One of the significant mental health issues of the 1990’s concerns the recognition of trauma as the root cause of some psychiatric conditions.
Until recently, Multiple Personality Disorder (MPD) and other Dissociative Disorders have been considered to be rare and extraordinary phenomena. It is now understood that these conditions can be common effects of severe trauma in early childhood, most typically extreme, repeated physical, sexual, and/or emotional abuse. In 1994, with the publication of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders–IV, the name and some of the diagnostic criteria for Multiple Personality Disorder were changed to Dissociative Identity Disorder (DID), reflecting changes in professional understanding of the disorder.
People who chronically dissociate often refer to the experience as “spacing out” or “trancing.” Technically, dissociation is a mental process which produces a lack of connection in a person’s thoughts, memories, feelings, actions, or sense of identity. When a person is dissociating, certain information is not associated with other information as it normally would be.
For example, during a traumatic experience, a person may dissociate the memory of the place and circumstances of the trauma from his ongoing memory, resulting in a temporary mental escape from the fear and pain of the trauma and, in some cases, a memory gap surrounding the experience.
Because this process can produce changes in memory, people who frequently dissociate often find their senses of personal history and identity are affected.
Most clinicians believe that dissociation exists on a continuum of severity. This continuum reflects a wide range of experiences and/or symptoms. At one end are mild dissociative experiences common to most people, such as daydreaming, highway hypnosis, or “getting lost” in a book or movie, all of which involve “losing touch” with conscious awareness of one’s immediate surroundings. At the other extreme is complex, chronic dissociation, which may result in serious impairment or inability to function.
Dissociative disorders develop under fairly consistent circumstances. For example, when faced with overwhelmingly traumatic situations from which there is no physical escape, a child may resort to “going away” in his or her head. This ability is typically used by children as an extremely effective defense against acute physical and emotional pain, or anxious anticipation of that pain. By this dissociative process, thoughts, feelings, memories, and perceptions of the traumatic experiences can be separated off psychologically, allowing the child to function as if the trauma had not occurred.
Dissociation is often referred to as a highly creative survival technique because it allows individuals enduring “hopeless” circumstances to preserve some areas of healthy functioning. Over time, however, for a child who has been repeatedly physically and sexually assaulted, defensive dissociation becomes reinforced and conditioned. Because the dissociative escape is so effective, children who are very practiced at it may automatically use it whenever they feel threatened or anxious — even if the anxiety-producing situation is not abusive. Often, even after the traumatic circumstances are long past, the left-over pattern of defensive dissociation remains. Chronic defensive dissociation may lead to serious dysfunction in work, family, social, and daily activities.
Repeated dissociation may result in a series of separate entities, or mental states, which the trauma survivor may perceive as having identities of their own. These entities may become the internal “personality states,” of a DID(MPD) system. Changing between these states of consciousness is described as “switching.”
People with dissociative disorders may experience any of the following:
Depression, mood swings, suicidal tendencies, sleep disorders (insomnia, night terrors, and sleep walking), panic attacks and phobias (flashbacks, reactions to stimuli or “triggers”), alcohol and drug abuse, compulsions and rituals, psychotic-like symptoms (including auditory and visual hallucinations), and eating disorders. In addition, individuals with DID(MPD) can experience amnesias, time loss, trances, and “out of body experiences.” Some people with dissociative disorders have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed).
Dr. Gnap is a family practice physician and behavioral medicine specialist in suburban Chicago. Dr. Gnap developed the Inner Control™ Program in 1970 and has worked with thousands of people to improve and correct medical, emotional, behavioral and learning problems including performance. He started the Inner Control program because so many patients asked, “what more can be done along with traditional treatment methods?”