Dissociative Disorders: A Complete Guide for Indian Families
What dissociation actually is
Your mind normally keeps a lot of things stitched together: your sense of who you are, your memory of what has happened, your awareness of your surroundings, your sense of controlling your own body.
Dissociation is when some of that comes apart.
You already know a mild version of it. Driving a familiar road and arriving with no memory of the journey. Being so absorbed in something that you do not hear your name. Feeling oddly distant during a shock — people describe the hours after a death as though watching from behind glass. These are ordinary and universal.
In dissociative disorders, the same mechanism goes much further and arrives uninvited.
It is best understood as a protective response that has become a problem. When something is overwhelming — frightening, painful, inescapable — the mind’s capacity to disconnect is a genuine mercy. It becomes a disorder when it starts happening outside those circumstances, or when it will not switch off.
That framing matters, because it explains why the accusation of faking is not merely unkind but factually backwards. This is a defence mechanism operating without permission. It is closer to fainting than to lying.
The forms it takes
Feeling unreal — depersonalisation and derealisation.
Watching yourself from outside. Your hands not feeling like yours. Your voice sounding as though it belongs to somebody else. Or the world going flat, distant, dreamlike, as though a pane of glass has been placed between you and everything.
I put this first because it terrifies people and almost nobody has ever heard it described. Patients tell me they thought they were going mad, and had told no one for years for exactly that reason.
You are not going mad. This is a recognised experience; it is common — particularly alongside anxiety, panic and exhaustion — and it does not mean psychosis. It is deeply unpleasant, and it is not dangerous, and knowing that alone reduces it for some people, because much of what sustains it is the fear that it means something catastrophic.
Gaps in memory — dissociative amnesia.
Losing a period of time, or being unable to recall personal information, usually around something stressful. Not ordinary forgetfulness. Not the gradual memory loss of dementia. A gap.
Episodes that look like fits — but are not epilepsy.
Convulsive movements, collapse, unresponsiveness. Investigations come back normal. The person is then frequently told there is nothing wrong with them, which they hear as an accusation.
There is something wrong. It has a name — these are recognised as dissociative or functional seizures — and they have a treatment. Importantly, some people have both these and epilepsy, which is one of several reasons this must be assessed properly rather than concluded from a normal test.
Loss of function — weakness, paralysis, inability to speak or see, abnormal movements.
Real loss of function, without disease in the nerve or the muscle. The problem lies in how the brain is producing and controlling the movement, not in the equipment. This overlaps with what is covered on the somatic symptom disorders page.
Trance and possession states.
Its own section, below.
Dissociative identity disorder.
Two or more distinct patterns of identity taking control at different times, with gaps in memory between them. It exists, it is rare, and it is strongly linked with severe and repeated childhood trauma.
I mention it mainly to say this: it looks almost nothing like the films. Cinema has produced an image that is dramatic, usually violent, and completely misleading, and it has done real harm — to the small number of people who have this condition, and to the much larger number who watch a film and become frightened about themselves.
Trance and possession states
In many Indian households, an episode in which a person’s identity and behaviour change — a different voice, different bearing, a deity or an ancestor speaking — has an established meaning. In some settings it happens during a ceremony, is expected, is contained within the ritual, and causes nobody distress.
That is not illness, and I have no business calling it one. A doctor who cannot distinguish between a cultural practice and a symptom is not being scientific; he is being narrow.
The clinical question is not whether the deity is real. That is not a medical question, and I will not pretend to answer it.
The questions that are medical:
- Is it happening outsidethe accepted setting — at home, at college, alone, unexpectedly?
- Is it causing distressto the person themselves?
- Is it taking over— repeating, lengthening, disrupting school, work, marriage, sleep?
- Is it involuntary and unwantedby the person, even when the family accepts it?
- Is there something else going on that is being missed — epilepsy, psychosis, severe depression, the effects of a substance? These are the ones that get overlooked while months pass elsewhere, and some of them are dangerous.
Where the answer to several of these is yes, an assessment is warranted, and it will not require anybody to abandon what they believe.
And one thing said without qualification. Practices that involve beating, burning, starving, chaining or confining a person as treatment are harmful, and they are illegal. They occur in this country, in homes and in places calling themselves healing centres. If someone is being treated that way, that is an emergency, and it needs a hospital.
I would rather a family came to me having also been to a temple than not come at all. There is no need to choose in the order anybody assumes.
Where it comes from
Trauma is the strongest association, particularly repeated adversity in childhood. Not always — and I want to be careful, because “you dissociate, therefore something must have happened to you” is a damaging leap that has caused real harm.
Acute stress. An impossible situation with no visible exit. In this region, in young women, that is very often an intolerable domestic situation, pressure over marriage, or a conflict in which the person has no voice at all. A body that stops working sometimes gets heard when a person cannot speak.
That is not a manipulation and it is almost always outside the person’s awareness. Saying it clumsily to a family — implying she is doing it to get her way — is how this diagnosis gets weaponised.
Anxiety and panic, particularly for the feeling-unreal symptoms.
Exhaustion, sleep deprivation, and some substances — cannabis is a common trigger for depersonalisation in young people.
Getting it assessed properly
Other things must be excluded. Epilepsy, other neurological conditions, thyroid disorder, the effects of drugs or alcohol, psychosis, and severe depression. This is not a diagnosis to be made because a scan was normal.
A normal EEG does not, by itself, mean the episodes are dissociative — and it certainly does not mean nothing is wrong. Diagnosis rests on the pattern of the episodes and a proper history, sometimes with prolonged monitoring.
It should not be diagnosed by exclusion alone, and it should not be delivered as a dismissal. If a doctor has told you there is nothing wrong with you, you have been given an incomplete sentence.
Treatment
The explanation is the first treatment, and it is not a small thing. A great many people improve substantially simply from being told, credibly, what this is: that the episodes are real, that they are not deliberate, that the mechanism is understood, and that it has a name. Being believed does a large part of the work.
Psychotherapy is the main treatment. Working on the underlying stress or trauma, on anxiety, on recognising early signs of an episode, and on grounding techniques that interrupt one.
For functional and dissociative seizures, specific therapy approaches exist and are effective, often alongside physiotherapy where there is weakness or difficulty walking.
Treat what is alongside it. Depression and anxiety are frequently present and treating them properly often improves the dissociation as well.
No medication treats dissociation itself. Medicines are used for the accompanying conditions. And a specific caution: sedatives are not a treatment here, and long-term use creates a second problem — which, as a de-addiction specialist, I see the end of rather often.
Change the situation where the situation is the problem. Where an episode is arising from an intolerable circumstance, no amount of therapy substitutes for addressing it. Sometimes the most therapeutic intervention is a family conversation in which somebody’s actual objection is finally heard out loud.
What to do during an episode
For families, since almost nobody is told this:
Keep the person safe. Move hard objects away. Support the head if they are on the floor.
Do not restrain them, and do not put anything in the mouth. That advice is wrong for epilepsy too, and it causes injuries every year.
Do not crowd around. A room of ten frightened relatives, all talking, prolongs episodes. Two calm people are better.
Speak calmly and briefly. Say their name. Say where they are. Say that they are safe and it will pass.
Do not shout, slap, throw water, or use anything painful to bring them out of it. These are common; they do not shorten the episode, and they teach the person that being unwell is met with force.
Afterwards, do not interrogate and do not accuse. They will often be confused and frightened and may not remember. This is the moment when the accusation of drama gets made, and it is the moment when the most damage is done.
Get a proper assessment rather than waiting for the next one.
A story from the consulting room
The following is a composite — assembled from patterns I have seen many times. It is not any one patient, and all details have been changed.
She was nineteen, from a village outside Nashik, and the episodes had been happening for about seven months when the family brought her.
They began in the evenings. She would become unresponsive, her body would move in ways she did not control, and she would speak — sometimes in a voice her mother described as not hers. A neighbour identified it. The family did what almost anybody in that situation does: they took her to somebody who was known for this work, three times, at considerable expense.
They came to me because it had begun happening during the day, at her college, in front of people. Their concern was not primarily medical. It was that word had spread, and there was a proposal being discussed for her marriage.
Two things emerged over the assessment.
She had been withdrawn from her course six months before the episodes started, to be married, and had not been asked. She had said nothing about it to anybody. When I saw her alone she was clear and articulate and had a great deal to say, none of which she had ever said in her own house.
And there was a physical condition that had never been assessed at all, because nobody had taken her to a doctor. It turned out not to be epilepsy, but it took proper assessment to establish that, and I would not have known otherwise.
I did not tell that family they had wasted seven months, and I would not now. I told them the episodes were real, that she was not doing it deliberately, that this was something I had seen many times, and that it usually improved.
Treatment: an explanation delivered to the whole family at once, therapy for her, and — the piece that actually changed things — three sessions in which her father heard, in my room, with somebody else present, what his daughter thought about her own future. That conversation was more difficult for everyone than anything else we did.
The episodes stopped for about four months. She is not married yet. She went back to her course.
Her mother asked me at the last visit whether it had been an illness or the other thing. I told her honestly that I could only speak to the part I understood, and that the part I understood had got better.
That answer is not a dodge. It is the only honest thing I can say, and families accept it more readily than doctors expect.
Frequently Asked Questions.
Is she faking it?
No. This is not under conscious control. The accusation is the commonest thing patients with these conditions experience and it is wrong.
The EEG and MRI were normal. Does that mean nothing is wrong?
No. It means the tests did not find epilepsy or structural damage. Dissociative and functional conditions do not show up on those tests and are diagnosed on the pattern of the episodes.
Can someone have both epilepsy and these episodes?
Yes, and it is not rare, which is one reason this needs proper assessment rather than a conclusion drawn from one normal test.
I feel unreal and detached. Am I going mad?
No. This is a recognised experience; it is common alongside anxiety and exhaustion, and it is not psychosis. Tell a doctor — most people with it have never told anybody.
Is dissociative identity disorder like the films?
No. It is rare, and cinematic portrayals are dramatic and misleading.
Does dissociation always mean there was abuse?
No. Trauma is the strongest association, but it is not the only route, and assuming it is has caused real harm.
Should we stop going to the temple?
That is not my decision, and I would not make it. My only request is that the medical assessment happens as well, and reasonably early.
Sources
- Indian Psychiatric Society — Clinical Practice Guidelines
- World Health Organization — ICD-11 dissociative disorders, including trance and possession trance disorder
- National Institute for Health and Care Excellence (NICE) and international consensus guidance on functional neurological disorder
- DSM-5-TR — dissociative disorders