What is Dissociation and Dissociative Identity Disorder (DID)? (2023)

overview

• When you dissociate, you may experience symptoms such as feeling disconnected from your own body or developing other identities.
• Dissociative disorder is a mental illness that affects your thinking. You can have the symptoms of dissociation without having a dissociative disorder. You may have the symptoms of dissociation as part of another mental illness.
• There are many different causes of dissociative disorders.
• You can get talking therapies for dissociative disorders.
• You may be given medications that can help with symptoms of dissociation and dissociative disorder.

above

What is dissociation?

Many people experience dissociation at some point in their lives. Many different things can cause you to dissociate. For example, you might dissociate when you are very stressed or after something traumatic has happened to you. You could also have dissociation symptoms as part of another mental illness, such as anxiety.

Some of the symptoms of dissociation are as follows.

• You can forget specific time periods, events and personal information.
• Feeling disconnected from your own body.
• The feeling of being disconnected from the world around you.
• You may not have a sense of who you are.
• You may have multiple unique identities.
• You may feel little or no physical pain.

You may have these symptoms for as long as the event that triggered them, or for a short time afterwards. This is called an episode.

In some people, these symptoms can last much longer. If you suffer from dissociative disorder, these symptoms can be present for long episodes or even constantly.

The type

What Are the Different Types of Dissociative Disorders?

There are different types of dissociative disorders. Below is more information on each of these items.

It's important to remember that you can have the symptoms of dissociation without having a dissociative disorder. There is also much disagreement among professionals about dissociative disorders.

What is dissociative amnesia?

If you suffer from dissociative amnesia, you may not remember things that happened to you. This may or may not relate to a stressful or traumatic event.

In severe cases, you may find it difficult to remember:

• Who are you,
• what happened to you or
• how you were feeling at the time of the trauma.

This is not the same as simply forgetting something. It's a memory gap. That means you won't be able to access the storage at that point, but they won't be lost permanently either.

With dissociative amnesia, you may still be able to engage with other people, such as B. Have conversations. You may also remember other things and lead a normal life. But you might also have flashbacks, uncomfortable thoughts, or nightmares about the things you have a hard time remembering.

You may have dissociative amnesia with dissociative fugue. This is where someone travels or wanders elsewhere with dissociative amnesia related to things they cannot remember. They may or may not have traveled on purpose.

What is Dissociative Identity Disorder (DID)?

Dissociative Identity Disorder (DID) is sometimes referred to as "Multiple Personality Disorder". But we called it DID on this page.

When you have DID, you appear to have two or more different identities, known as "alternative identities." These identities can take control at different times.

You may find that your behavior changes depending on which identity is in control. You may also have trouble remembering things that happened when switching between identities. Some people with DID are aware of their different identities, while others are not.

There is much disagreement between researchers about the concept of DID.

We think that someone with DID has different identities. However, some researchers believe these are actually different parts of an identity that don't work properly together.

They suggest that DID is caused by experiencing severe trauma over a long period of time in childhood. By experiencing childhood trauma, you adopt different identities and behaviors to protect yourself. As you grow up, these behaviors are more fully formed until it seems like you have different identities. When in fact the different parts of your identity don't work together properly.

What is Another Specific Dissociative Disorder?

With this diagnosis, you may experience dissociation symptoms on a regular basis but do not fit into either type.

A psychiatrist uses this diagnosis when they feel the reason for your dissociation is important.

The reasons they give include the following.

• You dissociate regularly and have for a long time. They could dissociate in separate, regular episodes. You may not notice any changes between these episodes.
• You are at a distance from the compulsion. That means someone else coerced or persuaded you. For example, if you have been brainwashed or detained for a long time.
• Your dissociation is acute. This means your episode is short but serious. This may be due to one or more stressful events.
• You are in a dissociative trance. This means you have very little awareness of the things that are happening around you. Or you may not respond to things and people around you because of trauma.

What is Nonspecific Dissociative Disorder?

This diagnosis is used when you dissociate but don't fit into a specific dissociative disorder.

Psychiatrists also use this diagnosis when they choose not to give the reasons why you don't fit a particular disorder.

Or if they don't have enough information for a specific diagnosis. For example, after an initial assessment in the event of an accident or emergency.

What are dissociative seizures?

Dissociative seizures are difficult to diagnose. You are regularly misdiagnosed as epilepsy.

Dissociative disorders can also be referred to as non-epileptic attack disorder (NEAD).

It can be difficult to tell the difference between a dissociative seizure and an epileptic seizure. An EEG can read epileptic seizures, but not dissociative seizures. An EEG is a test that detects electrical activity in your brain using small metal discs attached to your scalp.

Dissociative seizures occur for psychological reasons, not physical ones.

What is Depersonalization/Derealization Disorder (DPDR)?

The feelings of depersonalization and derealization can be a symptom of other disorders. It has also been found in people with frontal lobe epilepsy and migraines.

But it can also be an independent disorder. This means that it is a "primary disorder". There is some disagreement among professionals as to whether DPDR should be listed with the other dissociative disorders at all.

DPDR has some differences from other dissociative disorders. In DPDR, you may not question your identity, or have different identities at all. You may still be able to tell the difference between things around you. And there must be no symptoms of amnesia. Instead, with DPDR you may feel emotionally numb and wonder what it feels like to live. We have explained this in more detail below.

You may have these feelings all the time rather than in episodes. It doesn't have to be caused by a traumatic or stressful event.

Many people think that this disorder is more common than previously thought. This could be because:

• missing information about
• Patients who have not reported their symptoms, and
• Doctors who don't know enough about it, which means they underestimate the condition.

With DPDR, you may have symptoms of depersonalization or derealization, or both.

depersonalization
Depersonalization may make you feel "cut off" from yourself and your body, or as if you are living in a dream. You can feel emotionally numb to memories and the things that are happening around you. It can feel like you're watching yourself live.

The experience of depersonalization can be very difficult to put into words. You could say things like "I feel like I don't exist anymore" or "It's like I'm watching my life from behind glass."

derealization
When you suffer from derealization, you may feel cut off from the world around you. You might feel like things around you don't feel real. Or they appear foggy or lifeless.

causes

What Causes Dissociation?

There are several things that can cause you to dissociate. For example:

• traumatic events,
• difficult problems that cause stress, and
• difficult relationships.

Other researchers have suggested that cannabis use can sometimes be a cause of depersonalization/derealization disorder (DPDR).

treatment

How are dissociation and dissociative disorders treated?

Dissociation can be treated in many different ways. The type of treatment you receive may depend on what type of disorder you have.

Can medication help?

There are currently no medications for dissociative disorder itself, although you may be taking medication for some symptoms.

If you are having dissociation episodes, you may also have a medical condition such as depression or anxiety. Some medications might help. For example, antidepressants could be used for depressive symptoms and benzodiazepines for anxiety.

Benzodiazepines can be addictive and should only be prescribed for a short time. Benzodiazepines can worsen the dissociation.

For more information, see:

• Antidepressants per Clickhere.
• Benzodiazepines by clickinghere.

Which psychosocial treatments can help?

Talking therapies are usually recommended for dissociation. There are many different forms of talk therapy. Different ones can be used for different dissociative disorders.

What is psychodynamic psychotherapy?
If you have DID, your doctors may consider long-term relationship psychotherapy. This is a type of therapy where you talk about your relationships and thoughts. Maybe you're talking about your past. Your therapist can connect the way you think and act to things that have happened to you.

DID may require psychotherapy over a longer period of time, with at least 1 session per week. This depends on the individual's situation and on their ability and level of functioning, resources, support and motivation.

Was ist Eye Movement Desensitization and Reprocessing (EMDR)?
DID can also be aided by eye-movement desensitization and reprocessing (EMDR). With EMDR, you make side-to-side eye movements while talking about the trauma that occurred.

Doctors need to be careful when using EMDR as it could make your DID worse if not done properly. But EMDR can have benefits when used alongside other treatments. The type of EMDR used for DID is slightly different than other conditions. Therefore, it is important for your doctor to know your DID before you start EMDR.

What is cognitive behavioral therapy (CBT)?
Cognitive behavioral therapy (CBT) is another form of talk therapy. You will talk about how your thoughts and feelings affect you. And how your behavior can make this worse. You focus less on the past and try to change the way you think and behave.

Portions of CBT are recommended for treating DID by helping you change your thoughts and behaviors that result from the trauma.

A CBT approach has also been proposed for long-lasting DPDR. If you have DPDR, you may often worry about your symptoms, thinking that you have a serious mental illness or that something is wrong with your brain. CBT can help change this mindset. By reducing your anxiety and depression that accompany this concern, it may also reduce your symptoms of DPDR.

For more information, see"talk therapies"When clickinghere.

What treatment should I be offered?

In the UK, the National Institute of Health and Care Excellence (NICE) publishes guidance on physical and mental health conditions. These guidelines are a standard for NHS treatment. At the time of writing, there are no NICE guidelines on dissociation or dissociative disorders.

However, this does not mean that you should not be offered treatment. If you think you have any of these symptoms, tell your GP. They can refer you to a psychiatrist.

You can find more about it“GPs – what you can expect from your doctor”When clickinghere.

What if I'm not satisfied with my treatment?

If you are not satisfied with your treatment, you can:

• ask for a second opinion
• Ask a lawyer to help you talk to your doctor
• Contact the Patient Advisory and Liaison Service (PALS) or
• file a complaint.

Below is more information about these options:

How do I ask for a second opinion?

If you are not happy with your diagnosis or treatment, talk to your doctor. If they don't offer you other treatment options, you can get a second opinion. Here another doctor will examine you and suggest diagnosis or treatment. You are not legally entitled to a second opinion, but your doctor may agree to one.

What is advocacy?

A solicitor can help you understand your rights to NHS treatment. They can also help you be fully involved in decisions about your care. A solicitor is separated from the NHS.

You can search online to see if there are local advocacy services in your area. Or the Rethink Mental Illness Advice Service could be looking for you. You can find your details at the bottom of this page.

What is the Patient Advice and Liaison Service (PALS)?

Your NHS Trust's Patient Advice and Liaison Service (PALS) can try to help you with any problems or issues you are having. The contact details of your local PALS can be found at:www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363.

How can I complain?

If you are not satisfied with the way you have been treated, you can make a complaint. You must make a complaint through the NHS within 12 months of what you wish to complain about.

For more information, see:

• Second opinions by clicking here.
• advocacy by clicking here.
• Complaints about the NHS or social services by clicking here.

Self Care & Risks

What are Self Care and Management Skills?

You can learn to manage your symptoms by taking care of yourself at home. You will learn how to recognize discomfort and know what your triggers are.

Not all techniques here will work for everyone. It's important to try something that you enjoy, that you can commit to, and that works for you.

To write a diary

It can be helpful to keep a journal. You could write how you felt throughout the day. Or you write down goals that you want to achieve. You could use it as part of cognitive behavioral therapy (CBT).

Keeping a diary is not for everyone. If you have Depersonalization/Derealization Disorder (DPDR), you may already be spending a lot of time thinking about how other people see you. Journaling can make you feel worse if it forces you to think about yourself. Keeping a journal can still help, but talk to your GP or a counselor first.

grounding techniques

These techniques can be helpful for people who have been through trauma or who dissociate regularly. They can help ground you in the here and now. This can be useful for flashbacks.

Grounding works best when practiced regularly. Try to practice these things every day. There are different grounding techniques.

use of your environment
To take advantage of your surroundings, look around you. Focus on all the details of everything around you. Try to describe this to yourself either out loud or quietly in your head. Use all your senses.

use words
You could try positive words or phrases about yourself. For example "I am strong" or "I will succeed". Write down a few things that make sense and are positive for you. You could carry these around with you. Try reading them to yourself or aloud if your symptoms are bad.

Using Images
This is similar to using your environment. Try to think of a place where you feel peaceful and safe. This can be a real or imaginary place. If it is a real place, choose a positive place with no traumatic memories. Close your eyes and imagine this place. Focus on all the details and all your senses.

use posture
Try to put yourself in a pose that makes you feel strong. This can be standing up with your shoulders back or relaxing your shoulders. Try different poses until you find one that works for you.

use objects
Try to choose an object that is personal to you. You should try to pick something that is only associated with positive memories. Carry it around and use it to remind yourself who you are and where you are.

Relaxation

There are many different ways to relax. The most important thing is to find something you enjoy. For example cooking, reading or gardening. You may find that meditation or mindfulness helps.

Some relaxation techniques, like meditation and mindfulness, can make some people feel worse. For example, if you have DPDR, you may have trouble meditating. If that's the case, try to find something else that works for you. If you have CBT, you can tell the therapist. They might help you find something that works.

exercise and diet

There are no specific exercises that can definitely help. But you could try jogging, swimming, or just walking more and doing something that suits your ability. Trying to eat more fresh fruits and vegetables can help. You can also try reducing the amount of fat, salt, and sugar you eat. Reducing the amount of caffeine you drink can help.

Sleep

Not getting enough sleep can make your symptoms worse. It may take a few weeks to get used to better sleeping habits. Here are some tips to help you fall asleep.

• Sleep when you feel sleepy.
• Consider your bedroom as a place to sleep.
• If you lie awake in bed for a long time, get up and move around for a while.
• Avoid taking naps during the day.
• Try not to consume caffeine a few hours before bed.
• Make sure you get up at the same time every day. This can help you get into a regular routine.

For more information, see"Complementary and alternative treatments"When clickinghere.

What risks and complications can dissociation cause?

Some people with dissociative disorder may also have another mental illness, such as anxiety or depression. This is referred to as a "comorbid" condition. In some cases, this can make your dissociative disorder difficult to deal with in everyday life. However, all of these conditions are manageable and treatable.

For more information, see:

• depression by clickinghere.
• Anxiety Disorders by Clickinghere.

carers, friends & family

What if I'm a caregiver, friend or relative?

What support can I get?

If you are a caregiver, friend, or family member of someone living with dissociative disorder, you can get support.

You can get peer support through carer support groups. You can search for local groups near you on the following websites:

• Rethinking mental illness:www.rethink.org
• Maintainer: Maintainer UK:www.carersuk.org
• trust of caregivers:www.carers.org

If you need more practical support, you can ask your local authority for a carer assessment. You may get support from your community.

As a caregiver, you should be involved in decisions about the care planning for your loved one. However, you can only participate if your relative agrees. If they do not agree, their healthcare professionals cannot share any information about them with you.

For more information, see:

• Supervisor assessment and support planning by clickinghere.
• Confidentiality and information exchange - For caregivers, friends and relatives with a clickhere.
• Benefits for family carers at a clickhere.

How can I support the person I am caring for?

You may find it easier to support someone with dissociative disorder when you understand their symptoms, treatments, and self-care options. You can use this to support and encourage them to get help and stay healthy.

You should also be aware of what you can do if you are concerned about their mental state. Have the details of your mental health team or GP ready and discuss a contingency plan with them.

For more information, see:

• Support someone with a mental illness by clicking here.
• Get help in a crisis by clicking here.
• Suicidal Thoughts - How to support someone by clicking here.
• Respond to unusual behavior by clicking here.

Further reading & useful contacts

Carolin Spring
Dissociation and dissociative identity disorder online training, webinars and literature.

Website:www.carolynspring.com/

Unreal
Reaching out to people with lived experiences of depersonalization and derealization disorders, as well as their caregivers and families, Unreal seeks to raise awareness. They support and encourage engagement through up-to-date information, signposts, networking, sharing experiences and celebrating successes. They provide information and resources as well as peer support groups.

Contact form on the website:https://www.unrealuk.org/get-in-touch
Website: www.unrealuk.org

Clinic for Dissociative Studies
This organization has a lot of information about dissociative disorders on their website. They also offer care and treatment for dissociative disorders. You can accept recommendations from the NHS. They offer general information about dissociative disorders but do not operate a hotline.

Telephone: 020 7794 1655
Address: 35 Tottenham Lane, London, United Kingdom, N8 9BD
Email:info@clinicds.com
website:www.clinicds.co.uk

South London and Maudsley Trauma and Dissociation Service
A specialized outpatient assessment, counseling and treatment service. It is for adults who have mental health difficulties after trauma and/or dissociative disorders. The only NHS specialist service to provide treatment for people with complex post-traumatic stress disorder (PTSD) and severe dissociative disorders. Referrals are accepted from general practitioners and senior physicians. All referrals must be approved and funded by the local Clinical Commissioning Group (CCG).

Telephone:020 3228 2969
Email:TDS@slam.nhs.uk
Website:www.slam.nhs.uk/national-services/adult-services/trauma-and-dissoziation-service