring bouts of disconnect, even when they are safe. When this happens, it might signal a dissociative disorder.
Some people theorise that dissociating may also be a protective response after a trauma – as a way to try to prevent you remembering the traumatic incident.
Types of dissociation
Dissociation exists on a spectrum. Almost everyone experiences low-level dissociation some of the time. In fact, day dreaming is an example of typical and low-level dissociation.
Here are some types of dissociation:
- Derealisation: feeling as though the world around you isn’t real. This might mean feeling as though you are watching a movie, or like everyone seems 2D or fake.
- Depersonalisation: an altered sense of your thoughts, behaviours, body or sense of self. For example, this can include feeling numb or like you are ‘watching from outside yourself’.
- Memory loss: when you dissociate, it’s hard to form memories or pay attention to things happening around you, which might make it hard to remember things later on. Amnesia (lost memories) are the most severe form of this.
- Changes in sense of identity: you might experience changes in your personality, feel like you are ‘two different people’ at once or like you have multiple personalities. Some people are aware of these changes, but some aren’t.
Types of dissociative disorders
In dissociative disorders, the kinds of dissociation experienced are normally intense, distressing and unhelpful. Here are the key types of disorder.
Depersonalisation-derealisation disorder
This is when a person feels detached from their life, thoughts, feelings and behaviours.
Other symptoms include difficulties concentrating and memory issues, feeling ‘spaced out’, like time seems to move differently, or even like their body is different than usual, e.g. their hands seem to grow and shrink.
Dissociative identity disorder
This is when a person has multiple personalities that all act differently.
The person usually has memory lapses in the different personality states, which means they are unable to remember the other personalities or anything they said or did while in a different personality state.
Dissociative amnesia
This is when you can’t remember the details of a traumatic event, but you realise you are experiencing memory loss.
There are multiple kinds of this kind of amnesia, including:
- Localised – no memory of a traumatic event
- Selective – remembering bits and pieces of a traumatic event
- Generalised – difficulty remembering details from your entire life
- Systematised – really specific memory loss, e.g. forgetting a particular person
- Fugue – when someone suddenly forgets who they are and have no memory of their past. They often know they have lost their memory and might invent a new identity. Eventually, when they come out of the fugue, they forget their new identity and life.
Other Specified Dissociative Disorders and Unspecified Dissociative Disorder
This is a category for dissociative disorders that don’t meet the diagnosis criteria for any of the other disorders.
This might include:
- Trance states (that aren’t part of accepted cultural or religious practices)
- Acute dissociation due to an extremely stressful or traumatic event, that lasts less than 1 month, e.g. during and after a car accident
- Identity changes caused by ‘coercion’, e.g. brainwashing or cult recruitment
Impacts on your life
People with dissociative disorders are likely to experience other mental illnesses, including depression or anxiety disorders, eating disorders, personality disorders, trauma-related disorders and substance use disorders. They might have other symptoms or impacts, including:
- Self-harm
- Thoughts of suicide
- Sleep difficulties
- Difficulties with work/study
- Conflict in relationships
- Other self-destructive behaviours, e.g. risk taking
Treatment and coping
Dissociative disorders can be successfully treated. Here are some things that might help:
Seek professional support
Diagnosis is an important first step to adequately treating a dissociative disorder. Treatment might include medication, talking therapies (like counselling) or other strategies. These often focus on helping you first regulate your emotions and reduce stress, before working on integrating your trauma (to heal and move forward with it). The most important thing is that any professional who supports you helps you to feel safe, treats you with respect and works collaboratively with you.
Create a sense of safety
Dissociation is a trauma response and can be triggered whenever someone feels unsafe. Some people with dissociative disorders are also unsafe due to self-harm, suicidal thoughts and behaviours, and other ‘self-destructive’ behaviours, e.g. risk taking. Sometimes, focusing on the trauma, like trying to retrieve lost memories, can be really distressing and unhelpful. In those cases, it’s important to create a sense of safety, by knowing the people, places, things and even topics of conversation that feel safe for you and make these part of your safety plan.
Be mindful of triggers
It’s not always possible to know what might trigger dissociation, but some people can identify patterns which can help them plan ahead. For example, if you know that being at the train station might trigger you, you might ask a friend to go with you to the train station to support you if you need to catch a train.
Create a safety plan with support people
Create a plan with support people around what they can do or say if you dissociate (especially if this occurs in public). This is an important strategy for staying safe. A safety plan should include ways a support person can get you to a safe space without causing you further distress. For example, a friend might tell you they are going to touch before actually taking your hand, know to call a parent or significant other if you dissociate when hanging out, or know that you feel safe in the drama room at uni and organise to take you there if you need some time/space during the day.
Find ways to manage your stress
As stress can be a trigger for dissociating, finding ways to manage stress (that works for you) can help reduce instances of dissociation and feel more in control.
Use grounding techniques
Some people find grounding techniques helpful. Grounding is designed to connect you with the present moment. One way to do this is to connect with your body as it’s always in the present moment. Some techniques might include connecting to your body through your senses, e.g. biting a lemon, splashing water on your face, or tuning in with your surroundings, e.g. listing five things that you can see, describing your surroundings in detail in your head, etc.
“In the past, people with dissociative disorders were sometimes treated poorly, even by psychologists and psychiatrists. This is because dissociative disorders were poorly researched and understood. Fortunately, since the 1980s, research has greatly improved. All people experiencing dissociation deserve to be taken seriously and to be treated with respect and dignity.”– Amanda, Kids Helpline Counsellor
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