Dissociation occurs when an individual experiences a disconnection or fragmentation between aspects of the self and the external world. For example, a lack of continuity can occur between perceptions of identity, thoughts, behaviors, and memories. People with dissociation often feel as though they are detached from the world and are observing what is happening rather than behaving as an active participant.
Why Dissociation Can be a Response to Abuse or Neglect
Dissociative disorder is thought to function as a defense against trauma and is often linked to abuse or neglect in childhood. Dissociation serves to protect the child from the emotional effects of complex trauma as it offers a kind of escape. A detachment from the self and what is happening from the body allows for the removal of oneself emotionally and mentally. In severe cases, abuse can lead to the development of multiple identities and personalities (1).
A history of complex trauma is common in those suffering from dissociative identity disorder (2). It is important for therapists working with these individuals to understand the common cause and pursue a treatment approach that will address past trauma.
A Developmental Perspective
Attachment researchers bring a developmental perspective to the etiology of dissociative disorder. To understand the nature of the cause and outcome of early relational trauma, we need to consider a neurobiological model of dissociation.
During infancy, the brain and nervous system develop in context to the environment. Early caregivers provide the opportunity to develop the biological and cognitive building blocks of emotion regulation abilities. In terms of the development of our nervous system, this means that as we develop and mature, things can go very differently for us depending on whether we are in a security-promoting environment or one that is trauma-inducing.
When we grow up in a stable and secure environment, the infant and child is able to depend on the caregiver to help regulate (manage the intensity and duration) of negative emotions such as fear, anger, and sadness. As the child matures, he or she becomes able to self-sooth and manage her own emotional state.
This management includes the stress state such as anxiety and/or fight or flight. The child developing in a stable and secure environment learns that negative states can be managed and will not last. The body and nervous system learn, over time, that positive experience follows negative experience. If there is an interruption in the caregiver-child relationship, stress is followed by repair.
The Neurobiology of Relational Trauma
In contrast to the secure-promoting environment, a trauma-inducing environment does not allow the child the opportunity to manage negative emotions, especially fear-terror in cases of abuse. When children experience abuse, or the threat of physical, sexual, or emotional abuse, they can react with the autonomic nervous system kicking into fight or flight.
A more extreme reaction to actual abuse or the threat of abuse is the freeze state and dissociation. Disassociation becomes a last resort protective response in which the child is able to leave the situation, not physically but cognitively. Unfortunately, exposure to extreme stress over long periods of time results in an alteration of neurological functioning (3). And, over time, the child will experience alterations in consciousness, memory, perception, identity, and affect (4).
The Effect of Dissociation on Neural Development
Dissociation is a basic function of the human psychobiological response to trauma. The function is protective as it alters the state of consciousness as a response to overwhelming trauma. Although disassociation as a strategy can be effective in the short term, dissociation has been shown to be detrimental in the long term (5).
Researchers have hypothesized that when a child is constantly dissociating during formative developmental years there may be a loss of vertical connectivity between cortical (higher information processing) and subcortical limbic (emotional processing) areas (6)
This explanation makes sense when we consider the effects of the fight or flight response on the higher functions in the brain. When our nervous system interprets a threat, a range of responses occurs in the brain, body, and nervous system. In addition to the body readying itself for fight or flight (increased heart rate, rapid breathing, heightened senses), the lower emotion-processing areas of the brain (the limbic system) actively suppress the higher information processing centers. These are the areas involved in language, information processing, and memory.
This process of suppressing the higher information processing centers makes sense for responding to an unusual emergency situation. It is better to act fast physically rather than stop and think carefully in a situation where a car is careening down the street or when a bear is chasing you!
When the situation persists over time, as in the case of a child growing up in a trauma-inducing environment, the process becomes costly and has long-term consequences.
During formative years, if we are exposed to extreme stress and the nervous system is reacting in a state of fight or flight, we lose the opportunity to develop the regulatory functions of the higher processing structures (7). These higher structures are responsible for the management of our emotions. If during infancy and childhood we are dissociating, we are quite literally not developing and integrating the higher information processing centers of the brain with the lower emotion centers. Unfortunately, the result can be dissociation, consciousness, and identity disturbances.
Mao, F. (2019). Dissociative Identity Disorder: The woman who created 2500 personalities to survive. BBC News. Retrieved from https://www.bbc.com/news/world-australia-49589160
Hurwitz, T. A. (2004). Somatization and conversion disorder. The Canadian Journal of Psychiatry, 49(3), 172-178.
Krystal, J.H., Bremner, J.D., Southwick, S.M., & Charney, D.S. (1998). The emerging neurobiology of dissociation: implications for treatment of posttraumatic stress disorder.
Krause-Utz, A., Frost, R., Winter, D., & Elzinga, B. M. (2017). Dissociation and alterations in brain function and structure: implications for borderline personality disorder. Current psychiatry reports, 19(1), 6.
Loewenstein, R.J. (1996). Dissociative amnesia and dissociative fugue. In L.K. Michaelson, & W.J. Ray (Eds.), Handbook of dissociation: Theoretical, empirical, and clinical perspectives (pp. 307-336). New York, NY: Plenum In J.D. Bremner & C.R. Marmar (Eds.), Trauma, memory, and Dissociation, pp. 321-363. Washington, DC: American Psychiatric Press.
Krystal et al., (1998
Roberts, N.A., Levens, S.M., McCoy, K., Werner, K., Beer, J.S., Scabini, D., & knight, R.T. (2001). Orbitofrontal cortex and activation of defensive responses. Society for Neuroscience Abstracts, 27, 1705
Dr. Franco is licensed to practice psychology in New York, Maryland, Virginia, and the District of Columbia. She received her doctorate degree in clinical psychology from The George Washington University. Dr. Franco completed her internship at the University of Rochester School of Medicine, Department of Psychiatry.
She specializes in trauma and abuse issues, PTSD, C-PTSD, multicultural issues, and forensics and is a clinical professor of psychology at The George Washington University.