• It can be hard to know how to help someone in distress, especially if it can be hard to identify, like dissociation

  • Dr Claire de la Varre offers her advice if you want to help a loved one who is dissociating

  • We have therapists who specialise in dissociation – find them here

Almost all of us will have at some time experienced mild forms of dissociation, feeling somewhat detached from our surroundings. You might regularly zone out during meetings, or recall your mind going blank when asked a simple question in high school. The former is a kind of daydreaming, while the latter is caused by the fight-or-flight response reducing blood flow to the prefrontal cortex. Dissociation also happens when we go into shock, have a panic attack, become emotionally flooded, or as a side effect of certain drugs.

Our ability to dissociate exists on a spectrum and under mild to moderate stress, dissociation can function as a coping strategy to distance us from uncomfortable emotions. We all have different parts of the personality, and when we are functioning well, we tend not to notice them. However, trauma may cause fracturing or splitting of the self into parts, and for people with dissociative disorders, who have often experienced significant trauma, this sort of shutdown of the mind may last for hours, days or even longer. The most extreme dissociative disorder is dissociative identity disorder, or DID, where a part of the fractured self takes over and acts autonomously for a while.

Not everyone is aware that they are dissociating – they might just feel fuzzy-headed, sleepy, or experience sudden confusion or a loss of confidence. They may appear to others to be acting out of character, perhaps uncharacteristically shy or bold. Some people who are dissociating are unable to process spoken or written instructions or follow simple instructions. They might struggle or forget how to drive, have trouble finding words or formulating sentences, or appear not to be able to hear when spoken to.

Whilst it is often difficult to tell if someone around you is dissociating, if you think that they are:

  • make sure they are in a safe, quiet space if possible and not engaging in any activity that could be potentially dangerous, like driving a car
  • don't ask a lot of questions but be a comforting and reliable presence
  • if you feel that it is appropriate and not intrusive, then you can always ask them if it is OK to touch them e.g. hold their hand, pat them on the arm or back, or give them a hug. Some people who are dissociating will respond well to the pressure from a hug, whilst for others it might be triggering, so check with them first.

If you suspect that they are dissociating to the point where it is affecting their life and relationships with other people, you should encourage them to see their GP and get a referral to a psychiatrist who has experience with dissociative disorders. 

A structured clinical interview is required to diagnose a dissociative disorder, and such disorders are commonly underdiagnosed or misdiagnosed because many of the symptoms experienced during dissociation are also common to other conditions. These range from depression, bipolar disorder, or anxiety, to narcolepsy, brain disease, body dysmorphic disorder, or personality disorders.

Here are the core features of dissociative disorders, although a person who is dissociating does not necessarily experience all of these:

  • Amnesia: losing time (anything from minutes to years is possible), black outs, or unexplained gaps in memory
  • Depersonalisation: disconnection from the self, emotions or body, just 'going through the motions', looking out from behind someone else's eyes
  • Derealisation: feeling disconnected from familiar people and surroundings in that they may seem unreal, strange, or even unrecognisable
  • Identity confusion: internal conflict or uncertainty about sense of self. May include gender or age confusion
  • Identity alteration: acting completely out of character, like a different person, and sometimes even using a different name

Once diagnosed, treatment primarily consists of psychotherapy, and medications may be prescribed if appropriate for other co-occurring symptoms. Therapy should include learning new skills for stress reduction, emotional regulation, communication and relationships, self-confidence and assertiveness. 

Therapy will also help a dissociative person to become aware of stressors, as well as helping to heal from unresolved trauma. Regular stress reduction or anxiety management techniques like deep breathing, yoga, and mindfulness can be a helpful part of healing from trauma, as well as basic self-care practices that include plenty of sleep, regular exercise, and good nutrition.

Dr Claire de la Varre is a verified Welldoing therapist in Stirling and online

Further reading

Healing from dissociation: integrating the self

Dissociation: understanding the impact of relational trauma

Numbness: what it means to feel numb and how counselling can help

How to keep healthy boundaries with a friend in need