Coping with dissociation

When stress is very high, your body’s alarm system takes over. Thinking clearly gets hard, and for some people this is the moment dissociation kicks in to turn things down.

What can help

• A longer out-breath than in-breath
• Cool water on your hands or face
• Moving your body: walking, shaking out your arms
• Stepping away from the trigger if you can

This doesn’t mean feeling calm all the time. It means feelings are there, but manageable. You can still choose what to do.

Staying in the window is a lifelong skill for everyone. Therapy can help you widen your window over time.

Here, things go flat or distant. You may zone out, lose time or feel unreal. People who dissociate a lot may not always notice when they have left the window, because switching off is so familiar.

What can help

• A calm, familiar voice
• Gentle movement, like standing up or stretching
• Naming things you can see, out loud
• Strong, safe sensations: a sour sweet, a cold drink

Catching it early is easiest. Small actions can stop the slide.

Try

• Look around and name five things you can see
• Press your feet into the floor and notice the pressure
• Say the date and where you are, in your head or out loud
• Touch something with texture, like your sleeve or keys

Research on depersonalization found that strong physical sensations, intense feelings and comforting company tended to make it lighter.

Try

• Call or sit with someone safe and talk about ordinary things
• Chew a strong mint or smell something sharp
• Hold something cold, or run water over your hands
• Walk, and notice each step

When you are far away, it can be hard to remember any skill. That’s why a written plan, shared with someone you trust, really helps.

Ideas for your plan

• A calming playlist ready to play
• A card in your phone case with your name, the date and “I am safe now”
• A grounding item kept in your pocket or bag
• Simple steps a friend can follow, like saying your name and the date

Coming back can leave you tired, shaky or confused. Have a drink of water, eat something, and rest if you can.

When you feel ready, jot down what happened before and what helped. Keeping a diary of episodes and triggers is part of therapy for dissociation.

Kind things to tell yourself

• “My mind was trying to protect me.”
• “I came back. That’s a skill.”
• “I don’t have to figure it all out right now.”

Brief feelings of detachment are common when people are very tired. Regular sleep and meals give your nervous system a steadier base.

If nightmares or trauma memories disturb your sleep, tell your provider. See the Sleep & mental health guide.

Alcohol and drugs can trigger symptoms. Cannabis and hallucinogens were among the most common starting points for long-lasting depersonalization in one study.

Be honest with your care team about what you use, so they can help.

ISSTD notes that scrolling can be dissociative. It can feel like rest, but it may not meet your needs.

Ideas

• Ask yourself: is this helping me, or helping me avoid?
• Mute or block accounts and words that upset you
• Set a timer or alarm for screen time
• Turn off video auto-play

Relaxation tended to lessen depersonalization in research. Slow breathing with a long out-breath, or meditation, can ease anxiety.

ISSTD shares free grounding and calming resources for the public, such as gentle yoga, art and breathing exercises.

Comforting time with other people was one of the things that eased depersonalization. Real connection helps your body and brain feel safe.

Telling people close to you about your experiences can help them understand how you feel.

If you often lose time or feel far away, some everyday activities, like driving, can become risky. Talk with your provider about which activities are safe for now.

Ideas

• Avoid driving when you feel foggy, and have a backup ride
• Keep your ID and an emergency contact on you
• Set timers when cooking or running a bath
• Use a phone map if you sometimes find yourself somewhere unfamiliar

More than 70% of people with DID attempt suicide or hurt themselves. People with the dissociative form of PTSD also have more suicidal thoughts.

If you have urges to hurt yourself, you deserve support now. See Coping with urges to self-harm and If you’re having suicidal thoughts. Call or text 988 any time.

People who dissociate may not always notice warning signs of unhealthy or abusive behaviour from others.

It can help to check in with a trusted friend or therapist about relationships that feel confusing.

Treat anything you share online as public. Most people in survivor groups mean well, but these spaces can also attract people who want to cause harm.

ISSTD suggests

• Don’t share where you live or work, or bank details
• Take time to get to know a group before sharing
• Think about how photos and videos could be used
• Use a pseudonym

You could say

• “I often feel far away, like I’m not really here.”
• “I lose chunks of time and don’t know why.”
• “Sometimes I feel like I’m watching myself from outside.”
• “I find it hard to describe, but I want to try.”

Many people struggle to put dissociation into words. That is normal. Bring your notes from the “What I want my therapist to know” worksheet.

ISSTD suggests asking

• Have you treated dissociation before?
• How do you work, and what approaches do you use?
• What training do you have in this area?
• Do you get supervision or consultation?

It is fine to contact a therapist briefly first, to see if they might be a good fit. Ask about fees and insurance too.

Good treatment focuses on safety and managing feelings first, and works on trauma memories only when you are ready, at a pace agreed with you.

It can take several sessions to get past first nerves. Many survivors find trust hard, and a good therapist will understand.

ISSTD has a free “Find a Therapist” directory of members with a special interest in trauma and dissociation.

If you live in a rural area, a therapist who is willing to learn and consult with an expert colleague may also work well.

See Finding mental health care for help finding and paying for care. For anything medical, consult with your clinical provider.

Ask what support they want, both in the moment and in general. A big, open conversation about how you support each other can help.

Talk about safety before a crisis, including your own limits and how to reach professional help.

When the past feels close, stay grounded yourself and focus on what is happening now and what they need. If they are safe, a gentle reminder can help.

Encourage them to talk with their therapist about ways to stay in their window of tolerance.

Try not to focus only on symptoms or treat them as “sick”. Notice their strengths and what they bring to your relationship. Healthy relationships are give-and-take.

You can’t support someone if you are exhausted. Clear, kind boundaries help everyone know where they stand. Get your own support if you are struggling.

See the Caregiver stress & burnout guide.