With the topic of trauma becoming more influential in the public arena, the narrative that surrounds this topic can become confusing. A related idea to trauma that may be unclear to many is dissociation. The word is a noun primarily and it is a psychological construct; although dissociation carries physical symptoms, dissociation begins in the mind. I want to shed some light on the topic of dissociation in this blog. I hope my short commentary on the topic informs readers who are interested in trauma, and trauma survivors to move forward in their healing journey.
Dr. Scaer, the world-renowned physician who studies the neuroanatomical effects of trauma, suggests that dissociation is defined in terms of experiencing a sense of fragmentation-in pieces, split, and broken up of the mind, and perception of the self and the body (Scaer, 2001). The main ways dissociation may show up in a person is an altered view of the self, including derealization, depersonalization, distortions of perception of time, space, and body, and conversion hysteria. Pierre Janet, a pioneer, and key figure who created the field of psychotraumatology, describes dissociation as a “phobia of memories”, in the form of expression of excessive or inappropriate physical responses to thoughts or memories of old traumas (Janet, 1920). The basic mechanism of dissociation was felt to involve the splitting off of parts, memory, or perception in order to escape the anxiety that is overwhelming and unbearable triggered by the senses.
One major reason the concept of dissociation has been ignored for decades is due to Sigmund Freud’s view on trauma. He published an important work in the field of mental health in 1925 that, sadly, argued for the view that dissociation can be stories that are told of childhood sexual tragedies are simply a “fabrication, based on unacceptable sexual wishes and fantasies they could not acknowledge” (Scaer, 2001; Freud, 1925/1959). This work by Freud created a view for the field that informed clinicians for many decades that childhood violent experiences may not contribute to trauma. Moreover, the introduction of the diagnosis of Post-Traumatic Stress Disorder (PTSD) into the Diagnostic and Statistical of Mental Disorders, 3rd edition (DSM-III) in 1980 also resulted in classifying many conditions formerly attributed to trauma and dissociation, often times ignored their association with prior life trauma (American Psychiatric Association [APA], 1980). History paints often an ugly picture of how trauma symptoms and their diagnosis was treated, creating harmful spaces for many individuals who presented symptoms that are apparent to us today that relate to trauma and complex trauma. The invalidation of trauma experiences must end.
Classifying symptoms of dissociation is a challenge for clinicians because these symptoms assume many and varied forms and expressions. Some of these symptoms may be emotional, perceptual, cognitive, or functional. The symptoms individuals possess may involve the altered perception of time, space, sense of self, and reality. Some physical symptoms are expressions that frequently involve weakness, paralysis, and ataxia, but may also present as tremors, shaking, and convulsions. Equally important, a person’s memory changes and may appear as hypermnesia in the form of flashbacks, as amnesia in the form of fugue states, or more selective traumatic amnesia. Scaer points out that symptoms of dissociation strongly resemble the symptoms related to bipolar disorder.
A major feature of the experience of dissociation is the freeze response. Freezing is a state of immobility, i.e., the body stops moving. Freezing is routinely seen in the wild. An animal assumes an immobile state in the presence of a predator; this state may proceed to sudden flight or, if the fawn is attacked and captured by the predator, an animal will fall into a deeper state of freeze that is associated with unresponsive behavior. In the event of an attack, when the creature is rendered helpless, a different state of freezing appears in the creature. Hofer (1970) exposed rodents to a variety of predator-related stimuli in an open space with no means of escape. The results showed that all rodents entered a deep phase of freeze that may last up to 30 minutes. This state of freeze would be associated with marked bradycardia which is connected to cardiac arrhythmias. If a person is not allowed to react to a threat because they are over-powered, they may experience pain and suffering enough to dissociate down the line. The choice to fight or flee is why people may not experience dissociative states in other words.
The lack of recovery from a freeze response may lead to stored energy that comes from a flight/fight response that harms a person’s functioning. Researchers in the field suggest this stored energy can lead to negative physical reactions; for example, a person may become sick more frequently, may have intestinal or digestive issues, and may also experience increased blood pressure. The combinations of these ailments may create challenges for a human being to complete daily tasks. Peter Levine (1997), the key researcher in the trauma field, suggests that if energy is not removed from the body, created by the central nervous system, a person’s world continues to “shrink” so they can avoid any cues that may invoke intense physical experiences.
The most, Scaer (2001) argues, that a unique symptom of dissociation is that of flashbacks. The somatic experience patients have due to flashbacks are upsetting. One patient reported to me feeling trapped when she experienced a flashback of being raped by a past partner. This same patient went on to say that she just waited “for him to be done”. The emotional toll a flashback has on a brain and nervous system is devastating. Flashbacks may be episodes that involved often intense arousal and reexperiencing, symptoms more related to acute symptoms linked to PTSD. Flashbacks can last minutes to several hours or even days. Some patients experience an out-of-body experience when they dissociate. During a flashback, a patient may appear confused and detached from the present moment. A person’s nervous system can only tolerate so much, and the person may survive only by dissociating. Although this state of the mind helps many survive horrific situations, the long-term effects of dissociation continue to be documented.
Lastly, dissociation at the time of trauma is the primary predictor for the later development of PTSD, Dr. Van der Kolk argues (1989). Memories that seem fractured when a person attempts to reflect on the type of harm they experience are one indication of dissociation. Parts of your brain protect themselves when experiencing intense emotions. This form of protection also, in the end, brings about harm to the person’s ability to “piece” together a personal history. What we determine as our history increases our quality of life. Memories, at times, of past experiences, create hardships in our lives that increase doubts about what type of life we can live now.
- Living rather than existing through life is challenging to do without healing from dissociation
- Dissociation that goes unprocessed may lead to a diagnosis of PTSD
- Dissociation shrinks someone’s world and limits your functioning
- Dissociation “splits” up your life, creating shame and a negative outlook on life
Ramon Diaz is currently completing his master’s in clinical mental health as well as completing certification to become a certified alcohol and drug abuse therapist. He plans to move on to medical school to complete his MD. Ramon wants to specialize in learning the biological substrates of trauma in infants, toddlers, and adolescents.