A woman wrapped in a blanket sits on a pier overlooking a calm lake.Dissociation describes a lack of psychological connectedness. It could manifest as gaps in one’s memory, a split in identity, or a feeling of separation from the world. 

Many people experience mild dissociation on occasion, such as bouts of daydreaming. Most individuals do not need help for mild dissociation unless it interferes with daily life. 

Clinical dissociation can take the form of amnesia, depersonalization, derealization, and dissociative identity (DID). These diagnoses can interfere with a person’s ability to care for themselves. Severe dissociation often requires treatment from a mental health professional.

THERAPY FOR DISSOCIATION

Individual therapy is the most common method of treatment for dissociative issues. People generally dissociate to cope with an experience that is too overwhelming for them to handle in an adaptive way. Thus, therapy for dissociation generally focuses on acknowledging and processing the painful emotions that are being avoided. 

By changing how a person responds emotionally to a trauma, therapy can help reduce the frequency of dissociative episodes. A therapist may also teach coping skills for use during dissociation. When dissociation causes feelings of suspicion or insecurity, a strong therapeutic relationship can be vital to establishing trust. 

There are no psychotropic medications designed for dissociation specifically. But a psychiatrist may prescribe a drug to treat co-occurring issues such as anxiety. Treating co-occurring issues can keep a person’s other diagnoses from contributing to the dissociation. 

Helping a Loved One with Dissociation

If you have a loved one who dissociates, you likely know that dissociation is rarely intentional behavior. A person who dissociates may not realize what is happening in the moment. You can support your loved one by creating a grounding plan with them. A grounding plan outlines ahead of time how you will help your loved one break free of a dissociative episode.

The first step of a grounding plan is to watch your loved one for signs of dissociation. These could include lapses in conversation, glazed eyes, and so on. When you see these signs, you can use the following grounding techniques to “wake them up”:

  • Get their attention to make eye contact. You may try snapping your fingers or calling their name. Ask your loved one in advance if they are willing to be touched.
  • Give them an object with a strong smell, taste, or texture. Calming scents will likely work better than unpleasant ones.
  • If your loved one was triggered by a certain situation, help them walk to a less stressful location. Even the act of moving their body can help calm them down.
  • Remind the person who they are and where they are. Reassure them they are safe.
  • Ask the person to describe their surroundings. For instance, you could tell them to name five red items in the room. 

Grounding techniques will likely work better on some forms of dissociation than others. Someone undergoing derealization is likely to benefit more than someone experiencing amnesia. You and your loved one may need to try several strategies out before you find one that fits.

As your loved one becomes more grounded, you may ask them to practice the coping strategies they learned in therapy. For example, you could remind them to repeat a certain mantra aloud. If they cannot remember what exercise they are supposed to do, you can have them repeat a generic affirmation such as “I can get through this.”

Self-Help for Dissociation

If you have dissociation issues, you can practice the grounding techniques above to guide you through an episode. You can also take preventive steps to manage your condition. These include:

  • Wear a watch with the time and date on it. (If you wish to use your phone, make sure you have some way to unlock it.)
  • Write notes to yourself. These memos could be on a whiteboard, sticky notes, etc. Make sure they are in a visible place rather than hidden in a drawer.
  • Keep a daily journal. Journaling can help you improve overall self-awareness. It may help you fill in memory gaps or recognize patterns of behavior.
  • Make crisis cards to carry around. In an emergency, you may not be able to explain to others what you need. A crisis card lists your name, your address, who to contact for help, and other useful information.

You may also wish to create a crisis plan with your friends or family. A written plan can ensure that everyone knows what to do in an emergency. It can also prevent panic in the moment.  

Although lifestyle changes can help you cope with dissociation, your condition is unlikely to improve without treatment. The right therapist can help you reduce symptoms and increase your quality of life. 

CASE EXAMPLE OF DISSOCIATION TREATMENT

  • Dissociating during sexual encounters: Pat, 29, recently ended a relationship with a man because she found herself dissociating during sexual encounters. She is aware that she was sexually abused as a child but is not sure how to get over it. Pat’s therapist helps her identify some of her fears, both rational and irrational, along with ways to protect herself. She also refers Pat to a support group where she can talk about her experiences with others who have experienced similar trauma. Meanwhile, in therapy, Pat begins working through feelings of helplessness, rage, and grief. She develops communication skills for use with potential future sexual partners. With the therapist's help, Pat explores possible ways to choose appropriate sexual partners, something that has always been difficult for her. During their sessions, the therapist uses redirection and encouragement to keep Pat fully present (as opposed to dissociating) as they discuss the abuse Pat experienced, which helps Pat learn how to stay present on her own.

References:

  1. American Psychological Association. APA Concise Dictionary of Psychology. Washington, DC: American Psychological Association, 2009. Print.
  2. Crisis services: How can I plan for a crisis? (n.d.) https://www.mind.org.uk/information-support/guides-to-support-and-services/crisis-services/planning-for-a-crisis/?o=10152#.W32I0ehKiM9
  3. Dissociation information [PDF]. (n.d.) Retrieved from https://depts.washington.edu/hcsats/PDF/TF-%20CBT/pages/7%20Trauma%20Focused%20CBT/Dissociation-Information.pdf
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