Working with Dissociative Disorders Conference

pancake-ice_850I went to a conference by Carolyn Spring on Saturday, which presents fresh insights into repeated childhood trauma and who are presenting with chronic dissociative symptoms. She describes, as I also frequently argue, that such behaviours and symptoms are entirely logical in the light of their early life history, and through a particular environment in therapy a life that is no longer dominated by trauma responses.

Dissociative Identity Disorder (DID) is post-traumatic and a developmental condition. A traumatic even does not mean you will get a post-traumatic disorder, being traumatised is different to a traumatic event, as it is linked to the responses one develops to sustain continued abuse and traumatisation. Dissociative symptoms are an adaption to life threatening powerlessness. DID helped an individual to survive a perpetually dangerous environment, however once one is safe this is no longer helpful. Though you are safe, you don’t feel safe and so you are kept in a cycle of trauma responses and recovery is about changing some of those responses. Trauma resides mostly in the ‘back brain’, more than the ‘front brain’ and thus it conceals itself from awareness and comes out in implicit and somatic memory. This is why people often come to therapy unaware of their dissociative aspects and they present with a disconnection between symptoms and their past experiences.

Dissociative and traumatised states develop when there is childhood trauma, without the opportunity for integration and recovery (unable to calm body, meaning-make, feel emotion). There was never an opportunity to leave the ‘war zone’ and so they had to stay ‘on duty’ ready for another attack. The body and brain therefore adapt to this environment and ongoing terror. In adulthood, this response is still activated and we are physiologically very alert and more attention is paid to threat cues, over safety cues and ‘better safe that sorry’ generalisations are made. This can keep one safe, but comes with costs to relating with self, others and the world.

A good example, is that if as a child you were in a lot of fires, your fire alarm will sound when the toast is being burnt and not only when there is a fire. It takes time to not take the alarm so seriously and scan the environment for safety cues and not continue to have a bias for threat. It is challenging these automatic, habitual interpretations of danger that is important and to just ‘notice’ and be ‘curious’ of these tendencies. When you get triggered it is more useful to think about ‘how’ you know you are feeling unsafe in brain and body, attending to sensations (spacey feelings, distance), movements, senses, thoughts, as opposed to focusing on ‘why’ you feel unsafe, in order to shift the brain’s processes. Your body might be feeling unsafe, but if the world around you signals that it is safe, it is these signals that need to begin to be listened to.

I have come across people who have felt ashamed for a freeze response within a traumatic event. But when you look at the brain’s survival function this is an automatic response of the brain and body, which relies on instinct and not conscious choice. Therefore, dissociating, freezing and fainting is not being a coward, or consenting to what is being done, it is a highly adaptive survival mode, when all other options seem impossible.

Carolyn Springs takes a neurobiologically-informed approach, looking at how the body and brain’s natural defences become stimulated by overwhelming threat in response to repeated trauma, and how this response becomes stuck and manifests in the complex behaviours of a trauma-related disorder. It is put forward that recovery from trauma involves a continual shift away from survival-based, back brain reflexes into more adaptive, elective, front brain choices.

In therapy the focus is on integration of brain processing and through therapy it is important that experience is reframed and symptoms can be learnt to be overcome. If you experience multiple parts and personalities, the aim is to become fully present in one’s skin and learn how to be a whole self. Structural dissociation can include ANPs (an apparently normal personality which deals with daily life, but often in quite a robotic and empty way) and EPs (emotional personalities which are often stuck in the time of trauma, and often can seem a younger, childlike part of oneself). It is tempting to distance from one’s abused part, but the adult part needs to understand that it also happened to them. The focus is on relieving the suffering of unresolved trauma and reducing the processes which maintain the dissociation. The focus is on integrating the trauma, not the parts. So rather than trying to stop someone coughing with cough medicine, and therefore treating the multiplicity/symptoms, you treat the infection. In the same way you certainly do not accuse someone coughing from an infection as attention seeking, though the way in which trauma is expressed through sometimes challenging and complex behaviours and symptoms, they should not be seen as this either, but instead meaningful attempts to live with and make sense of unbearable trauma.

Useful Resources:

Carolyn Springs Podcasts

Carolyn Springs Blog

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