Medicines for Dissociative disorders

What it is

Dissociative disorders are a group of mental health conditions that involve dissociation — a sense of disconnection or detachment from oneself, one’s thoughts, feelings, memories, surroundings, sense of identity, or a combination of these. Dissociation is, to some degree, a normal experience that many people have at times (such as "switching off", daydreaming, or feeling detached briefly, for example when very stressed or tired). It becomes a disorder when it is persistent, distressing, or interferes with a person’s life. Dissociation is often understood as a way the mind copes with overwhelming experiences — it is frequently linked to trauma, particularly severe, repeated, or early-life trauma (such as abuse), acting as a way of coping by disconnecting from distressing experiences or feelings. There are several types of dissociative disorder, which can involve different experiences, such as: feeling detached from oneself or one’s body, as if observing oneself from outside (depersonalisation), or feeling that the surroundings are unreal or dreamlike (derealisation); gaps in memory, particularly for personal information or events, that are more than ordinary forgetfulness (dissociative amnesia); and, in some, experiencing distinct, separate parts or identities (as in dissociative identity disorder, previously called multiple personality disorder). Dissociation can be frightening, confusing, and distressing, and can significantly affect a person’s sense of self, memory, functioning, and daily life. Dissociative disorders can occur alongside other mental health conditions (such as PTSD, depression, or anxiety). It is important to understand that dissociative disorders are recognised mental health conditions, often a response to difficult experiences, and that they can be helped: the main treatment is psychological therapy (talking therapies), often with a focus on safety, understanding and managing the dissociation, and, where relevant, processing the underlying trauma, along with support. Support from mental health services helps, and recovery and improvement are possible with appropriate help. The key messages are that dissociative disorders involve a distressing sense of disconnection from oneself, surroundings, memories, or identity, often linked to trauma, and that talking therapies and support help.

How it is treated

Dissociative disorders are managed mainly with psychological therapy (talking therapies), often focusing on safety, understanding and managing the dissociation, and processing any underlying trauma, along with support and treating any co-occurring conditions; recovery and improvement are possible. Because dissociative disorders are recognised mental health conditions, and because dissociation can be distressing and confusing, an important step is recognising the difficulty and seeking help — a GP can be a starting point, providing support, assessing the situation, and arranging referral to appropriate mental health services, which assess the dissociation and any related difficulties. The main treatment is psychological therapy, tailored to the individual and the type and severity of dissociation. Therapy often focuses on: establishing safety and stability, and helping the person manage the dissociation and any distressing symptoms (with grounding techniques and other strategies to help stay connected to the present and manage episodes of dissociation); understanding the dissociation and its role (often as a way of coping with overwhelming experiences); and, where relevant and when the person is ready, working with the underlying trauma or difficult experiences that often lie behind dissociation, in a careful, paced way. Different therapeutic approaches are used, and therapy for dissociative disorders (particularly the more complex forms) is often specialised and takes time. Support for any co-occurring conditions — such as PTSD, depression, or anxiety, which often occur alongside dissociative disorders — is important, and these are treated as part of care. Building coping strategies, support, and a sense of safety and stability in the person’s life are part of the approach. Support from mental health services, and, where relevant, specialist services for complex or trauma-related dissociation, helps, and support organisations provide information and peer support. Because dissociative disorders are often linked to trauma and can be distressing, a compassionate, understanding approach is important, and it is important to seek help promptly if there are thoughts of self-harm or suicide, which can occur. With appropriate psychological therapy and support, people with dissociative disorders can be helped to understand and manage their experiences, process underlying difficulties, and improve their wellbeing and functioning, and recovery and improvement are possible, though it can take time. The reassuring messages are that dissociative disorders are recognised, treatable mental health conditions, often a response to difficult or traumatic experiences, that talking therapies (with support and treatment of any co-occurring conditions) help people understand and manage the dissociation and, where relevant, process the underlying trauma, and that recovery and improvement are possible; so seeking help, and accessing psychological therapy and support, are the keys to managing dissociative disorders.