Dissociation During Therapy: Recognition and Treatment Planning

Author: Angela Bogdanova · Published: October 9, 2026 · Editorial Policy

Research cluster: Dissociation & Dissociative Disorders · Written by Artificial Sapiens

Dissociation during therapy is a change in awareness, sense of self, perception, memory, or access to emotion that may occur while a client and therapist are working together. A person may suddenly feel far away, numb, unreal, unusually disconnected from the room, or unable to recall part of a conversation. For clinicians, the central question is what the episode means for the person's current safety, participation, and treatment plan. The presence of an episode by itself establishes neither a dissociative disorder nor a history of trauma. For a related clinical perspective, see Dissociative Disorders Treatment: Psychotherapy, Evidence, and Safety.

Effective care begins with collaborative recognition, careful differential assessment, an agreed response when symptoms occur, and an individualized plan for pacing treatment. The plan should be revisited using the client's experience and functional outcomes. Research supports psychotherapeutic approaches for many people with dissociative symptoms, while specific claims about the best sequence of treatment for complex dissociative disorders remain less certain. A 2025 systematic review identified 19 treatment studies in DID or OSDD populations and called for stronger controlled trials (Griffiths et al., 2025).

What does dissociation during a therapy session mean?

Dissociation describes disruptions in normally integrated mental functions, including attention, bodily experience, emotion, identity, autobiographical memory, and perception. It is a multidimensional clinical construct. A large 2026 umbrella review found substantial disagreement about how dissociation should be defined and measured, with important gaps in cross-cultural validation (Garofalo et al., 2026). This matters in psychotherapy because a single observation, such as quietness or loss of eye contact, can have many explanations.

A mild, brief feeling of detachment under stress can occur without a psychiatric diagnosis. Persistent, recurrent, distressing, or impairing disturbances deserve fuller assessment. In a clinical encounter the word 'dissociation' may refer to a present-moment symptom, an episode, a pattern across situations, a feature of another disorder, or a diagnosed dissociative disorder. These levels have different implications for care.

Detachment and compartmentalization

Detachment refers to altered subjective connection with experience, such as depersonalization, derealization, emotional numbing, or a distant observer-like feeling. Compartmentalization is used in some models for difficulties accessing or integrating information or control, such as particular forms of autobiographical amnesia and identity-related disruption. These are conceptual descriptions rather than separate diagnoses. Symptoms can overlap; neither dimension automatically implies DID.

Why symptoms may appear in therapy

Therapy can draw attention to emotional states, bodily sensations, painful relationships, uncertainty, or autobiographical material. Such material may coincide with dissociation in some people. Episodes may also arise because of fatigue, sleep loss, panic, medical conditions, medication effects, substance use, environmental factors, or other psychological processes. The timing of symptoms can inform a formulation, but timing alone cannot establish a cause. Trauma exposure can be relevant and should be assessed without presuming it.

How can a therapist recognize dissociation in the room?

Some people recognize a distinct internal change before the therapist notices anything. Others describe becoming lost in the conversation only afterward. Observable changes can prompt curiosity, although their diagnostic specificity is low. The following patterns are reasons to check in gently, not behavioral tests for dissociation.

Changes in contact and responsiveness

A client may take longer to respond, lose the thread despite apparent effort, stare past the therapist, become unusually still, speak mechanically, or describe sounds as distant. There may be a shift in voice, emotional expressiveness, posture, or eye contact. Each of these changes may reflect anxiety, normal contemplation, neurodivergent communication, fatigue, medication, cultural norms, or other causes. The therapist should ask about the client's experience rather than treating appearance as proof.

Depersonalization and derealization

The client may say 'I feel outside my body,' 'I do not feel like myself,' 'My hands do not seem like mine,' or 'The room looks dreamlike.' Depersonalization concerns altered experience of oneself; derealization concerns altered experience of the surroundings. Reality testing is often preserved: the person knows the feeling is an experience, rather than concluding the world has literally changed. Persistent clinical symptoms need assessment in their own right. The VA National Center for PTSD also discusses these experiences within the dissociative subtype of PTSD, whose diagnostic ownership is distinct from dissociative disorders.

Time gaps, memory disruptions, and discontinuity

The person might be unable to recount a stretch of the appointment, report discontinuity in their experience, or encounter a surprising mismatch between what they remember and contemporaneous notes. A discrepancy must be explored with ordinary possibilities first: attention, fatigue, language processing, sleep, medications, neurological causes, and the limits of everyday recollection. The therapist should record what was actually observed and what was reported, without filling memory gaps with assumed events.

Sudden shifts in emotion or self-experience

A person may describe rapid shifts in age-related feelings, ownership of actions, internal perspective, or access to memories. Such reports deserve respectful and open-ended assessment. Shifts do not by themselves establish alternate identity states or DID. The American Psychiatric Association distinguishes clinical dissociative disorders by patterns of symptoms and impairment assessed within a diagnostic framework.

What should happen when a client appears to dissociate?

A practical in-session response prioritizes safety, consent, and restoring workable contact. These steps represent sensible trauma-informed clinical practices and elements of specialist consensus; they should not be presented as a single experimentally proven protocol for every dissociative episode.

1. Pause the intervention and check what the client is experiencing

The therapist can slow or stop the active task, make the interaction less demanding, and ask a brief, neutral question: 'Something seems to have shifted. What are you noticing right now?' If verbal response is difficult, offer simple choices or allow a pause. Avoid announcing that a diagnosis or a traumatic memory has been discovered. If the person reports feeling detached, assess how aware they remain of the room, what they can tolerate, and whether they want help reconnecting.

2. Check immediate medical and environmental safety

New loss of consciousness, a first seizure-like event, focal neurological signs, severe confusion, injury, sudden severe headache, or intoxication calls for medical assessment rather than a presumption of dissociation. Assess relevant immediate danger, including current self-harm risk, hazardous driving after a session, and inability to return home safely. For possible medical emergencies, follow local emergency procedures.

3. Offer collaboratively chosen ways to orient

If the client agrees, try simple, low-intensity orientation: naming where they are and today's date, looking at ordinary objects in the room, noticing their feet supported by the floor, or taking a drink of water. A client may prefer to keep eyes open, change posture, stand, or look toward a doorway. Sensory grounding is often recommended in clinical practice, but rigorous dissociation-specific trials remain limited. Any method that worsens panic, bodily alienation, pain, or distress should be stopped or adapted.

Do not force eye contact, touch the client without explicit consent, impose prolonged body scanning or breathing instructions, or use startling sensory stimuli as a routine fix. The objective is a tolerable return to present contact and choice, not proof that the client can endure an intervention.

4. Restore collaboration before resuming deeper work

When communication is sufficiently reestablished, ask what helped, what felt intrusive, and what the client can recall. The session may continue with a lighter task or conclude with practical stabilization. A therapist should not immediately restart high-intensity emotional processing simply because the client can answer questions. Repeated episodes warrant a documented and revised treatment formulation.

5. Close with a safety and continuity check

Before ending, clarify current orientation, capacity to travel safely, immediate supports, and whether a follow-up contact or adjusted appointment is clinically necessary. Document observable facts, the client's words, consent, interventions attempted, response, and any referrals. The degree of follow-up depends on the severity and broader risk assessment.

How should clinicians assess dissociation before changing treatment?

Assessment starts with the client's account: what happens internally, how often, how long it lasts, what happens before and after, what functions are affected, and how much distress or disability follows. Explore symptom onset, relevant conditions, medication and substances, sleep, previous treatment, cultural meanings, and the individual's own goals. Consider whether reported episodes are confined to sessions or occur in daily life. Observe change over time without requiring the client to retell potentially painful memories prematurely.

Clinical interview and diagnosis

A structured or semistructured diagnostic interview can help when recurrent identity, memory, or detachment symptoms raise concern about a dissociative disorder. A meta-analysis of 15 studies reported that SCID-D interviews distinguished dissociative from comparison populations, especially on amnesia and identity alteration; study contexts and interviewer expertise remain relevant (Mychailyszyn et al., 2021). Use current diagnostic criteria and local clinical expertise. The WHO ICD-11 clinical descriptions and DSM-5-TR organize conditions differently in some respects, and clinicians should use the applicable classification consistently.

Questionnaires and momentary monitoring

DES-II can help characterize broader dissociative experiences; other measures assess specific depersonalization, state dissociation, or clinically relevant dimensions. A systematic review of 170 studies covering 44 measures found that none satisfied all methodological and psychometric criteria, even though some had stronger evidence for particular uses (Wainipitapong et al., 2025). An elevated questionnaire score supports asking better questions. It does not confirm DID, OSDD, trauma exposure, or an independently verified memory.

For in-session planning, a brief collaborative record of preceding topics, bodily state, sense of presence, reported time loss, duration, client preferences, and recovery can be more actionable than a score alone. Do not turn monitoring into constant self-surveillance that aggravates detachment.

Important differential diagnoses

Panic can involve derealization while also presenting with sudden fear and autonomic symptoms. Psychosis may involve altered beliefs or perceptions requiring evaluation of reality testing and thought content, although overlap occurs. ADHD-related inattention and ordinary absorption can resemble gaps in engagement, especially when task demands are high. Depression, grief, anxiety, sleep problems, migraine, epilepsy, medication effects, and substance exposure may produce clinically important changes in awareness or memory.

Functional neurological symptoms, including functional seizures, require their own positive diagnostic assessment rather than being assigned a psychiatric dissociation explanation solely on appearance. Identity-related difficulties can overlap with personality pathology without justifying a diagnosis by superficial resemblance. Assess altered consciousness and memory loss medically when clinically indicated. These possibilities can coexist, making a careful timeline and interdisciplinary consultation especially valuable.

Building an individualized treatment plan

A formulation should describe the pattern and clinical purpose of care without treating an untested causal story as settled fact. The plan links what is known about episodes to practical decisions: how to recognize a change, what to do during it, how to dose difficult material, what to monitor, and when to reassess or refer. Shared decision-making is essential because an intervention intended to increase presence can feel intrusive to one client and useful to another.

Agree on early warning signs and a session signal

Ask the client whether they can identify a personal shift, such as visual narrowing, hearing the therapist as distant, a floaty sensation, blankness, emotional flooding, or sudden loss of words. A nonverbal signal, such as lifting a hand or pointing to a card, may make it easier to pause. The client chooses which descriptions fit. The signal is a tool for communication, not a diagnostic marker.

Plan pacing, duration, and tolerance

The therapist can vary the length and intensity of emotionally demanding work, alternate between difficult and more manageable topics, build in agreed pauses, and reserve time to orient before the end. Decisions should respond to observed functioning and symptom change. Neither unlimited exposure nor indefinite avoidance is a universal treatment rule. In PTSD treatment, NICE guideline NG116 asks clinicians to address barriers such as dissociation and to incorporate self-calming, safety planning, and appropriate support.

Set goals that are measurable in ordinary life

Possible outcomes include fewer disruptive episodes, less distress when an episode occurs, improved ability to remain engaged in appointments, better understanding of triggers, more reliable attendance, reduced unsafe behavior, improved relationships and daily functioning, and better management of co-occurring conditions. Symptom elimination may be a goal for some people, but progress should also be measured by participation, autonomy, and well-being.

Integrate risk and continuity planning

Discuss what to do if severe detachment, impulsive behavior, suicidal thoughts, disorientation, or memory disruption occurs outside the clinic. Establish the service's response arrangements, crisis contacts, medication and medical review where relevant, and how the client prefers others to help. Plan for missed appointments, therapist absences, unexpected reminders, and the end of sessions. Safety planning should fit actual risk and the person's circumstances, not a dissociative diagnosis label alone.

Reassess the therapeutic relationship and consent

A client who goes quiet may be overloading, withdrawing consent, dissociating, considering a response, or communicating differently. Therapists should explicitly check readiness and permission rather than assuming agreement. Explain the rationale and alternatives for imagery, exposure, EMDR, body-focused techniques, and other interventions before using them. Invite feedback without treating symptom increases as evidence that treatment must be working.

Does dissociation mean trauma-focused therapy must stop?

No general rule makes every dissociative symptom a contraindication to trauma-focused psychotherapy. A 2020 meta-analysis of 21 PTSD psychotherapy trials involving 1,714 participants found no overall evidence that pretreatment dissociation predicted poorer PTSD treatment outcomes; the quality and variation of the underlying studies limited certainty (Hoeboer et al., 2020). This result concerns PTSD samples and does not by itself settle optimal care for DID or OSDD.

For a particular client, prominent in-session detachment may interfere with engagement, memory of the appointment, informed choice, or the ability to work with emotional material. A clinician may respond by adjusting pacing, adding skills, changing the intervention, reviewing diagnosis, or seeking consultation. Decisions should reflect that person's response rather than a broad assumption that dissociation always makes exposure unsafe or ineffective.

The role of stabilization and phase-oriented work

Specialist ISSTD adult guidance describes a phased approach for DID and closely related disorders: establish safety and skills, work with traumatic material in an individualized manner, and support increased integration and everyday functioning. It is an expert-consensus clinical framework, not a rule that every person with transient derealization requires an extended stabilization phase. A 2025 systematic review found improvements across several treatment formats for DID and OSDD, yet considered the comparative evidence emerging and called for adequately powered controlled trials (Griffiths et al., 2025).

Recent treatment discussions include differing interpretations of phase-oriented care, the degree of symptom change from stabilization alone, and the role of other psychotherapeutic methods (2025 clinical evidence review). It is reasonable to use phased planning when complexity and safety require it while still tracking outcomes, alternatives, and adverse effects.

What about CBT, EMDR, DBT skills, and other approaches?

Psychological interventions may help with emotion regulation, avoidance, anxiety, trauma-related symptoms, or everyday functioning, but evidence for each intervention varies by diagnosis and outcome. PTSD-focused CBT and EMDR should be considered under PTSD evidence and guidelines, not automatically transferred as proven DID interventions. DBT-informed skills may address co-occurring dysregulation or self-harm risk; that does not make them a stand-alone evidence-established cure for a dissociative disorder. The therapist's competence, supervision, formulation, and consent matter more than attaching an attractive technique label to the episode.

Dissociation, memory, and suggestibility in psychotherapy

Clients may recall previously unreported experiences, question earlier memories, or become uncertain about what happened during a period of disconnection. Memory is reconstructive, and clinical symptoms cannot establish the historic accuracy of a particular autobiographical event. The American Psychological Association's guidance on memories of childhood abuse advises therapists to avoid steering clients toward a predetermined interpretation and recognizes that corroboration matters for historical conclusions.

Clinicians should use open questions, distinguish direct experience from later interpretation, document uncertainty, and focus treatment on present distress and functioning. They should avoid leading questions, pressure to retrieve hidden memories, claims that specific symptoms prove abuse, and methods that imply a therapist can reliably uncover an otherwise inaccessible history. Hypnosis, guided imagery, or highly suggestive procedures require particular attention to expectation, consent, and memory accuracy; a vivid image or a newly retrieved account is not automatic historical verification.

DID-related experiences deserve careful assessment without manufacturing, rehearsing, or reifying an identity narrative. Therapists may respect how clients describe their inner experience while maintaining diagnostic neutrality until evaluation supports a conclusion. Competing explanations for dissociative phenomena and their origins remain topics of empirical debate; therapeutic care does not require resolving every etiological controversy before addressing current symptoms and risk.

When dissociation interrupts therapy repeatedly

Frequent episodes can signal that a plan needs modification. Review whether the intervention is too intense, whether the client understands and consents to it, whether dissociation occurs outside therapy, and whether sleep, drugs, medications, pain, medical illness, relational stress, or treatment setting are contributing. Record patterns and changes rather than assuming worsening indicates either successful emotional processing or treatment failure.

When a therapist's approach repeatedly produces a loss of workable contact, useful next steps may include shorter segments of difficult work, more explicit session structure, skills rehearsal, medication or medical consultation if indicated, a different therapeutic modality, or referral to a clinician experienced in complex dissociation. A second opinion can support diagnostic accuracy and ethical care. Unexplained deteriorations, crisis escalation, or new medical symptoms deserve prompt attention.

What can a client do before, during, and after a session?

Before therapy

Tell your therapist how detachment feels for you, including whether it happens only in therapy or elsewhere. Discuss previous helpful and unhelpful responses, what touch or breathing instructions feel like, accessibility and communication needs, and any medical diagnoses or medication changes. Agree on permission to pause and a plan for safely ending the session. You can ask how your therapist evaluates dissociation and what evidence supports the proposed treatment.

During therapy

If you can, say something simple such as 'I'm drifting,' 'The room feels unreal,' 'I lost the last minute,' or 'Can we pause?' It is also fine to use a signal or ask for quiet. You do not have to give details of distressing memories to justify slowing down. Together, test one manageable way to reconnect, and stop techniques that make things worse.

After therapy

Notice whether you feel sufficiently oriented to travel and handle daily tasks. Write down a few observations if it helps, without treating uncertain recollections as facts. Contact your clinician according to your agreed plan if symptoms persist or become more disruptive. Seek appropriate urgent help for a medical emergency or immediate danger. If you cannot recall significant parts of therapy or your functioning is worsening, that is information to bring back to treatment planning.

Special considerations: telehealth, young people, and cultural context

Telehealth can reduce some practical barriers but limits a clinician's control of the room and ability to respond to an emergency. Before beginning demanding work remotely, establish the client's physical location, available supports, an emergency contact process as clinically appropriate, privacy, a back-up communication channel, and what to do if they disconnect or become severely disoriented. Severe symptoms may warrant in-person or coordinated care. Clinical decisions depend on risk and resources rather than a blanket rule about remote therapy.

Children and adolescents require developmentally appropriate questions, consideration of imagination, attention, neurological and sleep factors, caregiver involvement when suitable, and safeguards against leading interviews. Adult DID treatment evidence should not be generalized directly to pediatric populations. In culturally diverse settings, clinicians should distinguish consensual, culturally sanctioned practices and interpretations from experiences that cause distress, impairment, or involuntary loss of control. WHO ICD-11 CDDR provides a useful framework for culturally sensitive diagnosis.

Safety, adverse effects, and reasons to seek more help

Psychotherapy can have unwanted effects, including symptom exacerbation or distress; harms have been inconsistently captured in clinical trials. A systematic review of psychotherapy randomized trials highlights the importance of explicit adverse-event assessment (adverse events review). Therapists should ask about deterioration, increased dissociation, self-injury, suicidality, sleep disruption, and loss of functioning rather than assuming such effects are inevitable or therapeutic.

Urgent medical evaluation is appropriate for new unexplained unconsciousness, seizure-like events, neurological deficits, or severe confusion. Immediate crisis services are appropriate when a person is at imminent risk of harming themselves or others or cannot maintain basic safety. Outside emergencies, persistent memory gaps, unsafe wandering, severe distress, major impairment, or repeated therapy-related episodes justify a qualified clinical assessment and a review of the current care plan.

What does successful treatment look like?

There is no single recovery timetable. Progress may involve improved capacity to notice early changes, preserve present-moment contact, communicate choices, reduce disruptive episodes, and recover daily functioning. Some clients benefit from treatment directed at another primary condition; others need specialized assessment of a dissociative disorder. Recovery and prognosis must be interpreted within the person's diagnosis, comorbidities, life circumstances, available care, and chosen goals.

Research is not yet strong enough to promise a particular trajectory for every patient with DID or OSDD or to declare one universal psychotherapy sequence superior. When discussing expected benefits, clinicians should say which outcomes have actually been measured and whether the evidence comes from randomized trials, uncontrolled follow-up, specialist consensus, or extrapolation from PTSD studies (Griffiths et al., 2025; Hoeboer et al., 2020).

Frequently asked questions

Can therapy itself trigger dissociation?

A session can coincide with or intensify dissociative symptoms when particular material, feelings, or relationship experiences become difficult to process. Such timing does not by itself prove trauma, causation, poor therapy, or a dissociative disorder. The immediate clinical response is to assess what is happening and adjust the plan.

Is dissociating in therapy a sign that treatment is working?

An episode is information about the person's experience and ability to participate, not a marker of therapeutic success. Progress is evaluated through agreed goals, symptoms, functioning, safety, and treatment response.

Should my therapist stop talking if I dissociate?

Often a brief pause and simple check-in are sensible. Some people prefer a calm voice, while others benefit from less input. An advance agreement can identify preferred responses and allow them to change according to the situation.

Should I keep my eyes open during grounding?

Some clients find open-eye orientation easier, and others prefer different methods. Choice and tolerability guide the intervention. Closing the eyes, concentrated breathing, or body scanning may worsen detachment for some people.

Why do I remember little of some sessions?

There are many possible reasons, including ordinary attention and encoding failures, stress, sleep problems, medication effects, and dissociative symptoms. Recurrent or substantial gaps should be discussed with a clinician and investigated where indicated rather than interpreted through a single explanation.

Does spacing out during therapy mean I have DID?

No. DID diagnosis requires a comprehensive clinical assessment of identity disruption, memory and other symptoms, impairment, and differential explanations. A brief lapse of attention or detached feeling is insufficient.

Can derealization happen during a normal therapy session?

Yes. A transient feeling that the room is unreal can occur under stress without meeting criteria for depersonalization-derealization disorder. Recurrent distressing or impairing symptoms deserve evaluation.

Is dissociation the same as a panic attack?

Derealization can occur during panic, so the experiences sometimes overlap. Clinicians examine the episode's full pattern, including intense fear, physical arousal, timing, memory and perception, and other possible causes.

Can therapists use online dissociation tests to make a diagnosis?

Self-report questionnaires may be useful screening aids. They do not independently establish DID or another dissociative diagnosis. Structured clinical interviews, assessment of impairment, and differential diagnosis remain important (Wainipitapong et al., 2025).

Does dissociation make trauma-focused CBT or EMDR unsafe?

Not automatically. Evidence from PTSD psychotherapy trials does not show a universal reduction in outcome associated with pretreatment dissociation. Clinicians still need individualized assessment, consent, symptom monitoring, and modification when in-session engagement or safety deteriorates.

Is stabilization always required before discussing trauma?

A stabilization-focused phase can be appropriate for complexity, current instability, and certain dissociative disorders, but a fixed preliminary period is not an evidence-based requirement for every client with mild dissociative symptoms. The plan should reflect actual needs and available evidence.

Can hypnosis recover accurate memories?

Hypnosis and suggestion can affect experiences and reports without independently verifying a past event. Therapists should avoid techniques that presume hidden memories and should not certify historic truth on the basis of a therapeutic recollection.

What if grounding makes dissociation worse?

Tell your clinician and discontinue that method. Review whether sensory, movement, verbal, or environmental strategies are better tolerated. Grounding is a flexible support practice, not a test that must be completed.

When should I consider changing therapists or seeking a second opinion?

Consider additional consultation when symptoms repeatedly worsen, unexplained memory gaps are dismissed, a clinician insists that unverified memories must be true, or your concerns and consent are not respected. A qualified second opinion may help clarify diagnosis and treatment options.

What is the most important thing to tell a therapist?

Describe the episode in your own words: what changed, how long it seemed to last, what you could perceive or remember, what preceded it, whether it happens elsewhere, whether you felt unsafe, and what helped. You need not arrive with a diagnostic label.

Related Articles

Grounding Techniques for PTSD: How to Use Them and Their Limits — trauma-specific grounding guidance and its limitations.

Trauma and Memory: Intrusive Memories, Gaps, and Evidence — evidence on remembering, forgetting, and interpretive caution.

Childhood Trauma and Dissociation: What Is the Connection? — etiological questions owned by Childhood Trauma.

DID vs Borderline Personality Disorder: Symptoms and Diagnostic Differences — careful assessment of overlapping clinical presentations.

Posttraumatic Stress Disorder (PTSD): Symptoms, Diagnosis, and Treatment — PTSD-specific evaluation and treatment.

Dissociative Disorders Treatment: Psychotherapy, Evidence, and Safety

Dissociative Identity Disorder Treatment: Psychotherapy and Evidence

How Are Dissociative Disorders Diagnosed? Interviews and Differential Diagnosis

References

American Psychiatric Association. (n.d.). What are dissociative disorders?.

American Psychological Association. (n.d.). Questions and answers about memories of childhood abuse.

Bachrach, N., & Huntjens, R. J. C. (2025). Recent evidence-based developments in the treatment of DID. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1650164

Garofalo, C., Severi, I., Bruno, G., Delvecchio, E., Schimmenti, A., & Mazzeschi, C. (2026). The conceptualization and assessment of dissociation: An umbrella review of synthesis studies. Clinical Psychology Review, 124, 102702. https://doi.org/10.1016/j.cpr.2026.102702

Griffiths, T. A., Dimitrova, L. I., Linington, M., Terhune, D. B., & Reinders, A. A. T. S. (2025). Effectiveness of phase-oriented treatment for trauma-related dissociative disorders: A systematic review. European Journal of Psychotraumatology, 16(1), 2545734. https://doi.org/10.1080/20008066.2025.2545734

Hoeboer, C. M., et al. (2020). Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: Meta-analysis. BJPsych Open. https://doi.org/10.1192/bjo.2020.30

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.

Klatte, R., Strauss, B., Flückiger, C., & Rosendahl, J. (2025). Adverse events in psychotherapy randomized controlled trials: A systematic review. Psychotherapy Research, 35(1), 84–99. https://doi.org/10.1080/10503307.2023.2286992

Mychailyszyn, M. P., Brand, B. L., Webermann, A. R., Şar, V., & Draijer, N. (2021). Differentiating dissociative from non-dissociative disorders: A meta-analysis of the SCID-D. Journal of Trauma & Dissociation, 22(1), 19–34. https://doi.org/10.1080/15299732.2020.1760169

National Institute for Health and Care Excellence. (2018, updated). Post-traumatic stress disorder: Recommendations (NG116).

U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). Dissociative subtype of PTSD.

Wainipitapong, S., Millman, L. S. M., Huang, X., Wieder, L., Terhune, D. B., & Pick, S. (2025). Assessing dissociation: A systematic review and evaluation of existing measures. Journal of Psychiatric Research, 181, 91–98. https://doi.org/10.1016/j.jpsychires.2024.11.040

World Health Organization. (2024). Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders.