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Dissociation – Support options part two

We’ve discussed the treatment options available to us through your GP or therapy, but what else is there to choose from?

There are some options remaining that you can look into from the comfort of your own home, though, I will state for the record. It is important to discuss any treatments you want to try with your GP. There are less regulations around these treatments so it’s important to look into their legitimacy, reviews and any potential risks.

Without further ado lets get into it

Herbal home remedies

Anxiety and depression can trigger dissociation, so it may be worth looking into some herbal or home remedies if pharmaceuticals aren’t your thing.

St Johns Wart, lavender roll-ons, aroma therapy are all options to help you destress and reduce the chances of being overwhelmed. Be sure to check in with a doctor if you are on any other medications and you should first discuss it with them before you start self medicating.

Another topical treatment is CBD. I won’t get into the details but CBD is being viewed as a very helpful drug with little to no risk. CBD is made from marijuana extract but without the chemical THC. This chemical THC is what makes you feel high, its psychedelic properties are what you often associated with weed. CBD however, will not get you high and is totally legal. What’s more, research from King’s College LDN has even shown it have preventative properties when it comes to psychosis and has been shown to aid depression, anxiety and insomnia. All of which can help reduce dissociation.

When shopping around be sure to check reviews and ensure you know what dosage you’re getting. Start small and build up. Also, ensure you check for any side effects with any medications you’re on. I’m currently of an antidepressant that interacts with CBD so that it becomes metabolized by the body in excess, resulting in an increase in my medication dosage. Which could risk overdose. So be sure to look into this if you’re on any meds!

Third wave therapies

Meditations, hypnosis and mindfulness can all help with anxiety symptoms and reduce your levels of stress. In particular, mindfulness has been touted as a particularly effective treatment for dissociation.

I’ve been told, dissociation is characterised by a disconnection with everything around you, while mindfulness is characterized by a deliberate awareness of everything around you. This cognitive opposition may explain why mindfulness is seen as an effective treatment for dissociation.

However, it is suggested to be most effective when added to your daily routine. The emphasis is on learning mindfulness and integrating this mindset into your everyday life. It is not a magic solution and cannot stop dissociation when it occurs but generally can limit the severity and length of dissociative episodes if adopted into your routine.

Hypnosis sessions can be useful if you suffer with insomnia. From personal experience I find myself more anxious and more likely to dissociate if I’m tired. So hypnosis for sleep can help reduce this!

Grounding ideas – for when it’s too late

Once you’re feeling dissociated, many of these techniques may not be much use to you. That is, other than mindfulness. Techniques such as mindfulness ground you in the present, in the environment and pull you out of the dissociative blur.

The best way to do this is to incorporate your senses. What can you see? Touch? Smell? Can you name 5 things you see?

Some particularly useful methods may include heat. A cold shower, splashing cold water over your face, or holding ice in your palms have been praised for their effectiveness.

Additionally, familiar smells may help. This may be sad to admit but I had a particular room spray in a period of my life I look back on fondly. The smell itself relaxes me. The same may be true for you!

Anything that gets you invested in the present can help you in your fight against dissociation.

Resources

There are an abundance of online resources for you to choose from. So please, take a look. These resources have helped me in my understanding and appreciation for my dissociative experiences.

Carolyn Spring’s blog: https://www.carolynspring.com/blog/

Grounding tools: https://www.psychologytools.com/resource/trauma-dissociation-and-grounding/

Youtube: Multiplicity&Me, DissociaDID

Mind resources: https://www.mind.org.uk/information-support/types-of-mental-health-problems/dissociation-and-dissociative-disorders/self-care/

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Well-Being

Dissociation – Support resources: part 1

As we’ve seen, dissociation is highly complex and variable phenomenon. With it’s roots in our past experiences, influencing our present this hard to define disruption to our perception can be tricky to live with. But what treatment options are available to us?

Let’s take a look at the main treatments available, note treatments will vary depending on your location. This summary is based on those available in the UK.

Pharmaceutical treatments

Unfortunately there are no medications that can fix or reduce dissociation directly. Dissociation exists in a relative blind spot for pharmaceutical companies. However, it is not all bad news, there are medications out there that can indirectly help with dissociation.

If you came to a doctor or mental health professional with depressive or anxious symptomology you’re more than likely going to be put onto anti-depressants. The most commonly prescribed and most-side-effect-free being SSRIs. These Serotonin Specific Reuptake Inhibitors provide individuals with a much needed relief from their most intense symptoms.

SSRIs won’t influence your mood instantly, as they take a number of weeks to take effect, but for many they provide a much needed lifeline. For those that experience dissociation as a result of environmental or personal stress such as PTSD, BD, BPD, or anxiety disorders such as OCD, these medications can significantly reduce negative symptoms. As we’ve discussed, dissociation can occur when an individual becomes overwhelmed so these SSRIs can help prevent this from occurring and by extension reduce instances of dissociation or by the very least reduce the severity of episodes.

Therapies

NHS options

There are multiple therapies available to individuals with mental health concerns. Though, the focus is generally on dealing with anxiety and depression. Dissociation is something less familiar to most in the industry so it’s important to find someone that knows what they’re talking about.

In order to find a therapist that knows their stuff it’s worth consulting with your GP or health care provider to see if you can work out the best option available to you. A good rule of thumb to remember is that – generally – trauma centres will have more knowledge and expertise on dissociation than the average therapist. So it may be worth looking there for options and even worth contacting them to discuss it with them before you request a referral.

Through the NHS you can fairly easily be assigned a therapist, but you may have to wait a while due to unfortunately long waiting lists. However, it’s important to find the right therapist, try not to settle if you feel your therapist isn’t the best fit for the job. You’re allowed to not get on with a therapist, you can request a change.

Private options

If you can afford it, and not all of us can, it may be worth seeking a private counsellor or therapist that specializes in dissociative disorders. While it can be pricey, you get the benefit of freedom of choice. You can identify therapists near you using the counselling directory, which allows you to include specific areas of expertise. What’s more, many therapists are happy to discuss their skills and knowledge before you start treatment so it’s worth emailing a brief summary of your situation, symptoms and goals, and asking them if they think they could help.

The downsides of this of course, are the costs. Dissociative disorders can be hard to shake, so fees can stack up over time. What’s more you may have to relay some information to your GP or health care provider from your therapist if you require medication or specific referrals. They can communicate but when it is NHS-NHS inhouse it can be easier for the client as they are not stuck in the the go-between role.

Specialist dissociation clinics

If you have severe dissociative symptoms you do have the option of going to see a specialist. In the UK there are currently three clinics set up that specialize in dissociation. These are, The Pottergate Centre, The Clinic for Dissociative Studies, and The CTAD Clinic. Each other these specialise in dissociation and offer the best and most informed treatment options.

Of course, the downsides of these are that they’re incredibly hard to get referred to. The Pottergate Centre is open to private treatment but if you’re looking for an assessment this will cost you at a minimum £500 and more likely over £1000. If you’re trying to get a referral through the NHS you will be required to jump through a lot of hoops.

It is likely you will be told that, because these clinics exist outside of your clinical group (your local NHS trust) you will need to be referred by secondary care and display tangible reasons for why the care provided locally is not sufficient.

This will require you getting an assessment from a psychiatrist, the waiting lists for which are…lengthy. For context, I told my GP I wanted to be referred to one of these clinics in August 2020 and so far I have spoken to a psychiatrist for 15 minutes and given another appointment in three months time. During this whole time I have been fighting to get this referral but without any luck.

I’m not saying it’s impossible, but it won’t be a walk in the park.

For the next instalment of support, take a look at our self-help resources.

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Well-Being

Dissociation – causes and mechanisms

Disclaimer: this is not meant as a substitute for expert advice, and help from a professional is the safest way to find answers for your concerns.

Trigger warning: reference to trauma and abuse.

Causes of dissociation

It is the widely held belief that dissociation is caused by significant trauma. Now, what is significant can vary from person to person. Contrary to common held belief there is no universal yard stick for what is and is not a traumatic experience.

A lot of research has gone into understanding trauma, but efforts on defining what constitutes a traumatic event has been ultimately abandoned. Commonalities of traumatic events such as hostility and threat are accepted but a more nuanced understanding recognises that what constitutes a trauma is an individual matter.

Many like to view trauma as an external matter, what has happened to you. It is more accurate to view trauma as internal, what you felt as events took place. This understanding far better explains the apparent variation in trauma responses from person to person.

What traumatizes one person may not traumatize another, even if the event or events they experienced were the same or similar. A multitude of personal and situational factors influence an individual’s relationship to a potentially traumatic event.

With such variation it stands to reason why there are so many disorders associated with dissociation and trauma. For many individuals, dissociation is the brains attempt and protecting you. But how does this occur?

Mechanisms of dissociation

It is commonly understood that dissociation occurs more frequently in people that have a pre-existing inclination to imagine. Yes, to imagine or day dream allows us to exist in alternate realities. Linking back to the first article in this series, many of us dissociate when we watch TV or a movie. We become emotionally engaged and moved by what we are viewing even though we know it to be fictional or staged.

This ability for dissociative states to elicit emotion is also seen in reverse. Individuals with the ability to imagine that find themselves in hostile or unsafe environments can subconsciously or consciously escape from this unpleasant environment by way of their imagination.

Escaping an environment by way of dissociation is frequently seen in children from abusive homes. Like we can escape to a dissociative state of joy or sadness when we watch TV we can also escape negative emotions in our real environment and ‘switch’ to a safer imagined or dissociated environment to protect ourselves when we become overwhelmed. This explanation is used to justify why dissociation occur in adults.

A defence mechanism out of control

Dissociation offers us an escape from negative emotions we cannot do anything about. As children have little autonomy or power in our society it is theorized dissociation is frequently used as an escape because they have no tangible control to remove themselves from the environment.

This route of escape can become a learned behaviour. Meaning that adults can experience dissociation when they become overwhelmed. This can explain why people often experience dissociation as part of an anxiety or depressive disorder. The extreme emotions are too much to handle and the brain switches to a dissociative state as a form of protection.

Issues occur as dissociation is in essence avoidance of the consciousness, making it very hard to function while dissociated. Deficits in memory, knowledge, attention and perception are all altered during dissociative states, making it hard to meet any of the demands of every day life. Not to mention, the experience of dissociation can be unnerving.

For many people, their trauma or previous dissociative experiences may be alien to them, pushed to the back of their mind in a dissociative haze. Meaning that each and every time can feel as unfamiliar and bizarre as the first. Unsurprisingly this can provoke anxiety in people, which can further drive them onto a path of dissociation as they question what is wrong and why their thoughts feel so alien to them.

For people experiencing dissociation there are tips and techniques to help manage the experience. These techniques may not 100% remove you from the dissociative state, but they can provide a sense of routine and control for those of us that struggle with the uncontrollable nature of dissociation.

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Well-Being

Dissociation – categorizing the unknown

Now we’ve discussed dissociations occurrence in every day life as well as it’s relative none-existence within my undergrad it’s time to look into how it is categorized.

Diagnosis or experience – the slight paradox of dissociation

Dissociation is understood in terms of diagnosis and dissociative type. Yet these types and diagnoses vary and overlap wildly. For instance, there are two types of dissociation known as depersonalization and derealization. The former involves a distinct feeling of being detached from ones self. Whereas derealization involves the distinct feeling of being dethatched from ones surroundings.

This detachment is described as a feeling of separation, distance, and the feeling that things or oneself are not real or fake. It is this detachment that makes dissociation so hard to pin-down. By their nature all dissociative states involve a detachment that make the perception and experience of the state hard to remember and describe. This is a unique occurrence as the individual is dissociated from the very senses they use to describe every other lived experience.

In the case of depersonalization/derealization disorder (DP/DR) these two states reoccur as the defining features of the disorder. As such it is known by this name, yet these states are also experienced within plenty of other disorders.

For example, Post Traumatic Stress Disorder (PTSD), Borderline Personality Disorder (BPD), Bipolar Disorder (BD), Dissociative Identity Disorder (DID) and psychosis are all closely linked with dissociation.

Yet all of these disorders have elements that make them distinctly different, despite sharing the same dissociative states.

What complicates things further is the matter of identity and dissociation. Common feelings for dissociation-plagued individuals is that of a disconnection from themselves and their identity. Yet, in more extreme cases, in what is considered the most extreme dissociative disorder a person’s identity is not only dissociated but altered.

Dissociative Identity Disorder (DID) is better but inaccurately known as Multiple Personality Disorder. This involves the fragmentation of a personality into distinct personality states separated by so-called dissociative barriers.

These barriers keep these distinct personalities – mostly – separate. For example, many of these personality states (known in the community as ‘alters’ for alternative personality states) cannot recall events experienced when another was ‘fronting’ (in control of the body). This ‘dissociative amnesia’ is integral to the memory problems reported by people that experience dissociative symptoms.

Yet, this amnesia can occur in varying forms. Either between alters, as seen in DID. Or for times during a dissociative episode. This is characterized by an ongoing and reoccurring loss of memory for these times, known as time-loss or black-outs.

On top of this, it is reported that some individuals do not knowingly experience dissociation until repressed memories emerge from an event that their brain had locked away and hidden from them.

This adds additional complexity to matters as you have an almost impossible to pin down mental state that can influence your memory of past and present events while also influencing your personality. As such, people that experience dissociation often have trouble finding the right diagnosis as dissociation exists on multiple planes. The type, severity, trigger and related disorder all impact an individuals understanding of their dissociative experience.

With all these variables, trying to find support for dissociation is all too difficult, with many health care providers ill-equipped for such matters. Making finding the right diagnosis next to impossible.

What we are yet to discuss is, why does dissociation occur? What self-help tips can you carry out daily?

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Well-Being

Dissociation – academic reception?

As we saw in the previous article, dissociation can take many forms. What occurred me is that the subject barely came up during my undergrad in Psychology…

As a recent graduate I was well versed in the ins and outs of Cognitive Behaviour Therapy (CBT), various paradigms and perspectives in Psychology with a particular focus on depression and anxiety throughout the course.

Yet the neglected concept of dissociation was all but left out of my education. I recognise that not every concept can be addressed in a bachelor’s course but when it is a concept that is integral to so many disorders and present in everyday life, I would think it deserved significantly more attention.

So I want to know, what do you know about dissociation? Have you ever come across it? And if so, how? When? Why? Comment down below!

For more on dissociation, see our next article.

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Well-Being

Dissociation – two sides of the same coin

So, what is dissociation?

Dissociation is a much debated and difficult to articulate concept that alludes being pinned down by one succinct definition. This altered state of being can be experienced by most people as a typical part of their day-to-day lives. Many of us will be familiar with the experience of driving on autopilot and getting to your destination safely. This is a normal and non-disruptive procedural dissociative state. The brain functions guiding you in this state function beyond your conscious attention, you are present yet absent.

Another example of dissociation can also be seen in everyday hypnotic states. When watching a film or a television programme you find yourself emotionally moved by what you are viewing despite no real impact being made to your life or well-being.

Unfortunately, dissociation has a more disruptive, darker side. Commonly experienced as a significant disconnection between conscious attention, awareness and ones understanding of reality. Dissociation is often likened to seeing oneself floating, separate from oneself, or as living life in third person. This may be experienced as ongoing feelings of unreality of one’s self or surroundings (derealisation/depersonalisation) seen as part of PTSD, Bipolar disorders (BP), personality disorders such as borderline personality disorder (BPD).

These often have a basis in anxiety or trauma which often mitigate the levels of dissociation experienced. Contrastingly, dissociation can be caused by deep rooted identity manifestations such that seen in Dissociative Identity Disorder (DID) and the DSM-5-unrecognised variations Otherwise Specified Dissociative Disorder (OSDD) variants A & B. This is not an exhaustive list of disorders and dissociative experiences, but an overview of dissociation in the context of mental disorders.

Due to this complexity, dissociation is an increasingly hard to categorize phenomena. For more on this, look no further than part 2.