A person walks home alone in the rain“Memories warm you up from the inside. But they also tear you apart.”  Haruki Murakami

We all know from popular drama (TV shows, movies, etc.) that traumatic events are often forgotten by the sufferer. People who experience a devastating event such as a car accident, natural disaster, or terror attack often cannot remember the incident. It’s also common not to remember what took place right before or right after the incident. In a similar way, many adults who suffered child abuse have difficulty recalling large chunks of time from childhood. In these cases, problems with memory can continue into adulthood as well, particularly when faced with emotional distress.

Our brain and nervous system have evolved to do spectacular things: we can read, write, make music, and contemplate the meaning of life. But the brain’s first and foremost duty is to keep us alive. When it comes to traumatic events, the part of our brain that protects our physical and emotional well-being takes control. In this process, the parts of the brain that are responsible for higher thought processes, such as forming and retrieving memories, are suppressed.

How the Brain Forms Memories

On a regular stress-free day, memories for facts are made and stored in three steps: acquisition, consolidation, and retrieval.

When we are confronted with life-threatening danger, the brain behaves differently. The amygdala sends an emergency signal to the hypothalamus, which in turn activates the fight or flight response. Corticosteroids are then released into the bloodstream in order to prepare the body for action. Blood pressure, heart rate, and respiratory function all increase to provide the body and brain with extra energy and oxygen. Our alertness increases, and our body is ready to move.

When this is happening, the amygdala inhibits the activity of the prefrontal cortex. When faced with danger, this is useful, as the prefrontal cortex operates substantially slower. While it is trying to work out what is happening, our body may be harmed. The quicker, action-oriented part of the brain enables us to respond rapidly and try to avoid danger. We act fast. Later, once we are safe, we have time to think. In respect to memory, the parts of the brain involved in memory formation are shut down when faced with a traumatic experience.

The activation of the fight or flight response prevents the parts of the brain responsible for creating and retrieving memory from functioning effectively. This is why we can forget what occurred around a traumatic event. In the case of ongoing trauma, such as with childhood abuse, ongoing problems with memory and the related process can occur, leading to what is understood as dissociation.

Dissociation and Memories

At the heart of dissociation is memory disruption.At the heart of dissociation is memory disruption. During dissociation, the normally integrated functions of perception, experience, identity, and consciousness are disrupted and do not thread together to form a cohesive sense of self. People with dissociation often experience a sense that things are not real; they can feel disconnected from themselves and the world around them. Their sense of identity can shift, their memories can turn off, and the connection between past and present events can be disrupted.

In understanding the human response to trauma, it is understood that dissociation is a central defense mechanism because it provides a kind of mental escape when physical escape is not possible. This type of defense is often the only kind available for children living in abusive situations. Posttraumatic stress (PTSD) and complex posttraumatic stress (C-PTSD) often go hand in hand with dissociation. In studies investigating the impact of PTSD and memory, researchers have found that people with dissociative symptoms have a greater impairment with both working memory and long-term memory.

Long-Term Impact of Memory Impairment

To understand the long-term impact of memory impairment due to dissociation, we need to look at the context from which it arises. Dissociation occurs as a result of ongoing trauma which is associated with chronic stress. A chronically stressed brain and nervous system have difficulty learning. The hippocampus, critical for memory formation and consolidation, can become damaged from ongoing exposure to stress hormones. Researchers have found that the hippocampus actually shrinks in people who suffer from major depression. In addition to the emotional impact of chronic stress and abuse, difficulties with learning and memory can occur as well.

Implications range from difficulties with academics to reduced on-the-job learning and performance. In terms of survival, the implications are serious, as we all need the ability to prepare for, find, and keep employment. Unfortunately, once a person frees him or herself from an abusive childhood, the effects can follow into adulthood in unexpected ways. A damaged hippocampus and overactive nervous system can make life more difficult than it has to be. Over time, self-esteem and confidence can be negatively impacted as well.

Fortunately, the prognosis of dissociation can be optimistic. Researchers have found treatment with antidepressants can increase hippocampal volume. Talk therapy and other therapeutic approaches that are designed to reduce stress and increase emotional resilience may also help.

If you are experiencing trauma or dissociation, you can find a mental health professional here.

References

  1. Bedard-Gilligan, M., & Zoellner, L. A. (2012). Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis. Memory, 20(3), 277-299. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22348400
  2. Lanius, R. A. (2015). Trauma-related dissociation and altered states of consciousness: A call for clinical, treatment, and neuroscience research. European Journal of Psychotraumatology, 6(1), 27905. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439425
  3. Nuwer, R. (2013, August 1) Why can’t accident victims remember what happened to them? Smithsonian. Retrieved from https://www.smithsonianmag.com/smart-news/why-cant-accident-victims-remember-what-happened-to-them-21942918
  4. Özdemir, O., Özdemir, P. G., Boysan, M., & Yilmaz, E. (2015). The relationships between dissociation, attention, and memory dysfunction. Nöro Psikiyatri Arşivi, 52(1), 36-41. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5352997
  5. Phelps, E. A. (2004). Human emotion and memory: Interactions of the amygdala and hippocampal complex. Current Opinion in Neurobiology, 14(2), 198-202. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15082325
  6. Rosack, J. (2003, September 5) Antidepressants may prevent hippocampus from shrinking. Psychiatric News. Retrieved from https://psychnews.psychiatryonline.org/doi/full/10.1176/pn.38.17.0024
  7. Sapolsky, R. M. (2001). Depression, antidepressants, and the shrinking hippocampus. Proceedings of the National Academy of Sciences, 98(22), 12320-12322. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045

A father holding his newborn is distracted by his phoneAttachment may be understood as the relationship between child and caregiver (often a parent). This relationship is the most important in the child’s life, as the caregiver is the provider of all his or her needs. Not only is the child dependent on the caregiver for basic survival, but the child’s social, emotional, and cognitive development also take shape within this relationship.

Attachment and the Disorganized Response

In a secure relationship, the caregiver is able to recognize and respond to the child’s needs in a way that provides support. The caregiver’s behavior is predictable and stable. In a secure relationship, the child is more likely to develop healthy emotion-regulation abilities as well as a healthy view of the self and world. This is because when the child needs comfort and reassurance, they are available. Over time, the child develops a view of the world that when help is needed, it can be counted on. In addition, the child comes to see themselves as worthy of love and support. In a safe and secure environment, the child is better able to take advantage of important opportunities for learning and development.

In contrast, children with unpredictable or abusive caregivers often experience inner conflict and may not form an organized response to fear or distress. When attachment researchers speak about an “organized response”, they are referring to the strategy the child uses when in need of care. For example, if the child’s caretaker is a source of both safety and danger (as in the case of a violent, neglectful, or abusive caregiver), the child may run to the caregiver when upset and then display ambivalence toward the caregiver, such as refusing to be picked up or displaying anger. This demonstrates a fundamentally conflicted situation for the child, as they need the caregiver for safety and at the same time need to protect themselves from the caregiver. In this way, the child can form a disorganized response to distress.

How Dissociative Symptoms Can Develop

Researchers have found that disorganized attachment is associated with dissociative symptoms. Children in a relationship with an unpredictable or sometimes traumatizing parental caregiver have a difficult time establishing a consistent view of the parent and of themselves. The parent is both needed and to be avoided. The child may not understand what makes them a “good” child or a “bad” child, as the caregiver’s behavior is often confusing and unpredictable.

In order to maintain a relationship with the caregiver—and attempt to make sense of themselves—some children simply forget or deny the abuse. Jennifer Freyd refers to this as betrayal blindness. Forgetting or denying trauma is a symptom of dissociation. It is an adaptive and defensive strategy that enables the child to function within the relationship, but it often leads to the development of a fragmented sense of self.

Disorganized Attachment Is Not Always the Result of an Abusive Caregiver

While disorganized attachment is often associated with abuse, sometimes loving caregivers who have experienced trauma themselves can behave in confusing ways toward the child. This happens because of the caregiver’s own inability to control their emotions. Traumatized parents can have a difficult time managing their emotions and providing a sense of security for the child even though they are not abusive or neglectful. Anger or fear can erupt unexpectedly and traumatize the child. A loving caregiver can be experiencing posttraumatic stress disorder (PTSD) or dissociative identity disorder and unintentionally behave in frightening or confusing ways to their child.

If a caregiver is dealing with their own trauma, it is recommended they seek therapy. In therapy the caregiver can learn to cope with stress, develop emotion-management skills, and learn more about understanding their child’s needs. Often caregivers who were raised in abusive families are unaware of how to appropriately respond to a child’s emotional needs because they themselves did not have their own needs met when they were children.

There are a range of therapeutic treatments for adults suffering from PTSD that have shown to be helpful. These techniques help reduce symptoms of trauma such as anxiety, depression, and chronic stress. Psychotherapy can provide emotional support to caregivers so they can begin to grow and provide a safe and responsive environment for themselves as well as their children.

References:

  1. Bedard-Gilligan, M., & Zoellner, L. A. (2012). Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis. Memory, 20(3), 277-299. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310188
  2. Firestone, L. (n.d.). Disorganized attachment: How disorganized attachments form & how they can be healed. Retrieved from https://www.psychalive.org/disorganized-attachment
  3. Freyd, J. J. (n.d.). What is betrayal trauma? What is betrayal trauma theory? Retrieved from: https://dynamic.uoregon.edu/jjf/defineBT.html
  4. Gillath, O., Karantzas, G. C., & Fraley, R. C. (2016). Adult attachment: A concise introduction to theory and research. Academic Press.
  5. Paetzold, R. L., Rholes, W. S., & Andrus, J. L. (2017). A Bayesian analysis of the link between adult disorganized attachment and dissociative symptoms. Personality and Individual Differences, 107, 17-22. Retrieved from http://isiarticles.com/bundles/Article/pre/pdf/155055.pdf
  6. Psychological treatment of PTSD in adults. (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. Leicester, UK: Gaskell.
  7. Waters, S. F., Virmani, E. A., Thompson, R. A., Meyer, S., Raikes, H. A., & Jochem, R. (2010). Emotion regulation and attachment: Unpacking two constructs and their association. Journal of Psychopathology and Behavioral Assessment, 32(1), 37-47. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821505

Reflection of woman walking with an umbrella in a puddleDissociation can be described as feeling disconnected from the self, the world, or reality. Someone experiencing dissociation may not remember what happens during the episode. They might also feel as if they are observing themselves from an outside perspective.

Many people begin dissociating while experiencing abuse or another traumatic event. Dissociation can help people cope with what’s happening, but if it continues after the trauma stops, it can negatively affect a person’s life.

There are several types of dissociation, though they share some common features. According to Mental Health America, about a third of people experience dissociation on occasion. About 4% of people have more frequent or severe dissociation.

People who dissociate might:

Dissociative identity (DID) is perhaps the most well-known dissociative condition. It occurs in about 1.5% of the population, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

People with DID have more than one identity state. These different identities, often called alters, can take control of the person’s thoughts and behavior, often during times of trauma or stress. The person may not remember what happens when an alter is in control.

As with other types of dissociation, DID can develop in response to trauma. It’s often linked to ongoing trauma in childhood.

What Does Dissociation Feel Like?

Mild dissociation is common. Most people daydream or lose track of time on occasion. Even briefly seeing familiar surroundings as strange or unrecognizable isn’t unusual. If these feelings happen often, last for a long time, or cause distress, it may be a good idea to talk to a counselor.

How dissociation feels may vary based on the type of dissociation and the person who has it. There are three main types of dissociation: dissociative identity, dissociative amnesia, and depersonalization-derealization. The DSM also lists other specified dissociative disorder and unspecified dissociative disorder.

People with dissociative identity might:

DID can cause distress and emotional strain. People with DID also have an increased risk for self-harm and suicidal thoughts. They may feel powerless to maintain their identity, afraid of what their alter states might do while in control, and frustrated with their inability to remember events.

Dissociative amnesia is memory loss associated with trauma. People may:

Dissociative fugue, a rare form of dissociative amnesia, can indicate DID. It occurs when a person has a period of memory loss and takes on a new identity away from home. The person may not regain memories and identity for some time.

Depersonalization-derealization disorder (DDD) is characterized by a sense of detachment from reality. People with this condition may:

People often seem unconcerned, detached, or disoriented during episodes. But because people with DDD remain aware of reality while feeling disconnected from it, the condition often causes significant distress.

5 Triggers for Dissociation

Dissociation typically develops in response to trauma. Research has linked dissociation and several mental health conditions, including borderline personality, ADHD, and depression.

Dissociative depression

Dissociative depression, a type of chronic depression, tends to develop earlier than other types of depression, sometimes as early as childhood. It’s been linked to trauma and post-traumatic anger. People may have more somatic symptoms, like pain, and are at increased risk for suicidal thoughts. They may experience mood swings, difficulty concentrating, and weight fluctuation more frequently than people with other types of depression.

Research suggests this type of depression is most common in women who experienced childhood sexual abuse. It’s often treatment-resistant—until dissociative symptoms are treated. Then the depression typically improves.

Borderline personality (BPD)

Some characteristics of dissociation are similar to those of borderline personality. For example, an alter identity may be seen as an unstable sense of self. Self-harm, suicidal ideation, and difficulty managing emotions when stressed are associated with both dissociative issues and BPD. People with BPD also often struggle in relationships and avoid difficult experiences, and many hear voices. BPD is also commonly linked to childhood trauma and neglect.

Seventy-five to eighty percent of people with BPD may experience dissociation during stress. In fact, dissociation is one of nine diagnostic criteria for BPD (five are needed for diagnosis). According to a 2016 analysis of 10 studies, dissociation occurs more often with BPD than with other mental health issues.

Recent research suggests dissociation may affect memory and emotional learning, which may be one reason why BPD is often difficult to treat.

Addiction

Research has linked addictive behaviors and dissociation. A 2005 study found that more than 17% of people getting help for substance abuse had a form of dissociation. Addiction, which can be seen as a type of dissociative behavior, has further been linked to trauma and alexithymia, a condition where people can’t identify their emotions. A study published in 2014 suggested trauma, alexithymia, and dissociation could often predict alcohol dependence. Like dissociation, addiction to alcohol may develop in response to trauma.

A 2015 study looking at 68 people who were substance-free for at least six months found that almost 25% had severe depersonalization symptoms, while over 40% experienced mild depersonalization. The study did not determine a cause of the symptoms, but the findings suggest a further link between addiction and dissociative symptoms.

Obsessive-compulsive disorder (OCD)

Multiple studies have found links between dissociation and OCD. Dissociative symptoms occur often with OCD. People with OCD might have dissociative episodes without having a specific dissociative condition. OCD symptoms can resemble dissociative symptoms, especially when the person experiences distress related to their thoughts or compulsions. People trying to resist intrusive thoughts, for example, may push them away by making themselves experience memory loss (forcible amnesia).

When people have both conditions, dissociative symptoms tend to be more severe. The risk for depression also increases, as does the risk for a co-occuring personality disorder.

Attention-deficit hyperactivity (ADHD)

ADHD is often misdiagnosed. Research suggests some children thought to have ADHD may in fact be showing signs of trauma. Telling the two conditions apart can be difficult. Blanking out while remembering something frightening, having difficulty focusing, and acting out are all signs of both posttraumatic stress and ADHD. A small 2006 study found that children who experienced abuse were more likely to show apparent symptoms of ADHD but actually have a dissociative condition.

Many children exposed to repeated trauma or abuse go on to develop a dissociative condition.
Though they may still have ADHD, it’s often not be the primary cause of symptoms. Mental health professionals may find it helpful to evaluate for posttraumatic stress as well as ADHD and ask the children they work with about home and school.

A study published in 2017 further linked ADHD and dissociation. According to the study, people with BPD are more likely to have a history of childhood trauma, dissociation, and ADHD symptoms.

Does the Cause of Dissociation Influence How It’s Treated?

Therapy is the primary treatment for dissociation. Medication might be recommended when severe symptoms of depression or anxiety accompany dissociation, but there is no medication that treats dissociation itself. If another mental health issue occurs with dissociation, effective treatment should consider both concerns.

People with borderline personality, ADHD, depression, substance abuse issues, or OCD can also benefit from therapy, but the most helpful types of therapy vary.

Dialectical behavior therapy is considered the most effective therapy for BPD, but some research suggests dissociation may negatively impact the success of DBT. People who have both conditions may respond better to treatment that focuses on dissociative symptoms. Treatment that focuses on managing BPD symptoms may not help dissociative symptoms. Research shows it’s important to address the underlying trauma as well.

Dissociative depression is often resistant to treatment when dissociation symptoms aren’t addressed, so it’s important for mental health professionals to be able to recognize dissociative issues in therapy. If chronic depression is treated with antidepressants, people with dissociative depression may see little improvement. But treating the dissociation often helps improve depression.

One study suggested screening people with substance abuse issues for dissociative symptoms, in order to treat both issues. Dissociation symptoms in people with addiction could persist if only addiction is treated.

Dissociative symptoms often go unrecognized in therapy, especially when the person seeking support has another mental health condition. Dissociation is treatable, but it’s important for therapists to recognize and address symptoms when they occur with other mental health conditions. Treatment may have less benefit when the person seeking help is dissociating, as they may not be as “present” in therapy.

When seeking help, tell a therapist about all symptoms, even if they don’t seem connected. Therapy is most effective if you can discuss all symptoms and begin to work through underlying trauma.

Remember you are not alone! Help is available. Begin your search for a counselor today.

References:

  1. American Psychiatric Association. (2018). What are dissociative disorders? Retrieved from https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders
  2. Craparo, G., Ardino, V., Gori, A., & Caretti, V. (2014). The relationships between early trauma, dissociation, and alexithymia in alcohol addiction. Psychiatry Investigation, 11(3), 330-335. doi: 10.4306/pi.2014.11.3.330
  3. Dissociative disorders. (2017, November 17). Retrieved from https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/diagnosis-treatment/drc-20355221
  4. Endo, T. (2006). Attention-deficit/hyperactivity disorder and dissociative disorder among abused children. Psychiatry and Clinical Neurosciences, 60(4), 434-438. doi: 10.1111/j.1440-1819.2006.01528.x
  5. Foster, C. (2016). Understanding dissociative disorders. Retrieved from https://www.mind.org.uk/media/4778451/understanding-dissociative-disorders-2016.pdf
  6. Goff, D. C., Olin, J. A., Jenike, M. A., Baer, L., & Buttolph, M. L. (1992). Dissociative symptoms in patients with obsessive-compulsive disorder. The Journal of Nervous and Mental Disease, 180(5), 332-337. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1583477
  7. Kleindienst, N., Limberger, M. F., Ebner-Priemer, U. W., Keibel-Mauchnik. J., Dyer, A., Berger, M., Schmahl, C., & Bohus, M. (2011). Dissociation predicts poor response to dialectical behavior therapy in female patients with borderline personality disorder. Journal of Personality Disorders, 25(3), 432-447. doi: 10.1521/pedi.2011.25.4.432
  8. Krause-Utz, A., & Elzinga, B. (2018). Current understanding of the neural mechanisms of dissociation in borderline personality disorder. Current Behavioral Neuroscience Reports, 5(1), 113-123. Retrieved from https://link.springer.com/article/10.1007%2Fs40473-018-0146-9
  9. Kulacaogu, F., Solmaz, M., Ardic, F. C., Akin, E., & Kose, S. (2017, September 30). The relationship between childhood traumas, dissociation, and impulsivity in patients with borderline personality disorder comorbid with ADHD. Psychiatry and Clinical Psychopharmacology, 27(4), 393-402. Retrieved from https://www.tandfonline.com/doi/full/10.1080/24750573.2017.1380347
  10. Mosquera, D., & Steele, K. (2017). Complex trauma, dissociation and borderline personality disorder: Working with integration failures. European Journal of Trauma and Dissociation, 1(1), 63-71. Retrieved from https://www.sciencedirect.com/science/article/pii/S2468749917300145
  11. Ruiz, R. (2014, July 7). How childhood trauma could be mistaken for ADHD. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2014/07/how-childhood-trauma-could-be-mistaken-for-adhd/373328
  12. Saddichha, S., Pradhan, N., Gupta, H. (2011). A case of obsessive-compulsive disorder presenting as dissociative disorder: The role of sodium thiopental interview. The Primary Care Companion for CNS Disorders, 13(3). doi: 10.4088/PCC.10l01134
  13. Sar, V. (2015). Dissociative depression is resistant to treatment-as-usual. Journal of Psychology and Clinical Psychiatry, 3(2). Retrieved from https://pdfs.semanticscholar.org/2e1f/54678c76ed2071655c9378ce60c56d4abfc1.pdf
  14. Sar, V. (2014). The many faces of dissociation: Opportunities for innovative research in psychiatry. Clinical Psychopharmacology and Neuroscience, 12(3), 171-179. doi: 10.9758/cpn.2014.12.3.171
  15. Scalabrini, A., Cavicchiolo, M., Fossati, A., & Maffei, C. (2016, November 21). The extent of dissociation in borderline personality disorder: A meta-analytic review. Journal of Trauma and Dissociation, 18(4), 522-543. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/15299732.2016.1240738
  16. Schafer, I., Langeland, W., Hissbach, J., Luedecke, C., Ohlmeier, M. D., Chodzinski, C. … Driessen, M. (2010, June 1). Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both-A multi-center study. Drug and Alcohol Dependence, 109(1-3), 84-89. doi: 10.1016/j.drugalcdep.2009.12.012
  17. Sirvent, C., & Fernandez, L. (2015, May 11). Depersonalization disorder in former addicts (Prevalence of depersonalization-derealization disorder in former addicts). Journal of Addiction Research & Therapy, 6. Retrieved from https://www.omicsonline.org/open-access/depersonalization-disorder-in-former-addicts-prevalence-of-depersonalizationderealization-disorder-in-former-addicts-2155-6105-1000225.php?aid=52845
  18. Spiegel, D. (2017). Dissociative amnesia. Retrieved from https://www.merckmanuals.com/home/mental-health-disorders/dissociative-disorders/dissociative-amnesia

Hand holding a four-leaf cloverSaint Patrick’s Day brings a barrage of green, four-leaf clovers, good-luck charms and wishes of good fortune. But many people, especially those who have a trauma background, feel like a dark cloud of misfortune follows them everywhere they go.

I can’t tell you how many times, in my work as a trauma therapist, I’ve heard a person say “I feel like I’m a magnet for bad things happening.” They describe a sense of beginning to get their lips above water when something terrible happens to knock them down again.

In some cases, they may actually be right. There has been some research to suggest that someone who has been traumatized is likely to be victimized again. A number of theories attempt to explain this phenomena, and while I want to explore a few here, I want to make it clear, first and foremost, that the intention of this article is not to blame victims of trauma. If there is abuse or perpetration, the accountability, responsibility, and fault always lies with the perpetrator. No one desires abuse. No one wants to be perpetrated upon. No one asks for it. The intention here is to both validate the experiences of people who have experienced trauma and explore the various explanations why some individuals seem to be unable to get out from under the “dark cloud” of trauma. [fat_widget_right]

The Cycle of Poverty

The first avenue I’d like to explore is the cycle of poverty. For those who struggle with the challenges that often accompany a lack of financial resources, the likelihood of being victimized is high. Living paycheck to paycheck, constantly uncertain of whether we will be able to afford groceries, heat our homes, or pay rent, threatens our sense of safety in the world. When we do not feel safe, when our basic needs are not met, it is extremely difficult to feel emotionally regulated. We may seek to numb emotional pain with substances, sex, gambling or self-harm. These methods of coping may, in turn, make it even more difficult to maintain a typical level of function.

The Adverse Childhood Experiences (ACE) questionnaire, a longitudinal, comprehensive study conducted by the Centers for Disease Control and Prevention, linked trauma in childhood with a host of problems, such as chronic health issues, addiction issues, relationship issues, and workplace issues (CDC, 2015). There is a strong correlation between poverty and trauma, and it can be difficult to see yourself as lucky or fortunate when you don’t know where your next meal is coming from.

Dissociation

When we experience trauma, we “check out” from the present moment to some degree, though some may check out more than others. Many people describe a feeling of floating above their bodies or watching themselves from far away. Some may experience feelings of fogginess, sleepiness, or even feel as if they’ve been drugged.

Dissociation leads us to another explanation of the “bad luck” many people with trauma backgrounds report (Sar, 2014). Often, people who have experienced trauma may dissociate to a point of not being able to read people’s nonverbal cues. They may not see, for example, the red flags of an abusive relationship until the abuse has already started. It’s often the case that they exist in survival mode, just getting through each moment without being able to see how actions and choices might affect their future. At times, dissociation can also prevent folks from being able to read people’s boundaries, which can result in relationship struggles and conflicts. They may even be less mindful of what they are doing with their bodies or their belongings, frequently leaving things behind or losing them.

The repetition of trauma seems to help our systems create a new and more empowered ending to the story. We do the same thing as adults—we just do it with our bodies. In other words, we may seek out relationships with people that subconsciously mirror our perpetrators to try to work out a happier, more resolved ending.

Those with a trauma background are also more vulnerable to addiction, which can be considered another form of dissociation. In other words, they may be more likely to attempt to numb their pain with substances. The misfortune that accompanies the struggles of addiction are numerous: financial hardship, legal issues, failed relationships—these are all things people might call bad luck. Using substances to numb pain is one factor that can contribute to these struggles. Difficulty being mindful and an inability to organize thoughts and prioritize urgent matters are other factors that may occur with dissociation.

The Compulsion to Repeat the Trauma

A third theory for why people with trauma tend to be re-victimized and end up experiencing even more trauma is based in Bessel Van der Kolk’s theory of the “compulsion to repeat the trauma” (van der Kolk, 1989). (I again want to state here how important it is to avoid blaming the victim.)

Human systems want health. When children experience trauma and have the opportunity to enter play therapy, they are likely to reenact the trauma with dolls or toys. They will reenact the trauma over and over again until Superman comes and rescues the victim or a lion comes and eats the perpetrator. At that point, we consider the trauma processed, at least for that developmental stage (children may experience a resurfacing of symptoms when they hit puberty or adulthood and need to process through the trauma again).

The repetition of the trauma seems to help our systems create a new and more empowered ending to the story. We do the same thing as adults—we just do it with our bodies. In other words, we may seek out relationships with people that subconsciously mirror our perpetrators to try to work out a happier, more resolved ending. The problem is, of course, we usually end up experiencing more abuse, more trauma, more bad fortune.

Our Brains Love a Story

Finally, there is just this simple fact: sometimes bad stuff happens—to everyone. Our brains function on stories. Our brains try to make sense of our world. If the story we tell ourselves is that we are unlucky and cursed, we may filter all of the things that happen to us to refine a narrative that fits that story (Brown, 2017).

For the most part, there is cause and effect in our lives. There are patterns to what we do and the lives we create. The belief that we have “bad luck” might in reality be a lack of understanding of these patterns. In order to address our trauma and dissociation and create lives of abundance, we may need professional support.

But we can also strive to remember that accidents happen. Bad things happen. If we walk around looking for evidence that we are unlucky, we are likely to find it, since our brains can filter the things that happen to us to fit our hypothesis.

I am not saying the previous theories should be discounted, because they do hold water. And again, no one asks to experience trauma or be victimized, and those who do experience traumatic experiences are not to blame for them. But the more we can own the paths we walk and the choices we can make, the more we will likely begin to see our own strength and power. We may, then, begin to realize there is no better way to good fortune than bravery and compassion, both for our paths and for our ability to sit with the whole truth.

References:

  1. Adverse childhood experiences (ACEs). (2016, April 1). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/index.html
  2. Brown, B. (2017). Rising strong: How the ability to resent transforms the way we live, love, parent, and lead. New York, NY: Random House.
  3. Sar, V. (2014). The many faces of dissociation: Opportunities for innovative research in psychiatry. Clinical Psychopharmacology and Neuroscience, 12(3). 171-79. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293161
  4. van der Kolk, B. (1989). The compulsion to repeat the trauma. Psychiatric Clinics of North America, 12(2). 389-411.

2017 Best Resources for DissociationDissociation describes a detachment from reality during which a person might hallucinate, daydream, or experience changes in their behavior or identity for a period of time. Individuals who dissociate may have memory loss or an “out-of-body” feeling during these episodes. Extreme dissociation can negatively impact a person’s life and daily function, and those who have dissociative experiences are urged to seek help to better understand their symptoms and learn about what is causing the dissociation.

Though dissociation may co-occur with other mental health conditions, it has no single predictor. Because it is common for individuals with dissociation to have experienced trauma or posttraumatic stress (PTSD) at some point in their lives, it can often be associated with trauma. Others may experience anxiety, panic, or obsessions and compulsions (OCD) alongside dissociation.

As dissociation is often a method of coping with stress or trauma, therapists who treat dissociation aim to help people find alternative coping mechanisms that can help them feel empowered rather than removed in their personal lives. Seeking help from a trained mental health professional is strongly encouraged, but in the meantime, or even if you or a loved one are already pursuing therapy, GoodTherapy.org’s favorite dissociation websites and organizations of 2017 may also help provide guidance and support.

Double exposure image shows silhouette of person's head looking out among clouds with second exposure of cloudsThe condition that used to be known as “multiple personality disorder” is perhaps one of the most complex types of mental health condition. Though frequently depicted in movies and the media, since the 1994 publication of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, multiple personality has not been recognized as a clinical diagnosis by the American Psychological Association. In its place is the more enigmatic-sounding, lesser known “dissociative identity disorder” (DID).

Though it’s been more than twenty years since this change, a Google search of “multiple personality disorder” still produces many times the results as a search of “dissociative identity disorder.”

What, then, is the difference between the two concepts, and why hasn’t DID gained more cultural traction?

The Rise and Fall of an Idea

The idea of multiple personalities inhabiting the same body, which appears to be a constant source of fascination to the public, has long been explored in fiction, poetry, and film. Robert Louis Stevenson’s famous novel Dr. Jekyll and Mr Hyde, first published in 1886, permanently imprinted the idea of the dual personality in the collective mind long before the popularization of psychological ideas.

By 1980, when multiple personality was first identified as a separate condition, the concept of multiple personalities was already well known. Seven years previous, the book Sybil: The Story of a Woman with 16 Different Personalities, which described a woman who had 16 personalities, sold hundreds of thousands of copies and was even turned into a movie. The book’s title illustrates the way the concept of multiple personalities plays on deeply rooted concepts of possession. From 1980 to 1994, the year multiple personality was replaced with DID in the DSM, annual diagnoses went up from the low hundreds to the mid-thousands.

When psychology and popular culture intersect so neatly, there is often a danger of the latter leading the former astray, as with this case. Increasingly, professionals came to recognize that the popularized concept of multiple personalities substantially distorted the real experience of those who had been diagnosed. Thus, in the DSM-4, the diagnosis of MPD was replaced with DID to emphasize it was dissociation, rather than multiple personalities, per se, that was particularly significant.

What is different about people who have DID is the dissociation they experience when they transition between these personality states, dissociation that often leads to lapses of memory and a sense of discontinuity. In other words, what is unique is that their personality states are not integrated into a greater whole.

Increasing awareness of dissociation involves more than simply changing the name of the condition, however. To do so, I believe it is essential to consider these two key points.

First, having different personae is not what is unusual about dissociative identity. All of us are likely to behave and even think in substantially different ways depending on whether we are at work, at a party, with an old friend, a new partner, our children, and so on. What is different about people who have DID is the dissociation they experience when they transition between these personality states, dissociation that often leads to lapses of memory and a sense of discontinuity. In other words, what is unique is that their personality states are not integrated into a greater whole. As some people put it, rather than having more than one personality, they have less than one.

Another key point is that the dissociation between personality states is part of a spectrum of dissociative phenomena experienced by people who have DID. Dissociation can occur in the way the individual experiences the passage of time (i.e. flashbacks), consciousness (thinking about themselves as if they were a third or second party), their body (feeling that they are “out of body” or looking at themselves from the outside), and emotion (not experiencing normal emotions in response to stimulus or experiencing them only vicariously). In more extreme cases, dissociation might present as different personality states that may be startlingly dissimilar, but this does not mean there are actually two or more identities within the same body. Instead, DID can perhaps best be understood as a cluster of severe dissociative symptoms.

The Link Between DID and C-PTSD

As I discussed in an earlier article, dissociation is one of the most frequent and characteristic symptoms of complex posttraumatic stress (C-PTSD). Children who experience multiple incidents of abuse, neglect, or other forms of ill treatment at the hands of a caregiver may respond by detaching in some way from their situation as a coping or survival mechanism. This detachment, or pattern of dissociative thoughts, becomes a fixed part of their personality and persists into adulthood in radically changed circumstances. The stimuli triggering dissociative episodes is beyond the individual’s control and often also beyond their understanding. A central part of therapy for C-PTSD is the identification of these triggers and the development of responses that can help the individual avoid or manage dissociation.

It’s not surprising, then, that DID often co-occurs with C-PTSD. Indeed, one might go further and wonder whether the two should really be considered separate categories. Many people have criticized the “dynamic nominalism” of the DSM—in other words, the distillation of complex arrays of symptoms into concrete syndromes … until they are changed ten years later. Nothing illustrates this better than the history of DID. In the first two editions of the DSM, the phenomenon of split personalities was included as a category of what was referred to as hysterical neurosis. In the DSM-3, the terms ‘hysteria’ and ‘neurosis’ were omitted entirely and multiple personality emerged as a separate diagnosis, only until it was replaced in the DSM-4 with DID.

In this, I am reminded of the words of John Briere:

“If we could somehow end child abuse and neglect, the eight hundred pages of the Diagnostic and Statistical Manual (and the need for the easier explanations such as DSM-IV Made Easy: The Clinician’s Guide to Diagnosis) would be shrunk to a pamphlet in two generations.”

References:

  1. Gillig, P. M. (2009). Dissociative identity disorder: A controversial diagnosis. Psychiatry (Edgmont), 6(3), 24–29.
  2. Lanius, R. A. (2015). Trauma-related dissociation and altered states of consciousness: A call for clinical, treatment, and neuroscience research. European Journal of Psychotraumatology, 6, 10.3402/ejpt.v6.27905. http://doi.org/10.3402/ejpt.v6.27905
  3. Lawson, D.M. (2017). Treating adults with complex trauma: An evidence-based case study. Journal of Counseling and Development, 95(3), 288-298. http://doi.org/10.1002/jcad.12143
  4. Najavits, L., & Walsh, M. (2012). Dissociation, PTSD, and substance abuse: An empirical study. Journal of Trauma & Dissociation : The Official Journal of the International Society for the Study of Dissociation (ISSD), 13(1), 115–126. http://doi.org/10.1080/15299732.2011.608781
  5. Spitzer, C., Barnow, S., Freyberger, H. J., & Grabe, H. J. (2006). Recent developments in the theory of dissociation. World Psychiatry, 5(2), 82–86.
  6. Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. D. (2013). Therapeutic assessment of complex trauma: A single-case time-series study. Clinical Case Studies, 12(3), 228–245. http://doi.org/10.1177/1534650113479442

Person in long black dress walks down street looking back over shoulderDissociation was first described more than a century ago. It was not until more recently, though, that the concept became a standard part of the psychological lexicon. For many people, it is still shrouded in mystery. Terms such as dissociative identity, “dissociative fugue,” or “depersonalization” sound opaque, even intimidating. This can make it difficult for those experiencing dissociation to understand what they are going through and seek appropriate help.

Better-known concepts such as anxiety or depression may be easier to understand because they are extreme versions of universally recognized feelings. Someone who has not struggled with clinical depression or anxiety can fully appreciate how it feels. But to some extent we can extrapolate from common feelings of sadness and nervousness to draw a picture of what these conditions are. By comparison, dissociation may be an alien and unfamiliar experience to many people.

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However, while this may not be generally recognized, dissociation is actually something experienced by many—perhaps even the great majority—of people on an occasional basis. Have you ever walked somewhere and got to your destination realizing you remember nothing from the trip? Have you ever been in a boring meeting and found yourself daydreaming, only “awakening” 15 minutes later to find you have no idea what was discussed? Have you been engrossed in a book, only to suddenly realize you can’t remember what you just read? Even if the answer is no, you probably know plenty of people for whom the answer is yes.

All of these are miniature examples of dissociation which occur in day-to-day life. What they share is an experience of detachment, disconnection, or dissociation from the surrounding environment. Such experiences need not be indicative of anything wrong. They may well not even be unpleasant. But when they are frequent, uncontrollable, or a source of distress, they become problematic.

Dissociation is a common response to trauma. Many people who have been through traumatic experiences find that they are temporarily unable to remember what happened, even when they have feelings of fear, anguish, or grief as a result of their experiences. Others have a somewhat opposite experience: they can remember the incident clearly, but they feel detached from it, as if it happened to someone else or they watched it in a movie.

In many cases of posttraumatic stress (PTSD), the person experiences dissociation when confronted by stimuli that remind them of the traumatic experience. They “tune out” of memories that are too painful to confront head-on. In more mild cases, this coping mechanism is not particularly problematic, but it becomes so when dissociation is a habitual response to everyday occurrences. Therapy for PTSD typically consists of adopting strategies to cope with these stimuli without triggering dissociation.

One of the key links between PTSD and complex posttraumatic stress (C-PTSD), dissociation plays a central role in diagnosing and understanding C-PTSD. As I have discussed in other articles, the concept of C-PTSD was developed to understand personality conditions that had many features associated with PTSD.

When the trauma is drawn out over a number of years, dissociation becomes a way of life. Once learned, it is a fixed part of the personality that asserts itself long beyond the original dangers that prompted it.

While similar to PTSD in many ways, C-PTSD has features that make it unique. This pattern of similarity and difference is the product of their overlapping but distinct causes. PTSD is the result of a small number of impersonal dramatic and traumatic incidents (often just one), such as road accidents, witnessing a violent death, or being held hostage. The different pattern of C-PTSD comes from the fact it results from a sustained period of traumatic incidences (which, taken individually, may not be significant enough to produce symptoms of trauma), usually in childhood, which happen at the hands of someone the victim has a personal relationship with—often a primary caregiver such as a parent.

In C-PTSD, dissociation may play an even more crucial role than it does in PTSD. Children are particularly likely to engage in dissociation because of their lower emotional maturity and limited experience. Children have little or no ability to control their situation. They are reliant on caregivers for the primary needs of food, shelter, nurturing, and safety. In response to abusive or disturbing behaviors at home, where active resistance is out of the question, the child will find that the most natural and safe response to cope with the abuse is to detach, to go through these traumatic experiences without really experiencing them.

When the trauma is drawn out over a number of years, dissociation becomes a way of life. Once learned, it is a fixed part of the personality that asserts itself long beyond the original dangers that prompted it. This is an illustration of the principle that C-PTSD is essentially a learning process gone awry as a consequence of the child developing in a dangerous environment.

Forms of dissociation resulting from C-PTSD can be extreme. A common symptom is fragmented personalities. Growing up, the child may have developed different personality states that were called upon in abusive situations. These multiple personalities may persist into adulthood and are triggered by situations reminiscent in some way (often tangentially) of the abusive situation. When these supplementary personalities take over, the person may do things that are out of character for their main state, even things they find abhorrent. In the most extreme cases, these dissociative states may persist for days on end, leaving the person with no memory of what they have been doing during the interval.

Learning to gain control over dissociation and, in particular, mitigate negative effects that may result from dissociative episodes is a central part of therapy for C-PTSD.

References:

  1. Ford, J. D., & Courtois, C. A. (2014). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1, 9. Retrieved from http://doi.org/10.1186/2051-6673-1-9
  2. Lawson, D.M. (2017). Treating adults with complex trauma: An evidence-based case study. Journal of Counseling and Development, 95(3), 288-298. Retrieved from http://doi.org/10.1002/jcad.12143
  3. McKinsey Crittenden, P., & Brownescombe Heller, M. (2017). The roots of chronic post traumatic stress disorder: Childhood trauma, information processing, and self-protective strategies. Chronic Stress, 1, 1-13. Retrieved from https://doi.org/10.1177/2470547016682965
  4. Sar, V. (2011). Developmental trauma, complex PTSD, and the current proposal of DSM-5. European Journal of Psychotraumatology, 2, 10.3402/ejpt.v2i0.5622. Retrieved from http://doi.org/10.3402/ejpt.v2i0.5622
  5. Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. D. (2013). Therapeutic assessment of complex trauma: A single-case time-series study. Clinical Case Studies, 12(3), 228–245. Retrieved from http://doi.org/10.1177/1534650113479442

Double exposure image of woman on street in two places at once with long blonde hair, looking outHollywood often does a disservice to people with mental health conditions. Consider the number of feature films and television shows depicting people experiencing mental health issues as being dangerous, low functioning, and undesirable. Not only are people with mental health challenges not accurately represented, these inaccurate depictions can also do damage by generating prejudice and creating additional stigma and related stress for those trying to function. The burden of stigma is likely to make the world even more difficult to navigate for individuals living and coping with mental health concerns.

In recent years, efforts to increase mental health awareness and reduce stigma have led to some changes, including more accurate portrayals of mental health issues and those who experience them, but much work still needs to be done. One particular portrayal that fell flat appeared in the movie Split, released in early 2017. In this movie, which was roundly criticized for its portrayal of mental health conditions, a character with dissociative identity disorder (DID) had a dangerous alternate personality. As a counselor who treats dissociative conditions such as DID, the majority of which are not characterized by violent behavior toward others, this was particularly disturbing to me.

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It is imperative we, as a society, receive accurate information about not only DID but all mental health conditions, instead of relying on the distorted information, provided by Hollywood and other unreliable sources, that so often leads to fear and discrimination.

Prevalence of DID

When I was in graduate school, dissociation wasn’t really highlighted. It was only briefly mentioned before we quickly moved onto “more common” mental health concerns. Based on this, I assumed dissociative conditions, DID in particular, were such a rare phenomenon I was highly unlikely to encounter them in practice.

As it turns out, this couldn’t have been further from the truth. DID and other forms of dissociation are far more common than many think. In fact, according to the Institute for the Study of Trauma and Dissociation, it is estimated the prevalence of DID in the general population is between 1 and 3%. In inpatient psychiatric units (including those for adolescents, eating disorder treatment, and substance abuse programs) the prevalence is estimated to be between 1 and 5%.

Factors in the Development of DID

There are varying theories about why a person might develop DID. One theory, based on the work of pioneers in the diagnosis and treatment of dissociative disorders—Pierre Janet, Francine Shapiro, Onno van der Hart, Frank Putnam, Colin Ross, Stephen Porges, and Bessel van der Kolk, among others—is that DID is a way the brain learns to organize itself in order to survive traumatic experiences. This theory, incidentally, describes my own belief about DID’s origins. In my work with people who have developed DID, I have found 100% of them to have experienced some kind of trauma in childhood, including ritual abuse; neglect; sexual, physical, or emotional abuse; and medical trauma, among others.

To better understand DID, we must consider the nervous system and information processing system in the brain. When a person has normal, healthy experiences, the brain is able to take in this information, decide what is important and what is not, and then file it away in the area designed to hold memory. When the person recalls the experience, there likely won’t be much of an emotional charge when bringing up the (non-traumatic) incident.

However, when a person, particularly a very young person, experiences trauma, the nervous system immediately experiences a heightened sympathetic nervous system response (also known as “fight or flight“). When the child—DID typically begins in childhood—goes into this sympathetic nervous system arousal but cannot fight off the pain, perpetrator, or trauma, the next best thing they can do is to shut down into a hypoaroused, numb, disconnected state. The nervous system is in survival mode, and the integrative capacity of the brain is compromised and therefore unable to properly integrate the information. Thus, the traumatic memory stays frozen in time.

As the child grows up, these parts/alternate memory may become more distinct, and subsequent traumatic events may cause the brain to divide further into various parts to hold on to the aspects of trauma. These parts take on distinct personalities and identities.

For people with DID, pain and abuse are experienced again and again. Because these experiences are pervasive and so overwhelming to the nervous system, the person’s brain has to split off the experience(s) so they can continue to survive and function in life. One or more alternate memory networks, or parts, are created in the brain to hold the various components of memory to allow the person to continue to function. In a child who has experienced or is experiencing abuse, this process is particularly helpful as they attempt to survive in an environment where they are being hurt by their caregivers but must depend on those who are abusing them at the same time. Essentially, the process of dissociation allows a person to survive what might otherwise not be survivable.

As the child grows up, these parts/alternate memory may become more distinct, and subsequent traumatic events may cause the brain to divide further into various parts to hold on to the aspects of trauma. These parts take on distinct personalities and identities. This internal dynamic, if not treated, continues into adulthood. Some parts are responsible for helping the person to function in daily life. Other parts continue to hold any unresolved traumatic memories, feelings, sensations, images, thoughts, and beliefs the person experienced at the time of trauma.

A person with DID may or may not be fully aware of the dynamic inside. Often they believe they are “crazy,” but the reality is they are incredibly resilient. They are intelligent and creative. They are generally not at all like the dangerous, unstable characters often depicted in films and television—though viewing these portrayals could lead them to believe they are in fact similar, or at least appear to others as such. In my experience, people who have DID are often high-functioning and highly adaptive. In fact, you have likely met someone with DID and not known—people with this condition are generally adept at skillfully navigating social situations because they have clever parts who learned how to adapt to various challenges.

Treatment for DID

Although they navigate the world skillfully, people with DID experience real suffering. The parts or alternative memory networks holding the trauma may become activated and bring about various challenges:

These parts are not malicious in their intentions. They are merely operating with the information they hold, which is not complete. Often, these parts do not know the trauma is over. They are not aware the person got out of the situation and became able to act on their own and do things to keep themselves safe. Essentially, the whole system wants to feel better, but sometimes parts are not on the same page. This is where therapy helps.

The great news for those who have DID is that the condition is treatable. Good therapy treats DID (as well as the underlying trauma) not by attempting to “get rid” of parts. Instead, a well-trained therapist will help the system orient to the present, work with the person seeking treatment to explore each part and help them learn to together, and help the system work through the memories that could not be integrated at the time of trauma.

If you want more information on the realities of dissociation, a good resource for research-based, accurate information is the Institute for the Study of Trauma and Dissociation.

The next time you see an example of any mental health issue (not just DID) in the media, suggesting people with that condition are unstable, dangerous, or undesirable, remember to consider the reliability of the source and seek out the truth from experts and reliable organizations.

References: 

  1. Chu, J. A., Dell, P. F., Van der Hart, O., Cardeña, E., Barach, P. M., Somer, E., … & Twombly, J. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12, 115–187. Retrieved from http://www.isst-d.org/downloads/guidelines_revised2011.pdf
  2. Nedelman, M. (2017, January 23). What Shyamalan’s Split gets wrong about dissociative identity disorder. CNN. Retrieved from http://www.cnn.com/2017/01/23/health/shyamalan-split-movie-dissociative-identity-disorder/index.html

Arms to chest, staring out window Dissociation is a way people, to varying degrees, disconnect from their thoughts and feelings in order to avoid pain or traumatic memories. It is a refuge of sorts into an altered state of mind that is often characterized by obsessive thoughts, fantasies, or even non-thinking states. It can be employed consciously or unconsciously as a defense mechanism and can range in intensity from mild daydreams to feeling separate from one’s body.

In this time of advanced technology (societal dissociation?), dissociating is easier than ever. You can simply turn on the television or, better yet, turn on your computer or mobile device and find yourself on a high-speed train through the internet highway, encountering all kinds of people, distracting yourself with all kinds of information, and stimulating yourself in all kinds of ways. All the while, your body is there, in the chair or wherever it is, coping with the emotional unrest residing deep inside.

Although dissociation can be an effective short-term strategy for pain management, it often wreaks havoc on relationships.

The Impact of Dissociation on Relationships

Relationships flourish when the participants relate to each other, which requires mutual sharing of thoughts and feelings not just about each other but about their lives and the world around them, about their pasts, and about the future. Relating is the “food” of a relationship.

Dissociation can distress relationships because it undermines the ability to relate and thus starves the relationship over time.

Dissociation can distress relationships because it undermines the ability to relate and thus starves the relationship over time. It is a bit of a catch-22: people often (unconsciously) choose partners who will bring up elements of their painful past in order to grow, heal, and develop. For those who dissociated during that original pain, however, employing the strategy now starves the relationship of the food of relating to each other.

Many people who frequently dissociate find that relationships can feel quite stifling. Inevitably, painful memories and feelings arise in the relationship and they (unconsciously) dissociate. At the same time, they see this other person there feeling hurt that they’ve disconnected or “left,” and feel trapped. They can’t leave, but they can’t stay, either. It can feel agonizing, lonely, and confusing to both partners when dissociation occurs. [fat_widget_right]

How Couples Counseling Can Help

A good couples counselor can be an invaluable resource and guide to finding a new way forward, both for the individual who dissociates and for the distressed couple. Specifically, couples counseling can help by:

If there is unresolved pain or trauma in the background of your relationship and you suspect dissociation may be hurting your ability to relate to your partner, contact a trained and compassionate couples counselor. You don’t have to suffer alone.

Person seated on bed looks out open windowIf you are already working on healing from a history of trauma, dissociation is likely a familiar concept. You are likely aware it is a system of coping that, in times of distress, offers protection from the full realization of trauma and its associated emotions, sensations, images, thoughts, and patterns of thinking.

The lack of realization and integration of these components creates the symptoms that bring people to therapy. The greater the extent and intensity of the traumas, the greater the complexity of the typical dissociative process and, of course, the treatment approach.

The “window of tolerance,” a concept introduced by Daniel J. Siegel, describes the equilibrium our systems need in order to heal from trauma. When we have unhealed traumas, our systems may not be fully present. They might not fully know or feel that the danger has passed and can become fixed in states of hypoarousal and hyperarousal or fluctuate between the two states.

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Hypo- or hyperarousal can result from the dissociative symptoms linked to the trauma, which may be positive (adding to the experience) or negative (taking away from the experience). Positive dissociative symptoms might include intrusive images, emotions, sensations, and thoughts. Negative dissociative symptoms may include amnesia, derealization, and depersonalization.

When we are stuck in these upper and lower zones of hyper- or hypoarousal, the full integration and healing of trauma cannot occur. But in the middle, within the window of tolerance, healing and integration can occur.

The shift outside the window of tolerance into hypo- or hyperarousal is the dissociative process, and it may be subtle or extreme. In those moments we experience what I call the “quantum leap effect,” where aspects of our former self, still stuck in the original trauma, do not have access to what the present self knows. That keeps us stuck in the reliving of the traumatic material, even though a part of us—an inaccessible part, so long as we are dissociating—knows it is in the past.

Anchoring Yourself in the Present

After noticing a dissociative shift into hypo- or hyperarousal, it may be helpful to utilize a skill that anchors you mindfully to the present. The anchor is not just about noticing you are “in the now.” It is imperative you notice and acknowledge the present is different from whatever you think you are stuck in. “I know I may be seeing old stuff,” you might tell yourself, “but that old stuff can’t be happening because I am in this room now, and these are the ways it looks different.”

The shift outside the window of tolerance into hypo- or hyperarousal is the dissociative process, and it may be subtle or extreme.

A more specific example might look like this: “The wall is brown, there is carpet, and I am 22 years old. I can’t be in that old circumstance. I am in the same room as this brown carpet. It must be over, because I am in a different room and I am older. I wasn’t wearing these shoes. In fact, I couldn’t fit in these shoes if I was in that time.”

If you are trying to heal from trauma, think of this anchoring skill as a way to get aspects of your former self more current and stay within your window of tolerance. To really take root, it must be practiced over and over. But it is an essential coping skill for any trauma survivor, even before processing any traumatic material in therapy.

Reference:

Siegel, D. (1999). The Developing Mind. New York: Guilford.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.