Hello and welcome to The Healthy Coconut Blog. This blog is dedicated to bringing you information on trauma and trauma healing from a holistic perspective. I’m Gabbie Bodkin, a licensed mental health counselor, and this blog’s author. Today I’ll be sharing information covering dissociation, as it relates to a symptom of trauma.
More specifically, I’ll be addressing:
Definitions and causes of dissociation
What happens in the brain during dissociation
The spectrum of dissociative symptoms
How to cope with symptoms
"People from all age groups and racial, ethnic, and socioeconomic backgrounds can experience a dissociative disorder. In fact, it is estimated that up to 75% of people experience at least one depersonalization/derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes (Nami)."
What is Dissociation?
Dissociation can be defined as a mental process by which a person disconnects from themselves, others, or the world around them. Dissociation can affect an individual's thoughts, feelings, memories, sense of identity, and/or conscious awareness. Dissociation is one of the many ways the brain protects itself when in high-stress situations, especially those deemed as traumatic. While the primary cause of dissociative symptoms and disorders is trauma, it can also occur during cases of epilepsy, or drug use such as ketamine. Dissociation can also occur without stress or drugs involved at all. During these occasions, dissociation is often the result of being in a flow state which can be described as a sense of complete absorption in one task. When in a flow state, the external environment may not be recognized and time may feel like a distant construt.
Examples may include:
When you are reading a good book, engaging in a long-distance run, meditating, doing breath work, etc.
When you are completing a routine drive. You may tune out and the next thing you know you've arrived at your destination. You're still taking in information and progressing through automatic responses such as pressing the break at a red light or turning on your blinker for a turn, yet you're not paying attention to the automatic actions and instead focusing on what's on your mind or what you may be listening to while driving.
When you rush to leave your home and forget if you locked the door behind you.
When you intentionally try to numb or disconnect by going on social media.
While these examples are rated as mild and common forms of dissociation, there are many other forms of dissociation that are less common and may warrant a certain level of care or intervention.
Symptoms of dissociation:
Dissociation as a symptom can be viewed on a spectrum ranging from mild, which includes the examples I just mentioned, to extreme, which would include symptoms of dissociative identity disorder (DID). What rates the severity of the dissociative symptom is how much it impacts an individual's ability to function.
The important thing to remember when speaking about symptoms of a mental health issue or disorder is that symptoms are first established as a means of protection. While the logical part of your brain may understand these symptoms aren't helpful in your day-to-day life, they're often an adaptive response the brain makes to an initial stressor, which then turns into a maladaptive trait. For example, let's say you experienced a horrific trauma. In the moment of the trauma, your brain decided that the only way you were going to survive the trauma was if your brain "turned off" and you were detached or pulled out of your reality. I like to visualize this process through a little analogy. Imagine you're standing in a bright room with a lot of stimuli around the room- (textures, colors, smells, things you could feel/touch, hear, taste, etc). Now imagine that someone walked in and turned the lights off so now you cannot see your surroundings. You're still in the room and still surrounded by all the items in the room, yet you're unable to see or experience the details in the same way with the lights off. This is what happens during dissociation. It is a form of intentional numbing that takes place so a person can survive. Now the level of dissociation the brain decides is necessary during the traumatic event is subjective to the individual and the circumstance. Once that initial dissociation was deemed necessary during the traumatic event, the brain may rely on dissociation as a protective measure with less extreme cases moving forward, thus causing it to become a maladaptive response/symptom. In the clinical world, the range of dissociative responses can be broken out into 8 different types:
Triggers: include sensory details that remind a person of the trauma or stressor. They can include any detail pertaining to sight, smell, taste, touch, or sound that is similar to a detail that was stored in the brain and related to the trauma or stressor. When someone experiences being triggered, the automatic response to the trigger can be to dissociate at that moment to avoid the memory or numb the emotional pain that the trigger represents.
Flashbacks: are vivid memories that surface and cause an individual to feel as if they are reliving an experience. Flashbacks are typically prompted by triggers, however, they can also come up through dreams and intrude during states of non-distractions. Flashbacks are a common symptom of Post Traumatic Stress Disorder (PTSD).
Identity confusion: occurs when an individual does not feel confident in their identity. They may feel as if their identity changes frequently or feel unable to define characteristics about themself.
De-realization: the feeling as if the outside world is not real. Individuals with this symptom can describe it as being detached from others, feeling like they are living a dream, or as if their reality is foggy or lifeless.
Depersonalization: is commonly described as an out-of-body experience. It can feel as if the individual is a spectator to their own life, disconnected from their emotions, and/or feels a lost sense of identity.
Dissociative amnesia: is the process in which a person cannot remember information about themselves, others, or events. It can be depicted as having gaps in their memory where they do not remember certain events, cannot recall autobiographical information, cannot perform tasks they used to be proficient in, or find belongings that they don't recall purchasing or ever owning.
Dissociative fugue: encompasses a particular form of memory loss where a person travels or wanders to an unfamiliar setting with no recollection of how they got there. It includes dissociative amnesia but also includes a state of travel without recollection.
Identity alterations: encompass the most severe form of dissociation where identity shifts and changes drastically. People who experience identity alterations describe switching between different personas, may speak in different voices, take on different names, or feel as if they are losing control to someone else. They may shift from different ages, and genders, and have different characteristics such as being empathetic in one identity state and lacking remorse or being aggressive in another identity state.
Now that we have reviewed dissociative symptoms, it's important to understand what is happening neurologically.
What happens in the brain during dissociative episodes?
Research on the neurobiology of dissociation is still ongoing, however, one study conducted by Stanford University has helped to pinpoint a network in the brain that may be responsible for dissociative symptoms. The study was originally conducted in response to patients with epilepsy who are in a dissociative state during a seizure. The findings of the study were clinically significant so the researchers expanded on the findings by turning to mice to further assess the results. The researchers did this by synthetically inducing dissociation in mice through the administration of the drug, Ketamine. This particular study highlighted that the brain areas involved in dissociation include a collection of areas known as the Default Mode Network. The Default Mode Network is a collection of neural networks that are constantly running, even when we daydream or "go offline" so to speak. When we're in a flow state or tune out, this Default Mode Network allows us to continue working at a base-level capacity.
Included in the Default Mode network is the Posteromedial Cortex which is directly involved in the individual perception of self. This brain region is able to answer the question, "Who am I?" and therefore is critically involved in identity and bodily awareness. During a dissociative episode, this part of the brain is stimulated at a particular electrical frequency that causes the activation of dissociation. What causes the electrical firing of this region is inconclusive however, often with dissociation it can be trauma-induced. This would indicate the perception of a threat would initiate an electrical firing to the Posteromedial Cortex.
You can visit the summary of the study referenced here.
How to cope:
Coping with dissociation requires awareness of triggers and physical sensations that precede the dissociative state. If you can recognize the early warning signs and utilize coping skills, you can then reduce the likelihood of a dissociative episode.
Recognizing sensations and emotions may be done in the moments leading up to the dissociative episode or they can be logged after the fact when you are able to go back and reflect on what you experienced. In many cases, it is difficult for individuals to look back on the early warning signs and instead, it may be more helpful if someone witnessed the dissociative episode to reflect on what transpired before you checked out. Some common sensations to look out for include:
feeling emotionally numb.
feeling your mind wander.
feeling as if you are floating away.
having motor tics or agitations such as clenching a fist, tapping fingers, shaking legs, repetitive eye movements, etc.
If you can pinpoint some early warning signs that a dissociative episode is about to start, you can immediately apply coping skills to ground you in the present moment. The most effective coping skills for dissociative symptoms include:
Grounding:
Allows the brain to stay in touch with reality and the present environment. To do this,
1. Identify 5 things you can see.
2. Identify 4 things you can feel or touch.
3. Identify 3 things you can hear.
4. Identify 2 things you can smell.
5. Identify 1 thing you can taste.
Diaphragmatic breathing:
Stimulates the vagus nerve to trigger the parasympathetic nervous system responsible for relaxation. To do this,
1. Sit or lie in a comfortable position.
2. Place one hand on your chest and one hand on your abdomen.
3. Inhale through your nose while expanding your abdomen like a balloon.
4. Exhale slowly through your nose or mouth while contracting your stomach like a deflated balloon.
5. Repeat until you feel calm and relaxed.
Reminding yourself you are safe:
Allows your brain to recognize that it does not need to go into a protective mode (aka- dissociate).
1. tell yourself you are safe in the moment.
2. look around your environment and list detailed evidence as to why you are safe.
3. Tell yourself you are in control.
Journaling:
Journaling allows for increased internal communication which is what is lacking during a dissociative episode. Journaling at the first sign of an episode can help increase internal control and provide feedback you may need after an episode.
If your symptoms of dissociation are impacting your ability to function or if you are unable to control the symptoms, it's important to speak to a healthcare professional so you can address the symptoms and increase functionality.
Thank you all for reading this post. As always, I hope you found this information useful. This information is purely intended to inform, not to treat. If you are struggling with brain health issues or childhood trauma, speaking to a healthcare professional is recommended to receive a specific plan for treatment and healing based on your individual needs. You can follow along for more posts and psychoeducational tools on trauma and trauma healing from a holistic perspective. You can also check out my website, thehealthycoconut.com, or Instagram the_healthycoconut for more resources or to book a free consultation with me. If you found this blog helpful, please like and subscribe to support these resources.
Safety Disclaimer:
If you find any of this information triggering or do not feel safe being alone with your thoughts, call a support person or 911 if you feel you are at risk of hurting yourself or others. I’m a Licensed Mental Health Counselor, and I help adults heal from childhood trauma. Follow along for more self-help tools and psychoeducation on trauma and trauma healing.
Sources:
Dissociative disorders | NAMI: National Alliance on Mental Illness. (n.d.). https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Dissociative-Disorders#:~:text=People%20from%20all%20age%20groups,full%20criteria%20for%20chronic%20episodes.
Krause-Utz A, Frost R, Winter D, Elzinga BM. Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder. Curr Psychiatry Rep. 2017 Jan;19(1):6. doi: 10.1007/s11920-017-0757-y. PMID: 28138924; PMCID: PMC5283511.
Researchers pinpoint brain circuitry underlying dissociative experiences. (2020, September 16). News Center. https://med.stanford.edu/news/all-news/2020/09/researchers-pinpoint-brain-circuitry-underlying-dissociation.html
Comments