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Dissociation in Psychological Trauma

February 8, 2012

The extreme immediate response to severe emotional trauma is a condition referred to as “dissociation”, a state in which a person’s awareness and ability to engage psychologically in the present is temporarily lost.

These victims have responded to overwhelming threat with intense fear or horror, and “dissociation” represents a psychological defense that allows their consciousness (or awareness) to “escape” them.

Dissociation is the psyche’s reaction to unbearable pain whereby the usual synchronous elements of the psyche, such as awareness, mood regulation, and memory consolidation, lose their usual integrated function.

Victims describe the symptom as follows:

“It was as if my brain was telling me ‘I can’t deal with this’ and magically my psyche “parked” itself somewhere in meta-space, like in a state of limbo.”

This displacement of the traumatized individual’s integrated awareness can range greatly in terms of both severity and duration.

The most common and benign indicator of dissociation is amnesia, which manifests by the trauma survivor being unable to recollect the details of what happened.

Some trauma victims with amnesia will retain only memory fragments of the incident, lacking sufficient detail to synthesize into a coherent trauma narrative.

Donald Kalsched explains that while dissociation allows the psyche to “forget” and external life to continue, unmetabolized images of trauma fragments remain free-floating in the unconscious mind and attack the individual at free will, as if functioning autonomously (The Inner World of Trauma. Routledge, 1996).

These split off trauma fragments constitute the “flashbacks” found in most PTSD victims.

Sometimes the person with amnesia will retain only memory fragments of the trauma incident, which are insufficient to synthesize into a coherent trauma narrative.

Psychiatrists describe the memory of the chronic trauma victim’s life as being “full of holes.”

A more serious form of dissociation is the “fugue state,” where the victim experiences total disorientation following a traumatic event.

Well-documented cases abound in the trauma literature describing survivors of catastrophic events wandering around confused, unable to identify themselves.

This form of severe dissociation, with temporary identity loss, is at the extreme end of the “dissociative spectrum” of disorders.

At a biological level, neuro-scientists have demonstrated that these symptoms correlate with a ” shutting-down” effect on Hippocampal functioning.

Recent imaging studies confirm that overwhelming stress causes volumetric change in the Hippocampus, which explains its impaired capacity to synthesize emotionally laden images or memory fragments into a coherent memory narrative (Bremner, et al. “MRI Measurement of Hippocampal Volume in PTSD Related to Childhood Abuse.” Biol Psychiatry (1997): 41).

Among those with dissociative disorders of various types and degrees are survivors of prolonged interpersonal trauma, such as childhood or spousal abuse.

These victims may present themselves as being emotionally “tuned out,” appearing as merely distracted, detached, or emotionally absent.

Pierre Janet, the French psychiatrist who pioneered research in the subject of hypnosis and hysteria, suggests that the phenomenon represents a form of “structural dissociation.”

Janet’s explanation for this phenomenon is that the trauma has split the personality into separate compartments, which function independently.

One most often finds this in victims of chronic abuse, where victims compartmentalize their “emotional self” from their “apparent self” (Van der Hart, Onno, et al., “The Haunted Self”, Structural Dissociation WWW Norton & Company, 2006).

According to Janet, this “defense” allows the individual to partially engage the world in an operational way (via the “apparent self”) while remaining emotionally detached and disengaged.

While this form of emotional repression may be adaptive in some circumstances, “structural dissociation” represents a permanent structural split in the personality of these damaged trauma survivors.

The most serious manifestation of structural dissociation was formerly termed “Multiple Personality Disorder” in DSM-III and then renamed as “Dissociative Identity Disorder” in DSM-IV.

The essential feature of this disorder is the presence of two or more distinct identities that recurrently take control of the individual. Each personality has a distinct name, personal history, and identity.

While psychiatrists now consider this condition quite rare, there are some clearly documented cases. They all objectively confirm that these individuals had past histories involving physical or sexual abuse.

Dissociation in its chronic form interferes with creative engagement in relationships at all levels.

The goal of trauma therapy would be to recreate a sense of inner cohesion and mobilize intact core ego functions by establishing a safe “holding environment.”

Therapy is only of value once vital “rescue services” are in place, so that the victim no longer feels under threat. This would include providing trauma- survivors access to vital resources such as food, shelter, medicine, and communication with significant others.

Victims who received empathic parenting and developed strong self-soothing capacities are more-likely to reestablish an inner sense of cohesion.

Cognitive behavioral strategies attempt to help victims anchor themselves in the present, regain their sense of autonomy, and regain their sense of safety, optimism, and creativity.

Biologically, in order to heal, the victim will eventually have to “switch down” the brain’s stress-circuitry in order to metabolize the trauma into a cohesive narrative.

In summary:

1. Dissociation is an automatic response to an overwhelming feeling of emotional pain.

2. In this process part of the individual’s “self-functions” become disconnected from an intolerable reality.

3. The Psychodynamic model emphasizes how this serves a defensive function of allowing the victim to escape unbearable emotional pain.

4. To an external observer, individuals appear either as being “spaced out” or “shut down” as they “lose touch” with their immediate surroundings.

5. This is the rationale behind the Cognitive School of Therapy’s emphasis on “being anchored” in the present as a cornerstone in the process of restoring or reintegrating core ego functions.

 

6. Structural dissociation is a term developed by the school of Pierre Janet. It usually applies to victims of prolonged trauma.

 

7. Structural dissociation refers to the permanent split between a contracted authentic self and a manifest (but highly defended) “apparently normal” personality.

 

8. In Jungian language, the authentic self is often capitalized (as “Self”) because it is closer to “essence,” while the “apparently normal” component of the externalized self would correspond to the “persona.”

 

9. The more serious examples of structural dissociation include clients with borderline personality disorder.

 

10. “Axis II Disorders” in the DSM-IV is the category for placing “Disorders of the Self.” Borderline patients are frequently associated with histories of childhood deprivation or abuse.

 

In summary, “Dissociation” is usually caused by severe psychological trauma and continues to confound and challenge those working in the field of trauma and the neurosciences.

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5 Comments
  1. As a husband who is deeply involved in his wife’s healing journey, I haven’t found d.i.d. all that complicated, but I have found it VERY difficult to undo. It seems each of the insiders in my wife have 3 basic needs: to be loved, to be accepted as part of my family and to be safe. Once those are met, I then have had to teach them the very HARD lesson of working together (or ending the dissociation…which means NOT working together.) and “growing up.”

    Sam

    • I don`t know whether others view this comment. Since I like to use comments like this as a general teaching forum, you might want to spell that out a little more in detail.
      But from what I understand, the three needy compartments represent three traumatized components that were “split-off” from the rest of an otherwise integrated personality.
      So while the remaining, intact personality continued its growth in an integrated way, these traumatized “insiders” remained undeveloped.
      When you say that you “have to teach them the very hard lesson of working together”, I react with some concern.
      Perhaps you might be able to play a role by positively reinforcing wholesome “individuation”, autonomy, and self-agency, a therapist has to be involved in “opening a dialogue” between the various split-off aspects of the self.
      They might represent “rejection-trauma” or some other “attachment need” that was reactivated at various life-stages.
      In that case they`ll soon realize that they are different aspects of some failure in receiving adequate ’empathy” emotional nurturence or “Caretaking”.
      The problem with “dissociation” is, (by definition), its state of “dis-connectedness”.
      For a spouse, “normal” attempts to “soothe” are doomed to fail, and since a marriage requires a reciprocal process of emotional sharing, you will be stymied by continuously running into “roadblocks”.
      The therapeutic relationship for recovery is one dedicated to “repair”, as opposed to a marriage, where success requires the partner to “share”.

  2. Hi David,

    unfortunately as a husband I am caught in a situation in which the only way to meet my needs thru my marriage is to first pour myself into my wife’s healing first. This is the my blog entry in which I dealt with this subject. http://samruck2.wordpress.com/2011/05/25/why-should-a-husband-help-in-the-healing-process/

    It would appear that you took so many various issues with my short comment, that there’s not really any benefit for me to defend my statements. Let’s just say my wife (according to her opinion and as she interacts with others whom she has left far behind in the healing process) has made such great progress in her healing because of the things I do on a day to day basis to promote healing and break down the dissociative walls between each of the girls. I am clear what I do on my blog, if you have interest.

    There’s much a husband can do that a therapist can’t. Hopefully some day therapists will recognize that and collaborate together.

    Take care,

    Sam

  3. What you are looking for is praise for being a good husband and “good therapist” at the same time.
    I had no intention of being critical of your efforts.
    I merely expressed a general concern in “role-definition”.
    Some therapists make it a rule not to treat family members.
    I will post an article on this subject, under the title “Power Dynamics”.

  4. David,

    If I had a healthy wife, I would GLADLY give up my role of being her therapist, but after 23 years of a dysfunctional marriage I can either dive in and help her heal as quickly as possible or I can push that off on her and her therapist/counselor like I see so many other husbands on wordpress doing (and then they complain about their dysfunctional spouse and actually slow the healing process by the things they do). I do NOT want to be her therapist. I would love to just be a husband, but that luxury was taken away from me by the man who abused her as a little child and my emotionally detached in-laws who refuse to help in the healing process.

    “Role definitions” if I understand the term, unfortunately gets messy when someone is a trauma victim. I just want a healthy wife and I’m willing to do ANYTHING it takes to get that.

    Sam

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