Dissociation may be thought of simply as disconnection or disruption. In terms of posttraumatic stress disorder, we talk about dissociation as a disruption in four different areas of functioning: identity, memory, consciousness, self-awareness, and awareness of surroundings.
In understanding the human response to trauma, it is thought that dissociation is a central defense mechanism because it provides a method of escape 1. When physical escape is impossible, dissociation provides a type of mental escape.
Those who experience dissociation may notice lapses in memory of certain time periods or events. Personal information can also be forgotten. They may also experience a sense of disconnection and detachment from themselves and their emotions. A blurred sense of identity is also common.
Compartmentalization is another form of escape from trauma. Compartmentalization occurs when aspects of psychological functioning are not linked together. Opposing views or behaviors can be held separate in order to avoid uncomfortable feelings when one has conflicting values, beliefs, and emotions 2.
Depersonalization refers to the feeling of being detached from one’s own life. Some describe it as the feeling of living in a dream or experiencing the sensation of watching events in their life as if it were a movie.
Every form of dissociation is a coping mechanism. Disengaging or separating from ourselves and the situation can prevent us from experiencing too much pain, either physical or emotional. Studies have found individuals with high levels of dissociative symptoms also have higher levels of posttraumatic stress disorder symptoms 3.
Implications for Therapists
When working with a client experiencing dissociation and related symptoms of trauma, the client requires help in strengthening his or her sense of self. Traumatized individuals often experience issues with identity.
They may even suffer from a conflicting inner dialogue. In severe cases, more than one voice can participate in inner self-talk. For example, a personal narrative “I am bad … I do not deserve to live …” Can switch to “You are bad … You do not deserve to live.” In a case like this, the person is no longer the only one telling his or her personal story 1. This situation can lead to the sense that more than oneself exists.
In therapy, it is important to help the client create a shared narrative among the different aspects of self. The goal is to facilitate collaboration among the distinctly compartmentalized feelings, beliefs, motivations, and goals. Further, helping the client develop a sense of self-compassion is critical to overcoming symptoms and distress associated with trauma and dissociative effects.
The treatment recommendation for dissociation is long-term psychotherapy. Talk therapy, hypnotherapy, even movement, and art therapy can be helpful. The therapeutic relationship allows the traumatized client to reach out and hold onto something that will provide a sense of stability and safety (the therapist). It takes time to re-wire the brain into a cohesive and secure feeling self. It is human nature to heal through connection with others. In this unique way, a therapist can provide the safe space and opportunity for healing.
- Lanius, R. A. (2015). Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research. European Journal of Psychotraumatology, 6(1), 27905.
- Spitzer, C., Barnow, S., Freyberger, H. J., & Grabe, H. J. (2006). Recent developments in the theory of dissociation. World Psychiatry, 5(2), 82.
- Swart, S., Wildschut, M., Draijer, N., Langeland, W., & Smit, J. H. (2017). The clinical course of trauma-related disorders and personality disorders: study protocol of two-year follow-up based on structured interviews. BMC Psychiatry, 17(1), 173.