How to Help Someone With a Dissociative Disorder

What is dissociation?

Dissociation is when we feel detached from our surroundings or feel as if we are outside of our body. Most individuals will experience this at least once in their lifetime without long-term concern. For example, a person may be having a conversation with a friend and without noticing, realize that minutes have gone by and they cannot recall what was said. Another example would be during the commute to school or work, a person has a hard time recalling the last ten minutes of their journey, so much so that it seems as if the time has simply disappeared. These experiences are not characteristic of dissociative disorders, but illustrate common occurrences in which a person’s thoughts are disconnected from their surroundings.

Dissociation may include:

• Depersonalization – Feeling detached from one’s thoughts or body, such as feeling as if they are in a dream or are outside of their body.
• Derealization – Feeling detached from surroundings, such as when the world around feels distant or distorted

For some people, dissociative symptoms are persistent and recurrent.  Patterns of dissociative symptoms usually develop after a traumatic event. They are an adaptive response to manage distressing memories.  

Dissociation may occur as a symptom of many conditions, such as post traumatic stress disorder (PTSD) and borderline personality disorder (BPD), and can sometimes occur as a consequence of substance misuse (for example, blackouts during intoxication). In other cases, regular dissociation occurs as part of a dissociative disorder.

Understanding dissociative disorders

According to the National Alliance on Mental Health, up to 75% of people will experience an episode of dissociation in their lifetime; 2% of those people meet the full criteria for chronic episodes. For the friends and family of individuals experiencing regular dissociative episodes, it can be difficult to understand what their loved one is experiencing, and may feel uncertain on how to respond.

There is also a great deal of confusion surrounding dissociative disorders due to frequent misrepresentation of dissociative episodes in popular media. This can lead family and friends to make assumptions about their loved one’s struggle with mental health that are incorrect and possibly harmful for the individual and the relationship. This article will provide a brief overview of dissociation, dissociative disorder, and offer some suggestions for friends and family members to better support their loved one as they manage their dissociative episodes.

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What are dissociative disorders?

Dissociative disorders such as dissociative amnesia and dissociative identity disorder are an involuntary escape from reality that often occurs due to past trauma.  In these disorders, there is a disconnection between a person’s memory, identity, emotions, perceptions, behaviors, and sense of self.

A person with a dissociative disorder will experience a disconnection from reality, oftentimes without warning, to stop the recollection of traumatic events, and to lower the fear and anxiety related to those memories. The episodes of dissociation are sometimes brought on by a “trigger,” a situation that places the person under an unmanageable level of stress. There are several different types of dissociative disorders, and the severity and length of the dissociative episodes can vary depending on the diagnosis and the person.

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Chronic dissociative episodes can have a negative effect on an individual’s ability to live their daily life, disrupting their ability to work, go to school, and maintain interpersonal relationships. People with a dissociative disorder may also experience other conditions associated with trauma, including anxiety, depression, substance use disorders, and post traumatic stress disorder (PTSD).

If you feel as though someone you love is suffering from dissociative episodes on a regular basis, and that these episodes are negatively affecting their life, the best thing to do is to encourage them to seek professional help. With the guidance of a mental health professional along with the support of family and friends, it is possible that the frequency and severity of symptoms can improve. 

How to help someone with a dissociative disorder

Here are several other ways to support your loved one on their journey towards recovery:

1. Educate yourself about dissociative disorders

Most people lack a reliable frame of reference for understanding dissociative disorders which complicates their ability to conceptualize the challenges someone with a dissociative disorder faces in daily life. Most of the time, what little people do know about the disorder is from popular films such as Split (2016), in which the main character exhibits behavior that could be attributed to an extreme type of dissociation called dissociative identity disorder (DID). Unfortunately, the majority of the representations of people with a dissociative disorder in film portray them as violent, maniacal, sexually promiscuous, and/or untrustworthy. These representations add to the already negative connotation surrounding dissociative disorders, when in reality research shows that people with DID are more likely to be victimized by others than to be the perpetrator of abuse. Low rates of incarceration, convictions or probations have been found in people with dissociative disorders who are actively in treatment. 

In other words, it is important to recognize that if your loved one is struggling with a dissociative disorder, this does not necessarily make them dangerous to others or morally compromised as certain media portrayals could lead one to believe. Researching dissociative disorders online from reliable sources such as the Charlie Health Resource Library can help you better understand the reality of the diagnosis. 

2. Help to ensure your loved one’s safety

There are several realities about dissociative disorders that make safety the number one priority when considering ways to support your loved one.  In the case of DID, suicide attempts and other self-harm behaviors are common. In fact, more than 70% of outpatient patients with this severe form of dissociation having reported a suicide attempt. For this reason, if a situation arises in which you feel as though your loved one is at risk for harming themselves, it is important to reach out to the correct authorities. 

Individuals with dissociative disorders can experience fugue states, a unique type of amnesia wherein the person finds themselves in an unexpected place without any memory of how they arrived there. This can be incredibly dangerous and disorienting for the person experiencing the amnesiac event. Due to the reality that an individual with dissociative disorder can find themselves in dangerous situations unknowingly, it is suggested that you and your loved one create a crisis plan together. In the event that a person’s dissociative episodes become a threat to their safety, a thorough and well thought-out plan can help mitigate the risk of harm. Talk to your loved one about how they would like to manage a crisis if it were to arise, and write down these decisions so they can be better remembered. There are number of questions that you can ask your loved one to help better prepare for a crisis situation:

• How can I better understand your symptoms so I can anticipate a crisis scenario?
• How can I best help you if a crisis arises?
• Who are the people we should contact in this situation? (examples: emergency services, mental health clinicians, other family members, an advocate)
• What treatment options would you prefer in the case of an emergency?

3. Understanding and managing triggers

It can be helpful to speak with your loved one about the situations that trigger their dissociative events. Through this collaborative effort, you can help avoid high stress scenarios that place your loved one at risk for a serious dissociative episode. These triggers can vary depending on the person, so it may be helpful to make a list of triggers to help your loved one avoid them if possible. It is also important to collaborate with the mental health professionals who are taking care of your loved one. Share information with them about your loved one’s triggers and how your loved one is managing their dissociative episodes when they do arise. 

One of the best techniques for managing dissociative episodes is using grounding exercises. These exercises aim to bring your loved one back to reality. Your loved one should attempt to use these grounding techniques when they feel triggered and anticipate the possibility of a dissociative episode, and when appropriate, you can help them engage in their grounding practice. Here are some examples from Drs. Melnick and Bassuk of ways you can assist your loved one in their grounding techniques: 

• Ask them what they see or feel around them. Remind them that they are in a safe space, and reorient them to the present moment, reminding them of things in the world around them now, such as what they can see around them, what day of the week it is and what time it is. (“Right now, you are in a safe place. See the poster on the wall.” or “Feel your feet on the floor, the floor is cold today.”) Try to focus their attention on something within their immediate surroundings to bring them back to the here and now.
• Distract with simple tasks. Try to distract them from their negative emotional state through counting exercises, or by wiggling toes, or clenching and unclenching fists.
• Breathe. Guide your loved one in mindful breathing exercises in which they breathe in through their nose, and out through their mouth. You can suggest they place their hand on their abdomen and watch their hand go up and down as their abdomen moves with their breath.

Touching a familiar, soothing object can also be grounding.  

4. Acceptance is key

Doing your best to try to understand your loved one’s struggle and avoiding anger and resentment towards the situation is one of the best things you can do for them. Being the caregiver or advocate for an individual suffering from mental illness can be both rewarding and frustrating. If frustration does arise, it is important not to direct the negative emotions towards your loved one. Allie Cotterman, in an article for the National Alliance on Mental Illness, shares her experience living with dissociative disorder and gives some advice to friends and family that might be struggling with their loved one’s behavior. She explains, “Anger is another experience that may cause the person dissociating to further retreat. They are already reacting to a perceived threat, and anger will only build on that threat. If you must speak with them, use a calm voice and don’t be surprised if they do not respond. Additionally, do not attempt to argue. If someone has dissociated, they are not available for this type of interaction.”

Compassion, patience, and an open and honest dialogue between you and your loved one can help mitigate a possible situation in which you contribute negativity to an already difficult situation. 

5. Take care of your own mental health and well-being 

According to Mental Health America, there are 60 million Americans who provide unpaid care to a family member, friend, or neighbor who has a physical or mental illness. According to the organization, while acting as a caregiver, it is important not to forget that a person that is not taking care of themselves will have a more difficult time taking care of another person. It is possible that caregivers may find themselves in a situation in which they begin to experience caregiver burnout. 

According to the Cleveland Clinic, caregiver burnout is, “a state of physical, emotional and mental exhaustion. It may be accompanied by a change in attitude, from positive and caring to negative and unconcerned. Burnout can occur when caregivers don’t get the help they need, or if they try to do more than they are able, physically or financially.” The organization highlights that caregivers can feel a sense of guilt when they focus their energy towards self-care instead of focusing on their loved one’s needs. Here are some suggestions provided by Mental Health America to avoid caregiver burnout:

• Find a friend or someone you trust to confide in
• Set realistic goals, realize you cannot do it alone 
• Take advantage of social programs and services 
• Find a therapist to support your own mental health needs
• Stay healthy with a well rounded diet and regular exercise 
• Join a caregiver support group 

Connecting with Charlie Health for support 

There are many ways that Charlie Health can help both the caregiver and the person struggling with dissociation.  One of the avenues to consider for this particular situation would be to engage in family therapy. Some of the tools mentioned above, such as creating a crisis plan, collaborating with your loved one in grounding exercises, fostering communication and compassion, and avoiding lashing out in anger, could all be explored with one of our licensed professionals.

Another invaluable tool that Charlie Health offers is family support groups that are led by experts in family mental health and connection. Family participation in the child or young adult’s mental health journey is a key indicator for successful treatment. Our Family and Caregiver Support Groups are specifically tailored for parents, grandparents, or guardians of teens and young adults who struggle with mental health issues. Discussing topics such as caregiver burnout and tools to help cope with the overwhelming challenges of being a caregiver with other individuals who are experiencing similar circumstances can help alleviate the feeling that you are on this journey alone. 

Lastly, trusting one of our therapists that specializes in trauma-informed care to help your loved one struggling with dissociation can give you the peace of mind that they are taking meaningful action towards their recovery. Our team of clinicians and mental health experts specialize in leading evidence-based and holistic areas of care so that your loved one can receive the specific type of treatment they need. Through collaboration, compassion, and understanding, a safer and more fulfilling life can be made possible for both the person struggling with dissociation, and for the caregiver. If you are concerned your loved one’s life or safety is at risk, call 911 or the 988 Suicide and Crisis Lifeline. 

To get started with a personalized treatment plan, get in touch today.