The impact of trauma on an individual is complex, and stress reactions vary considerably. It’s true to say that two people experiencing a similar traumatic event may react in completely different ways.
There are, however, some common responses to trauma. Dissociation is one such response, and this is especially so in cases of extreme physical, emotional and/or sexual abuse or severe neglect. The important thing to understand about dissociation is that it’s a defense mechanism – it is a way the mind copes with the stress of a traumatic event.
A person can dissociate for a short period (hours or days) or for longer periods. Dissociative disorder is a mental illness that happens when a person dissociates for a long time.
This blog explains what dissociation is, how trauma causes it, and what kind of treatment can help.
What is dissociation?
Dissociation is a disconnection between a person’s thoughts, feelings, and memories and their sense of self. There is a break in how the mind handles information in response to extreme stress. It involves detaching from reality.
It is a natural response to trauma, especially in cases of cumulative psychological trauma and/or early life trauma. In this context, dissociation is acting as a protective mechanism. It is way for a person to distance themselves from what is happening (during a traumatic event) or has happened (after a traumatic event). In some sense, it is helping the person to survive it.
Research shows that up to 10% of the population will experience the phenomenon known as dissociation during their lifetimes.1 And that nearly three of every four individuals who have experienced a traumatic event will enter a dissociative state during the event or in the hours, days, and weeks that follow.
Dissociation can also be experienced as part of a mental illness, such as schizophrenia, bipolar disorder or borderline personality disorder (BPD). Certain substances, such as ketamine, can also induce dissociative states.
What happens when you dissociate?
Mild forms of dissociation present as daydreaming or ‘zoning out’, a bit like getting lost in a book, movie, or meditation, or simply by losing a sense of awareness of what is going on around you. This is a normal process that almost everyone experiences from time to time.
In its chronic and more serious form, it involves a deep disconnection from feelings and memories and is highly disruptive. When a person dissociates, they may forget completely about certain time periods, events, or personal information and can feel strangely detached from their own body.
A person with a serious dissociative disorder has no sense of identity and feels completely disconnected from the world. People have described the experience as feeling like being “outside the pilot’s chair, looking at, but not controlling, the gauges.”1
What are the different types of dissociative disorders?
There are three main types of dissociative disorders.2 These are:
- Dissociative amnesia – forgetting personal information and memories of events
- Depersonalization or derealization disorder – disconnecting from surroundings (the world doesn’t appear real, as though in a dream), feeling detached from one’s own body and thoughts (body parts can feel smaller or not real)
- Dissociative identity disorder – experiencing two or more persistent personality states
What kind of trauma causes dissociation?
Any kind of trauma can cause a person to dissociate. For most people, it happens in response to a traumatic event that they can’t control. This could be a one-off event or ongoing trauma (such as war), or abuse. Dissociation allows a person to distance themselves from the reality of their situation and to disconnect from the pain and horror.
Any kind of trauma can cause dissociation. This could be assault, abuse (physical, emotional, or sexual), natural disasters, military combat, war, kidnapping, invasive medical procedures, neglect, or any other stressful experience.
According to the American Psychiatric Association, among people with dissociative identity disorder in the United States, Canada, and Europe, about 90 percent experienced childhood abuse and neglect.3
How does trauma cause dissociation?
To understand how trauma causes dissociation, it is important to look at neurobiology. You are probably aware of the body’s stress response, ‘fight or flight’. This is the body’s in-built protective mechanism for helping us to deal with danger.
When we perceive we are under threat or in danger, for whatever reason, the body releases certain hormones that prepare us to stay and fight or flee. It’s an automatic physiological reaction that provides the body with a burst of energy and heightened alertness. Physiological changes include the heart rate getting faster to increase oxygen levels in the blood, breathing speeds up to deliver more oxygen, peripheral vision increases, and so on.
But sometimes a person can’t fight or run (perhaps because they are too young). In these instances, the body freezes. The body releases chemicals to make you feel numb to the situation. Thinking processes shut off. Feeling numb and lost is dissociation. It is an instinctive survival mechanism.4
After a traumatic event, the body can also develop an exaggerated or overactive response. Research at Stanford University has revealed molecular underpinnings and brain-circuit dynamics underlying dissociation.1 The findings implicate a particular protein in a particular set of cells as crucial to the feeling of dissociation.
Recent research on traumatized children and adolescents has demonstrated some neurochemical, functional, and structural abnormalities in the brain areas responsible for cognition and memory.5
In BPD dissociative symptoms have been shown to have an impact on cognitive functioning. There is evidence of “reduced activity in limbic(-related) temporal areas (amygdala, superior temporal gyrus, fusiform gyrus), increased frontal activity (inferior frontal gyrus, dlPFC), and altered interactions between these regions.”6
What is the treatment for dissociative disorders?
Psychotherapy is the main treatment for dissociative disorders with the goal of integration. Treatment must foremost be focused on healing from any childhood trauma. Most importantly, treatment must be carried out with the utmost experience and care to avoid retraumatization.
At CALDA, we use trauma-specific psychotherapy techniques to process core trauma. Then the split fragments can be reassociated again, integrated, and forwarded to the memory. We primarily work with clinical hypnosis and EMDR, and for complex PTSD, also with Enactive trauma therapy.
Dr. Claudia M. Elsig, Medical Director at CALDA Clinic, is a specialist in this field, working with trauma therapy techniques developed by the eminent Prof. Ellert Nijenhuis, who has treated and scientifically studied severely traumatized patients for over 40 years and written a trilogy of books on dissociation and how to treat it (The Trinity of Trauma Vol I and II, and the third volume, Enactive Trauma Treatment).
With borderline personality disorder, skills training, mindfulness training, and elements of DBT (dialectical behavior therapy) are used.
At CALDA, every case is treated individually, and a personalized program devised. The clinic approach is holistic. We support the body with the correct micronutrients. Our therapy extends over 7 days a week with 6 to 8 therapy hours a day.
Along with trauma-specific psychotherapy, we focus on alternative and complementary therapies such as equine-assisted psychotherapy. Therapy dogs are also available to us. We use voice therapy to facilitate the development of proper breathing and breath support. We recommend a minimum of 4 weeks stay with us, but for deep trauma, it can take 6 to 12 weeks to heal.
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- Goldman, B. 16Sept2020. Researchers pinpoint brain circuitry underlying dissociative experiences. Stanford Medicine News Center. [Online: accessed 5Jun2022].
- Tull, M. 6Apr2021. What is Dissociation? Website: VeryWellMind.com [Online: accessed 5Jun2022].
- American Psychiatric Association. Physician Review By: Philip Wang, M.D., Dr.P.H. Aug2018. What Are Dissociative Disorders? Website: Psychiatry.org [Online: accessed 5Jun2022].
- Dissociation and dissociative disorders Website: mind.org.uk [Online: accessed 5Jun2022].
- Diseth TH. Dissociation in children and adolescents as reaction to trauma–an overview of conceptual issues and neurobiological factors. Nord J Psychiatry. 2005;59(2):79-91.
- Krause-Utz A, Elzinga B. Current Understanding of the Neural Mechanisms of Dissociation in Borderline Personality Disorder. Curr Behav Neurosci Rep. 2018;5(1):113-123.