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Dissociation: who to see and what helps

Dissociation · Kitchener, Waterloo & Cambridge

Dissociation is a feeling of being disconnected from yourself or from the world around you: watching yourself from outside, surroundings that seem unreal, or gaps in your memory. It is one way the mind copes with too much stress, and brief episodes are quite common. When it keeps happening or gets in the way of life, the treatment is talking therapy; no medicine treats dissociation itself. At CARESPACE that means counselling with a Registered Psychotherapist or Registered Social Worker. Ask when you book for a counsellor with experience of trauma and dissociation.

What dissociation is

Most people have had a mild version. The UK charity Mind gives two examples: being so absorbed in a book or film that you lose awareness of your surroundings, and driving a familiar route, the daily run along the 401, say, and arriving with no memory of the trip. Brief experiences like these are quite common during periods of intense stress or great tiredness, and you can have them without having any disorder.

It becomes a health problem when it lasts, recurs or disrupts your life. The NHS describes three main dissociative disorders:

  • Depersonalisation-derealisation disorder. Feeling outside yourself, or that the world is unreal, for moments at a time or on and off over many years. A 2013 review put it at between 1% and 2.4% of the general population.
  • Dissociative amnesia. Periods when you cannot remember information about yourself or events in your past, far beyond normal forgetfulness and not caused by another medical condition.
  • Dissociative identity disorder (DID), formerly called multiple personality disorder: gaps in memory for everyday events together with several distinct identities.

Symptoms of dissociation

  • Feeling as if you are outside yourself, observing your own actions, feelings or thoughts from a distance (depersonalisation)
  • The world seeming unreal, with people and things looking lifeless or foggy (derealisation)
  • Forgetting stretches of time, events or personal information
  • Finding yourself somewhere unfamiliar without knowing how you got there
  • Feeling uncertain about who you are
  • Feeling little or no physical pain

An episode can last hours or days, or go on for weeks or months. Some people with dissociative disorders also have seizures, which can range from something like a faint to something like an epileptic seizure.

What causes dissociation

It usually happens during overwhelming or traumatic events. Switching off from what is happening is a normal defence while a trauma is under way; it becomes a problem when the danger has passed and the mind goes on reacting as though it had not. Many people with a dissociative disorder were physically, sexually or emotionally abused as children. Others begin to dissociate after war, a kidnapping or an invasive medical procedure. Cannabis can also bring on feelings of depersonalisation and derealisation.

Dissociation also turns up alongside other conditions. It often goes with post-traumatic stress disorder, covered on our Trauma & PTSD page, and dissociative states are a recognized symptom of borderline personality disorder. The NHS lists depression, anxiety and panic attacks, obsessive compulsive disorder and sleep problems among the conditions that often accompany it.

How dissociation is diagnosed

Start with a family physician or nurse practitioner, who may examine you and run tests to check whether another illness is causing the symptoms, and can then refer you to a mental health specialist for a full assessment. That specialist should have a good understanding of dissociative disorders. This matters because these conditions are often missed: reviewers say lack of awareness may contribute to a high rate of misdiagnosis, and people with undiagnosed DID may go through long and frequently unsuccessful treatment for other conditions first. Diagnosing and prescribing are outside what Registered Psychotherapists and Registered Social Workers do.

When it is urgent

A seizure or sudden confusion should not be put down to dissociation until it has been medically assessed. The NHS advice, with 911 in place of the UK number, is to call an ambulance for a seizure if:

  • it is the first time the person has had a seizure
  • the seizure lasts longer than is usual for them
  • the seizure lasts more than five minutes, if you do not know how long their seizures usually last
  • the person does not regain full consciousness, or has several seizures without regaining consciousness
  • the person is seriously injured during the seizure
  • the person has difficulty breathing after the seizure

If someone suddenly becomes confused, call 911 or go to an emergency department. Sudden confusion has many possible causes, among them infections, stroke and head injury.

Suicidal thoughts and self-harm are among the problems that can come with a dissociative disorder. If you are thinking about suicide, or you do not feel safe, do not wait for an appointment: use the numbers below.

If you are in crisis or thinking about suicide, help is available right now.

  • Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
  • Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
  • Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What the evidence says about treating dissociation

  • The research is thin. These points rest on NHS and British Columbia health advice, on the 2011 guidelines of the International Society for the Study of Trauma and Dissociation, which are expert consensus about dissociative identity disorder and say they are not a standard of care, and on a 2013 systematic review of depersonalisation-derealisation disorder that found only four randomized trials.
  • Talking therapy is the main treatment. Counselling and psychotherapy are what the NHS says are often recommended, to work on the underlying cause and to teach ways of managing periods of disconnection. British Columbia’s health service says professional counselling is needed for dissociation that does not resolve on its own or is causing problems with behaviour or mental health.
  • Stability comes before trauma work. The expert guidelines describe three phases: establishing safety, stabilization and symptom reduction; then working with traumatic memories; then integration. They warn that drawing out the details of a trauma history too early may cause a serious setback. For DID they describe individual psychotherapy at least once a week, usually over years.
  • EMDR needs care. Eye movement desensitisation and reprocessing is sometimes used for dissociative disorders. The expert guidelines report that early use of standard EMDR in people with unrecognized DID caused serious clinical problems, say the protocol must be modified, and recommend it only when the person is generally stable and has adequate coping skills.
  • No medicine treats dissociation itself. In the 2013 review, the only randomized trial of an antidepressant of the SSRI type found fluoxetine was not effective for depersonalisation-derealisation disorder, and the evidence for lamotrigine was inconsistent: one trial found a benefit and another did not. Antidepressants may still be prescribed for depression, anxiety or panic that comes with it.
  • CBT is untested in trials for depersonalisation. That review found no randomized trial of cognitive behavioural therapy and described it as a potential form of treatment.
  • Groups are not a main treatment for DID. The guidelines say group psychotherapy is not a viable primary treatment, and that self-help groups not led by a professional are generally viewed as contraindicated for people with DID.

What a doctor may offer

A check for physical causes, a referral for specialist assessment, and treatment of the depression, anxiety or panic attacks that can come with dissociation, which may include an antidepressant.

How CARESPACE helps with dissociation

Counselling & Psychotherapy

Counselling can begin with the first phase: understanding what your episodes are like and what sets them off, and building the tools the guidelines name, such as grounding techniques and a crisis plan. The expert advice is against pressing for the details of what happened to a person before they have ways to steady themselves.

CARESPACE counsellors offer cognitive behavioural therapy (CBT). EMDR for someone who dissociates calls for training in EMDR and experience with dissociation, so ask about both when you book. If you have, or think you may have, dissociative identity disorder, ask whether a counsellor has worked with it; if not, a physician or nurse practitioner can refer you to specialized care.

See our counselling team →

More about cognitive behavioural therapy (CBT) →

Occupational Therapy

The expert guidelines describe rehabilitation therapies, occupational therapy among them, as especially helpful in improving overall functioning for people with DID, and note that an occupational therapy assessment can show how daily living, personal hygiene and meal preparation are being affected. An Occupational Therapist can work on those everyday routines. This is expert opinion about one dissociative disorder, not trial evidence, and it is an addition to psychotherapy, not a replacement for it.

See our occupational therapy team →

Other services people ask about

Massage therapy and other hands-on treatment get a caution in the expert guidelines. When someone with DID wants massage or other body work alongside psychotherapy, they say the risks, benefits and timing should be carefully discussed first. Some people with DID have found it helpful, particularly when the practitioner is knowledgeable about trauma and careful about personal boundaries. Others have had severe intrusive PTSD symptoms, switching and disorientation while being touched during massage or any procedure involving physical contact. If you have DID, talk it over with your therapist before you book a hands-on treatment, and tell the practitioner.

Where most people start

With a counsellor, if the symptoms have already been medically checked. If they are new, or include blackouts, seizures or memory loss that nobody has looked into, see a physician or nurse practitioner first.

How your team works together

This is mostly one-practitioner work; the expert guidelines put building a working alliance with the therapist in the first phase of treatment. A physician or nurse practitioner looks after the medical side, and an Occupational Therapist can be added when daily routines are suffering.

Browse by service: counselling and occupational therapy.

What to expect at your first visit

The counsellor’s job at a first visit is to understand your concern and come up with a plan. You decide what to talk about and how fast to go. It may help to think about:

  1. What an episode is like and how long it lasts.
  2. What seems to set it off, if you know.
  3. What helps you come back to the present.
  4. Who else is involved in your care, and whether a physician has looked into the symptoms.

What you can do at home

These suggestions are from Mind.

  • Grounding techniques. Breathe slowly while counting, hold an ice cube, or splash cold water on your face.
  • A journal, which may help you understand and remember different parts of your experience.
  • Visualisation: imagining a place that feels safe to you.
  • Practical supports for memory gaps. Wear a watch that shows the time and date, and leave notes for yourself around the house or on a whiteboard.
  • A personal crisis plan, written when you are well.
  • The basics. Try to get enough sleep, eat regularly and take some exercise.

Mind also suggests peer support. If you have DID, weigh that against the expert caution about self-help groups without a professional leader, and talk it over with your therapist first.

Outlook

Many people with a dissociative disorder make a full recovery with treatment and support, according to the NHS. Some episodes are short-lived, particularly after a traumatic event, and resolve within weeks or months. Others last much longer: depersonalisation and derealisation can come and go over many years, and therapy for DID is usually measured in years.

Dissociation treatment in Kitchener, Waterloo and Cambridge

Kitchener. Counselling in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Counselling in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Counselling in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is dissociation the same as zoning out?

Losing yourself in a film, or arriving home with no memory of the drive, is the everyday end of it and not a disorder. Dissociation needs professional counselling when it does not resolve on its own or is causing problems with behaviour or mental health.

Can stress or anxiety cause dissociation?

Brief experiences of dissociation are quite common during periods of intense stress or when you are very tired. Anxiety and panic attacks are also among the conditions that often go along with dissociative disorders.

Can EMDR help with dissociation?

It is sometimes used. Expert guidelines say the standard EMDR protocol has to be modified for people with dissociative identity disorder and should be used only once the person is generally stable. Ask about a counsellor’s training in EMDR and experience with dissociation before you start.

Is dissociation always caused by trauma?

No. The NHS says there are many possible causes, trauma among them. Cannabis can also bring on feelings of unreality.

Where can I find counselling for dissociation in Cambridge?

Counselling in Cambridge: our location there is on Hespeler Road. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

Trauma & PTSD
Borderline Personality Disorder
Anxiety
Panic Disorder
Functional Neurological Disorder

The CARESPACE Central Reception Team

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