Dissociation in Psychological Trauma

May 17th, 2013

Dissociation in Psychological Trauma


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 metaspace, 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, neuroscientists have demonstrated that these symptoms are associated with a shutting down of 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 rescue services are in place and the victim is no longer exposed to threat. That involves providing access to vital resources such as food, shelter, medicine, and communication with significant others.


Once these are in place, healing strategies would emphasize the use of empathy and enhanced therapist availability.


The victim will gradually internalize soothing objects and reestablish an inner sense of cohesion and well-being.


Cognitive behavioral strategies attempt to help victims anchor themselves in the present, regain their sense of autonomy, feel empowered, and engage the world with a new set of more adaptive social behaviors.


Biologically, in order to heal, the victim will eventually have to metabolize the trauma and “switch down” the brain’s stress circuitry.


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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