Why is dissociation often misunderstood and goes unrecognised?
Life can be a huge struggle for a client that has been chronically traumatized. Often they present a mix of many symptoms and receive not seldom up to five different clinical diagnoses. This makes it highly challenging for assessment and treatment. Also, I keep coming across many misconceptions about dissociation among clinicians and clients alike. Clinicians either don’t identify dissociation or make a problem out of it, and clients don’t know what is happening with them. They are in a state of confusion, often accompanied by feelings of shame and not sharing symptoms. This combination leads to the fact that clients often don’t get the treatment they need.
Therefore, I want to shed some light on it. So what is actual dissociation?
Complex trauma survivors often lack the adequate interactive capacity to realize and process their traumatic experiences fully. Since they often need to go on with life, they start to mentally avoid their unresolved and “too much to handle” past and sometimes present and try to keep up an appearance of normality, which can be easily triggered. Therefore, it is eminent to understand and start treating dissociation if we want to treat trauma effectively.
Chronically traumatised clients often present different parts that roughly can be separated into an “Apparently Normal Self” (ANS) and “Emotional Part” (EP).
What exactly is an Apparently Normal Self (ANS)?
Trauma Survivors, as ANSs, are rational, present-oriented, and mainly grounded with a focus on how to cope with their everyday life. For example, the ANS handles social relationships, work, learning, and caretaking for others and their physical needs while avoiding reminders of their traumas.
Because an ANS cannot correctly integrate and process the traumatic materials contained by the EP, ANSs are often highly phobic and avoidant towards reminders of their trauma to prevent the activation of flashbacks. Examples of avoiding behaviors are:
- Anesthesia (insensitivity or loss of particular sensory input
- Detachment by disconnecting from emotions and body sensations.
Consequently, those avoidant behaviors can drain mental energy and not seldom cause depression, anxiety, or chronic feelings of hopelessness, shame, guilt, or rage. Particularly desperate ANSs might engage in more harmful detached self-soothing activities such as self-harm, binge eating, or substance abuse to prevent EPs from intruding. Unfortunately, those emotionally disconnected ANSs will struggle to form meaningful relationships with others and have a poor grasp of their physical and emotional needs.
To sum up, you can recognize an ANS by its need to be from the outside high functioning and often can show signs of solid work ethic and dedication that is not seldom admired by others. However, the seemingly relentless ANS is motivated and driven to avoid any triggering situation, often at the cost of mistrust and insecure attachment with others.
What are the Emotional Parts (EPs)?
Emotional parts (EP) are parts of the personality that represent the dissociation or contain the traumatic materials (memories, internalized negative beliefs, body sensations, and learned responses). EPs are often less developed than the ANSs because EPs are mainly activated by trauma reminders and are not experiencing much of everyday life.
For trauma survivors with primary structural dissociation, the EP may be limited to direct results of the trauma. For example, EP is experienced as various aspects of dissociative flashbacks and finds it hard to stay connected with the present when activated. Common feelings experienced by an EP are fear, anger, disgust, self-hatred, or guilt. Trauma survivors intensively focus on the same action systems or subsystems activated during the traumatic event. Those EPs might engage in defensive, offensive, or trauma-related actions, such as trying to fight, run, or surrender to the actual or perceived threats. Some trauma survivors also have the urge to repeatedly reenact elements of the trauma, such as engaging in compulsive sexual behavior as a response to sexual trauma.
Multiple EPs hold different traumatic materials for those with secondary structural dissociation, and EPs are more developed compared to primary dissociation. Otherwise, benign stimuli can trigger the trauma survivor and gradually become associated with trauma or abuse. Due to those indirect traumatic associations, some EPs in secondary structural dissociation may handle some daily life functions such as exploration or play. Interestingly, most of those EPs present or perceive themselves in a child mode and are not equipped to handle everyday life activities and stressors.
For those with tertiary structural dissociation, those multiple EPs are very similar to the EPs present in secondary structural dissociation. However, these EPs are often more developed and differentiated, though not always, and they may perceive themselves as older instead of necessarily frozen in time.
The difference between the ANS and EP
ANS and EP have both pretty inflexible patterns, at least some of which are maladaptive, and both parts are mainly closed to each other. In both cases, the client will experience emotions. However, in an EP, the feeling is vehement, overwhelming, and is perceived as non-adaptive or helpful. Usually, expressing this emotion leads to more dysfunction and feelings of not being in control.
Structural dissociation must be seen on a continuum and can range from a simple setup to high levels of complexity. The more complex the dissociation gets, the more unique is the structure of different parts and representations.
Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006) The haunted self: Structural dissociation and the treatment of chronic traumatization. New York: W.W. Norton.
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