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Complex Trauma and Dissociative Disorders

Treatment of Dissociative Identity Disorder typically includes the following components: a strong therapeutic relationship, a safe therapeutic environment, appropriate boundaries, development of no self- or other-harm contracts, an understanding of the personality structures, working through traumatic and dissociated material, the development of more mature psychological defences, and the integration of states of self.

Dissociation:

Have you ever experienced a total internal focusing on something you have been doing which makes the external seem to drift away? When watching the television, reading a book or driving the car, have you ever gone through a period of time where you have lost time when engrossed in a good book?

To dissociate is the wonderful ability to loose oneself at a particular moment and escape the day to day humdrum reality, and this is the ability that many of use during childhood. As adults reading this article I encourage you to think back to times where you may have used your imagination to 'make' things seem different. I remember when a child, a cardboard box had endless possibilities; a castle, a car….. which were only limited by imagination!

These kinds of normal dissociative responses begin to decrease with age, with its peak in terms of dissociative responses being around about the age of ten years. Dissociation for the child who is experiencing severe enduring trauma provides a coping mechanism to help them get through overwhelming experiences by separating themselves from the full impact of the immediate trauma which they are experiencing. In this way the child can ‘escape’ when there is no means of escape.

These dissociative patterns usually develop as a reaction to trauma and function to keep difficult memories at bay. An estimated 3 percent of U.S. adults are affected

Treatment may include psychotherapy, hypnosis and medication. Although the course of therapy can be difficult, many people with dissociative disorders are able to learn new ways of coping and lead healthy, productive lives and treatment outcomes can be positive.

Signs and Symptoms.

The major dissociative disorders are:

• Dissociative amnesia
• Dissociative identity disorder (DID)
• Dissociative fugue
• Depersonalization disorder
• Dissociative Disorder not otherwise specified (DDNOS)

Symptoms common to all types of dissociative disorders include:

 

• Memory loss (amnesia) of certain time periods, events and people
• Mental health problems, including depression and anxiety
• A sense of being detached from yourself (depersonalization)
• A perception of the people and things around you as distorted and unreal (derealization)
• A blurred sense of identity                                                                

 

Each of the four major dissociative disorders is characterized by a distinct mode of dissociation. Signs and symptoms of each disorder may include:

 

• Dissociative amnesia. Memory loss that's more extensive than normal forgetfulness and can't be explained by a physical or neurological condition is the hallmark of this condition. Sudden-onset amnesia following a traumatic event, such as a car accident, happens infrequently. More commonly, conscious recall of traumatic periods, events or people in your life — especially from childhood — is simply absent from your memory.
• Dissociative identity disorder. This condition, formerly known as multiple personality disorder, is characterized by "switching" to alternate identities when you're under stress. In dissociative identity disorder, you may feel the presence of one or more other people talking or living inside your head. Each of these identities may have their own name, personal history and characteristics, including marked differences in manner, voice, gender and even such physical qualities as the need for corrective eyewear. There often is considerable variation in each alternate personality's familiarity with the others. People with dissociative identity disorder typically also have dissociative amnesia.
• Dissociative fugue. People with this condition dissociate by putting real distance between themselves and their identity. For example, you may abruptly leave home or work and travel away, forgetting who you are and possibly adopting a new identity in a new location. People experiencing dissociative fugue typically retain all their faculties and may be very capable of blending in wherever they end up. A fugue episode may last only a few hours or, rarely, as long as many months. Dissociative fugue typically ends as abruptly as it begins. When it lifts, you may feel intensely disoriented, depressed and angry, with no recollection of what happened during the fugue or how you arrived in such unfamiliar circumstances.
• Depersonalization disorder. This disorder is characterized by a sudden sense of being outside yourself, observing your actions from a distance as though watching a movie. It may be accompanied by a perceived distortion of the size and shape of your body or of other people and objects around you. Time may seem to slow down, and the world may seem unreal. Symptoms may last only a few moments or may wax and wane over many years.
• DDNOS. (Dissociative Disorder not otherwise specified), an earlier stage or less serious form of other disorders that often precedes DID.

 

Information on Treatment:
Treatment of Dissociative Identity Disorder typically includes the following components: a strong therapeutic relationship, a safe therapeutic environment, appropriate boundaries, development of no self- or other-harm contracts, an understanding of the personality structures, working through traumatic and dissociated material, the development of more mature psychological defences, and the integration of states of self.

Guidelines for treatment of adults and children are available from the International Society for the Study of Dissociation, www.isst-d.org

I have undertaken training in Eye Movement Desensitisation & Reprocessing (EMDR) as approved by EMDRIA (www.emdria.org ) which is indicated in the UK's National Institutute for Clinical excellance as an approach which may be useful in the treatment of PTSD.