Understanding Dissociation
© Elizabeth Ruth Lyons, August 2004
The human mind has the protective capacity to instinctively respond to shock
or extreme inescapable stress through the “freezing” of the “flight”,
“fight”, “freeze” stress response. “Freezing”
is a form of dissociation, and so it is common for traumatised people to have
originally experienced some form of dissociation when first traumatised. For
survivors of chronic severe trauma, it is then not uncommon for dissociation
to later become generalised as an automated learned response to any fear,
stress or challenge. This is especially likely when traumatic stress originated
in early childhood and whenever posttraumatic stress disorder has been later
reactivated by associations with past trauma. As dissociation tends to be
not well recognised or understood (even by mental health professionals), this
handout is intended to help explain and normalise dissociation for dissociative
trauma survivors and their supporters...
What is dissociation?
The term “dissociation” is used to describe a disconnection or separation
between aspects of consciousness which otherwise would be well integrated with
each other. Dissociated experiences are not integrated into a person’s
usual sense of time, place and/or self. In more extreme forms of dissociation,
disconnections between usually integrated functions of memory, identity, and/or
perception result in discontinuity in conscious awareness. Dissociation may account
for a fragmenting of consciousness, perception, memory, or identity that can
then cause other problems in a traumatised person’s life.
Post-traumatic stress disorder (PTSD) involves dissociation both through dissociative
avoidance of reminders of trauma and a re-experiencing of the original trauma/s
as if still happening. Re-experiencing can include “flashbacks” of
trauma and intrusive images, thoughts or emotions that seem to come out of nowhere.
For example, someone may be suddenly overwhelmed by an emotion that does not
seem in context at the time, such as the sudden experience of intense fear or
rage or grief without any apparent present cause. This may alternate with dissociative
avoidance, including “emotional numbing”, in which a person may habitually
numb all their emotions or automatically dissociate their emotions while thinking
or talking about an event that was terribly distressing so as to be unaware of
any emotional response to it. “Avoidance” can also include instinctively
resorting to “self-hypnosis” or subtly altered states of consciousness
in order to avoid reminders of trauma. This adaptation may then cause the person
further problems related to disconnections in memory or control of behaviour.
They may find themselves “missing time”, or behave in a way that
they would not normally behave but feel unable to stop themselves, experiencing
this behaviour as though they were a “passenger” in their body,
rather than the driver.
Please note that it is only if some form of dissociation is severe and chronically
interferes with a person’s everyday functioning that a “dissociative
disorder” might then be diagnosed in order to help the individual make
better sense of their experience and better inform their therapy and recovery.
Different forms of dissociation
Dissociative phenomena can alter a person’s subjective awareness in distinctive
ways, depending on whether they experience a form of dissociation involving memory,
perception, identity, physical body sensations or a combination of these. These
four core dissociative processes have been identified as: dissociative amnesia,
depersonalisation & derealisation, identity alteration and somatoform dissociation.
Dissociative Amnesia
Dissociative amnesia is defined as “the absence from memory of a specific
and significant period of time” which does not reflect memory loss due
to substance use or cognitive deficit. For example, most adults do not have
verbal memory for events before the age of two or three but do have at least
some memories
for subsequent childhood years, whereas it is not unusual for survivors of
a traumatic childhood to have dissociative amnesia for the worst years. More
typically,
there are micro-amnesias such as when the content of a conversation is forgotten
from one moment to the next. Some people report that these kinds of experiences
can leave them scrambling to figure out what was being discussed and they may
try not to let the person with whom they are talking know they have no idea
as to what is being talked about.
Depersonalisation
Depersonalisation describes the sensation of detachment from one’s body
or parts of the body/ self or one’s actions. The depersonalised individual
may feel as though they are living in dream or a movie, as if they are not real
or even as if they have died, yet they also know that this is not actually objectively
true. Trauma survivors often report “out-of-body” experiences and
may sometimes feel profoundly alienated from their bodies, such as in finding
it difficult to recognise themselves in the mirror.
Derealisation
While depersonalisation concerns feelings of unreality regarding one’s
self, derealisation refers to the sensation of one’s surroundings feeling
unreal. Trauma survivors may focus so exclusively on their internal subjective
experience that their external world recedes into the background. An individual
experiencing derealisation may feel as if they were looking at external reality
through fog or through a veil and hear someone talking to them as though from
far away. Normally familiar places, people and objects may seem unfamiliar
or hard to recognise, as if in a dream, and they may report disorientation
and an altered perception of space and time.
Identity alterations
Identity alterations occur when a person’s sense of integrated identity
(ie. having one core “self” which has different aspects or roles)
becomes split or fragmented into parts of self that are compartmentalised by
dissociative barriers such as amnesias. Each separate identity may have a sense
of being markedly different from other parts of self. Some survivors of chronic
childhood trauma have dissociated all aspects of self that remember or feel
the trauma in order to develop a well functioning adult identity in the present.
For example, a survivor may have dissociated a younger identity who experiences
himself as a six years old boy living in his childhood home and expecting a
deceased
person whom he fears to appear at any moment. He may experience the characteristic
affect (feelings), speech patterns, cognitions and body language consistent
with this dissociated child state. This form of dissociation has generated
the most
controversy amongst mental health professionals.
Somatoform dissociation
“Soma” means “body”, and this form of dissociation can
include involuntary muscle contractions, or physical sensations that were in
some way
associated with past traumatic experiences being re-experienced in the body
as “body
memories”. Alternatively, the person may experience sudden analgesia,
partial paralysis, or numbing of all or part of the body to physical sensations.
The development of dissociation and dissociative disorders
Habitual dissociation usually develops in childhood as neurophysiological
adaptations to overwhelming traumatic stress that in turn reinforce the
tendency to dissociate
(such as the ready release of endogenous opioids or natural pain relieving
neurochemicals). Children are particularly adept at dissociation, and most
commonly, repetitive
childhood physical and/or sexual abuse and other forms of interpersonal trauma
lead to the development of dissociative states or dissociative disorders. In
the context of chronic, severe childhood trauma, dissociation can be considered
adaptive because it reduces the overwhelming distress created by trauma. However,
if dissociation continues to be automatically used in adulthood when inescapable
danger no longer exists, it can become problematic. The dissociative adult
may automatically dissociate in all situations that are perceived as dangerous
or
threatening, without being able to determine whether there is actually any
real danger present. This can leave the person “spaced out” in many challenging
situations in ordinary life but unable to protect themselves in conditions of
real danger. This is partly why so many survivors of chronic child abuse have
subsequently been re-victimised as adults, when danger and safety may have become
difficult to discriminate because of the familiarity of the conditioned “freeze” response.
Therapy can be aimed at helping the adult survivor learn to discriminate safety
from danger, gain more conscious control over their dissociative responses,
and learn effective ways to stay safe. All dissociative disorders respond remarkably
well to longer-term, safe, informed therapy.
Dissociation as Affect Regulation
One of the core problems for dissociative trauma survivors is “affect
phobia” and “affect dysregulation”, or difficulty tolerating
and regulating intense emotions. Humans (and all mammals) learn to self-soothe
distressed states by the experience of being consistently protected and nurtured
over time. Some trauma survivors have had little opportunity to learn to calm
themselves or to express, modulate and contain their feelings, due to growing
up in an abusive or emotionally neglectful family. Problems in affect regulation
can also be compounded for trauma survivors by the sudden intrusion of traumatic
memories and the overwhelming emotions accompanying them. The difficulty in
managing intense feelings may trigger a change in self-state from one prevailing
mood to another. Depersonalisation, derealisation, traumatic amnesia and dissociative
identity alteration can all be thought of as efforts at self-regulation when
affect regulation might otherwise fail. Each dissociative adaptation is an
attempt by the overwhelmed mind to increase the person’s ability to
survive a particular emotion, such as feeling threatened. Becoming aware of
these emotions can be terrifying. Effective trauma therapy gradually builds
skill and confidence in a survivor’s ability to tolerate and safely
express all their emotions, in order to help the individual actualise their
full potential in relation to themselves, others and their place in the world.