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PTSD: Dissociation
Experiencing a sense of detachment from one’s mental processes, body or surroundings can occur following exposure to one or more significant traumatic events. In the context of PTSD, dissociation is a common coping response – a phenomenon I will elaborate upon in the present article.
Understanding Dissociation
Post-Traumatic Stress Disorder (PTSD) dissociative symptoms typically manifest in two primary categories: depersonalisation and derealisation. Depersonalisation symptoms involve a sense of detachment or disconnection from one’s mind and body. Individuals may describe feeling like external observers, as though they are watching themselves from a distance. They may also experience a sense of being outside their own body, with a feeling of unfamiliarity or distortion. Emotional numbness, characterised by a detachment from emotions or a pervasive sense of dullness, is a prevalent aspect of these symptoms.
On the other hand, derealisation involves persistent perceptions of one’s surroundings as unreal, dreamlike, distant, or distorted. This can manifest through visual distortions, with objects appearing fuzzy, unreal, or undergoing changes in shape and size. Individuals experiencing derealisation may feel as though they are in a dreamlike state, where the usual flow of time becomes disrupted, leading to an altered perception of its passage. This state may also entail diminished sensory experiences, such as dulled colours, muted sounds, a lack of tactile sensations, and an overall perception of the world as less vibrant.
It is also possible, although generally occurring with more complex traumatic symptoms, that one develops dissociative disorder, which is a more severe form of dissociation encompassing symptoms of distinct personalities, or parts. However, PTSD related symptoms, be they mild, moderate or severe, are assessed in terms of depersonalisation and derealisation. The DSM-5 outlines the key symptom categories as follows:
Depersonalisation: Experiencing a sense of being detached from, or an observer of, one’s mental processes or body. It may feel like you are in a dream or watching yourself from outside your body.
Derealisation: Experiencing a sense of unreality or detachment from, or unfamiliarity with one’s surroundings. The environment may appear distorted, blurry, or not real.
A third key feature that the DSM-5 includes as a symptom of dissociation is amnesia. This is defined as having difficulty remembering important aspects of the traumatic event. This can include gaps in memory or an inability to recall specific details of the trauma.
Whilst symptoms of dissociation can be unpleasant, even scary, it’s important to know that they serve a purpose, which is to help the person to cope with intense emotional distress and pain. In this context, similar to short term adaptive stress responses, dissociation represents a normal reaction to one or more highly stressful events. When a person experiences dissociation it can prevent them from falling apart and not being able to fully function in the event of experiencing emotional dysregulation. Thus, it is also a protective mechanism designed to ensure one’s survival.
Personal Experiences
I’ve worked with numerous clients that struggled with dissociation as a result of experiencing multiple traumas. With one patient who recalled the details of a road traffic accident, the mere act of remembering what happened caused an immediate sense of disconnection, where she felt outside her body. At other times she described feeling fuzzy-headed and dizzy. In my experience, clients who faced multiple traumas often developed dissociative symptoms triggered either by the recollection of specific incidents or by encounters with triggers reminiscent of the trauma. This pattern seemed to serve as a protective mechanism, helping them avoid overwhelming emotional pain.
Impact on Daily Functioning
The challenge, however, is that symptoms of dissociation only serve the person temporarily. If the underlying trauma that causes the dissociation is not addressed, symptoms of dissociative distress escalate, and give rise to other mental health conditions, and ultimately leading to severe impairment to one’s daily functioning.
Treatment & Coping strategies
Healing dissociation is therefore essential. This process involves addressing the underlying traumas causing the symptoms; once this is done, the symptoms will subside. To achieve this, I recommend trauma informed therapy that is tailored to your needs, and enables you to achieve your wellness goals at a pace that is right for you. It’s important to note that an immediate focus on healing trauma may not always be the most effective approach. Depending on your circumstances, you might benefit from a series of sessions aimed at applying grounding techniques, counselling, or somatic approaches before addressing the underlying trauma. This underscores the significance of individualised treatment.
As an adjunct to therapy, following are some self-care tips that may also help:
1. Grounding: This technique can foster presence and tranquility. Engage your senses by identifying 5 things you can see, 4 things you can hear, 3 things you can feel, 2 things you can smell, and 1 thing you can taste.
2. Deep Breathing: Controlled breathing can calm the sympathetic nervous system and promote relaxation. Try placing your hand on your chest, inhaling for 5 seconds, fully focusing on the physical sensation of breath, and exhaling for 5 seconds.
3. Body Scan: Conducting a mindful scan from feet to head can enhance your connection to your body and the present moment, promoting a sense of groundedness.
4. Creating a Safe Space: Invest time in crafting an environment that is comforting—incorporate plants, aromatherapies, soothing music, cosy blankets, or other personal preferences to promote relaxation and tranquility.
5. Establishing a Routine: Structure and planned activities contribute significantly to mental health. Set and achieve goals, providing a sense of purpose and stability.
6. Self-Compassion: Embrace self-kindness using the Buddhist technique of meta-bhavana. Spend a few minutes each day saying words like ‘may I be well, may I be happy, may I be free from suffering,’ extending these sentiments to others. Consistent practice transforms negative thoughts, fostering a positive mindset.
7. Creative Outlet: Cultivate creativity through activities like writing, painting, or making music. Engaging in creative activities not only supports cognitive health, but can also improve mood and general well-being.
8. Yoga: Trauma is also experienced as a felt sense in the body. Techniques like yoga can reduce emotional distress, as well as help you feel more connected to your body.
Hope & Recovery
Remember, dissociation, be it mild, moderate or severe, is a typical response to coping with intensely distressing events, therefore completely normal. However, it functions as a short term response to cope and survive. If symptoms persist, they can impair your psychobiological and social functioning. The most effective way to heal dissociation is to address the underlying trauma(s). With the appropriate therapeutic approach, this can generally be undertaken without experiencing overwhelming painful negative emotions.
I hope you found this article useful. If you have any questions, or to discuss treatment and support options then feel free to get in touch.
With best wishes,
Sadaf
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