Dissociative disorders

Dissociation

Dissociation is a way the mind copes with too much stress. People who dissociate may feel disconnected from themselves and the world around them.

Periods of dissociation can last for a short time (hours or days) or for much longer (weeks or months).

Someone with a dissociative disorder may have problems with:

• movement
• sensation
• seizures
• periods of memory loss

They may also feel uncertain about who they are and have many different identities. Many people with a dissociative disorder have had a traumatic event during childhood. They may dissociate and avoid dealing with it as a way of coping with it.

Types of dissociative disorder

There are several different types of dissociative disorder. The three main types are:

• dissociative disorders of movement or sensation
• dissociative amnesia 
• dissociative identity disorder

Dissociative disorders of movement and sensation

Dissociative disorders of movement or sensation include:

• convulsions (seizures)
• paralysis
• loss of sensation

There doesn't appear to be a physical cause, but it seems to be the result of a communication problem within the brain. The symptoms are sometimes confused with neurological disorders like epilepsy or stroke.

Dissociative amnesia

Someone with dissociative amnesia will have periods where they can't remember information about themselves or events in their past life. They may also forget a learnt talent or skill.

These gaps in memory are much more severe than normal forgetfulness and aren't the result of an underlying medical condition.

Some people with dissociative amnesia find themselves in a strange place without knowing how they got there. They may have travelled there on purpose, or wandered in a confused state.

These blank episodes may last minutes, hours or days. In rare cases, they can last months or years.

Dissociative identity disorder

Someone diagnosed with dissociative identity disorder may feel uncertain about their identity and who they are.

They may feel the presence of other identities – each with their own names, voices, personal histories and mannerisms.

Typical symptoms include:

• feeling like a stranger to yourself
• feeling like there are different people within you
• referring to yourself as "we"
• behaving out of character
• writing in different handwriting

Mind has more information about the different types of dissociative disorders.

Associated conditions

Someone with a dissociative disorder may also have other mental health conditions, such as:

• medically unexplained symptoms
• post-traumatic stress disorder 
• depression
• mood swings
• anxiety and panic attacks
• suicidal tendencies or self-harm 
• phobias 
• an eating disorder
• obsessive compulsive disorder

They may also have problems sleeping (insomnia).

People with dissociative disorders may have repeated investigations or treatments for similar conditions with a physical cause. This in itself can cause symptoms or further illness.

Causes of dissociative disorder

The causes of dissociative disorders are poorly understood. They may be related to a previous traumatic experience, or a tendency to develop more physical than psychological symptoms when stressed or distressed.

Someone with a dissociative disorder may have experienced physical, sexual or emotional abuse during childhood. Some people dissociate after experiencing war, kidnapping, or even an invasive medical procedure.

Switching off from reality is a normal defence mechanism that helps the person cope during a traumatic time. It becomes dysfunctional when the environment is no longer traumatic but the person still acts and lives as if it is, and hasn't dealt with or processed the event.

Diagnosing dissociative disorders

If your GP thinks you have a dissociative disorder, they'll refer you to a mental health specialist for a full assessment.

Your GP may also contact a medical specialist, such as a specialist in conditions affecting the nervous system (neurologist), to make sure you're examined to make the right diagnosis.

Assessment

The specialist who carries out your assessment should be specially trained and have a good understanding of dissociative disorders.

During the assessment, they'll ask you how you're feeling and whether you've had a traumatic experience in the past. They'll also ask about any medication you're taking and whether you use drugs. 

It's important to be honest about your symptoms so you can receive the help and support you need.

Treatments for dissociative disorders

Many people with a dissociative disorder make a full recovery with treatment and support. Physical therapies may be used to address specific physical symptoms, such as:

• paralysis
• speech loss
• difficulty walking

Talking therapies are often recommended for dissociative disorders. The aim of talking therapies such as counselling and psychotherapy is to help you cope with the underlying cause of your symptoms, and to learn and practise techniques to manage the periods of feeling disconnected.

There's no specific medication to treat dissociation, but medication, such as antidepressants, may be prescribed to treat associated conditions like depression, anxiety and panic attacks.

If you're feeling suicidal

If you have, or have had, thoughts about taking your life, it's important you ask someone for help. It's probably difficult for you to see it at this time, but you're not alone or beyond help.  

There are people you can talk to who want to help:

• speak to a friend, family member or someone you trust, as they may be able to help
• call lifeline
• call the Samaritans' free 24-hour support service
• go to, or call, your nearest emergency department and tell the staff how you're feeling
• make an urgent appointment to see your GP

• Read more about getting help if you're feeling suicidal

What to do if you're worried about someone

If you're worried that someone you know may be considering suicide, try to encourage them to talk about how they're feeling. Listening is the best way to help. Try to avoid offering solutions and try not to judge. 

If they've previously been diagnosed with a mental health condition, such as depression, you can speak to a member of their care team for help and advice.

Further help and support

If you have a dissociative disorder, getting help and support is an important part of the recovery process.

Talking to someone about how your past experiences have affected you can help you come to terms with what happened, as well as helping them understand how you feel.

You can find services to help on the Minding your head website

Mind has also has a comprehensive list of support organisations for people with dissociative disorders.

More useful links

• How to use your health services