Dissociative disorders

A dissociative disorder is a mental health condition that alters a person's sense of reality.

Someone with a dissociative disorder may have memory loss or may feel:

that their body or the world around them is unreal
uncertain about who they are
that they have many different identities

Most people affected by this disorder will have experienced a traumatic event during childhood. They 'dissociate', or switch off from reality, to cope with it (the box on this page explains what 'dissociation' means).

This feeling of being disconnected from yourself or from the world can be extremely distressing, significantly affecting work and personal life.

It can affect people at any age and is nothing to do with a head injury or underlying health condition – it's the result of the brain adapting to a difficult early life.

If you have been diagnosed with a dissociative disorder, or a friend or family member has, read on. This page explains three main types of dissociative disorders:

It then explains what we know about the cause of dissociative disorders, other conditions commonly associated with dissociative disorders, and how dissociative disorders are treated.

What is dissociative amnesia?

Someone with dissociative amnesia will repeatedly have periods where they cannot remember information about themselves or about 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 are not the result of an underlying medical condition.

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

These blank episodes may last minutes, hours or days – and rarely, months or years.

What is depersonalisation-derealisation disorder?

'Depersonalisation' means feeling detached from yourself, observing yourself and your feelings and thoughts as if they belong to someone else you are watching in a movie. Some of the typical symptoms are:

out-of-body experiences
loss of feeling in parts of your body
distorted views of your body
unable to recognise your image in a mirror
a sense of detachment from your emotions
feeling like you are watching a movie of yourself
feeling like you are unreal

'Derealisation' means seeing other people and the environment around you as dream-like and unreal. Objects may change in shape, size or colour. Typical symptoms are:

feeling like a normal environment is unfamiliar
a sense that what is happening is unreal
feeling detached from the world
a perception of objects changing shape, colour, size
feeling that people you know are strangers

You might experience one or both of these problems if you have been diagnosed with depersonalisation-derealisation disorder, and will probably be aware that these experiences aren't reality.

Episodes of depersonalisation or derealisation may last just a few moments and come and go over many years, or may be ongoing.

What is dissociative identity disorder?

Dissociative identity disorder, or 'multiple personality disorder', is the most extreme of the three types.

If you've been diagnosed with dissociative identity disorder, you may feel uncertain about who you are and struggle to define yourself.

You may feel the presence of other identities, which may each have their own names, voices, personal histories and mannerisms.

Typical symptoms are:

feeling like a stranger to yourself
being confused about your sexuality or gender
feeling like there are different people within you
referring to yourself as 'we'
behaving out of character
writing in different handwriting

What's the cause?

Many people with a dissociative disorder will have experienced a traumatic event in the past.

Often, this traumatic event will have been physical, sexual or emotional abuse suffered during childhood, although 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 to cope during a traumatic time – it's a form of denial, as if "this isn't happening to me".

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.

So, a dissociative disorder is the result of the brain adapting to a difficult early life environment. It is not:

to do with genes
the result of another medical condition
the result of a head injury
the result of drug or alcohol abuse (although many people with dissociative disorders misuse alcohol or drugs to cope)

What are the some of the associated conditions?

Someone with a dissociative disorder may also suffer from:

post-traumatic stress disorder
depression
mood swings
anxiety and panic attacks
suicidal tendencies and/or self-harm
headaches
hearing voices
sleep disorders
phobias
an eating disorder
obsessive-compulsive disorder

How are dissociative disorders treated?

If you have been diagnosed with a dissociative disorder, a mental health specialist will want to ask you more questions about how you are feeling and find out whether you suffered any trauma in the past.

It's important to be honest about your symptoms, and not feel ashamed or embarrassed, so you can receive the help and support you need.

Some people with dissociative disorders will benefit from a course of psychotherapy or counselling. This talking therapy aims to help you cope with the underlying cause of your symptoms, and helps you to manage the periods of feeling disconnected. Read more about how psychotherapy works.

If you have suffered a traumatic event in the past, you might benefit from a technique called eye movement desensitisation and reprocessing (EMDR).

EMDR has been found to reduce the symptoms of post-traumatic stress disorder. It involves making side-to-side eye movements, usually by following the movement of the therapist's finger, while recalling the traumatic incident.

It is not clear exactly how EMDR works, but it may help the malfunctioning part of the brain to process distressing memories and flashbacks so that they have less influence over your mind. Read more about EMDR.

There is no medication to specifically treat dissociation, although medication may be prescribed to treat any depression, anxiety and insomnia.

Read about the:

treatment of depression

treatment of anxiety

treatment of insomnia

Many people make a full recovery with treatment and support.

If you're feeling suicidal

If you are reading this because you have, or have had, thoughts about taking your own 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 and not 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 you calm down and find some breathing space
call the Samaritans 24-hour support service on 08457 90 90 90
go to, or call, your nearest accident and emergency (A&E) department and tell the staff how you are feeling
contact NHS 111
make an urgent appointment to see your GP

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

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

If they have 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.

Support and further information

You may find that reading about other people's experiences of a dissociative disorder may help. Visit healthtalkonline for other people's accounts of living with a mental health condition.

You may also find these organisations helpful: