Dissociative Disorders: A Trauma-Informed Guide for Care Staff

Dissociation is a way the mind copes with overwhelming stress, and for many people it is a brief, passing experience. For some, it becomes a long-lasting disorder that affects memory, identity and the sense of being real. Care and healthcare staff meet people with these difficulties in mental health services, care homes, primary care and community settings, often without the diagnosis being known. This guide explains the main dissociative disorders, how they can present, and how to support someone in a safe and trauma-informed way. It should be read alongside our guide to trauma-informed care in practice.

What dissociation is

Rethink Mental Illness describes dissociation as something that affects how you perceive yourself and the world around you, and notes that many people experience it at some point in their lives, often triggered by stress or traumatic events. The NHS says dissociative disorders often stem from trauma, particularly childhood abuse (physical, sexual or emotional), war or kidnapping experiences, and invasive medical procedures, and that dissociation works as a coping mechanism during traumatic stress.

The main dissociative disorders

The NHS names three main types:

• Depersonalisation-derealisation disorder: feeling outside yourself or seeing the world as unreal.
• Dissociative amnesia: severe memory gaps about personal information or past events.
• Dissociative identity disorder (DID): having more than one distinct identity, with separate names and histories.

Rethink's information also lists dissociative neurological symptom disorder, in which a person has physical symptoms such as seizures or loss of movement without a medical cause being found, and trance and possession trance disorders. The NHS notes that seizures can occur in some people with dissociative disorders, which is why a medical assessment matters.

Signs care staff may notice

Common symptoms from the NHS and Rethink include:

• feeling disconnected from yourself, your body and the world around you;
• forgetting specific periods of time, events or personal information;
• uncertainty about who you are;
• reduced or absent sensation of physical pain;
• emotional numbness;
• in some disorders, multiple identities.

Episodes may last from hours to months, according to the NHS. A person may seem "zoned out", unresponsive, or unable to remember a conversation you had earlier in the day. They may not know they are dissociating. Because reduced pain sensation is possible, injuries can go unnoticed, so look at skin and joints during personal care.

Why it can be misunderstood

Rethink points out that dissociative disorders are not as well known as some other conditions, which may limit professional knowledge. Dissociation can be mistaken for lying, attention-seeking, psychosis, dementia or a seizure disorder. Memory gaps can lead to the person being told they are "forgetful" or "making things up", which can increase shame and distress. Staff who understand dissociation are better placed to respond kindly and to flag the need for a proper assessment. Our guide to psychosis and schizophrenia explains the difference between those experiences and dissociation.

Assessment and diagnosis

The NHS says a GP will examine the person and may arrange tests to rule out other illnesses before referring to a mental health specialist for a full assessment. Care staff do not diagnose. Your role is to record what you see, when it happens and what seemed to trigger it, and to pass that on, because a clear timeline helps the person and the clinicians. Rethink suggests people consider bringing information to appointments and writing down symptoms beforehand, so offer practical help with this if the person wants it.

Treatment

The NHS lists talking therapies, such as counselling and psychotherapy, aimed at the underlying trauma, eye movement desensitisation and reprocessing (EMDR) for PTSD-related symptoms, and antidepressants for any associated depression or anxiety. Rethink adds that long-term psychotherapy and cognitive behavioural therapy for trauma-related thoughts can help, and warns that standard EMDR is not suitable for dissociative disorders themselves. It also states that there are currently no medicines for dissociative disorders themselves, though antidepressants may help associated depression or anxiety. Treatment decisions belong to specialists, and staff should avoid suggesting therapies to the person without clinical advice.

How to support someone day to day

• Stay calm and use their name. Speak slowly in simple language, and say who you are and where they are.
• Use grounding. Rethink describes grounding techniques that anchor a person "in the here and now", such as focusing on sensory details, positive self-talk, mindful movement or carrying a meaningful object. They work best when practised regularly, so ask the person which ones help them.
• Offer choice and predictability. Explain what you will do before you do it, and avoid sudden touch.
• Do not argue about memory gaps or identities. Respond respectfully to the person in front of you without challenging or interrogating them.
• Know their crisis plan. Keep mental health contact details to hand and agree what to do if the person is distressed.

Trauma can also bring a risk of self-harm. If someone mentions thoughts of suicide, follow your organisation's procedures, and see our guide to suicide and self-harm awareness for care staff. The NHS advises contacting Samaritans on 116 123, NHS 111 or A&E when someone has suicidal thoughts.

Supporting colleagues and carers

Working with trauma can be emotionally demanding. Make time for reflective supervision and team debriefs. Carers and families can find support through Rethink Mental Illness, Carers UK and Carers Trust, as Rethink notes, and learning about the person's symptoms and treatments is a good first step for them.

Frequently asked questions

Is dissociative identity disorder the same as schizophrenia? No. DID involves distinct identities as a response to trauma, whereas schizophrenia is a psychotic disorder.

Can dissociation be a normal reaction? Rethink says many people experience dissociation at some point, especially under stress, so brief episodes are not always a disorder.

Where can staff train? Learnsignal's CPD courses for health and care staff include mental health and trauma-informed practice.