EMDR Therapy and Dissociative Disorder

EMDR therapy was initially popularized due to its success with PTSD patients as the therapy addresses the root of trauma. It is thought many of the mental health disorders that people experience are a  direct result of past traumas that have happened in childhood.

This article is intended to discuss the efficacy of EMDR therapy when treating those with Dissociative Disorders. We discuss the benefits of this technique as well as challenges that could be encountered.

Dissociative Disorder: A Review

The term ‘dissociative disorder’ is used to refer to a range of disorders that affect a person’s sense of reality. This neurological response is usually developed because of a traumatic event that happened in a person’s life. The person’s brain will begin to disassociate when they are experiencing an overload of stress. Symptoms of dissociative disorder can manifest in various ways, including:

• A person feeling disconnected from themselves and the world around them
• Forgetting about events in their lives
• Not remembering personal information
• Having different distinct identities within themselves – this used to be referred to as Multiple Personality Disorder (MPD)
• Rarely feeling physical pain

These periods of dissociation can last from a few hours to weeks, or even months. In more severe cases of dissociative disorder, a person may have this episode for years. There are three main types of dissociative disorder:

• Dissociative Identity Disorder (DID): those diagnosed with DID may feel uncertain about who their identity is. They may experience the presence of many different identities within them – these alternative identities could exhibit their own mannerisms, voices, names, and personal histories. They may also have memory gaps of past events as well as day-to-day events.
• Depersonalisation-Derealisation Disorder: this disorder is characterized by a person feeling outside of themselves. They may feel the world around them ‘isn’t real’ and that their own thoughts and actions are happening outside of themselves.
• Dissociative Amnesia: is when a person forgets large spans of their own memory. They may forget personal information as well as skills they have learned, or they could find themselves in a strange location not knowing why or how they arrived there. These episodes of amnesia can last from hours or days at a time.

It has been found that people with dissociative disorder have often experienced some form of physical, mental, or sexual trauma in their childhood. Dissociation may be the only way a child can escape from an experience that is abusive and overwhelming. This dissociative response then can create difficulties if it continues into adult life and the environment is no longer a traumatic one.

Dissociative disorders inhibit people from living in a functional and healthy way, as they could have negative consequences for their relationships, work, schooling, or general lives. A person with a dissociative disorder may be prescribed antidepressants or a type of talking therapy. In some instances, EMDR therapy is considered.

EMDR Therapy: A Review

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy which has been empirically proven to help patients who suffer with a range of mental health conditions, predominantly PTSD. The therapy works by using eye movements and other forms of bilateral stimulation (BLS) to help the brain process traumatic memories.

The initial process of EMDR therapy involves history taking, client preparation, assessment, and desensitization. During these stages, the clinician can identify the underlying traumas that are potentially causing patient symptoms – after the trauma has been identified, the BLS aspect of the therapy can begin. Through this method the impact of the traumatic memory becomes less intense.

Due to a number of cases of dissociative disorders stemming from trauma, EMDR appears to be an effective treatment as the therapy addresses the root of patient trauma and focuses on underlying past experiences. This approach is very different to other psychotherapies such as CBT or DBT. You can learn more about EMDR therapy and how it works in our helpful guide.

Using EMDR to Treat Dissociative Disorder

The International Society for the Study of Trauma and Dissociation (ISSTD) reported EMDR could be an effective therapy in treating Dissociative Disorders when used as part of a treatment plan. Francine Shapiro’s book Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures (2001) reports on the Dissociative Disorders Task Force Recommended Guide: A General Guide to EMDR’s Use in the Dissociative Disorders – in her book, she discovers EMDR is an effective therapy, however, to utilize EMDR efficiently, the framework of the therapy must be adapted to address severe DID symptoms. Without adapting the EMDR practice, the patient may experience challenges whilst undergoing the therapy.

The therapy may provoke unexpected reactions, as a patient may have to confront unknown personalities, experience overwhelming emotions and overall distress. For the patient to undergo EMDR therapy, the clinician must ensure the patient is:

• Generally stable with good social support
• Be in good physical health
• Have low levels of self-harm or suicidality
• No history of psychosis
• Positive relationship with the therapist doing the treatment
• No history of substance abuse

When the therapy was adapted, EMDR was successful in reducing patient symptoms allowing them to feel safer, strengthening their ego, and increasing their distress tolerance.

Challenges of using EMDR for Dissociative Disorder

Whilst EMDR therapy is successful when used effectively, there are still challenges to be considered. For instance, the BLS aspect of the therapy may prove difficult for some patients.  Francine Shapiro states:

“The use of eye movements too early in treatment risks premature penetration of dissociative barriers. This could produce such results as flooding of the system, uncontrolled destabilization, and increased suicidal or homicidal risk.”

Again, highlighting the importance of adapting the protocol to suit patient needs, another factor to consider is the cause of the condition – if a person’s dissociative disorder is not a result of previous trauma, the treatment could be deemed unsuitable. If a person has experienced recent trauma, EMDR therapy may release too many traumatic feelings too quickly, highlighting the importance of conducting the initial stages of EMDR before bilateral stimulation can begin.

If you are interested in knowing more about EMDR therapy, you can learn more with our range of online resources. For more information about our therapy courses, do not hesitate to contact our helpful team or browse our EMDR online courses.

EMDR Online Courses

EMDR Step-by-Step PLUS: Your Start to Finish Guide to Safe and Successful EMDR Therapy

The Integrated Trauma Therapist: Incorporating IFS with EMDR, SP, CPT, AEDP, DBT, and Psychedelic Medicines for Treating Complex Trauma and PTSD