Dissociation and Its Traumatic Origin

Dissociation is defined in the handbook of psychologists and psychiatrists which is The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) as “a disruption and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior” (American Psychiatric Association, 2013, p.291). Typical dissociative symptoms are amnesia, fugue, identity confusion, derealization and depersonalization. Amnesia can simply be described as loss of memory. Dissociative fugue is the severe form of amnesia, which a person do not have any memory about himself/herself or his/her past. Identity confusion is the struggle of a person on defining who s/he is. Normal developmental phase might include identity confusion as a process during adolescence (Steinberg & Steinberg, 1995). Derealization, can be defined briefly as the rupture from reality and depersonalization as the detachment of one from himself/herself. A number of different combinations of these symptoms make up each of the dissociative disorders. For example, a patient diagnosed with dissociative identity disorder (DID) might suffer from amnesia, depersonalization, derealization, and identity alteration (Steinberg & Steinberg, 1995). DID is the most chronic, severe and complex type of dissociative disorders (Sar, 2011; Golebiowska, 2017). Other types are dissociative amnesia, dissociative fugue, depersonalization/ derealization disorder, and dissociative disorder not otherwise specified (DDNOS) (American Psychiatric Association, 2013). Not every dissociative symptom is pathological which distress the person severely and interfere with daily functioning, yet some are normal experiences in daily life (Ross, Joshi, & Currie, 1990). The consideration of dissociation is a spectrum rather than the expression of either presence or absence of a dissociative symptom (Bernstein & Putnam, 1986). Dissociative experiences of both children and adults can be seen in mild to severe forms (Myrick & Brand, 2015). Mild dissociative experiences such as identity confusion or depersonalization seems intrinsic to normal adolescents and these experiences usually decrease as age increases. However, if the experience is pathological, it does not spontaneously decline with age (Armstrong et al., 1997). Symptoms closer to the ‘severe’ end of the spectrum are more serious and most of the time, appropriate treatment is necessary to control severe symptoms and (Bernstein & Putnam, 1986; Tutkun et al., 1988) and so that daily life functioning may continue without being negatively affected.

Some of the 19th century pioneers described the dissociation in its oldest ways, while they suggested also the traumatic origin (Dorahy & Van der Hart, 2007). Today, besides widening of the term dissociation, it is still suggested a positive relationship between experiencing trauma and dissociation rates. Subjects with trauma history show significantly higher dissociation levels than subjects without the particular experience (Zoroglu et al., 2001). Dissociation is thought to be developed as a coping mechanism due to severe traumatic experiences in childhood (Parry et al., 2018). Childhood traumatic experiences have a role in triggering dissociative experiences, in other words, the origin of dissociation is based on traumata in childhood (Arargun et al., 2003). The trauma model of dissociation is related with the defense cascade model. The defense cascade model explains different types of behavior (Freeze-Flight-Fight-Fright-Flag-Faint responses) displayed when confronted with an extremely dangerous situation (Schauer & Elbert, 2015). Although dissociation is a defense mechanism against trauma and has therapeutic effects, it is not systematically included in the original model. Dissociation means that the person exposed to trauma becomes subjectively detached from self, time and place, which occurs during the event (peri-traumatization) (Schauer & Elbert, 2015). For example, in a DID case, person develops a new personality in every encounter with a traumatic event after the first split because it is a coping mechanism (Golebiowska, 2017). Dissociation can be argued as a psychobiological response that enables the individual to survive when confronted with a traumatic event, which can be deduced as trauma plays a leading role in dissociation through various ways along with some biopsychosocial moderators and mediators (Myrick & Brand, 2015; Dalenberg et al., 2012). According to the trauma model of dissociation, it is an effective way of protecting the self, but has a cost, as it is known to be related with various psychopathologies including posttraumatic stress disorder (PTSD) and dissociative disorders (Carrion & Steiner, 2000). The development of the literature is vital due to the particular existence reason of dissociation, the severe damage caused by dissociative symptoms in human psychobiology, remarkable prevalence rates, and the connection between trauma and dissociative experiences.

Arş. Gör. D. Nihal Çarıkçı
 
 

 
 
 
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