Dissociation, PTSD Risk, And Childhood Trauma
Dissociation — a sense of being detached from one’s own body, thoughts, and feelings — can be a common response to physical or psychological trauma. As such, it’s often observed in people with post-traumatic stress disorder (PTSD). The exact relationship between these psychological reactions to trauma is still debated within the psychological literature. However, research suggests that there could be a significant overlap between the dissociative response and some symptoms of PTSD.
Dissociation during traumatic events appears to increase a person’s risk of developing PTSD, and dissociative responses afterward may predict greater symptom severity. Experiences such as intense flashbacks in response to PTSD triggers may be partly enabled by dissociation. Some neurobiological evidence points toward a subtype of PTSD marked by strong dissociative symptoms, such as a loss of connection to the self and the world. PTSD and symptoms like dissociation can often be treated with various types of therapy.
What is dissociation?
Dissociation generally refers to a psychological state in which an individual senses they are disconnected or detached from some aspects of their experience. This can take many forms, but all of them tend to involve a subjective impression of separation, distance, or diminishment.
- Disconnection from one’s body, as though physical sensations are happening to someone else
- Perceiving your surroundings as blocked off or obscured, as though you’re perceiving events through a haze or a partially translucent window
- Sensing that the world around you is unreal, like a movie, a dream, or a video game
- Loss of a sense of unified identity, with nothing connecting your various thoughts, emotions, and sensations
- Limitation of emotional responses
- Feeling that you’re on “autopilot,” not consciously directing your actions
- Loss of narrative coherence — experiencing events as disconnected flashes rather than a continuous flow of time
- Gaps in awareness and memory
Some forms of dissociation may be mild and benign. For example, the feeling of “losing yourself” in a daydream or losing track of the flow of time while driving may be forms of non-pathological dissociation. However, severe dissociation can be highly distressing, potentially leading to consequences like isolation, relationship challenges, fear or worry, and difficulty functioning in everyday life.
Clinical evidence suggests that dissociation may play a role in generating or worsening other symptoms of serious mental illness. A 2021 paper found that dissociative symptoms can be linked to:
- Psychotic symptoms, such as hallucinations
- Cognitive disorganization
- Grandiosity (an exaggerated sense of importance or power)
- Paranoia
- Anxiety
- Depression
- Post-traumatic stress symptoms
Dissociative disorders
A dissociative disorder can be defined as a mental health condition characterized primarily by severe dissociative symptoms. The American Psychiatric Association recognizes three such disorders:
- Dissociative identity disorder: This disorder is what many people call “multiple personality disorder.” An affected individual may shift between two or more personas with distinctive speech patterns, behaviors, and thinking styles. Sometimes, this is accompanied by gaps in memory.
- Dissociative amnesia: This can refer to the loss of personal memories, such as forgetting a specific time period or sequence of events. In rare cases, dissociative amnesia can involve forgetting one’s entire identity and personal history.
- Depersonalization/derealization disorder: This disorder usually involves ongoing or repeated sensations of detachment from one’s body, actions, or sense of identity, or a persistent or recurring sense of unreality.
Trauma, dissociation, and PTSD
Not all cases of dissociation have clear causes, but researchers have found that they tend to be especially common in people who have had traumatic experiences. Childhood abuse and other severely distressing early-life experiences appear to be particularly likely to lead to dissociative symptomatology. Other kinds of events that may lead to dissociation include sexual assault, physical violence, natural disasters, and serious accidents
Mental health experts on the relationship between dissociation PTSD risk and childhood trauma
Many mental health experts believe that dissociation may result from the mind’s attempt to protect itself from extreme physical or emotional pain. By mentally distancing themselves from threats they can’t avoid or fight, people who dissociate might avoid becoming overwhelmed in dangerous situations.
This response can be helpful for immediate survival, but it may have harmful long-term consequences. Dissociation during or immediately after trauma can be linked to a higher risk of PTSD. This effect could be due partly to negative beliefs arising from dissociation. For instance, dissociative responses may lead to immobility during traumatizing events, potentially contributing to a sense of guilt in the survivor because of their seemingly passive response.
The dissociative PTSD subtype
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) recognizes a distinct subtype of posttraumatic stress disorder called “PTSD with dissociative symptoms” or d-PTSD. It’s typically marked by frequent occurrences of depersonalization (a sensation of detachment from one’s own body or mental processes) and derealization (sensing that the surrounding world is distant or unreal).
A 2022 meta-analysis estimated that between 22% and 48% of people with PTSD may exhibit the d-PTSD subtype. It seems to be more common in children but can affect adults as well, especially those who have experienced significant levels of trauma early in life. The Clinician-Administered PTSD Scale (CAPS), a tool frequently used to evaluate individuals for post-traumatic stress, includes items meant to assess the presence and severity of dissociation.
Controversy surrounding d-PTSD
Some researchers dispute the existence of a dissociative subtype of PTSD. For example, a 2019 study found little evidence that people with dissociative symptoms responded differently to therapies for PTSD.
Another paper argued that dissociation is a risk factor for all forms of PTSD, and, therefore, isn’t specific enough to one subcategory.
However, other evidence indicates that the dissociative subtype may be a diagnostically useful category. Evidence gathered from World Mental Health Surveys indicates that dissociative symptoms in PTSD can be associated with several specific features setting these cases apart from others, including a greater likelihood of the following:
- Experiencing the onset of PTSD in childhood
- Being male
- Having a high exposure to childhood adversity and other forms of trauma before PTSD onset
- Experiencing severe difficulties fulfilling social roles
- Experiencing suicidal thoughts and behaviors
In addition, there’s some clinical and neurobiological evidence that people with this PTSD subtype may show different physiological responses to trauma triggers. When most people with PTSD encounter triggers, they exhibit a heightened heart rate and increased activity in the amygdala — a brain region associated with fear processing — as well as diminished activity in the prefrontal cortex. These responses tend to be consistent with heightened activity in the sympathetic nervous system (the “fight-or-flight” response).
However, studies show that the opposite responses usually occur in people with dissociative PTSD. Some researchers believe this indicates that dissociation arises partly as a self-regulatory response, counteracting the hyperarousal of the sympathetic nervous system to protect against the effects of prolonged stress.
Dissociation and PTSD symptom severity
Dissociation may directly influence other symptoms of PTSD. A 2022 paper concluded that people who exhibited signs of dissociation soon after experiencing trauma could be likely to develop more severe cases of PTSD. These individuals frequently showed higher levels of depression and anxiety, as well as more functional impairment.
Another study in the Journal of Trauma & Dissociation found that, during PTSD treatment, changes in the severity of dissociative symptoms often predicted changes in other symptoms. Patients whose dissociation was successfully treated were usually more likely to show other markers of recovery.
Certain kinds of symptoms classically associated with PTSD may be rooted in dissociation. For example, “flashbacks,” in which the individual temporarily loses awareness of their present circumstances and senses they have been transported back to a traumatic memory, are often considered a type of dissociative experience.
Dissociation and complex PTSD
Another potential subtype of post-traumatic stress disorder is complex PTSD or cPTSD. While it’s not recognized by the DSM-V, the International Classification of Diseases (ICD-11) acknowledges it as a distinct category. This form of PTSD is thought to be associated with repeated or prolonged experiences of trauma, such as abuse throughout childhood, rather than singular experiences, such as surviving a car crash or a bombing.
The proposed characteristics of cPTSD include severe emotional, cognitive, and interpersonal difficulties. Dissociative symptoms may also be particularly common in cPTSD, reflecting a dysfunctional coping response to complex trauma. Some studies show that people diagnosed with this form of PTSD tend to exhibit higher scores on assessments like the Dissociative Experiences Scale (DES).
How are dissociative PTSD symptoms treated?
Current PTSD treatment standards tend to emphasize the use of psychotherapy in overcoming trauma-related symptoms. Medications may sometimes be used as secondary treatments, though many researchers believe options like benzodiazepines could worsen dissociative symptoms due to their hypnotic effects (inducing sedation and promoting sleep).
Some theories suggest that certain types of psychotherapy may be less effective for PTSD with dissociative symptoms. According to this view, therapies that involve confronting traumatic memories might be less effective because dissociation could reduce the patient’s emotional engagement. As a result, they might benefit less from this form of therapy.
However, the evidence for this difference in treatment effect is limited. A 2020 meta-analysis of existing research found no indication that people with dissociative symptoms responded differently to common trauma-focused therapies for PTSD.
Mental health services and treatments for post traumatic stress disorder
According to the American Psychological Association, the most strongly recommended treatments for PTSD are:
- Trauma-focused cognitive-behavioral therapy (TF-CBT)
- Cognitive processing therapy (CPT)
- Cognitive therapy for PTSD (CT-PTSD)
- Prolonged exposure therapy (PE)
Other therapies that may be beneficial for some patients include the following:
- Eye movement desensitization and reprocessing (EMDR)
- Narrative exposure therapy (NET)
- Brief eclectic psychotherapy (BEP)
Online therapy for dissociation PTSD risk and childhood trauma
If you’re having difficulty finding a treatment provider near you who specializes in trauma-focused therapy, you might want to try seeking care online. Internet therapy can sometimes make it easier to find a mental health professional with whom you can form a strong connection, which may have a significant effect on how well you respond to treatment.
Though more research on the topic may be needed, evidence suggests that online therapies can work well for those impacted by trauma. A review paper from 2016 concluded that based on current evidence, internet-based cognitive-behavioral therapy was an effective treatment for PTSD.
Takeaway
Is there a link between childhood trauma and PTSD?
Evidence suggests that a history of childhood trauma exposure increases the risk for post-traumatic stress disorder substantially. In addition to an increased likelihood of a PTSD diagnosis, those who experienced significant childhood trauma are also likely to experience difficulty with affective and interpersonal regulation, meaning they often have a harder time regulating their emotions and maintaining healthy social relationships.
Researchers are also investigating a relatively new type of PTSD, “complex” post-traumatic stress disorder (CPTSD). CPTSD is associated with long-term traumatic exposure that often begins early in life. Child abuse has the potential to lead to CPTSD. It might also induce other developmental concerns, such as increased difficulty with self-regulation, identity confusion, and a greater risk of substance misuse in adolescence and young adulthood.
How do you recognize if your childhood trauma is affecting you as an adult?
Child maltreatment can cause several concerns in adulthood. The most common are difficulty managing emotions and challenges in interpersonal relationships. It’s possible that childhood trauma can also form the roots of other psychiatric disorders. For example, there has long been an established link between childhood trauma and an increased risk of developing borderline personality disorder (BPD). BPD is characterized by emotional instability, volatile social relationships, and black-and-white thinking, features similar to symptoms seen in conditions like PTSD.
Your childhood trauma may be affecting you if you find it difficult to maintain self-esteem, manage social, professional, or romantic relationships, or experience adverse effects on your overall well-being. Regardless of whether childhood trauma plays a role, if you feel that your mental, physical, emotional, or spiritual well-being can be improved, it is likely worthwhile to reach out to a mental health professional for support. They can likely evaluate the impact of chronic trauma in childhood, help you manage subsequent mental health conditions, and help improve your resilience against several risk factors.
How can someone snap out of dissociation?
Sometimes, dissociation occurs following a traumatic experience or other source of severe stress. A dissociative state is typically characterized by strong feelings of detachment, depersonalization, and derealization. Depersonalization refers to feelings as if you are not real, while derealization refers to feeling as if the word is not real. Dissociation often improves independently with time, but some cases require treatment.
Those who have seen a professional for help treating dissociation may have a coping mechanism that they have practiced, which helps them exit a dissociative state. Common coping mechanisms include mindfulness strategies, exercise, socialization, and practicing meditation. Dissociation following a traumatic event might require professional help to manage the underlying trauma before dissociative events can be fully resolved.
Does post-traumatic stress disorder dissociation go away?
In many cases, dissociation reduces in frequency and severity over time and intervention is not required. However, some cases do require treatment, especially if the person meets the criteria for PTSD’s dissociative subtype. PTSD - Dissociative Subtype tends to be associated with an overwhelming traumatic experience from which escape is not possible, such as childhood abuse or war trauma.
Treating PTSD often helps symptoms like dissociation, trauma avoidance, mood changes, flashbacks, and distorted thoughts return to pre-trauma levels. While treatment modalities specifically for dissociation are still being investigated, emerging evidence suggests that treatments that include cognitive restructuring and emotional regulation skills training tend to be the most effective. As with most PTSD patients, treatment outcomes tend to be best when treatment is sought as early as possible.
Can childhood trauma cause dissociation?
Trauma experienced in childhood might lead to dissociation symptoms later in life, as well as other PTSD-related symptoms. Evidence suggests dissociation is likely more common in those who experienced significant adverse experiences in childhood. Researchers theorize that dissociative traits may have developed to help the child manage the inescapability of their upbringing. Furthermore, evidence indicates that ongoing trauma causes changes to the structure and function of the brain that often persist into adulthood.
Can childhood trauma cause PTSD later in life?
According to the American Psychiatric Association, early childhood trauma increases the risk of developing PTSD and many other mental health conditions. Physical and emotional abuse, neglect, and environmental crises (such as a natural disaster) can all change the way the brain develops, often leading to disorders later in life. Adverse childhood experiences are a significant risk factor for PTSD, especially complex PTSD (CPTSD), a newly proposed condition caused by long-term traumatic exposure, such as growing up in an abusive home or being deployed to a war zone.
Childhood trauma might also raise the risk of anxiety disorders, obsessive-compulsive disorder, depression, personality disorders, and dissociative identity disorder (formerly called multiple personality syndrome). Trauma also likely increases the risk of self-harm and suicidal ideation. The specific impact childhood trauma has on a person depends on individual risk factors, what support was available through their development, and what resources they have access to as an adult to help manage symptoms.
What does extreme dissociation look like?
Extreme dissociation might look different from person to person. In many cases, someone experiencing dissociation might seem to struggle to engage with the world around them. They might look like they are daydreaming, ignoring those around them, or looking at their body as though it does not belong to them. Traumatic exposure might also induce a dissociative fugue state, which is typically characterized by memory loss and wandering.
In more severe cases, the person may take on an entirely new identity and may meet the criteria for dissociative identity disorder (DID) - formerly known as multiple personality syndrome. The underlying mechanisms of DID are still being investigated, but many researchers theorize that, for many people, extreme dissociation is caused by early childhood trauma, such as verbal, physical, or sexual abuse.
What mental illness is associated with dissociation?
The mental illnesses most closely associated with dissociation are dissociative disorders, which include dissociative identity disorder, depersonalization/derealization disorder, and dissociative amnesia. Dissociative identity disorder is the most severe of the three. It is characterized by a person adopting multiple personality states - called “alters” - distinct from the “original” personality of the person experiencing the condition. Memories are often not shared among alters, and the frequent changes in behavior can create difficulty in navigating work, school, or social engagements.
Depersonalization/derealization disorder is characterized by recurring episodes wherein a person depersonalizes (experiences an out-of-body experience or feels like their body is not their own), denationalizes (feels like things and people in the world are not real), or both. Dissociative amnesia is most commonly associated with a traumatic event and involves not being able to recall information about oneself, such as not being able to recall one's name following traumatic exposure.
Can childhood trauma change your personality?
Childhood trauma can cause substantial changes in the brain and interfere with development in a way that may lead to personality changes, especially if the trauma begins early and continues throughout childhood. People who have experienced chronic trauma in childhood often have a harder time regulating emotions and maintaining healthy interpersonal relationships. In addition, those who experienced childhood trauma are more likely to develop personality disorders, such as borderline personality disorder or histrionic personality disorder.
Personality changes might also develop due to other health conditions related to traumatic experiences, such as depressive symptoms associated with mood disorders, worry associated with anxiety disorders, or physical symptoms like chronic pain. Those and other symptoms can affect a person’s likeability, willingness to socialize, and desire to seek self-improvement.
Why are those who have experienced trauma more susceptible to dissociation?
While researchers are still investigating the relationship between trauma and dissociation, many theorize that dissociation allows a person, especially children, to escape unavoidable traumatic situations, such as growing up in an abusive household. Dissociation may help someone protect themselves against ongoing trauma and trauma reminders. However, dissociation comes with its own adverse effects, and healthier coping skills might allow someone to manage the adverse effects of their trauma without dissociating. For those who obtain professional help, reducing the duration and frequency of dissociative episodes is a commonly sought treatment outcome.
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