Dissociation and C-PTSD: The Role of Detachment in Complex Trauma

Person in long black dress walks down street looking back over shoulderDissociation was first described more than a century ago. It was not until more recently, though, that the concept became a standard part of the psychological lexicon. For many people, it is still shrouded in mystery. Terms such as dissociative identity, “dissociative fugue,” or “depersonalization” sound opaque, even intimidating. This can make it difficult for those experiencing dissociation to understand what they are going through and seek appropriate help.

Better-known concepts such as anxiety or depression may be easier to understand because they are extreme versions of universally recognized feelings. Someone who has not struggled with clinical depression or anxiety can fully appreciate how it feels. But to some extent we can extrapolate from common feelings of sadness and nervousness to draw a picture of what these conditions are. By comparison, dissociation may be an alien and unfamiliar experience to many people.

However, while this may not be generally recognized, dissociation is actually something experienced by many—perhaps even the great majority—of people on an occasional basis. Have you ever walked somewhere and got to your destination realizing you remember nothing from the trip? Have you ever been in a boring meeting and found yourself daydreaming, only “awakening” 15 minutes later to find you have no idea what was discussed? Have you been engrossed in a book, only to suddenly realize you can’t remember what you just read? Even if the answer is no, you probably know plenty of people for whom the answer is yes.

All of these are miniature examples of dissociation which occur in day-to-day life. What they share is an experience of detachment, disconnection, or dissociation from the surrounding environment. Such experiences need not be indicative of anything wrong. They may well not even be unpleasant. But when they are frequent, uncontrollable, or a source of distress, they become problematic.

Dissociation is a common response to trauma. Many people who have been through traumatic experiences find that they are temporarily unable to remember what happened, even when they have feelings of fear, anguish, or grief as a result of their experiences. Others have a somewhat opposite experience: they can remember the incident clearly, but they feel detached from it, as if it happened to someone else or they watched it in a movie.

In many cases of posttraumatic stress (PTSD), the person experiences dissociation when confronted by stimuli that remind them of the traumatic experience. They “tune out” of memories that are too painful to confront head-on. In more mild cases, this coping mechanism is not particularly problematic, but it becomes so when dissociation is a habitual response to everyday occurrences. Therapy for PTSD typically consists of adopting strategies to cope with these stimuli without triggering dissociation.

One of the key links between PTSD and complex posttraumatic stress (C-PTSD), dissociation plays a central role in diagnosing and understanding C-PTSD. As I have discussed in other articles, the concept of C-PTSD was developed to understand personality conditions that had many features associated with PTSD.

When the trauma is drawn out over a number of years, dissociation becomes a way of life. Once learned, it is a fixed part of the personality that asserts itself long beyond the original dangers that prompted it.

While similar to PTSD in many ways, C-PTSD has features that make it unique. This pattern of similarity and difference is the product of their overlapping but distinct causes. PTSD is the result of a small number of impersonal dramatic and traumatic incidents (often just one), such as road accidents, witnessing a violent death, or being held hostage. The different pattern of C-PTSD comes from the fact it results from a sustained period of traumatic incidences (which, taken individually, may not be significant enough to produce symptoms of trauma), usually in childhood, which happen at the hands of someone the victim has a personal relationship with—often a primary caregiver such as a parent.

In C-PTSD, dissociation may play an even more crucial role than it does in PTSD. Children are particularly likely to engage in dissociation because of their lower emotional maturity and limited experience. Children have little or no ability to control their situation. They are reliant on caregivers for the primary needs of food, shelter, nurturing, and safety. In response to abusive or disturbing behaviors at home, where active resistance is out of the question, the child will find that the most natural and safe response to cope with the abuse is to detach, to go through these traumatic experiences without really experiencing them.

When the trauma is drawn out over a number of years, dissociation becomes a way of life. Once learned, it is a fixed part of the personality that asserts itself long beyond the original dangers that prompted it. This is an illustration of the principle that C-PTSD is essentially a learning process gone awry as a consequence of the child developing in a dangerous environment.

Forms of dissociation resulting from C-PTSD can be extreme. A common symptom is fragmented personalities. Growing up, the child may have developed different personality states that were called upon in abusive situations. These multiple personalities may persist into adulthood and are triggered by situations reminiscent in some way (often tangentially) of the abusive situation. When these supplementary personalities take over, the person may do things that are out of character for their main state, even things they find abhorrent. In the most extreme cases, these dissociative states may persist for days on end, leaving the person with no memory of what they have been doing during the interval.

Learning to gain control over dissociation and, in particular, mitigate negative effects that may result from dissociative episodes is a central part of therapy for C-PTSD.

References:

  1. Ford, J. D., & Courtois, C. A. (2014). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1, 9. Retrieved from http://doi.org/10.1186/2051-6673-1-9
  2. Lawson, D.M. (2017). Treating adults with complex trauma: An evidence-based case study. Journal of Counseling and Development, 95(3), 288-298. Retrieved from http://doi.org/10.1002/jcad.12143
  3. McKinsey Crittenden, P., & Brownescombe Heller, M. (2017). The roots of chronic post traumatic stress disorder: Childhood trauma, information processing, and self-protective strategies. Chronic Stress, 1, 1-13. Retrieved from https://doi.org/10.1177/2470547016682965
  4. Sar, V. (2011). Developmental trauma, complex PTSD, and the current proposal of DSM-5. European Journal of Psychotraumatology, 2, 10.3402/ejpt.v2i0.5622. Retrieved from http://doi.org/10.3402/ejpt.v2i0.5622
  5. Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. D. (2013). Therapeutic assessment of complex trauma: A single-case time-series study. Clinical Case Studies, 12(3), 228–245. Retrieved from http://doi.org/10.1177/1534650113479442

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 28 comments
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  • Sophia

    Sophia

    November 6th, 2017 at 10:36 AM

    Wow this must be a really scary feeling to have! And to think that those who live with this, this is what becomes their normal, I feel sad for them.

  • Fabiana Franco, Ph.D.

    Fabiana Franco, Ph.D.

    November 7th, 2017 at 5:12 AM

    You are right Sophia it is difficult that is why a correct diagnosis with the appropriate treatment is so necessary.

  • Bart V.

    Bart V.

    December 5th, 2018 at 9:37 AM

    I’ve been looking for appropriate help for 5 decades. I’m hoping that soon there will be someone here in Albuquerque that can reach me.

  • Patti M.

    Patti M.

    November 10th, 2017 at 7:18 AM

    I live with two of my Granddaughters. The older one, 12, has C-PTSD and has developed at least one “alter” when she gets triggered. This alter is so angry and hostile. It looks to me like this is the part of her that holds the pain and rage. She remembers what she says when she has dissociated. I’m try I g everything under the sun. She refuses to work with a therapist or take medication. She gets triggered so often and so severely it has made our lives unbearable at times. This is heartbreaking to see. She is a really amazing and caring young lady when she is calm and rational. I think at this point she will need some kind of residential program that unfortunately in NY is difficult to make happen. My heart goes out to any parents or Grandparents trying to care for children who have been traumatized.

  • Fabiana Franco, Ph.D.

    Fabiana Franco, Ph.D.

    November 11th, 2017 at 4:20 AM

    Dear Patti,
    Thank you for sharing your story. It seems to me that your granddaughter would benefit from treatment with a clinician that is seasoned in working with complex trauma and dissociation. If you feel that she is at risk of hurting herself or a danger to others you need to take her to the emergency room of a hospital near you. There they will be able to evaluate her and determine whether she meets the criteria for full or partial psychiatric hospitalization. If however, she is at risk and refuses to go to the hospital, you need to call 911. I hope this helps.
    Best wishes,
    Dr. Franco

  • Gage

    Gage

    November 7th, 2017 at 2:45 PM

    I never knew how much time I have lost, this truly helps me understand why. Ty

  • Fabiana Franco, Ph.D.

    Fabiana Franco, Ph.D.

    November 7th, 2017 at 5:20 PM

    You are welcome Gage. I am glad to hear the article was helpful.

  • Patricia

    Patricia

    November 7th, 2017 at 8:32 PM

    I️ really enjoy reading these articles. Ever since subscribing, it seems to never fail that for me when I’m experiencing struggles with my mental health, the right topic appears and helps me feel a little more normal. I’m not weird, just a little broken to no fault of my own and I️ sometimes need these reminders in the healthy ways to use what took years to develop as a result of the severe abuse I️ suffered throughout childhood. At 44, I’m still a work in progress but headed in the right way.

  • Fabiana Franco, Ph.D.

    Fabiana Franco, Ph.D.

    November 8th, 2017 at 8:42 AM

    Dear Patricia,

    I am glad to hear that the article was helpful and that you are getting the help you need. I wish all the best in your recovery process.
    Sincerely;
    Dr. Franco

  • Kristina B.

    Kristina B.

    November 7th, 2017 at 10:06 PM

    Oh thank you for publishing this article!!! This nailed me to the wall!!! I always reffered to dissociation as “Blocking” this definantly helped me understand that issue of C-ptsd, lol, now to try and understand the other bs, that forms this complex and very deep disorder, and im just now learning what my triggers are and i just got started on. Big, curvey roads up ahead of me, but deep down, i know Gods got this, only he and i know and trust each other!!

  • Betty Farnsworth

    Betty Farnsworth

    November 8th, 2017 at 4:40 PM

    The biggest issue I’ve had is doctors who deny many forms of disassociation.

  • Fabiana Franco, Ph.D.

    Fabiana Franco, Ph.D.

    November 9th, 2017 at 8:56 AM

    Dear Betty?

    I do understand your frustration. Unfortunately dissociation is a pshychological phonomenon that remains largely misunderstood. As such, it can negatively affect the therapeutic process.

  • Randi

    Randi

    November 9th, 2017 at 1:52 PM

    What are other examples of dissociation besides multiple identities?

  • Patricia

    Patricia

    November 10th, 2017 at 7:44 PM

    For me, When i dissociate, i kind of zone out. My breathing gets slower, i become emotionless. Things are happening all around me and sometimes to me. But i can somehow mentally take a step back and can see or watch all the things happening to me (almost like an out of body experience). Loud noise becomes nearly silent. I become fixated on a focal / focus point. I don’t talk. I have been somewhat able to master some of these skills in a healthy way too. If it is not an ongoing (day after day month after month) situation i can use these skills at work by having the ability in high stress and sometimes hostile of near violent issues, remain calm and quickly deescilate situations restoring peace. But in my personal life, day after day and month after month, i can’t control it. I get to a point where it feels like my body is literally shutting down slowly to a point where i can’t function. I hope somewhere in all that rambling i was able to answer your question.

  • Fabiana Franco, Ph.D.

    Fabiana Franco, Ph.D.

    November 11th, 2017 at 4:40 AM

    Hi Randi,

    Impaired self-awareness, detachment, altered states of consciousness, flashbacks, feeling disconnected from reality. Beyond DID, dissociation can be anything from mild detachment from immediate surroundings to more severe detachment from both physical
    and emotional experiences. It involves a detachment with reality causing a lack of connection with a person’s memories, feelings, thoughts, actions and a sense of who he/she is. Is a defense mechanism were individuas separate from memory things they either don’t want to or are perceived as too painful to deal with. I hope this explanation helps answer your question.

  • Patricia

    Patricia

    November 11th, 2017 at 12:07 PM

    Very well put together. That’s what I was trying to get at in my rambling answer.

  • jim

    jim

    November 9th, 2017 at 10:50 PM

    I didn’t know what dissociation was nor did I acknowledge that it was part of my life. I have been in more than one motor vehicle accident where reflecting back on it now, I would say that they were caused by my inattentiveness despite being of sound mind and body at the time of both, or so I thought. I once upon a time attributed these black-out periods to long term cannabis use, now I know different. The longer I keep the people out of my life that caused me to be like this the healthier I feel. Part of me still wants to try and educate my parents about what is actually wrong with THEM and not on what they perceive is wrong with me. Wisdom comes with scares and I have largely given up any false hope of having my day in court.

  • Fabiana Franco, Ph.D.

    Fabiana Franco, Ph.D.

    November 11th, 2017 at 4:26 AM

    Hi Jim,
    Thank you for sharing your story. I believe treatment will help address the issues and concerns you brought up as well as help you find more adaptive ways of dealing with your feelings and processing the trauma you’ve endured.
    Kind regards,
    Dr. Franco

  • Stacey

    Stacey

    November 10th, 2017 at 7:33 AM

    Thank you for this article very enlightening. I had me Dr heard of c-ptsd till reading this.

  • Fabiana Franco, Ph.D.

    Fabiana Franco, Ph.D.

    November 11th, 2017 at 4:05 AM

    You are welcome Stacey. I am glad to hear that you find the article enlightening and informative.

  • Diana P

    Diana P

    December 7th, 2017 at 4:28 AM

    This article explains so simply my lifetime of experiences which most people, even mental health professionals, do not understand, or even believe. Thank you!!

  • Harriet

    Harriet

    November 11th, 2017 at 8:33 AM

    The more I read about C-PTSD, the more I can understand how I managed to survive my childhood, and why I am the way I am now, at 52. I have been diagnosed, but still struggle to understand how neurotypical people act. Since I lost so much of my childhood, I feel younger than my years, and it’s kind of like having been a time-traveler in my own life. Only bits and pieces show up, like I popped in and out of the timestream. In addition, there is a strong possibility that I’m on the autism spectrum, which just adds icing on the cake!
    Thanks for a great article!

  • Fabiana Franco, Ph.D.

    Fabiana Franco, Ph.D.

    November 11th, 2017 at 10:40 AM

    Dear Harriet,
    I am glad you enjoy reading my article. I appreciate you sharing your story.
    Kind regards,
    Dr. Franco

  • Gregory A.

    Gregory A.

    November 11th, 2017 at 12:13 PM

    Harriet,
    We are the same age, and I also struggled with the same as a child, and it show up now and again as an adult.
    I identify with the time traveler effect.
    Personality Type: INT-J

  • Shari

    Shari

    November 15th, 2017 at 9:33 PM

    All these years of my childhood traumas and adult traumas. I was told I was clinically depressed, had severe anxiety and anxiety attacks, chronic insomnia, somewhere o wa told disassosiatove disorder, and eventually when I saw the right type of counselor for my type of background PTSD. As I read your article, the years of my life where I was highly functional and then totally bedridden and agoraphobic, to sometimes somewhere in the middle and going through tithe motions for everyone else’s sake mostly. It makes more sense the DX of C-PTSD. Thank you Doty shining a light on why I’ve felt so stuck.

  • Fabiana Franco, Ph.D.

    Fabiana Franco, Ph.D.

    November 16th, 2017 at 9:12 AM

    Dear Shari,

    I am happy to hear my article was both helpful and informative. I wish all the best in your healing journey.

    Kind regards,
    Dr. Franco

  • NBD

    NBD

    January 14th, 2018 at 3:18 PM

    I have C-PTSD, diagnosed PTSD DESNOS, depersonalization and derealization and I often feel a disconnect between everything and everyone including myself and my own thoughts and feelings, it’s like I (usually)know what i’m thinking, saying, feeling or doing but at the same time I don’t or I can hear and understand what say my therapist is saying but at the same time I don’t, it’s like there’s a layer between me and everything. It sucks. Sometimes I lose days, entire days up to a week. It’s frightening.
    In the past couple of years I have some breakthroughs, where things actually clicked and I fully understood them, it felt amazing, I felt alive and was able to make huge changes in my life because of it but then the fully alive able to understand feeling goes again. It’s very frustrating and I often feel hopeless because of it but the changes made during those times stick so maybe that’s a good sign? I don’t know.

  • David

    David

    March 3rd, 2019 at 6:21 AM

    Hi I am currently diagnosed with a PTSD dissociative disorder. It stems from a 5 week kidnapping and multiple assault ordeal I went through as a 14 year old. I would describe dissociation as your mind being like a sieve. You are conscious but everything passes by without any recognition or retention. You don’t retain what is happening and time can pass incredibly fast..in fact episodes of many hours seem like just a moment because you are not logging or really even acknowledging them…afterwards it’s like waking from a dream but one you don’t remember…either all or in part. There is typically a stage leading up to dissociation which is more akin to going inside…shutting down but I still have cognition and my inner voice. When dissociation occurs this inner voice is no longer present and it’s return signals that I am coming out of my fugue state. Hope this helps people understand what this experience is like for me and I’m sure others. Take care.

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