The Relationship Between Dissociation and Trauma
A trauma is a very stressful life event that lasts over time and produces an intense perception of helplessness. The relationship between dissociation and trauma is a fact supported by numerous scientific studies because the dissociation mechanism acts as an emergency brake available to our mind to protect us against horrible events.
To dissociate means to break, split, separate, or fragment. Let’s explain it with a metaphor: Imagine that you have a plate in your hand (your mind). Suddenly, someone gives you a terrible fright, and your body jerks (traumatic event). Consequently, the plate falls over and shatters. This process of falling apart in psychiatry and psychology is known as dissociation.
Based on these concepts, we’re going to present what dissociation and trauma consist of and what their relationship with mental health and clinical practice is.
Japanese culture believes that when something has suffered damage, it becomes much more beautiful, and this is how they make it visible with the Kintsugi technique. This technique consists of repairing broken ceramic objects with resin and ground gold. In this way, instead of hiding the imperfection, they make it much more evident.
– Leal –
What is dissociation?
According to the dictionary of the Royal Academy of the Spanish Language, to dissociate has two meanings:
- To separate something from something else to which it was attached.
- To separate the various components of a substance.
For Temple (2019), dissociation is related to situations experienced in relation to primary attachment figures (usually with parents). These situations are potentially traumatic as they involve different types of abuse, negligence, or lack of care, which, depending on their intensity and duration, affect the presence and severity of dissociative symptoms.
Trauma is often related to mistreatment or abuse, physical and emotional neglect, and lack of affection.
– Lopez –
For Batalla (2022), dissociation is a common neurobiological mechanism in victims of childhood sexual abuse. Specifically, it’s a strategy that allows us to instantly disconnect our minds from the immediate environment. What’s the objective? Distancing ourselves from the sources of danger that we’re unable to process, from our emotions, our feelings, and our own body.
In this regard, it’s worth mentioning that dissociation also acts as a normal and natural protection mechanism. Dissociating isn’t necessarily pathological , and in this regard, it acts as a cushion against the impact of events that are potentially traumatic.
So, what differentiates normal or normative dissociation from pathological dissociation? Two variables: Its prolongation in time, that is, a traumatic event experienced for a long time, and its intensity.
Dissociation in clinical practice
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes the main clinical entities that can be diagnosed in reference to dissociation.
As a result of dissociation, there may be difficulties in regulating one’s own emotions and self-control of behavior.
-Van der Kolk-
Dissociative amnesia
This clinical entity is characterized by the fact that the person is unable to remember biographical events of a traumatic or stressful nature (for example, sexual abuse in childhood). It’s incompatible with ordinary forgetfulness, constitutes a reaction to severe stressors, and may constitute a symptom of post-traumatic stress disorder.
According to the American Psychiatric Association (APA), a large number of patients have chronic difficulty in forming and maintaining satisfactory relationships. The usual story behind these patients is trauma, abuse, and frequent victimization. Many of them have a history of self-mutilation, suicide attempts, and high-risk behavior.
Dissociative amnesia is defined as the inability to recall important autobiographical information of a traumatic or stressful nature.
Dissociative identity disorder or multiple personality
According to the World Health Organization (WHO), this disorder constitutes the existence, in the same person, of two or several different personality states, associated with marked discontinuities in the sense of identity and agency.
The “transition” from one personality to another can be sudden and in response to a traumatic situation that produces anxiety and distress.
Each personality state has its own pattern of experience and its idiosyncratic way of perceiving and conceiving the world. How do the different personalities relate to each other? The relationship can be as follows:
- Mutual: Personalities can converse with one another.
- With symmetric amnesia: No personality knows anything about the others.
- With asymmetric amnesia (or one-way amnesia): That is, personality A is completely unaware of personality B; but personality B does know about personality A and shares its memories.
In addition, the original personality tends to be more submissive, keeps the patient’s real name, is more passive, dependent, guilty, and depressed, while the others are more independent and may turn out to be aggressive and hostile.
In multiple personalities, there are recurrent lapses in memory for everyday events, important personal information, or traumatic events that are incompatible with ordinary forgetfulness.
– American Psychiatric Association –
Depersonalization-derealization disorder
According to the WHO, this clinical entity is characterized by the existence of persistent experiences over time, recurring or repeated episodes of depersonalization, derealization, or both:
- Depersonalization consists of experiencing the conscious self as strange and unreal, or feeling separated from it, as if we were external observers of our thoughts, feelings, sensations, body, or actions.
- Derealization is characterized by experiencing others, objects, or even the world itself as alien and unreal (e.g., dreamlike, distant, hazy, lifeless, colorless, visually distorted). It also implies feeling separated from the context that surrounds us.
For the professor of psychopathology Amparo Belloch, half of adults have had some experience of depersonalization or derealization at some time, while in the population of psychiatric patients, 4 out of 10 experience these symptoms.
Interpersonal traumas in childhood (such as emotional abuse and neglect) are powerful predictors of dissociative disorders in adulthood, and these, in turn, can constitute and seed the seeds of post-traumatic stress disorder, a closely related clinical entity.
What is PTSD?
The WHO states that post-traumatic stress disorder (hereinafter, PTSD) is a clinical entity that can develop after the person’s exposure to an event or series of events that are extremely threatening or horrible. It’s characterized by the following aspects.
Exposure to death or danger of death
The American Psychological Association requires the existence of exposure to events related to the potential for death or death, as well as serious injury or sexual violence:
- Direct experimentation
- Witnessing, in person, the event that happens to others
- Being aware of an event that has happened to someone close
- Repeatedly experiencing extreme exposure to aversive details of the event
In addition, in order to make the diagnosis, the alterations must last for more than a month and produce clinically significant deterioration in various important areas of the person, such as interpersonal, social, occupational, or academic areas.
Re-experiencing symptoms
The re-experiencing of trauma is a mechanism through which the mind tries and tries to elaborate and give meaning to what we’ve experienced. In this regard, symptoms such as the following appear:
- Recurring, involuntary, and intrusive memories
- Recurring unpleasant dreams with content or emotions linked to the trauma
- Dissociative reactions in which the person acts or feels that the traumatic event is occurring in the present moment
- Intense mental distress when exposed to internal or external stimuli that symbolize or recall an aspect of the traumatic event
In reference to the last symptom, we’re going to present an example. Let’s imagine that a teenager has been the victim of rape in the context of an elevator. Months after the event, when they see other elevators, they’re likely to experience (re-experience) the anguish they experienced at the time of the attack.
What’s more, every time they see closed rooms, doors, buttons, the same type of lighting, the characteristic noises of the machines, etc; they’re likely to relive their experience as if it were the first time it happened.
Re-experiencing the traumatic event involves reliving it in the form of intrusive memories that are often accompanied by overwhelming emotions, particularly fear and horror.
– WHO –
Avoidance symptoms
Because stimuli that trigger traumatic memories cause intense distress in PTSD patients, they tend to avoid them.
- They avoid thoughts, feelings, and conversations related to the event.
- They avoid external memories, activities, situations, or people that remind them of what happened.
Developmental regression may even occur. In cases of childhood PTSD, patients have been described who have lost language after having acquired it. In addition, in prolonged traumatic events, problems may appear when it comes to regulating emotions or maintaining stable personal relationships.
Avoidance symptoms are very marked in all patients with PTSD except in car accident victims, who, on the other hand, present a greater number of symptoms related to bodily startle.
– Echeburúa –
Discover more: Experiential Avoidance Disorder
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Alterations in cognitions and emotions
The APA requires two or more symptoms of disturbances in cognition and emotions. What does it consist of?
- Difficulty remembering an important aspect of the event (dissociative amnesia)
- Persistent negative beliefs or expectations about oneself, others, or the world
- Persistent distorted cognitions about the cause or consequences of the trauma that lead the individual to blame themselves or others
- Emotional states are characterized by very painful and persistent negative emotions
- Decreased interest in participating in activities that are meaningful and reinforcing to the person
- Feelings of indifference or distance from others
- Persistent inability to experience positive emotions
In addition, according to the WHO, perceptions of the existence of current threats may appear in the face of which the person is hypervigilant, tracking their context in their search. Consequently, the patient is startled by everyday stimuli such as unexpected noises.
Life can only be understood looking back, but it must be lived looking forward.
-Kierkegaard-
Symptoms of hyperarousal
The body of the person with PTSD is hypersensitive. This means that they respond more promptly and intensely to stimuli that are far from requiring this behavioral display. Among the symptoms of hyperarousal, we find the following:
- Irritable behavior or outbursts of anger
- Self-destructive or reckless behaviors
- Hypervigilance or hyper-tracking of the environment
- Exaggerated startle responses
- Trouble concentrating
- Difficulty falling asleep (insomnia)
Complex trauma is characterized by being repetitive or prolonged over time, involving harm or abandonment by the parents, and occurring at vulnerable moments in the person’s development and maturation process.
-Curtois-
To conclude, it’s worth mentioning the practice of Kintsugi. In Japanese culture, there’s an unshakable faith in the beauty of broken objects. When a vase falls to the ground and shatters, they take advantage of the pieces to join them with a special glue: Gold. Thus, the result is a new vase embellished with extraordinary veins of the precious metal. It’s an object with greater value, both physical and spiritual.
There’s a crack in everything, that’s how the light gets in.
-Cohen-
- American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (5.a ed.). American Psychiatric Association Publishing
- Bongaerts, H., Voorendonk, E. M., Van Minnen, A., Rozendaal, L., Telkamp, B. S. D., & de Jongh, A. (2022). Tratamiento centrado en el trauma intensivo completamente remoto para el TEPT y el TEPT Complejo. European Journal of Psychotraumatology, 13(2), 1-13
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Leal, S. (2022). Resurgir con resiliencia. Un análisis de la psicología humana mediada por la filosofía del Kintsugi [tesis doctoral]. Repositorio Institucional UPV. https://riunet.upv.es/handle/10251/184067
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Pena, E. (2022). Apego desorganizado y disociación en el trauma complejo [tesis de grado]. CEU Repositorio Institucional. https://repositorioinstitucional.ceu.es/handle/10637/13966