The Role of Dissociation

One thing (of many) that fascinates me about PTSD is the role of dissociation: that is, the distancing of oneself during or when reliving a traumatic experience. Think of dissociation as someone experiencing a trauma, but watching it happen from another's point of view.

What is the role of dissociation? Simply to cope with the trauma as it is occurring. When someone experiences trauma that is so psychologically uncomfortable or traumatizing, a natural defense mechanism is to avoid it completely.

This can be helpful in the short-term, but as Professor Richard Bryant from the University of New South Wales points out, it has some serious psychological consequences, but it prevents the trauma from being processed, and it could lead to PTSD. However, it doesn't always mean that PTSD will develop.

When we as people experience any type of hyper-arousing or stressful circumstance, we experience dissociation to a degree. We have temporary lapses in memory, we can't remember certain details, we stifle emotions related to the event, and the like.

In PTSD, this is a uniquely manifesting degree of symptoms, because while it initially may strive to help by distancing the survivor from the trauma, it comes back in ways like flashbacks, blind rages, the sense of being out of body, detachment, or other similar symptoms. What might start by appearing to be an escape of sorts can easily turn into a tonic for a type of amnesia or repression. It doesn't take a lot to come to the conclusion that this is a destructive coping pattern, not just for the survivor, but for the survivor's closest circles.

My wife has experienced this several times on several occasions brought on by several stimuli and environments. There are a few common results of a highly dissociative episode (especially in the form of blind rages):

1. The survivor remembers little to nothing of what happened during the episode. The survivor might remember feelings, fragments of thoughts or conversations, or other elements of the episode. We usually can't talk about everything that was said because she says, "I don't remember."

2. The survivor has feelings of guilt or remorse afterwards (when the survivor comes back to the present).

3. Depending on the responses during the conversation, the episode can last from several seconds to several hours. Flashbacks or blind rages can usually bring heated conversations, and it's important to recognize when they are happening and stay grounded (see my other blog post on developing a safety checklist to help you and your survivor cope before, during and after a flashback).

It is crucially important to help your survivor by maintaining an atmosphere of safety. The degree of safety depends on your relationship, but safety begets trust, and trust begets intimacy. True intimacy is what keeps a couple together. Your survivor is on a rough road, no doubt, but there's no fooling yourself into thinking that you're on a separate path. Maintain an atmosphere of safety, and you'll go a long way to helping your survivor manage their symptoms and trauma in a constructive and safe way.