Dissociation and Trauma

It’s a concept that many see in the movies.  The situation where one experiences a trauma and then “erases” it from their minds, and they are only reminded of it years later by some trigger in their environment.  Frightening as this may seem, it is in fact a phenomena referred to as dissociation.  It is, of course, not quite as it is shown to be in movies though, as the memory is not exactly erased. Detachment could be as simple as daydreaming, however this is considered to be a non-pathological form of dissociation.

The DSM-IV defines dissociation as “a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment" (p. 477).  Psychologists dealing with dissociation in patients have explained dissociation as a possible detachment from immediate surroundings, or from the immediate physical and emotional reality.  It is important to note though that it is a detachment from reality and not a loss of reality.  If there was a loss of reality; the condition would be considered a psychosis and not a dissociation. It is also important to note that a dissociative memory is still an active memory, which is why it leads to disturbing intrusions.  This makes it different from a forgotten memory, as they are inactive.These dissociative episodes allow the person to compartmentalize perceptions and memories, which allows them to separate from the trauma while it is occurring.

In many situations, this detachment could be considered a coping or defense mechanism, which helps the person to master or minimalize the immediate stress.  This would be the case in the immediate aftermath of a severe trauma or during a trauma, only then would it be considered as a coping mechanism.  Following that, the detachment could mean that the person never truly processes the trauma and could lead to serious psychological dysfunctions and maladjustment.

The pathological forms of dissociation include dissociative disorders, such as: dissociative fugue and depersonalization disorders.  Dissociative fugue is when the person assumes a new identity, which is coupled with total amnesia of their “previous” life.  It can also include the person upping and leaving physically, however they will not know why they left, where they were going or what they did whilst away. Depersonalization occurs when the person feels that they are outside their body and are observing themselves from the outside.  Both of these clearly show the detachment from reality.  Apart from the above-mentioned, the pathological forms of dissociation include a sense of derealization, dissociative identity disorder (separate streams of consciousness, previously Multiple Personality Disorder) and Post Traumatic Stress Disorder. All of these dissociations can be unexpected intrusions, which would obviously be very unsettling to the sufferer.

Dissociation has been linked to victims of multiple forms of childhood trauma, whether physical, psychological or sexual, with the higher levels of dissociation being linked to the abuse starting at younger ages. It is also linked with amnesia of the dissociative period (Merckelbach H., Munis, P. 2001).  The level of dissociation has also been linked to the severity of the abuse (Drayer, N., Langeland, W. 1999). 

Dissociation can be caused by stress or trauma but can now be treated with a combination of techniques. The main treatment usually used for dissociation is psychotherapy, which involves talking to a therapist who will assist in working through the underlying cause of the dissociation.  The psychotherapy can also include hypnosis to help the client access the underlying issue.  Other types of therapy include creative art therapy (to help express emotions which they may ordinarily find difficult), cognitive therapy (help identify negative feeling and associations and replace them with health ones), as well as medication (such as tranquilizers, anti-depressants and anti anxiety medication).