What Is Dissociation?
Dissociation is a term used to refer to the phenomena of disconnecting from oneself. A person experiencing dissociation feels separate from their thoughts, feelings, physical sensations, and behaviour. The experience is typically uncomfortable and can be frightening. There is a loss of one’s sense of identity. Many people who experience dissociation report feeling as though they have left their body and are watching their life events unfold from a distance.[1]
The Link Between Trauma and Dissociation
Dissociation usually happens in response to stress and overwhelm.[2] Traumatic events in both childhood and adulthood can lead to dissociation. Childhood trauma, in particular, such as physical, sexual, or emotional abuse, poses a significant risk that the affected child will develop a dissociative disorder.
According to research published in Clinical Psychopharmacology and Neuroscience, ‘patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders.’[3] Single events other than childhood trauma can also lead to dissociation, such as exposure to natural disasters, combat in war, or witnessing a violent crime.
Dissociation as a Freeze Response
Psychologists, mental health experts, and anyone with an active interest in psychology and trauma are aware of the threat response cycle – a natural internal process that helps us survive threats. An integral part of the natural threat response cycle in humans and other mammals is fight/flight/freeze.
When we face a threat, signals are sent from the brain to the body that mobilise us to survive the danger. Adrenaline, cortisol, and norepinephrine – important stress-related chemicals – flood the body. Our heart rate increases, our muscles tighten, and our breathing gets heavy. All of this serves to help us to fight the threat if we perceive that we can defeat it. If we perceive the threat as too strong to fight, we flee. If fighting and fleeing or not viable options, we freeze.
We see a simple example of freeze when we look at animals in the wild. Benjamin Fry’s The Invisible Lion offers a useful example of the threat response.[4] When a predator, such as a lion, chases its prey, such as a gazelle, the gazelle will flee for its life. It knows it cannot defeat the lion. It flees, and just as it is about to be caught, it freezes.
To the observer, the gazelle looks dead. It becomes completely inert. It became overwhelmed by the threat and had to shut down. This serves as a survival purpose. If there is a chance for the gazelle to escape later, all of that frozen energy will reactivate. The gazelle will run and kick with erratic energy, eventually discharging it and returning to normal.
Humans are complex mammals, so even though we share our threat response cycle with other mammals, ours is more complex. Our logical, rational human brain sets us apart from the rest of the animal kingdom. Although it helps us solve problems and utilise abstract thought, it can also distort our perception of the world around us.
As humans, we rarely freeze like the gazelle. Instead, our ‘freeze’ response happens on a psychological level. We can still move and, to the observer, look as though we are fine. However, the overwhelming threat that we can neither fight nor flee from causes us not to physically freeze but psychologically dissociate. Dissociation, then, can be considered as a human freeze response.
What Are the Symptoms of Dissociation?
Dissociation can look different among those affected. It can range from mild to severe and is usually reported to occur in the form of the following symptoms.
Depersonalisation
Depersonalisation is the experience of feeling disconnected from one’s body.[5] Parts of the body, such as the hands and feet, can seem as though they are not your own. Some parts may feel numb or cold, or appear to take a different shape or size. Some people who experience depersonalisation report feeling as though they have left their body entirely, where their point of view is slightly above or behind their physical body.
Depersonalisation is a symptom of dissociation most often seen in those with a history of childhood maltreatment and abuse. Abuse in childhood has an extensive list of consequences on a person’s health and well being. The abused child may not entirely understand what is happening.
The experience is deeply overwhelming and becomes more complicated when the perpetrator of abuse is a close family member. The child must take some line of defence. Since they are too small to fight or flee, they are likely to depersonalise – a momentarily adaptive, bit in the long term maladaptive, means of coping with the traumatic experience.
Derealisation
Derealisation refers to the feeling that the world or the people in it seem unreal.[6] A person experiencing derealisation might perceive the world as cartoon-like or distorted. Time is distorted, where recent events can feel like they happened months or years ago. There is a sense of falseness or artificiality about the external world. As a trauma coping mechanism, derealisation makes that traumatic event(s) seem less real, and therefore less overwhelming.
Dissociative Amnesia
All of us are forgetful from time to time. We might forget a person’s name or where we left our keys, but the memory usually comes back. If it doesn’t, it is still not usually a problem. However, memory loss can also occur as a result of trauma-related dissociation. This is known as dissociative amnesia.
Dissociative amnesia refers to the experience of forgetting one’s traumatic memories and information.[7] This arises in those suffering as lapses in memory that can span months or years, completely forgetting one’s traumatic experiences, or having an interrupted memory of the trauma where it feels like it was not a direct experience.
Dissociative amnesia can be frightening. Many of those who experience it report feeling embarrassed and disoriented. This experience is made more difficult when those suffering begin to worry that there is something wrong with them, that they have some form of brain damage, or low intelligence.
Dissociative amnesia is not a sign of low intelligence. It is a reasonable coping mechanism used to prevent the psyche from falling apart following a traumatic experience. Disconnecting from overwhelming and disturbing memories allows trauma survivors to continue their lives and engage in daily activities, such as going to school or work or looking after a loved one. Still, if this symptom of dissociation persists, intervention and treatment are necessary.
Identity Disruptions
Dissociation as a trauma response can jeopardise a person’s sense of self. People may forget who they are, what they believe, and how they have behaved or related to others in the past. Confusion around identity is a common, natural human experience but is problematic when it persists. Trauma survivors may experience such confusion to a much greater degree than the rest of the population.
Trauma can also alter one’s sense of identity. This is known as identity alteration and is a common symptom of dissociation. A person struggling with this symptom may believe that their thoughts and emotions are not their own, or that they themselves are more than one person.
The reality of this symptom is that we do, in fact, have different ‘parts’ that can seem like different personalities. Still, these are all parts of the ‘whole’. A person with identity alteration may struggle to fully integrate these parts, making each part feel like an entirely different personality.
Flashbacks
Flashbacks are a type of dissociative experience often reported by trauma survivors, particularly those struggling with post-traumatic stress disorder (PTSD). Flashbacks are experienced as a reliving of one’s traumatic past events[8], where one’s conscious awareness is not rooted in the present but when the trauma happened.
Healing from Trauma-Related Dissociation
Traditional talk therapy can help many clients, but those who struggle with dissociation typically need a trauma-focused approach to therapy. Merely talking about one’s dissociative symptoms rarely brings about the change in the nervous system necessary to heal from trauma-related dissociative conditions.
Trauma and dissociation are problems that are rooted in the nervous system. As such, healing approaches should address the nervous system. Clients require a visceral sense of safety for therapeutic outcomes to be effective. Safety must be perceived in the therapy office, in the relationship between client and therapist, and in the client’s own body.
Trauma-focused Cognitive Behavioural Therapy (TF-CBT)[9] and Eye Movement Desensitisation and Reprocessing (EMDR)[10] are trauma-focused healing modalities that can benefit dissociative clients. These modalities promote a visceral sense of safety and groundedness in the present in clients.
If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).
[1] Ciaunica, Anna et al. “When The Window Cracks: Transparency And The Fractured Self In Depersonalisation”. Phenomenology And The Cognitive Sciences, vol 20, no. 1, 2020, pp. 1-19. Springer Science And Business Media LLC, doi:10.1007/s11097-020-09677-z. Accessed 9 Mar 2021.
[2] Lanius, Ruth A. “Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research.” European journal of psychotraumatology vol. 6 27905. 19 May. 2015, doi:10.3402/ejpt.v6.27905
[3] Şar, Vedat. “The many faces of dissociation: opportunities for innovative research in psychiatry.” Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology vol. 12,3 (2014): 171-9. doi:10.9758/cpn.2014.12.3.171
[4] Fry, Benjamin. The Invisible Lion: Flatpack Instructions for Life. Independently Published, 2019.
[5] Simeon, Daphne. “Depersonalisation Disorder”. CNS Drugs, vol 18, no. 6, 2004, pp. 343-354. Springer Science And Business Media LLC, doi:10.2165/00023210-200418060-00002. Accessed 9 Mar 2021.
[6] Hunter, Elaine C M et al. “Depersonalisation And Derealisation: Assessment And Management”. BMJ, 2017, p. j745. BMJ, doi:10.1136/bmj.j745. Accessed 9 Mar 2021.
[7] Leong, Stephanie et al. “Dissociative Amnesia and DSM-IV-TR Cluster C Personality Traits.” Psychiatry (Edgmont (Pa. : Township)) vol. 3,1 (2006): 51-5.
[8] Brewin, Chris R. “Re-Experiencing Traumatic Events In PTSD: New Avenues In Research On Intrusive Memories And Flashbacks”. European Journal Of Psychotraumatology, vol 6, no. 1, 2015, p. 27180. Informa UK Limited, doi:10.3402/ejpt.v6.27180. Accessed 9 Mar 2021.
[9] Pollio, Elisabeth et al. “Treating Children And Adolescents In The Aftermath Of Sexual Abuse”. Handbook Of Child And Adolescent Sexuality, 2013, pp. 371-400. Elsevier, doi:10.1016/b978-0-12-387759-8.00015-5. Accessed 9 Mar 2021.
[10] Van der Hart, Onno et al. “Dissociation Of The Personality And EMDR Therapy In Complex Trauma-Related Disorders: Applications In Phases 2 And 3 Treatment”. Journal Of EMDR Practice And Research, vol 8, no. 1, 2014, pp. 33-48. Springer Publishing Company, doi:10.1891/1933-3196.8.1.33. Accessed 9 Mar 2021.