Evidence-Based Treatments for Dissociative Disorders

If you are living with a dissociative disorder, the question of where to begin with treatment can feel overwhelming. You may have spent years seeking answers, or perhaps you’ve only recently found language for what you’ve been experiencing. Whatever your journey so far, it’s important to know this: dissociative disorders are treatable. With the right support, many people experience meaningful improvement, including fewer and less intense dissociative episodes, greater emotional stability, and a deeper sense of connection with themselves and the world around them.¹

The research base for treating dissociative disorders has grown considerably over the past three decades. Whilst these conditions are complex, there are now well-established approaches that clinicians and researchers consistently recommend. This article walks through the evidence-based treatments currently available, explains how they work, and offers guidance on what to look for when seeking support.

This guide is intended for information and does not replace professional assessment or individualised care. Every person’s experience of dissociation is different, and treatment needs to be tailored accordingly. A trauma-informed therapist who understands the relationship between trauma and dissociation is your most important resource.

Understanding the Treatment Landscape

Dissociative disorders include Dissociative Identity Disorder (DID), Other Specified Dissociative Disorder (OSDD, sometimes referred to as DDNOS), depersonalisation-derealisation disorder, and dissociative amnesia. Whilst each condition has its own presentation, most share a common root in overwhelming early experiences that the mind could not fully process at the time.² Understanding this trauma-dissociation connection is fundamental to understanding why certain treatments are effective.

Unlike conditions where a single, standardised protocol is recommended, dissociative disorders typically require a carefully sequenced, flexible approach. The neuroscience behind dissociation helps explain why: when the brain is in a dissociative state, the way memories are encoded and the way different parts of the nervous system communicate can be significantly disrupted.³ Treatment must account for this, working gently and in stages rather than diving directly into traumatic material.

The International Society for the Study of Trauma and Dissociation (ISSTD) has published widely respected clinical guidelines for treating dissociative disorders, most recently revised in 2011.¹ These guidelines form the foundation of specialist clinical practice worldwide and are the closest thing to a consensus document the field has produced. Most of the approaches covered in this article are grounded in or consistent with these guidelines.

Phase-Based Treatment: The Foundation of Care

The most important concept in treating dissociative disorders is that of phased, sequenced care. The ISSTD guidelines outline a three-phase model that has become the standard framework for complex dissociative presentations.¹ Understanding these phases can help you make sense of what good treatment looks like and what to expect along the way.

Phase 1: Stabilisation and Symptom Reduction

This first phase is about building safety, both in your external life and in your internal experience. Before any traumatic material is processed directly, the priority is developing the emotional regulation skills, coping strategies, and therapeutic relationship needed to support that work. For many people, this phase involves learning to recognise and manage dissociative episodes, building grounding techniques into daily life, and beginning to understand how different parts of the self function.⁴

Phase 1 is not a waiting room before the “real work” begins. For many people it is the most important and formative part of treatment. Investing time here creates the foundation that makes deeper healing possible.

Phase 2: Processing Traumatic Memories

Once sufficient stability has been established, treatment can begin to address the underlying traumatic memories that maintain the dissociative structure. This phase is carefully paced and requires a skilled, dissociation-informed therapist. The aim is not to revisit trauma for its own sake, but to help the nervous system process experiences that were too overwhelming to integrate at the time they occurred.¹

Phase 3: Integration and Moving Forward

The third phase focuses on consolidating the healing work, developing a more coherent sense of self, and building a fulfilling life. Integration in this context does not necessarily mean the complete disappearance of all distinct parts or states. For many people, integration means those parts relating to each other with more cooperation, compassion, and communication.¹

It’s important to understand that this model is not a straight line. People move between phases throughout treatment, spending more time in stabilisation during periods of external stress and returning to deeper work when they feel more resourced. A skilled therapist will work flexibly within this framework rather than following a rigid timetable.⁴

Trauma-Focused Psychotherapy: Working With the Root

The most robustly evidenced treatments for dissociative disorders are trauma-focused psychotherapies: talking therapies adapted specifically to address the relationship between traumatic experience and dissociative symptoms. Talking therapies alone are consistently shown to produce better outcomes than medication alone for these presentations.⁵

Structural Dissociation-Informed Therapy

Developed from the work of Onno van der Hart, Ellert Nijenhuis, and Kathy Steele, the theory of structural dissociation offers one of the most comprehensive frameworks for understanding how dissociative disorders develop and what treatment needs to address.⁶ The model proposes that in response to overwhelming trauma, the personality becomes divided into different parts: some that carry on with daily functioning, and others that remain stuck in traumatic time, holding the emotional and physical residue of what happened.

Therapy grounded in this model works with each part of the self with curiosity and compassion. Rather than trying to suppress or override dissociative parts, the therapist helps to create dialogue and understanding between them, gradually reducing conflict and increasing internal cooperation. Many people find this approach profoundly validating, particularly after years of feeling confused or ashamed about their experiences.

Trauma-Focused Cognitive Behavioural Therapy (TF-CBT)

Cognitive Behavioural Therapy (CBT) adapted for trauma, known as TF-CBT, helps people identify and gently work with unhelpful beliefs that developed as a result of traumatic experience.⁵ It combines practical coping strategies with graduated exposure to traumatic material, always within a safe, boundaried framework. For dissociative presentations, CBT-based approaches are typically integrated within the phased model rather than used as a standalone intervention.

EMDR: Reprocessing Traumatic Memory

Eye Movement Desensitisation and Reprocessing (EMDR) is one of the most extensively researched trauma therapies available. It is recommended by both NICE (the National Institute for Health and Care Excellence) and the World Health Organisation for Post-Traumatic Stress Disorder (PTSD), and there is growing evidence for its effectiveness with complex trauma and dissociative presentations when appropriately adapted.⁷

EMDR uses bilateral stimulation, typically guided eye movements, taps, or sounds, to help the brain reprocess distressing memories. When trauma memories are processed through EMDR, they tend to lose their emotional intensity and become integrated as ordinary autobiographical memories rather than experiences that feel as if they are happening now.⁸

For people with dissociative disorders, standard EMDR protocols require careful adaptation. Moving too quickly into trauma processing without adequate preparation can be destabilising, particularly when different parts of the self hold different pieces of a traumatic experience. Specialist approaches such as the EMDR Therapy and Dissociation protocol integrate dissociation-informed principles throughout, extending stabilisation phases and incorporating parts-based work.⁸

EMDR is not a quick fix, and it should only be undertaken with a therapist who has specific training in both EMDR and dissociative disorders. When delivered in this way, it can be transformative for many people.

Dialectical Behaviour Therapy: Building Stability and Safety

Dialectical Behaviour Therapy (DBT) was originally developed by Marsha Linehan for people experiencing significant emotional dysregulation.⁹ It has since been widely adopted for complex trauma presentations, including dissociative disorders, particularly during the stabilisation phase of treatment. DBT does not directly process traumatic memories, but it provides an exceptionally practical toolkit for managing the emotional storms that often accompany trauma and dissociation.

DBT skills training covers four core areas:

• Mindfulness: Learning to observe internal experiences without becoming overwhelmed by them. For people with dissociation, mindfulness techniques are often adapted to emphasise grounding and present-moment awareness rather than prolonged inward attention, which can sometimes increase dissociative experiences.⁹
• Distress Tolerance: Practical strategies for managing crisis moments without making things worse. These skills are often particularly valuable for managing intense dissociative episodes.
• Emotion Regulation: Understanding and working with emotions, reducing vulnerability to overwhelming emotional states, and building positive experiences.
• Interpersonal Effectiveness: Navigating relationships in ways that meet your needs whilst maintaining self-respect, particularly important given how trauma can affect attachment and trust.

DBT is most commonly used alongside other trauma-focused approaches rather than as a primary treatment for dissociation itself. Many people find that building a solid DBT skills foundation creates the stability needed before deeper trauma processing becomes possible.

Parts-Based Approaches: Meeting Every Aspect of Yourself

Parts-based therapies are built on the recognition that dissociative disorders involve the experience of different aspects or “parts” of the self, each with its own perspective, feelings, history, and needs. Rather than treating these parts as problems to be suppressed or eliminated, these approaches work to understand and relate to them with compassion.

Internal Family Systems (IFS)

Developed by Richard Schwartz, Internal Family Systems (IFS) views the mind as naturally multiple and works to help all parts of the self feel seen, understood, and unburdened.¹⁰ At the heart of IFS is the concept of “Self”: a compassionate, calm inner state that is not a part among parts, but a fundamental quality of presence from which healing relationships with all parts can be developed.

IFS distinguishes between protective parts (which often take on roles to keep the system safe, sometimes in ways that create difficulties) and more vulnerable “exile” parts that carry the emotional weight of traumatic experience. The therapeutic work involves the Self developing a compassionate relationship with each part, understanding its role, and helping it to release the burdens it carries.¹⁰

Whilst IFS was not originally developed specifically for dissociative disorders, it has been widely adopted by trauma therapists working in this area and many people find its language deeply resonant with their lived experience.

Ego State Therapy

Ego state therapy, developed by John and Helen Watkins, works directly with different ego states within the personality.¹¹ It shares significant conceptual overlap with both IFS and structural dissociation-informed approaches and has a long history of clinical use in the treatment of complex trauma and dissociation. Ego state therapy often uses hypnotherapeutic techniques alongside relational work to help different states communicate and collaborate.

Somatic Therapies: Healing Through the Body

Trauma is not stored only in thoughts and memories. It lives in the body: in patterns of tension, posture, breath, and physiological activation. The neuroscience of dissociation demonstrates that traumatic experiences are encoded in bodily sensation and movement as much as in narrative memory.³ Somatic, or body-based, therapies work directly with this physical dimension of trauma, which talking therapies alone can sometimes miss.

Sensorimotor Psychotherapy

Developed by Pat Ogden, Sensorimotor Psychotherapy integrates somatic and cognitive approaches to trauma processing.¹² It helps people become aware of physical sensations and movement impulses associated with traumatic experience, working to complete interrupted defensive responses that remain stored in the body. This approach is often experienced as both validating and deeply effective, particularly for people whose trauma responses are primarily physical.

Somatic Experiencing

Somatic Experiencing, developed by Peter Levine, focuses on resolving the physiological activation underlying trauma-related symptoms, including dissociation.¹³ Rather than focusing primarily on narrative memory, it works with the body’s innate capacity to self-regulate. Somatic Experiencing often uses titration (working with very small amounts of activation at a time) and pendulation (moving between activation and resource) to help the nervous system gradually discharge stored trauma energy.

Both Sensorimotor Psychotherapy and Somatic Experiencing require a trained practitioner. They are typically integrated within the broader phased treatment model rather than used in isolation.

Online Therapy: Accessing Support Wherever You Are

Finding a specialist therapist with experience in trauma and dissociation can be genuinely difficult. NHS waiting lists for specialist trauma services are often long, and qualified practitioners may not be available in every area. Online therapy has significantly expanded access to support, making it possible to work with experienced therapists regardless of location.

When considering online therapy for a dissociative disorder, it is worth asking any potential therapist directly about their experience and specific training in this area. Working with dissociation requires specialist knowledge that not all therapists possess, and it is entirely reasonable to ask questions before committing to a working relationship.

That said, online therapy does have limitations for more complex or destabilising presentations. If you are frequently experiencing intense or distressing dissociative episodes, please discuss the most appropriate level of support with your GP before beginning any new therapy.

A Note on Medication

Medication is not a primary treatment for dissociative disorders, and there are currently no medications specifically licensed or approved for dissociation itself.¹⁴ However, medication can play a supportive role in managing co-occurring symptoms such as depression, anxiety, sleep disturbance, and hyperarousal, which are common in people with dissociative disorders and can make therapeutic work more difficult if left unaddressed.

Decisions about medication should always be made in careful consultation with a psychiatrist or GP who is familiar with your full history. It is particularly important to inform any prescriber about your dissociative symptoms, as some medications can affect dissociative states, and responses to medication can sometimes differ in people with complex dissociative presentations.¹⁴

Medication works best as a support to therapy, not a replacement for it. For most people with dissociative disorders, psychotherapy remains the central, most effective intervention.

When to Seek Help

If you are experiencing symptoms of a dissociative disorder and have not yet sought professional support, it is worth speaking to your GP as a first step. They can refer you to appropriate mental health services and discuss what might be available in your area. You can also self-refer to NHS Talking Therapies (formerly IAPT) for support with anxiety and depression, though specialist dissociation services may require a GP referral.

If your dissociative symptoms are significantly affecting your daily life, your safety, or your relationships, please do not wait for things to become more severe before reaching out. Early support can make a meaningful difference to outcomes.

When looking for a private therapist, the ISSTD website maintains a therapist directory of clinicians who have specialist training in trauma and dissociation. The UK Trauma Council also offers resources for finding qualified practitioners.

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Further Reading

For Those Beginning to Explore

• Boon, S., Steele, K., & Van der Hart, O. (2011). Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists. Norton. A compassionate, practical workbook that translates clinical knowledge into accessible, day-to-day support.
• Walker, P. (2013). Complex PTSD: From Surviving to Thriving. Azure Coyote. A highly accessible guide to complex trauma and its effects, written with warmth and hard-won wisdom.

For Deeper Understanding

• Van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. Norton. The foundational academic text on structural dissociation theory.
• Schwartz, R. C. (2021). No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model. Sounds True. An accessible introduction to IFS, written for both practitioners and general readers.
• Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking. An essential text on the neuroscience of trauma and the range of therapeutic approaches that address it.

Support Resources

• International Society for the Study of Trauma and Dissociation (ISSTD): Clinical guidelines, research resources, and a therapist directory.
• Mind: Dissociation and Dissociative Disorders: Accessible information and UK-specific support guidance.

References

1. International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115–187. https://doi.org/10.1080/15299732.2011.537247
2. Brand, B. L., Lanius, R., Vermetten, E., Loewenstein, R. J., & Spiegel, D. (2012). Where are we going? An update on assessment, treatment, and neurobiological research in dissociative disorders as we move toward the DSM-5. Journal of Trauma & Dissociation, 13(1), 9–31. https://doi.org/10.1080/15299732.2011.620687
3. Lanius, R. A., Vermetten, E., & Pain, C. (Eds.). (2010). The impact of early life trauma on health and disease: The hidden epidemic. Cambridge University Press. https://doi.org/10.1017/CBO9780511777042
4. Boon, S., Steele, K., & Van der Hart, O. (2011). Coping with trauma-related dissociation: Skills training for patients and therapists. Norton.
5. Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/S0005-7967(99)00123-0
6. Van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. Norton.
7. National Institute for Health and Care Excellence. (2018). Post-traumatic stress disorder (PTSD): Management (NICE Guideline NG116). https://www.nice.org.uk/guidance/ng116
8. Knipe, J. (2015). EMDR toolbox: Theory and treatment of complex PTSD and dissociation. Springer.
9. Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
10. Schwartz, R. C. (2021). No bad parts: Healing trauma and restoring wholeness with the Internal Family Systems model. Sounds True.
11. Watkins, J. G., & Watkins, H. H. (1997). Ego states: Theory and therapy. Norton.
12. Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. Norton.
13. Levine, P. A. (1997). Waking the tiger: Healing trauma. North Atlantic Books.
14. Gentile, J. P., Dillon, K. S., & Gillig, P. M. (2013). Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innovations in Clinical Neuroscience, 10(2), 22–29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615506/

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