There is a moment I return to often when I think about dissociation not from a textbook, but from a consultation room. A young woman sat across from me and said, quietly, “I was there but I wasn’t there. Like I was watching myself from the outside.” She had just described surviving something terrible, and what she was also describing without knowing the clinical term for it was dissociation.

It is one of the most misunderstood experiences in mental health, partly because it sits at the uncomfortable intersection of the ordinary and the extraordinary. My aim with this article is to demystify it: to explain what dissociation is, why it happens, what it looks like when it becomes a problem, and most importantly that it is treatable.

What Is Dissociation?

Clinically, dissociation refers to a disruption in the integrated functions of consciousness, memory, identity, and perception of the environment (Griffiths et al., 2025; Petrič, 2022). It is best understood not as a single event but as a complex psychological phenomenon situated at the intersection of mind, body, and lived experience. A person may feel disconnected from their thoughts, feelings, memories, or surroundings, and this disconnection can affect their sense of identity and their perception of time.

Importantly, dissociation is not inherently abnormal. Everyone has experienced it in mild forms daydreaming, becoming absorbed in a film, or arriving somewhere without remembering the journey. These moments of drifting attention are ordinary and benign.

The concern arises when dissociation shifts from an occasional, unremarkable experience to a persistent, intrusive one particularly when it is rooted in trauma.

Why Does the Mind Dissociate?

The short answer is: to survive.

When we encounter experiences too overwhelming to process, the mind responds by disconnecting almost like tripping a circuit breaker before the whole system overloads. Clinicians refer to this as peritraumatic dissociation: a protective response that allows a person to function in the immediate moment by compartmentalizing what would otherwise be unbearable.

This is a remarkable feat of psychological self-preservation. The difficulty arises later, when the danger has passed but the brain continues to rely on this same mechanism long after it serves any protective purpose.

Trauma and dissociation are closely linked. Experiences such as abuse, assault, accidents, war, medical emergencies, or childhood neglect can produce a flood of feeling and memory that cannot be processed all at once. Dissociation acts as a kind of psychological anesthetic, temporarily numbing the mind to pain it cannot otherwise bear. Initially protective, it can become a barrier to full engagement with life if it persists beyond the immediate crisis.

In essence: dissociation is how the mind survives when reality feels unbearable. Recognizing this without shame or judgment is where recovery begins.

The Spectrum of Dissociative Experiences

Dissociation does not look the same in everyone. It exists on a wide spectrum, and understanding its range is important.

At the milder end are experiences many people recognize: feeling foggy or detached after a stressful day, a sense of being “on autopilot,” or going through routine tasks without fully registering them.

More pronounced experiences include feeling like an observer of one’s own body, the world appearing blurry or dreamlike as if seen through glass or losing track of time in ways that feel disorienting rather than restful.

At the more severe end, dissociation can crystallize into recognized clinical presentations. The DSM-5 identifies three primary disorders:

Dissociative Amnesia

An inability to recall important autobiographical information, typically of a traumatic nature. The forgetting may be limited to specific aspects of a person’s life or may encompass much of their life history and identity.

Depersonalization/Derealization Disorder

A persistent sense of detachment from one’s own mind, body, or sense of self (depersonalization), or a feeling that the world is unreal, muted, or dreamlike (derealization).

Dissociative Identity Disorder (DID)

Formerly referred to as multiple personality disorder, this is the most complex presentation. It involves two or more distinct identity states, each with its own history, traits, and patterns of experience. Contrary to its dramatic portrayal in film and television, DID in clinical reality is far more subtle, and far more rooted in chronic, severe childhood trauma than popular culture suggests.

The Trauma Connection

It is impossible to understand dissociation fully without acknowledging the foundational role of trauma its depth, its duration, and the age at which it occurs.

Research consistently shows that individuals who endure physical or sexual abuse during childhood face a significantly elevated risk of developing DID. Most people diagnosed with dissociative disorders have experienced repeated, overwhelming trauma beginning in early childhood. The American Psychiatric Association reports that approximately 90 percent of individuals diagnosed with DID in the United States, Canada, and Europe have a history of childhood abuse and neglect.

Children who have a high capacity to dissociate may cope with ongoing trauma by generating multiple “not-me” self-states, each serving to distance the child from experiences and feelings that are too painful or frightening to integrate. This is not a character flaw. It is the mind of a child doing exactly what it can with the resources available to it.

Dissociation is also closely associated with anxiety and PTSD. It is a recognized symptom of both acute stress disorder and post-traumatic stress disorder, and it can function as an ongoing avoidance strategy; a way of not mentally returning to experiences that feel too raw to face.

Why It Is So Often Missed

This is something that genuinely frustrates me professionally, and I think it warrants broader attention within the healthcare community.

Severe dissociative disorders are more prevalent than several commonly assessed psychiatric conditions; including bipolar disorder, OCD, and schizophrenia and yet they remain significantly under-recognized and undertreated. People living with dissociative disorders spend an average of five to twelve years actively engaged in treatment before receiving an accurate diagnosis.

There are several reasons for this gap. The symptoms are easily misattributed to depression, anxiety, psychosis, or even neurological conditions. Training in dissociative disorders may face challenges due to the subtlety and complexity of their clinical presentation. Consequently, some professionals may primarily encounter media portrayals of these conditions, which are often sensationalized and inaccurate, failing to represent how they truly present in clinical settings.

There is also the issue of concealment. Dissociation can be hidden, even from the person experiencing it. For those with a trauma history, significant shame is often involved a tendency to minimize, to explain away, to avoid saying the full truth aloud. This makes disclosure genuinely difficult, and it is something clinicians need to actively create space for.

What Treatment Looks Like

There is real, substantive good news here: dissociation responds to treatment.

Psychotherapy is the primary approach, and the goal is integration helping the different elements of identity, memory, and experience come together into a coherent, functional whole. Commonly used modalities include Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). Hypnosis has also shown utility in certain presentations, particularly DID.

For more complex cases, a phased treatment model is considered best practice. This may involve a well-coordinated treatment team comprising therapists, family therapists, and specialists in EMDR (Eye Movement Desensitization and Reprocessing), all working in alignment toward the restoration of integrated functioning.

There are currently no medications that directly target dissociation, though pharmacotherapy can be helpful for co-occurring conditions such as depression or anxiety (APA, 2024). Evidence-based clinical guidelines for both children and adults have been developed by the International Society for the Study of Trauma and Dissociation (ISSTD), and these form a valuable resource for practitioners seeking to deliver effective specialty care.

Treatment for adults typically involves one to three sessions per week over several years. Children and adolescents often show progress more quickly. What is consistent across age groups is this: early, accurate diagnosis changes outcomes significantly reducing the burden on healthcare systems and, more importantly, offering people a meaningful path toward a life no longer dominated by disconnection.

A Note on Grounding

For those navigating dissociation in daily life, grounding techniques can offer real, immediate relief. These are practices that anchor a person to the present moment to the physical reality of where they are, right now.

One of the most accessible is the 5–4–3–2–1 technique: naming five things you can see, four you can physically feel, three you can hear, two you can smell, and one you can taste. By redirecting attention toward sensory input, this technique can interrupt a dissociative episode without requiring clinical training to use.

Grounding is most effective when it is personalized. What works for one person may not work for another, and it is always worth exploring different approaches with a psychologist rather than relying on a single tool.

Closing Thoughts

What I hope readers take away from this is a shift in how dissociation is understood. It is not bizarre. It is not manipulative. It is not a sign of weakness or instability. At its origin, it is an act of psychological self-preservation one that deserves the same clinical seriousness we would extend to any other response to severe adversity.

If you or someone close to you experiences persistent feelings of detachment, unexplained memory gaps, or a fragmented sense of self particularly in the context of a trauma history please seek an assessment from a qualified mental health professional. The path back to an integrated sense of self is real and well-travelled. No one should have to walk it alone.

The views expressed in this article are intended for educational purposes and do not constitute clinical advice. Always consult a qualified healthcare professional for individual assessment and treatment.

Sleep is one of the most important pillars of health. Sleep and mental health share a bidirectional relationship, meaning that poor sleep can negatively impact our mental health and that mental health difficulties can contribute to poor sleep quality.

Poor sleep quality can lead to symptoms such as anxiety, irritability, low and concentration difficulties. It reduces our capacity for managing stress. On the other hand, many mental health conditions can interfere with our sleep. Those who experience anxiety may be kept awake at night by racing thoughts, while those with depression may experience insomnia or hypersomnia (excessive sleep). This can lead to a cycle where poor quality sleep worsens mental health symptoms and these symptoms, in turn, interfere with sleep.

I grew up in a time where quotes such as ‘I’ll sleep when I’m dead’ or ‘sleep is for the weak’ were popularised and sacrificing sleep for productivity were glamorised. However, sleep is essential for optimal physical and mental health.

The Relationship Between Sleep, Cognitive and Emotional Symptoms

Emotional regulation: during sleep, our brain processes emotional experiences from the day, helping us to regulate our moods.

Memory and learning: Sleep strengthens neural connections that support memory and learning. Inadequate sleep means that the brain will struggle to retain information acquired during the day.

Stress management: Because sleep helps regulate stress hormones such as cortisol, poor quality sleep can heighten our stress responses and increase feelings of overwhelm.

Decision making and judgement: fatigue can impair our thinking and judgement, increasing the likelihood of poor decisions. It’s believed that driving when sleep deprived can be as harmful as driving under the influence.

Factors that Contribute to Poor Quality Sleep

• Stress and anxiety
• Inconsistent sleep routines or schedule
• Blue light exposure (from screentime can inhibit melatonin production)
• Environmental factors, e.g. noise, excessive light or unsuitable temperature
• Lifestyle factors such as caffeine, alcohol and eating close to bedtime
• Mental health conditions

Practical Tips to Improve Sleep Quality

• Go to bed and wake up at the same time every day (including weekends)
• Create a relaxing bedtime routine, engaging in a wind down activity such as reading or meditation.
• No screens for 1-2 hours before bed, or at lease use blue light filters.
• Make your bedroom comfortable, cool, dark and quiet.
• Limit caffeine intake to the mornings.
• Regular physical activity, but not close to bedtime.
• Relaxation practices such as journaling, mindfulness or breathwork.
• Get natural light in the morning and limited light in the evenings.
• Use your bed for sleeping (not for scrolling or working). Allow your brain to associate the bed with rest.
• Create time during the day to process your emotions and work through your stressors, so they don’t interfere with your sleep.

Improved sleep can result in improved mental health, balance and resilience. Stress may be inevitable in life, but being well-rested means that we can deal better with our challenges.

PMDD is a hormone related mood disorder that affects some females during the luteal phase of their menstrual cycle (1-2 weeks before menstruation). While PMS is more commonly spoken about, PMDD is more intense, more disruptive and can significantly impact on one’s daily functioning, emotional wellbeing, work performance and relationships. PMS is more a descriptive term and not a formal psychiatric diagnosis.

While PMS involves mild to moderate physical and emotional symptoms that are uncomfortable, PMDD involves severe emotional symptoms that can feel overwhelming and disabling. Mood-related symptoms are the hallmark of PMDD, while PMS includes physical symptoms such as bloating, breast tenderness, headaches and fatigue. While physical symptoms may be present in PMDD, they are not the main cause of distress. PMS is thought to reflect typical responses to hormonal changes, while PMDD is associated with an abnormal sensitivity in the brain to normal hormonal fluctuations. So while PMS is more prevalent, PMDD is more severe, yet less common.

PMDD requires a diagnosis from an adequately trained professional such as a psychologist, psychiatrist or gynaecologist.

The core emotional symptoms must include one of the following:

• marked mood swings (sudden sadness, tearfulness or emotional sensitivity)
• Persistent irritability or anger
• Feelings of sadness, hopelessness or self-critical thoughts
• Intense anxiety

Added to the core symptoms must be some of the following (five or more in total):

• Anhedonia (decreased interest in usually activities)
• Concentration difficulties or brain fog
• Fatigue
• Appetite changes (overeating or cravings)
• Sleep disturbances (either too much or too little)
• Feeling overwhelmed
• Physical symptoms such as breast tenderness, bloating, joint or muscle pain, headaches or weight changes)

To be diagnosed with PMDD symptoms must be occur during the menstrual cycle, be present in the week before menstruation, improve shortly after menstruation begins and cause significant impairment in work, relationships or daily life. What distinguishes PMDD from other mood or anxiety disorders is the link to one’s menstrual cycle.

Importantly, PMDD us not caused by abnormal hormone levels. Rather, it is a result of increased sensitivity to normal hormone fluctuations. The hormonal shifts affect serotonin, which is the neurotransmitter responsible for mood regulation, emotional stability and impulse control. There is evidence to suggest that PMDD may be genetic.

Because PMDD can interfere with important facets of life such as work, studies and relationships, self help strategies are not sufficient – professional help is recommended. Early intervention can improve quality of life. Treatment may include interventions from a psychologist, psychiatrist (if medication is required) and a gynaecologist.

In addition, there are things one can do to improve their quality of life. These include:

• Tracking symptoms to identify patterns and plan around them
• Planning for lighter loads and extra support during the luteal phase
• Eating balanced meals
• Reducing caffeine, alcohol and refined sugars, at least during the luteal phase
• Reducing high intensity work or workouts during the high-symptom days
• Breathwork, meditation or grounding practices
• Good sleep hygiene
• Communicating needs clearly with loved ones
• Setting realistic expectations for difficult days

Bear in mind that PMDD is not a reflection of weakness. It is a medical diagnosis caused by biological factors. PMDD is highly treatable with the appropriate combination of professional intervention and self care.

An intrusive thought is an unwanted, often distressing thought, that emerges in the mind, almost out of nowhere. Most people experience intrusive thoughts at some time in their lives. However, there are those who experience intrusive thoughts more frequently, which can cause high levels of distress. This is mostly a result of the content of such thoughts.

Common examples of intrusive thoughts are:

• A mother thinking about harming her newborn baby
• Sexual thoughts that are inconsistent with one’s sexual identity
• Thoughts of driving one’s car into pedestrians

It may be reassuring to note that intrusive thoughts are not intentional and are not an indication of one’s values, morals or desires. In fact, most people do not act on such thoughts, nor is there any intention to. The reason that intrusive thoughts are as distressing as they are, is because the content of the thought is very contradictory to the person’s beliefs.

While they are not harmful, intrusive thoughts are no doubt distressing and can consume a lot of a person’s time in trying to make sense of them.

Intrusive thoughts are sometimes (not always) a symptom of a mental health condition, such as obsessive-compulsive disorder or post-traumatic stress disorder. However, they may also be a result of high stress levels, lack of sleep, hormonal changes or heightened anxiety. Intrusive thoughts form the core of obsessive-compulsive disorder, but they are often accompanied by compulsive behaviors aimed at minimizing the anxiety. E.g. someone with intrusive thoughts of a sexual nature, may experience the compulsion to scrub themselves to a point of hard. A person experiencing post-traumatic stress disorder often experience intrusive memories or images related to the traumatic experience. E.g. recurrent images of the scene of a car crash.

The fact that one is distressed by intrusive thoughts is evidence that these thoughts are inconsistent with their beliefs and intentions. The emotional aftermath of an intrusive thought often includes anxiety, guilt, shame or disgust. This can lead to avoidance and social withdrawal.

So what can you do if you are plagued by intrusive thoughts?

First things first – remind yourself that this is just a thought. A helpful tip is to mentally say ‘the thought that I am thinking is….’ followed by the intrusive though. This helps create psychological distance from the thought and reinforces the fact that a thought is harmless if not acted on.

Trying to suppress intrusive thoughts may actually make them worse. This avoidance gives the thought more power over us as it influences our behaviour. It is more helpful to acknowledge the thought and allow it to pass. This awareness should ideally be paired with a simple grounding exercise – e.g. looking around you and naming  everything that you see. The grounding takes you away from your thoughts and refocuses your mind on the present.

Something that many patients of mine have found beneficial is first acknowledging the thought as an intrusive thought and then humming. Humming interrupts the intrusive thought and counters the anxiety with calmness.

While intrusive thoughts are not always an indication of psychiatric conditions, if they are concerning you and interfering with your quality of life, it is important to see a doctor, psychiatrist or psychologist, who can make a diagnosis and assist with either psychological interventions, medication, or both.

While this is the most wonderful time of year for some, it’s also the most stressful time of year for many. The reality is the mental illness does not take a break during the holidays. In fact, some aspects of the festive season can exacerbate mental health struggles.

The Comparison Trap

Those with mental health struggles may feel worse about their lives, seeing others in a festive mood and posting curated ‘picture-perfect’ moments on social media. Those who are grieving may find it especially difficult when others enjoying time with loved ones. Those who are in conflictual relationships or are undergoing a break-up or divorce can find it difficult seeing other couples happy together. This does not mean that one is unhappy for others, but it can be triggering to be reminded about what one hoped to have for themselves.

Take time to honor your feelings and the weight of the year. Be patient with yourself. Remember that social media is only a highlight reel and nobody’s life is as perfect as it may look from the outside.

Family Conflict

Those with family conflict may find it difficult to spend more time with family, meet family obligations or uphold traditions that no longer feel good for them. Many unresolved family issues can come to a head during the festive season with families spending more time together. Uncomfortable questions about personal issues are also a source of great stress. E.g. someone who is experiencing career uncertainty may dread questions about what they’re doing with their life. Someone who is struggling with infertility may dread being asked when they’re starting a family. Others dread comments about their appearance, relationship status or other personal challenges.

Ser boundaries to that help you feel safe. This may mean deciding to spend limited time (or none at all) in environments that stress you out, rehearsing answers to unwelcome questions, grounding exercises, a grounding person with you or an exit strategy.

Financial Stress

Financial stress has been a huge stressor for many this year with the cost of living crisis. The pressure to spend can add to this already stressful situation, especially if surrounded by those who are not considerate or empathic. Each of us need to be mindful of our individual situations and commitments, so we don’t overcommit ourselves. Set a reasonable budget and be honest about what you are able or unable to do.

Loneliness

Many feel lonely during this time of year. While some feel lonely due to distance from loved ones, grief or unresolved family/relationship issues, others may feel lonely even amid company, because they have disconnected from themselves (to maintain relationships). It helps to know who you can reach out to. Something that many fine find helpful when lonely, is to do something kind for others – perhaps looking for opportunities to volunteer or give back in some way. If you are religious, look out for services or activities where you will be surrounded by like-minded people.

Year End Reflection

As you reflect on the year, remember to celebrate your little wins and understand the obstacles in not achieving other goals. Wins aren’t just material or externally visible – it may be that you’ve grown more resilient, utilised more effective coping skills, become more assertive, etc. Also bear in mind that sometimes despite our best efforts, life happens and we have new challenges that divert our energy. Be kind to yourself.

End the year mindfully

Make time for things that bring you joy. Remember moderation in everything. The festive season is a busy time, so plan ahead, be reasonable about what you commit to and give yourself extra time to get things done. Spend some quiet time reflecting on your priorities for 2026.

Be honest with yourself if you need professional help. If it feels too big of a step, start out by calling a helpline to just chatting to your GP to point you in the right direction.

Wishing you a blessed and peaceful festive season.

The diagnosis of ADHD in adults is on the rise. Sometimes, diagnoses can take place years into marriage or long-term relationships. If your spouse has recently been diagnosed with ADHD, you may be asking yourself: What does this mean for us? Perhaps you will find that the diagnosis brings clarity to your relationship dynamics when you understand the interpersonal impact of ADHD.

Which ADHD symptoms cause strain in relationships?

1. Distracted: Difficulty staying mentally present.
2. Disorganisation: Poor organisation or planning skills, with difficulty in starting tasks or completing them.
3. Time management: People with ADHD are often late or have difficulty estimating how long something may take. They can become hyperfocused on a task at hand and forget about other important tasks or events.
4. Poor memory: Repeatedly forgetting conversations, plans, or requests from a partner.
5. Impulsive: Acting or speaking without consideration for consequences.

All of the above symptoms can have a negative impact on the perceived quality of a romantic relationship. The following facets of mature relationships may be compromised by the presence of ADHD:

• Attentiveness: We need to perceive that we are the object of someone’s focus and attention. Connection and romance can only take place when mutual attentiveness is present.
• Reliability: In adult relationships, responsibilities are shared. We need to be able to trust that our partners can manage their share of the daily living tasks. Reliability requires that expectations are met.
• Sense of being heard: We need to feel that our concerns are heard by our partner. Our partners need to remember what’s important to us and to follow through on promises they make to us. If your partner struggles to retain details of important conversations, you may feel overlooked or dismissed, even if that’s not their intention.

What you can do:

1. Be honest

What’s obvious to you may not be obvious to them. Share as deeply and as thoroughly as you can. Aim to share your own personal experiences rather than making accusations and placing blame. An easy way to do this is to start your sentences with, “I feel…”

1. What you say is as important as how you say it.

Express your frustration, needs and expectations in a clear and respectful manner. Many people with ADHD are sensitive to sound. If you are shouting or using an overly angry tone, your message may be completely lost as ADHD brains tend to hyperfocus on one thing at a time. Your tone may be too distracting. Be deliberate in choosing a tone and volume that is respectful so that you can share how you are feeling in a way that is easy to listen to.

1. Learn from others

Finding a support group or online forum can go a long way in putting words to how you feel. Learning from other’s experiences of handling ADHD’s impact on marriages can be incredibly helpful.

1. Encourage treatment

It’s all too easy to slip into a ‘parent-child’ dynamic in your relationship. Unfortunately, there is nothing that will kill romance faster. Don’t parent your spouse. This includes their personal ADHD treatment plan. It is not your place to offer advice and take charge of their medication. Seek to be supportive without being authoritative.

Living with ADHD in your relationship doesn’t mean love, connection, or growth are out of reach. In fact, many couples find that learning to navigate ADHD challenges brings them closer, especially with a foundation of honesty and empathy.

Movember is reminder to talk about men’s mental health. The reality that we hope to change is the fact that men are less likely to seek help for mental health and are more likely to die by suicide. While more men are starting to seek help, there are still many who refuse to because they feel that it’s ‘unmanly’.

Mental Illness in Men

Men and women often present with the same mental illness in different ways. For example, while depression may present as sadness and tearfulness in women, it may manifest as anger or irritability in men. Because men are less likely to identify and speak about their emotions, these may be expressed in harmful ways, such as reckless driving, substance use, excessive gaming and domestic violence – a clear consequence of poor emotional regulation. It is not unusual for men to use substances such as alcohol and other drugs as a means of numbing emotional pain or as an escape from their stressors. This can sometimes lead to addiction, which negatively impacts other areas of life such as finance, relationships, work and health.

The suicide rate for men is higher than for women globally. This is a reflection of poor mental health, the stigma surrounding mental illness (which is higher for men) and societal expectations for men to be ‘strong’.

Social Conditioning

Being raised with stereotypes such as ‘boys don’t cry’, can lead men to suffer in silence and not seek help, as they believe that being vulnerable is a weakness. Men who grew up in homes where they’ve never witnessed their fathers speak about or show emotions – or who were punished or mocked for showing emotions – learn early on in life that it’s not okay to cry.

So, it’s not uncommon for men to struggle with identifying, understanding and regulating their emotions. In my own professional experience, men struggle more than women to name negative emotions. The most common negative emotion that men identify is anger. Yet, anger is mostly a surface level emotion, which masks the vulnerable emotions, such as hurt, sadness, disappointment, betrayal, grief, etc. Anger is an emotion that seems more socially acceptable to men, as anger isn’t regarded as weak. The reality is that suppressed emotions can create other problems in our lives.

Eliminating the Stigma

Eliminating the stigma begins with parenting and being mindful of gender stereotypes in our own homes. Boys and girls should have the same opportunities. Both should be taught to talk about feelings. Children need adult role models who demonstrate that all feelings are acceptable and a normal part of human experience.

How to support the men in your life

• Create safe spaces for men to share their struggles, without feeling that they are weak.
• Be empathic to men in your life, realizing that men are human too.
• Be mindful of the expectations that you have of men.
• Share the load where possible
• Have open conversations about how you can be more supportive.

Tips for men:

• Get curious about your emotions in different situations
• Build supportive relationships where you can be vulnerable
• Make use of healthier stress reduction – e.g. physical activity or meditation
• Seek professional help when necessary
• Recognise that it is only human to struggle with emotions.
• Read up on or listen to podcasts on mental health and emotional wellbeing

The goal is to replace toxic masculinity with emotional intelligence.

Most of us know instinctively what to do if someone falls and bruises their knee. However, when someone experiences mental health challenges, trauma, loss, grief or heartbreak, most people aren’t skilled on how to respond. Emotional wounds may be invisible, but they can be long lasting and pervasive, impacting on many areas of our lives. And because none of us are immune to mental health challenges, it helps to have some psychological first aid skills.

What is Psychological First Aid

Psychological first aid is the psychological equivalent of tending to a wound before it worsens. It’s the immediate compassionate support that we give to someone in distress. While medical first aid aims to preserve physical health, psychological first aid safeguards mental health, helping a person in distress feel safe, calm and supported until more structured support is available.

Why Psychological First Aid Matters

Because we are social beings and encounter people in different areas of life (e.g. work, communities, socially, etc.) psychological first aid is an invaluable skill to learn – also considering that challenges are inevitable in life. It’s not unusual for one to feel helpless and hopeless in the aftermath of a crisis or traumatic event. Without appropriate support, these feelings may intensify, contributing to more serious issues. Psychological first aid acts as an emotional stabilizer, to reduce the immediate distress and help build the foundation for resilience. It can also be empowering in our different environments, because when more people are equipped to offer support, fewer will suffer in silence.

How to Offer Psychological First Aid

Psychological first aid is not therapy, however the qualities of empathy and respect must always be present.

1. Ensure their Safety

Ensure that the person feels safe to speak to you, e.g. by ensuring that you are in a private space.

2. Listen with Empathy

Most people are just looking to be heard – they’re not really looking for advice. Listen actively, by giving them your undivided attention and validate their emotions. Listening helps one feel supported and reduces feelings of isolation.

3. Help Stabilize their Emotions

Offer warmth, presence and reassurance that they are not alone. Speak in a calm voice to help co-regulate. Offer to take a few slow, deep breaths together. If they are catastrophizing, you may guide them through a grounding exercise by naming 5 things that they can see, 4 things that they can feel, 3 things that they can hear, 2 things that they can smell and one thing that they can taste. Remind them that they are safe. Always ask for consent before offering a hug or any kind of touch.

4. Assess their Needs

Try to ascertain what sort of support they would most benefit from. Not everyone needs or will benefit from the same type of help. Some may require practical assistance while others may prefer emotional support.

5. Connect to Support Systems

Once the immediate crisis stabilizes, help them reconnect with resources. These may include friends, family or professional services. It helps to have a network of referral sources in your area to facilitate referrals.

Psychological first aid is not reserved for mental health professionals. Whatever role you play in your respective communities, it is an important skill to have. We live in a time where crises from personal to global affect us, and knowing psychological first aid is central to hope.

Anxiety disorders are the most prevalent type of mental disorders in South Africa with one study finding that almost 16% of the population have experienced an anxiety disorder. Another recent study shows that almost 25% of South Africans experience symptoms of probable anxiety. It’s likely that we will all meet a person with anxiety at some point. Perhaps that person is even a family member. Supporting a family member diagnosed with anxiety disorder can contribute to their healing process, so long as your support is well-informed.

1. Truly understanding their needs

Even the best intentions to support a loved one can be misguided if you don’t take time to understand the unique needs of your family member. Mental health is a spectrum and treatment is not a one-size-fits-all. Commit to continued learning not just about anxiety disorder but its expression in your family member. You can try to understand their needs by asking the person these questions and revisiting these themes through the journey:

• What makes you feel supported?
• What do I say that is helpful? Is there anything I say that you find unhelpful?
• What are some triggers that I can be aware of?
• Have you set any goals with your therapist?

1. Gentle support in reaching their goals

Some of your loved one’s goals may not seem significant but your enthusiastic support of small goals may be exactly what your family member needs right now. Depending on the nature of their anxiety disorder, attending a large event or busy place may be very daunting. If the person in question is only able to achieve a small part towards a goal, meet this with encouragement rather than pushing them too far.

2. Gentle support in preventing stagnation

While staying positive and focusing on achievements rather than failures, you can also support them in preventing avoidance of difficult tasks. Try some collaborative negotiation:

I hear you say that attending the birthday party would be overwhelming. Could we stop by for five minutes? We could leave as soon as you are feeling uncomfortable.

The nature of anxiety means that long term goals are at times suppressed due to immediate feelings of unease. As a supporting family member, your gentle reminders can keep their bigger-picture goals in focus.

3. Self-care as the supporter

It is normal to feel concerned about your loved one and you may experience feelings of anxiousness yourself. Looking after your own mental health (possibly link to Medshield blog: https://medshieldmind.co.za/expert-advice-on-mental-health-self-care-at-home/) will only enable you to look after your family member better. Monitor yourself and make sure you are not sacrificing your own goals and self-care while spending energy caregiving. Keep checking in with yourself. When your loved one panics, be sure not to panic yourself.

4. Avoid dismissive statements

Try to avoid dismissive statements that invalidate the person with anxiety’s experiences:

• “Don’t worry about it!”
• “Just calm down!”
• “Just relax!”
• “Don’t be silly!”

These statements may negate what they are feeling rather than reassure them.

5. Use supportive language

• “I know you can do it, even if you are feeling that way.”
• “Tell me what you need right now?”
• “It’s not the place that is the problem, it’s the thoughts. I know you are in pain but the situation we are in is not dangerous.”
• “Take a second to breathe.”

Statements like these can help a person to feel encouraged and grounded.

Remember, every person is unique. The road to healing is so much richer when we find support and love from the people in our lives. Helping your family member to feel seen and heard can be one of the most powerful ways to provide support.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition, which presents as persistent patterns of inattention, hyperactivity and impulsivity that interfere with one’s daily functioning.

The DSM-V classifies ADHD into three subtypes:

• Predominantly inattentive (difficulties in focus and organisation)
• Predominantly hyperactive-impulsive (restlessness, impulsivity and difficulty staying still); and
• Combined presentation (features of inattention, hyperactivity and impulsivity)

While ADHD is commonly identified in childhood, symptoms often persist into adulthood.

How does ADHD present in Adults?

ADHD in adults does not always resemble the stereotypical hyperactive child, which is why it can be missed. Symptoms in adults may appear more subtle and internalised. Adults may struggle with chronic procrastination, disorganisation, forgetfulness, poor time management and difficulty prioritising tasks. Restlessness often manifests as an inability to relax or a need to always be doing something, as opposed to the over hyperactivity we see in childhood. Another common feature, which is often missed is poor emotional regulation. This presents as low frustration tolerance, irritability and mood swings.

Why ADHD can be easily missed in Adults

In my experience, the reason that most adults with ADHD were never diagnosed as children is because they were inattentive rather than hyperactive. It’s difficult to miss the hyperactive subtype, as they are disruptive. However, children who are inattentive are not really bothering anyone, so the diagnosis may go unnoticed. Girls are more likely to mask symptoms, often due to societal expectations of how girls should behave. So, I notice that girls are more likely to remain undiagnosed. In adulthood, ADHD can be mistaken for stress anxiety or even depression, due to an overlap in symptoms. Sadly, adults who have ADHD but have not been diagnosed spend many years feeling inadequate, without realising that there is an underlying neurological explanation. Many adults tend to feel great relief upon being diagnosed, due to having regarded the symptoms as character flaws. They may, at the same time, feel disappointed about not being diagnosed earlier in life, because their lives may have been easier and they may have realized more of their potential.

Adult ADHD in Everyday Life

Recognising ADHD in oneself or a loved one may involve noticing patterns such as:

• Chronic procrastination
• Starting many projects but rarely every completing them
• Poor time management -being consistently late or missing deadlines
• Misplacing everyday items such as one’s phone, glasses or keys
• Being easily distracted during conversations or tasks
• Low frustration tolerance
• Impulsivity in decision making, spending or relationships
• Overstimulation

A diagnosis needs to be made by a qualified healthcare professional and entails taking a detailed developmental history, a structured clinical interview and relevant psychometric assessments. It is important that other conditions that mimic or co-occur with ADHD are ruled out.

Treatment for ADHD is multifaceted and may include stimulant or non-stimulant medication and psychotherapy to assist with emotional regulation, organizational skills and problem solving.

Self Management

Lifestyle factors that can help improve daily functioning include:

• Planners, apps and reminders to structure tasks and manage time
• Breaking down large tasks into smaller, manageable steps
• Establishing consistent routines for work, sleep and exercise
• Practicing mindfulness or relaxation techniques to improve focus

The diagnosis and management of adult ADHD can be truly lifechanging. With the right combination of professional intervention and self management skills, adults with ADHD can harness their strengths, reduce daily struggles and live with greater confidence.