How do I get help for dissociation?

“I don’t feel real”. “I fell out of my body”.

The experience of dissociation and depersonalisation are confusing enough - but then comes the search for professional help. Many people worry that they will not be believed, or that professionals will not understand what they are trying to describe. It can also be complicated navigating the various different teams, pathways, and levels of care within the NHS.

So here is the Midlands Dissociation & Depersonalisation Centre (MDDC) “cheat sheet” of how to get help for dissociation and depersonalisation in the UK. (And if you’re a clinician reading this, we have tips for you, too!).

1. Watchful Waiting

If your symptoms began quite recently (in the past month, for example), your first step might be to wait and see how you feel over the next few weeks.

This is because depersonalisation and dissociative experiences can be a completely normal and appropriate response to events like grief, chronic stress, or going through a particularly hectic and challenging time. See if you can help your natural recovery by reducing your stress, giving yourself protected time to relax, and engaging in activities that you enjoy.

Often, people find it helpful to find out a bit more about their dissociative feelings during this time - to help them realise that they are not “going mad”, and that dissociation is a common form of stress response. Some of the other posts in our blog might be helpful for this.

2. Self-Referral into Primary Care

If your symptoms are long-standing, or do not naturally reduce after a month of watchful waiting and stress reduction, it may be time to make a self-referral for more support.

This could be by making an appointment to see your GP, or self-referring to NHS Talking Therapies.

Often, people feel nervous explaining to a GP or Talking Therapies staff (usually a “Psychological Wellbeing Practitioner”) about dissociation and depersonalisation. If you are feeling worried about getting across how you are feeling, try taking a validated questionnaire that measures dissociation along with you to your appointment. This can give the clinician you are speaking to a clearer idea of exactly what difficulties you are facing.

For this, we recommend the Cambridge Depersonalisation Scale (Sierra & Berrios, 2000) and/or the Dissociative Experiences Scale (Carlson & Putnam, 1993) - both of which are scientifically valid, reliable, and well-respected measurement scales.

You can also show your GP this infographic and this article from the British Medical Journal, explaining to them exactly what depersonalisation is, and what they can do to support you.

NHS Talking Therapies may be able to help by talking with you directly about the dissociative feelings. They may also help you understand whether stress or anxiety or another problem are underlying these feelings, and support you with those.

A GP may also support you this way, as well as exploring with you whether you think it would be helpful to try medication for any underlying anxiety. At the moment, there is no specific medication indicated for depersonalisation, but some people find that an SSRI for anxiety helps them. As always, the decision is up to you.

3. NHS Mental Health Teams (Secondary Care)

Sometimes, if your GP or NHS Talking Space recognise that there is something underlying or causing your dissociation that requires extra support, they may refer you straight onto “secondary care team” - your local NHS service that specialises in mental health. You may also be referred to an NHS mental health team if you went all the way through the support offered by your GP and/or NHS Talking Therapies and did not see any improvements.

Secondary mental health teams are made up of many clinicians with different specialities. For example, psychiatrists, psychologists, mental health nurses, peer supporters, social workers, psychotherapists, and more. Teams usually work together to plan a care package for each patient, depending on what input they think would be most helpful.

Unfortunately, secondary care teams are under a lot of pressure at the moment, so you are likely to experience a wait for care. In practice, this might mean a wait to be assessed, and a wait to see each of the clinicians the team think would be helpful. Teams know that this can be disheartening or frustrating, and often may be able to offer a group or some helpful resources whilst you are waiting.

Being on the waiting list is also a great time to see if there are any research studies taking place in your local NHS - these sometimes involve getting a new kind of talking therapy, getting paid to complete questionnaires, or simply a chance to contribute to science and try something new without losing your place on the waiting list.

If you are a secondary care clinician working with someone with dissociation and you are looking for further support and information, the infographic and BMJ article linked in the section above may be helpful for you. If you are a Psychiatrist, you may want to complete the Royal College of Psychiatrists’ training in depersonalisation. And, of course, you are always welcome to book a consultation with MDDC. We also offer clinical supervision to talking therapists.

4. Specialist (Tertiary) Care

The final step on the NHS ladder is ‘tertiary care’. These are specialist services, with expert teams, each focused on a specific problem.

For depersonalisation, there is only one tertiary (specialist) care service in the NHS. This is based in London, in South London & Maudsley NHS Foundation Trust. You will need a referral from a secondary care team to access this service, and it is important to be aware that they can only support people aged 18 or over.

For dissociation, the picture is more mixed, and your secondary care team will know if there is any local support.

5. Care Outside of the NHS

There are also options available if you do not want to proceed through the NHS systems.

Charities

The first is “third sector” or charity and non-profit organisations. At MDDC, we admire the work of Unreal - the only UK charity for Depersonalisation Disorder. Unreal run regular peer support groups online, have many useful resources on their website, and post interesting content on their social media channels. This could be a source of support if you are experiencing depersonalisation.

Similarly, the International Society for the Study of Trauma and Dissociation (ISSTD) has many free resources to support people experiencing dissociation, and a directory of trauma and dissociation-friendly therapists.

Both of these websites also have fantastic resources for professionals!

Private Care

The second alternative to the NHS is the private sector. Therapy clinics like MDDC can support people experiencing dissociation and depersonalisation, often without a waiting list. Why not book a free pre-therapy information call with us to see if this might be a good option for you?

However, as discussed in our earlier blog post, “How Can I Tell If A Therapist Is Qualified?”, do check that anyone you see for private therapy is fully qualified and appropriately registered.

The MDDC supports clinicians, too. Find out more here.

Now you have an overview of the pathways of care for dissociation and depersonalisation through the NHS, and the support available outside of it. We hope this helps you feel confident seeking help for dissociative experiences and wish you all the best.

The Midlands Dissociation & Depersonalisation Centre offers support for people with dissociation, their loved ones, & their clinicians. Dr Emma Černis is a qualified and HCPC-registered Clinical Psychologist with over a decade of research and clinical experience in dissociation and depersonalisation.