Trauma Related Dissociation and Its Treatment

Although dissociation is a defense mechanism that allows us to escape the memory of adverse events, in the long term, it causes problems and suffering. Find out more here.

Written and verified by the psychologist Valeria Sabater.

Last update: 29 August, 2023

Trauma-related dissociation is a concept that raises many questions and some misconceptions. Firstly, we must understand that it doesn’t imply weakness nor is it a pathological mechanism. It’s an adaptive psychological reaction that helps individuals cope with a painful event.

The human mind uses dissociation to separate the individual from the adverse experience and thus silence their emotional pain. However, this sophisticated survival resource has a psychological cost. In fact, it can fragment the individual’s memory and identity. It’s a complex mental reality that we’re going to explore in this article.

Trauma-related dissociation

Trauma-related dissociation is a neuropsychological defense mechanism that seeks to separate the individual from external and internal experiences in order to reduce pain. It blurs their memory and distances them from certain thoughts and emotions. After all, if the memory of a dramatic event was permanently at the forefront of their minds, they’d feel completely overwhelmed.

A study conducted by the University of Maryland (USA) suggests that the impact of this dimension has been neglected. They suggest that greater awareness of dissociative processes is needed because they significantly correlate with self-destructive and suicidal behaviors.

While it’s true that this response seeks to protect the individual from suffering, in the long term, a fragmented mind brings immense consequences at all levels.

Symptoms linked to dissociation

Trauma-related dissociation acts by mobilizing different neurological areas, to regulate the imprint of the painful memory and the consequent suffering. The cerebral amygdala activates the production of cortisol and centers such as the prefrontal cortex stop working normally. The hippocampus, the center of emotional memory, also becomes dysregulated.

This translates into an emotional numbness, memory failure, and a reduced capacity for reflection and reasoning.

An article written by the University of Leiden(Netherlands)emphasizes that this mechanism is an extremely complex process present in conditions such as post-traumatic stress disorder, dissociative identity disorder, and borderline personality disorder (BPD). It’s useful to know how the symptoms progress:

• Anxiety.
• Suicidal thoughts.
• Isolation of emotions.
• Doubts about identity.
• Persistent feelings of anxiety.
• Sleep disturbances, such as nightmares.
• Anhedonia or the inability to feel pleasure.
• Self-destructive behaviors such as self-harm.
• Being unable to remember certain periods.
• Disconnecting from themselves and the world around them.
• Going somewhere and not knowing how they got there.
• Having flashbacks (brief memories of traumatic events).
• Experiencing the feeling that many stimuli and experiences that are surrounding them aren’t real.

Types of trauma-related dissociation

According to the Diagnostic and Statistical Manual of Mental Disorders ( DSM-V), trauma-related dissociation can manifest itself in the following three ways:

• Dissociative amnesia. After one or several traumatic experiences, the individual develops gaps in their memory and forgets certain fragments prior to or following the adverse experience.
• Depersonalization/derealization disorder. This causes the individual to feel that they’re outside of their own body. They also believe that what happens or surrounds them isn’t real.
• Dissociative identity disorder. This condition used to be called multiple personality disorder. Patients suffering from it adopt different identities in response to trauma. An article published in The Journal of Mental Science claims that this condition is a severe form of post-traumatic stress. Moreover, it’s a complex reality to diagnose and treat.

The origin of trauma-related dissociation

Trauma-related dissociation usually appears after the superimposition of several traumatic events. It doesn’t always arise after a specific event, such as suffering the loss of a loved one. However, people who’ve been abused since childhood are at greater risk of developing this psychological defense mechanism.

The University of Turin (Italy) conducted a study that claims multiple traumatic experiences put mental functioning at risk and dissociation appears. The kinds of events that can trigger these harsh realities are as follows:

• Living in a war zone.
• Growing up in a dysfunctional family.
• Suffering mistreatment or abuse over several years.
• Living in a disadvantaged or adverse social setting.
• Witnessing violent events sustained over time.
• Working for years in a threatening and highly stressful environment.

The treatment of trauma-related dissociation

When dealing with trauma-related dissociation, the therapist always starts with the needs and particular reality of each patient. As pointed out in an article published in the Indian Journal of Psychiatry, an adequate diagnosis must be established, ruling out any other causes, possible comorbidities, and predisposing traumatic and personality factors.

Let’s take a look at the strategies employed to address this reality and the useful therapeutic models.

Strategies and treatments

• Promote a healthy self-concept.
• Change harmful thought patterns.
• Develop healthy coping skills.
• Promote the capacity for physical and emotional self-regulation.
• Reduce the constant overactivation of the central nervous system.
• Encourage the individual to draw up new goals and meanings.
• Facilitate a connection with the physical sensations of the body as a way to deal with emotional pain.
• Guide them to accept the emotional pain associated with dissociation and to gradually integrate their own identity.
• Make it easier for them to gradually process the traumatic experience.
• There’s no need for them to revisit their traumatic memories. It’s more appropriate to treat their emotions and dysfunctional thoughts and generate healthier behaviors.

Appropriate therapies for dissociation

One of the most widely used therapeutic approaches in dissociation is EMDR therapy or eye movement desensitization and reprocessing. Research published in The Permanente Journal highlights that EMDR is one of the most effective treatments for all traumatic processes. Other therapeutic techniques that are useful are as follows:

• Cognitive Processing Therapy (CPT). This is a convenient model for addressing cases of sexual abuse and mistreatment.
• Psychoactive drugs. These are an alternative valued by doctors and psychiatrists in continued treatment for emotional dissociation.
• Trauma-focused cognitive behavioral therapy. Thanks to techniques such as cognitive restructuring, emotional regulation, and exposure to aversive stimuli, the patient integrates their painful experiences.
• Somatic therapies. These work on the idea that dissociation leaves a deep imprint of suffering in the physical sphere. Addressing sensations and somatic discomfort gradually reduces the patient’s emotional pain.

Final recommendations

While dissociation is a useful mechanism of the mind, in the long run, it hinders our quality of life. Indeed, it’s true that there are certain memories, experiences, and images that shouldn’t ever return to our consciousness. But, traumatic experiences must always be processed and integrated into the trauma-sufferer’s identity, thus lowering their burden of suffering.

This is the purpose of psychological therapy. So, don’t hesitate to ask for specialized help if you need it.