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Dissociation is a disruption or the disconnection
from full awareness of self, time, memory, and/or
external circumstances. It is a complex
neuropsychological process. Dissociation exists along a
continuum from normal everyday experiences to disorders
that greatly interfere with everyday functioning. Common
examples of normal dissociation are highway hypnosis (a
trance-like feeling that develops as the miles go by),
"getting lost" in a book or a movie so that one loses a
sense of passing time and surroundings, and daydreaming.
Researchers and clinicians believe that dissociation is
a common, naturally occurring defense against childhood
trauma. Children tend to dissociate more readily than
adults. Faced with overwhelming abuse, it is not
surprising that children would psychologically flee
(dissociate) from full awareness of their experience.
Dissociation may become a defensive pattern that
persists into adulthood and can later result in a
full-fledged dissociative disorder.
The essential feature of dissociative disorders is a
disturbance or alteration in the normally integrative
functions of identity, memory, or consciousness. If the
disturbance occurs primarily in memory, Dissociative
Amnesia or Fugue (APA, 1994) results during which
important personal events cannot be recalled.
Dissociative Amnesia with acute loss of memory may
result from wartime trauma, a severe accident, or rape.
Dissociative Fugue is indicated by not only loss of
memory, but also travel to a new location and the
assumption of a new identity. Atypical dissociative
disorders are classified as Dissociative Disorders Not
Otherwise Specified (DDNOS). If the disturbance occurs
primarily in identity with parts of the self assuming
separate identities, the resulting disorder is
Dissociative Identity Disorder (DID), formerly called
Multiple Personality Disorder. The combination of
Posttraumatic Stress Disorder and Dissociative Disorder
Not Otherwise Specified (PTSD-DDNOS) is the most
frequent diagnosis in survivors of childhood abuse.
These survivors experience the flashbacks and intrusion
of trauma memories, sometimes not until years after the
childhood abuse, with dissociative experiences of
distancing, "trancing out", feeling unreal, the ability
to ignore pain, and feeling as if they were looking at
the world through a fog.
The symptom profile of adults who were abused as
children includes posttraumatic and dissociative
disorders combined with depression, anxiety syndromes,
and addictions. These symptoms include (1) recurrent
depression; (2) anxiety, panic, and phobias; (3) anger
and rage; (4) low self-esteem, and feeling damaged
and/or worthless; (5) shame; (6) somatic pain syndromes
(7) self-destructive thoughts and/or behavior; (8)
substance abuse; (9) eating disorders: bulimia,
anorexia, and compulsive overeating; (10) relationship
and intimacy difficulties; (11) sexual dysfunction,
including addictions and avoidance; (12) time loss,
memory gaps, and a sense of unreality; (13) flashbacks,
intrusive thoughts and images of trauma; (14)
hypervigilance; (15) sleep disturbances: nightmares,
insomnia, and sleepwalking; and/or (16) alternative
states of consciousness or personalities.
How can I get help?
The heart of the treatment of dissociative disorders is
long-term psychodynamic/cognitive psychotherapy
facilitated by hypnotherapy. It is not uncommon for
survivors to need three to five years of intensive
therapy work by specially qualified psychologists and/or
psychiatrists. Setting the frame for the trauma work is
the most important part of therapy.
One cannot do trauma work without some destabilization,
so the therapy starts with assessment and stabilization
before any abreactive work (revisiting the trauma)
begins.
Treatment modalities should be carefully considered.
These include individual psychotherapy, group therapy,
expressive therapies (art, poetry, movement,
psychodrama, music), family therapy (current and/or
extended family), psychoeducation, and pharmacotherapy.
Hospital treatment may be necessary in some cases for a
comprehensive assessment and stabilization.
Antidepressant and anti-anxiety medications can be
helpful adjunctive treatment for survivors, but they
should be viewed as adjunctive to the psychotherapy, not
as an alternative to it.
This is challenging and satisfying work for both
survivors and therapists. The journey is painful, but
the rewards are great. Successfully working through the
healing journey can significantly impact a survivor's
life and philosophy. Coming through this intense,
self-reflective process might lead one to discover a
desire to contribute to society in a variety of vital
ways.
Source:
APA (1994)
Cohen (1992)
Turkus (1994)
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