Useful examples might be test anxiety, stage fright, or a distressing meeting with a boss; however, the experience should be nothing too extreme or personal. Then take a piece of paper, fold it in half, and write the incident on one half of the paper. On the other half, write down the emotions that were felt when it occurred or those felt when thinking about it now. Also write down where in the body these feelings are experienced (e.g., “anxiety in my stomach” or “sadness as a lump in my throat”). The Dissociative Continuum There is a continuum to the process of dissociation, with one end of the spectrum being normative, or non-trauma-related dissociation. The other extreme of the spectrum is complete fragmentation of the self into nonconnected parts, which then qualify for the diagnosis of dissociative identity disorder, formerly referred to as multiple personality disorder or multiplicity. Normative Dissociation Normative dissociation is not trauma based; it is a phenomenon that everyone experiences occasionally. An example of normative dissociation is highway hypnosis, when someone operating a motor vehicle on a familiar roadway momentarily does not recognize or remember where they are, or the time spent traveling. This type of dissociation can also occur when someone “spaces out” and misses the exit on the highway, particularly on a frequently traveled route. The driver unconsciously feels free not to concentrate too intensely on the directions and trusts the “automatic pilot” to them there. This type of dissociation can also be experienced in a classroom situation, when a student suddenly becomes aware of having missed 10 minutes of a professor’s lecture. Dissociation exists along a continuum, the stages of which will be described below (Schiller, 2008). Temporary Separation of Thoughts and Feelings Temporary separation of thoughts and feelings can occur following an emotionally intense event (either positive or negative) that a person is able to put temporarily out of their mind in order to get through daily tasks or job responsibilities. The event will often flood back when the person’s guard is down or as they begin to relax. For example, consider someone who has experienced a death in the family and returns to work after taking time off for a period of grieving. The grief process is certainly not complete after a week or two, yet the individual is able to put it out of their mind all day in order to perform the job, often to have it flood back during the drive home or when sitting at home later that day. This phenomenon can also occur with positive or happy events that an individual needs to put aside in order to be effective throughout the day; for example, the therapist who just got engaged and wants to talk about it with everyone, yet is able to hold good boundaries with clients and not think about the feeling state for hours at a time. The individual may have consciously decided to put the feeling aside for a while, or it may be something they are able to do without a conscious effort. An Event Is Remembered without Congruent Expected Feelings This level of dissociative phenomena begins to get into the realm of trauma response. It represents the numbing that can occur following a traumatic event and is functional in the immediate aftermath, during the shock period. However, if the trauma is not processed along with the concurrent expected feelings, such as fear, anxiety, anger, shame, pain, sadness, or disgust, these feelings become walled off and are no longer available for access. The therapist will then see a client who has the “words without the music” and who will recount an event as if it happened to someone else. Depersonalization Depersonalization is another form of numbing in which survivors feel that they do not inhabit their own bodies. It can be a sense of looking into a mirror and seeing a stranger who the individual
Next, tear the paper in half, rip up, and throw out the half that had the incident written out on it. What is left is the half of the paper that has the feelings and body sensations written on it. This remaining half page is equivalent to what remains for the survivor of trauma who has dissociated the traumatic event: The somatosensory memories. The feelings and sensations that accompanied the event remain, without conscious memory of the event itself. recognizes as themselves, with whom they cannot connect. It can include a sense of unreality or, as several survivors have described it, the feeling of looking out at the world from the end of a long tunnel or through a telescope, rather than being a part of it. A Lack of Memory of the Event, with Just Feelings Remaining A lack of memory of an event, with just feelings remaining, is the classic form of dissociation, in which the memory of the event has been walled off and the subsequent intrusive thoughts, nightmares, panic, and other disconnected thoughts, feelings, and somatic states seem to come out of nowhere, without connection to an explainable reason. Some panic disorders and seemingly free-floating anxiety have their source here. Case Example During a therapy session, Joelle reported waking up during the night with the sensation that someone was in her room and touching her genitals. She reported screaming, bolting upright, and turning on her bedside lamp to find that no one was there. This series of events began happening every few nights, until Joelle developed a terror of going to sleep for fear that she would experience the same unnerving sensation. Gradually over the course of treatment, she was eventually able to remain in the memory of the sensation long enough during a therapy session to explore it without abreacting (i.e., becoming dysregulated), and she was able to reconnect this experience as an adult to sexual abuse she had experienced as a child. Fragmentation Fragmentation is present when an individual refers to “parts” of themselves and relates to them as if they are separate, rather than a unified whole, but is still aware of their existence. Fragmented individuals may describe feeling a loss of control or a sense of going through the motions of life, and they are aware of and can sense childlike or young parts of themselves. Such individuals are aware that they sometimes respond to situations from the point of view of these childlike parts, rather than from their present ages or life stages. Each fragmented part may access a different age or emotional state. Fragmented individuals frequently dislike some of these parts of themselves and wish to be separate from them. For example, Rebecca, age 26, periodically says, “I hate my child self. She’s so dumb.” The difference between this form of dissociation and dissociative identity disorder is a matter of degree and whether the person is conscious of these splits in their sense of self. This type of fragmentation is sometimes categorized as dissociative disorder not otherwise specified (American Psychiatric Association [APA], 2013). Dissociative Identity Disorder Dissociative identity disorder (DID) is at the far end of the dissociative spectrum and was formerly referred to as multiple personality disorder (APA, 2013). In this state, the fragmentation is complete and there are completely separate parts of the self that are not aware of each other’s existence. Each self part has a different function or a different job to do and may have originally emerged at different times in childhood to hold and compartmentalize different traumatic events, different perpetrators, or different intolerable feeling states.
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