PTSD and Dissociation

Estimated reading time: 31 minute(s)

Posttraumatic stress disorder, or PTSD, is a relatively common mental health disorder triggered by trauma and characterized by flashbacks and dreams containing traumatic memories. These traumatic memories can be hard to re-experience and often force people to develop coping mechanisms to avoid them. Dissociations are one of these coping mechanisms that many people with PTSD rely on to temporarily forget their traumas. These dissociations often feel like out-of-body experiences, and make a person completely disconnected from the world. Seeking help for PTSD and dissociation is urgent as these experiences involve detachment from reality and may prove dangerous or even life-threatening for victims.

What Is Dissociation?

Dissociations describe a disconnection between an individual’s sense of self and their ongoing thought processes. Mild dissociations are relatively common and may occur in the form of daydreaming or casual mind wandering, such as during long drives. In severe cases, these attacks may take the shape of a dissociation disorder, impacting identity, awareness, and memory, and leading to substantial consequences.

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Experts believe dissociations to be the brain’s way to protect itself from traumatic experiences while giving the person a chance to override their emotions and combat perceived threats. Without this mechanism, many people with PTSD are unable to perform everyday functions without becoming overwhelmed. While some dissociation tendencies may go away with time, others can become debilitating, especially if left unmanaged.

Trauma and dissociation share a close connection. Those with a history of childhood neglect or abuse make up a large part of those with diagnosed dissociative disorders. However, dissociation can also be used as a coping strategy by people with extended exposure to trauma

PTSD & Dissociation: The Connection

PTSD often develops after someone has lived through a traumatic event, such as being involved in an automobile accident, witnessing an active war zone, or undergoing abuse. The condition can hit anyone regardless of their age, pushing them to develop dissociations in many cases. While PTSD and dissociations can occur independently, it is more common for them to co-occur. For people with a traumatic past, these dissociative events are the brain’s way to cope with its painful effects. Chronic trauma is particularly linked with such episodes as it further ingrains dissociative tendencies into a person’s automatic brain responses, making it harder for them to combat these episodes.

Trauma carries the potential to cause physical damage to an individual’s brain structure, putting them at risk of developing dementia in later stages of life. These damaged neural connections also affect mood, cognition, and functional ability in patients regardless of their age. Moreover, trauma also negatively impacts the frontal lobe, a part of the brain responsible for relational behaviors and communication. [1] These changes are also likely to contribute to the likelihood of experiencing dissociation.

How to Tell if Someone is Dissociating?

When someone dissociates, they may feel disconnected from themselves and the world around them. A dissociative attack can make a person feel as if they have left their body or if the world around them is not real. Other symptoms that indicate a potential dissociation include the following:

• Feeling little physical pain
• Feeling disconnected from the body, also known as an out-of-body experience
• Lacking a sense of identity
• Feeling emotionally detached or numb
• Feeling separate from the surrounding world
• Forgetting personal information or certain events
• Having clear and different identities

Remember that a dissociative event may be different for each individual. The key to identifying one is finding out what it feels for you or a loved one so that you can timely notice it as soon as it arises. A mental health professional can help recognize the symptoms of dissociation when an episode is coming on so that you can take preemptive measures to keep yourself safe.

It is also important to remember that dissociation can be of two forms, including the following:

• Depersonalization: This may make a person feel as if they are watching themselves as an actor in a movie. It also entails an out-of-body experience where a person may picture themselves floating around their actual body.
• Derealization: This experience makes people and things around a person feel unreal, giving the impression that they are in a dream. The world also starts looking unnatural in some way, such as sounds may become distorted.

National surveys suggest that up to 75% of people experience an episode of derealization and depersonalization at least once in their lives with only 2 percent of them developing chronic dissociative disorders.

Negative Effects of PTSD Dissociation

Dissociation can be extremely effective as a coping strategy; however, the benefits are momentary, and the condition is likely to wreak havoc if nothing is done about it. Eventually, people start entering into dissociative states without any exposure to potential triggers or threats. This unpredictable disconnection may become problematic for work, relationships, and other commitments.

Mentioned below are other adverse long-term effects of dissociation: [2]

• Forgetting vital personal information
• Experiencing “blackout” periods with amnesia
• Confusion from the inner monologue
• Forgetting how people know you
• Inability to self-recognize
• Loss of self-identity
• Feeling as if others are not real
• Developing multiple personality disorders

Professional PTSD Dissociation Treatment

Medications and therapy are the most effective techniques for treating trauma-related dissociation. Additionally, some other techniques are available to make the healing process quicker. The main objective of treatment should involve finding a safe space where patients can identify the root cause of trauma and deal with its complications before the condition leads to further anxiety, depression, and interpersonal conflicts.

Therapy

Therapy can equip patients with productive ways to deal with PTSD and dissociation symptoms. Speaking with a trusted professional can help patients and their loved ones feel better about the underlying diagnosis while managing possible triggers and causes. The following are the two most commonly used therapy types for PTSD with dissociative symptoms:

• Dialectical behavioral therapy (DBT): This therapy helps people engage less in self-harming behaviors, such as substance misuse, unsafe sexual practices, and suicidal ideations. DBT sessions also focus on distress tolerance, mindfulness, interpersonal skills, and emotional regulation. These skills, in turn, help patients learn how to acknowledge and accept their emotions and feelings without facing any judgment while improving communication.
• Cognitive behavioral therapy (CBT): CBT aims to help individuals pick up patterns of negative thoughts and feelings and replace them with positive ones. [3]This therapy also equips patients with tools to combat complex behaviors and emotions in constructive and realistic ways. Trauma-focused CBT is a subtype of cognitive behavioral therapy specifically used for people experiencing PTSD with or without dissociation.

Medications

PTSD medications can be extremely helpful in managing dissociations associated with trauma. These medications also allow patients to manage their overall symptoms more effectively so that they can solely focus on healing. Ensure to discuss the options with the medical team to make the right choice about a prescription regimen.

Coping With Post Traumatic Dissociation

Once patients and mental health professionals mutually agree on a treatment plan that suits individual needs, the following strategies can be used for further management of dissociation as a part of PTSD:

Grounding Techniques

Experts recommend practicing grounding techniques when a person feels like slipping into a dissociative episode. These techniques involve connecting with surroundings more carefully and deeply. One way to achieve this is by placing the hands under running water and noticing the sensations felt. Alternatively, experts advise touching a familiar object and focusing on its properties, such as whether it is rough or smooth and warm or cold to touch.

In some cases, adopting a mental-based approach can also help, such as mathematics. Practicing timetables or counting backward by 2s, 4s, or 5s are some ways to avoid dissociating in the present. If none of this is possible, try naming as many countries as possible or look around to find objects of a specific color or shape to keep the mind occupied.

Mindfulness

Mindfulness has become a valuable resource for good mental health and well-being. This practice involves being present in the moment and training the brain to do so when needed. While there are different ways to practice mindfulness, one simple technique involves focusing on inhalation and exhalation.

Experts describe mindfulness as a powerful tool used to combat PTSD and dissociation. PTSD can push the body into a constant state of stress where it fails to recognize that the trauma it went through in the past no longer exists. Because of this lack of understanding, investing in mindfulness is essential as it helps the body invest in the present and eventually make it understand that trauma has passed so that it can come out of its survival mode.

Breathing Routines

While mindfulness can easily keep a person in the moment, breathing moments and routines can play a role in de-escalating intense moments of dissociation, which otherwise results in stress and anxiety. In this context, there are multiple strategies to try each of which teaches the body to calm down and turn off the fight-or-flight response.

By calming down the survival mode, breathing routines can make dissociation PTSD less likely to occur.

FAQs

Is there a specific age to develop PTSD and dissociation?

Because minds are still under development during childhood, people who experience trauma at a young age are more vulnerable to developing PTSD and dissociation. For instance, children who are neglected or abused, specifically between four and nine years, are the most vulnerable as they are not mentally equipped to handle the associated stress. Moreover, many of these negative events are continuous and lead to true dysfunction.

What comes first: dissociation or PTSD?

PTSD experts strongly believe dissociations to be a common feature of posttraumatic stress disorder. They propose that the same events that trigger PTSD can also cause individuals to experience a certain degree of dissociation where they have an emotional detachment from reality. In such circumstances, these dissociative behaviors can help with diagnosing PTSD. However, there are many cases where dissociation does not originate from past trauma but develops over time as a way to escape from severe anxiety and constant ruminations. For people experiencing these problems, it becomes easier to detach from the reality of their underlying condition instead of experiencing or coping with it.

References

1 Lebois LA, Li M, Baker JT, Wolff JD, Wang D, Lambros AM, Grinspoon E, Winternitz S, Ren J, Gönenç A, Gruber SA. Large-scale functional brain network architecture changes associated with trauma-related dissociation. American Journal of Psychiatry. 2021 Feb 1;178(2):165-73.

2 Panisch LS, Rogers RG, Breen MT, Nutt S, Dahud S, Salazar CA. Childhood betrayal trauma, dissociation, and shame impact health-related quality of life among individuals with chronic pelvic pain. Child Abuse & Neglect. 2022 Sep 1;131:105744.

3 Kredlow MA, Szuhany KL, Lo S, Xie H, Gottlieb JD, Rosenberg SD, Mueser KT. Cognitive behavioral therapy for posttraumatic stress disorder in individuals with severe mental illness and borderline personality disorder. Psychiatry Research. 2017 Mar 1;249:86-93.