9

Alterations in Attention or Consciousness: Dealing with Dissociation and Traumatic Amnesia

(Complex PTSD, Category 2)

Two of the most important features of the second symptom category of complex PTSD or disorders of extreme stress, not otherwise specified (DESNOS) are dissociation and depersonalization (Rothschild 2000; Herman 1999). The other is trauma-induced amnesia. We discussed dissociation in chapter 5 as a symptom of avoidance in PTSD.

If you dissociate, your awareness of the world around you splits off in some way. According to Branscomb, dissociation means “the separation of things that were previously related or ‘associated’” (1990, 3). Perhaps you no longer feel parts of your body during a traumatic event. Dissociation can occur at the level of physical sensation: dissociation can occur at the level of thinking: perhaps you separate out various aspects of the experience and remember only certain ones. Perhaps you get yourself into difficult situations and suddenly feel numb: this is dissociating at the emotional level. It is possible to dissociate at one or all of these levels at any point in time.

For example, say you are driving. You stop at a stop sign, look both ways, and then pull out to cross the road in front of you. Suddenly you hear and feel the impact of another car hitting you. It has come out of nowhere. Your car spins and you end up across the road turned in the opposite direction from where you began. Your first reaction is to breathe, notice where you hurt, and then look at your body and your car from the inside. You have a few bumps but basically you are all right. The car is crunched. You get out and see another car in the intersection. Your reaction is one of rage and anger; you go to the other driver and begin to yell. However, you are not aware of the motorcycle that’s also in the intersection. This motorcycle was also coming across the intersection and its rider witnessed the entire accident. You have dissociated part of what you obviously saw during the accident. Rothschild writes that “amnesia of varying degrees is the most familiar kind of dissociation” (2000, 65).

Or you may dissociate your physical pain and some of your emotions. After your accident, you get out of the car and walk to the other car. You are not yet aware of the huge bruise on your leg or the significant bump on your head. The only emotion you feel is anger at the other driver; you do not yet feel relief that you are not seriously hurt or fear that the accident happened. You did not dissociate your consciousness, though, as some people might have done: you are aware that you are still in your body.

One way to look at dissociation is to use Levine’s SIBAM model of dissociation (1992). SIBAM stands for sensation, image, behavior, affect, and meaning, the five elements of any experience.

• Sensation means your physical reactions and body (somatic memories).
• Image means the pictures that remain in your head.
• Behavior means what you did during the trauma.
• Affect means your emotions.
• Meaning means how you make sense of it all.

One or more of these elements can become dissociated during a traumatic event rather than staying intact in a whole memory. Thus, you might have a strong alarming emotion (affect) related to your father’s presence. The presence of your father means “danger” to you. You react to the danger by saying to yourself that you have to get away; in other words, your behavioral goal is to escape. You may also get a headache or goosebumps when he is near. However, as you try to make sense of your feeling of danger, you may have no visual memory (or image that tells you why your father’s presence spells danger). (This model does not take into account that you might merely have forgotten that aspect of the event, rather than dissociated it.) However, the model does make sense in terms of the discussion in chapter 1 of the types of memory. According to Rothschild (2000), implicit memory involves sensory images (visual memories, auditory memories), body sensations (pain, numbness, tingling), emotions, and automatic behaviors. Explicit memory involves facts, sequences of events, beliefs, and meaning. Do you have a sense that you dissociated to any degree during your traumatic event or events? Did you dissociate what you did (how you behaved), what you felt emotionally (your affect), what you experienced in your body, your awareness that the event was even happening (your sense of time, your knowledge of the trauma), or from your choices (your will) during the traumatic event? (You may want to write about that dissociation in your journal or notebook.)

Dissociation is a way to withstand an overwhelming event; it is a survival strategy to use during that event. The more severe your trauma (as in complex PTSD), the more naturally you dissociate to protect yourself.

How frequently do you use dissociation now? Do you daydream, have imaginary play, or go to a fantasy world to escape? Do you watch TV for hours without remembering anything you watched? Do you play computer or video games for hours on end?

Exercise: When Do I Dissociate?

List up to five situations that lead you to space out or dissociate at the present time:

1. ___________________________________________
2. ___________________________________________
3. ___________________________________________
4. ___________________________________________
5. ___________________________________________

*****

Traumatic Amnesia

Dolan describes traumatic amnesia as the “complete repression of memories associated with a traumatic event” and notes that it is “an extreme defense reaction to inescapable trauma” (1991, 141). Do you have no memories of certain periods of time in your life, particularly in childhood? You may be experiencing traumatic amnesia.

Dolan (1991) says that overcoming amnesia is important if a person is to resolve symptoms that seem to have no origin, including repetitive nightmares symbolically representing traumatic events; dreams of being chased, killed, or mutilated; eating disorders; sexual dysfunction; chronic anxiety attacks; and other symptoms of PTSD or complex PTSD. We believe, as does Dolan, that it is important to retrieve only what is absolutely necessary for healing. In some instances, no matter how hard you try, no matter how many years of therapy you have, no matter how much validation by others you receive, you may never remember all or even part of what happened to you during your “missing years.”

Memory is not a video camera and your memory is not infallible. You may find that you have flashes of memories in situations that in some way resemble the traumatic events that occurred or may have occurred but that you do not remember. Perhaps if you are in a state of intense fear or rage you may have flashes or images of something that happened to you. Perhaps you may have what might be a trigger experience that suddenly allows you to make sense or have a sense of what happened to you in your past.

One way to attempt to get to what you cannot remember is to look at the possible source of a symptom, Why do you have pains in your genital area if you think of your grandfather? Why do you have problems breathing or a panic attack in your shower when you think of your uncle? Be aware, however, that just because you have certain symptoms, you are not necessarily a victim of a certain type of trauma or abuse. However, if others who know you and your family give you verifiable information that leads you to realize that you were a victim, even if you have no memory of it, you may find that you may have to live with this incomplete knowledge and missing memory.

How do you know if you are dissociating? Schiraldi (2000) provides a list of indicators of dissociation; these form the checklist below.

Exercise: How Do I Dissociate?

Please check off any of the following indicators that you have or do.

When I dissociate, I:

• _____ lie very still
• _____ am slow to respond to others
• _____ seem to move in slow motion
• _____ have flat (muted) emotions
• _____ don’t feel pain
• _____ stare off blankly into space
• _____ tune out
• _____ am an observer of the present situation, not a participant
• _____ have lapses in my memory
• _____ feel as if I am on autopilot
• _____ feel as if I am a stranger in my own world
• _____ feel as if I am watching myself from outside my body
• _____ feel as if I am in a fog

When do you feel the sensations or do the behaviors you checked?

___________________________________________

___________________________________________

*****

What Do You Do about Dissociating?

The first thing to do about dissociating is to realize when you dissociate and why. Building awareness of triggers that might lead to dissociation can help you prepare yourself for the dissociative experience or can help to prevent it from occurring. Grounding techniques, such as those discussed in chapter 2, can also help you prevent dissociation or cut it short.

The following technique for dealing with dissociation comes from the field of neuro-linguistic programming (NLP); it was developed by Bandler (1985):

1. If you find that you have dissociated some aspect of a traumatic event, allow yourself to put the event on a movie screen and then sit in the audience (much as was done with the rewind technique in chapter 4.
2. Now go to your safe place to anchor yourself (see chapter 2 for information and exercises about your safe place).
3. Now freeze what you saw, heard, etc. (mentally put it in a container on ice, or compartmentalize it in some other way) and move back into your body.
4. Spend time comforting both your present self and the younger self who experienced the trauma. Tell that younger you that she or he is going to be okay and that she or he was not responsible for what happened. Explain all the details of the trauma that you observed to your younger self.
5. Use grounding techniques, such as those in chapter 2, to return to the present time.

There are many other ways to deal with dissociation. One excellent resource is the Sidran Traumatic Stress Foundation (see Resources).

Exercise: What I Learned about Dissociation

What have you learned about yourself by completing the exercise on dissociation? Are there parts of what happened to you that are totally gone from any type of memory (body, emotional, or cognitive memory)? Do you dissociate frequently? Are you more able to identify the triggers for that dissociation?

___________________________________________

___________________________________________

___________________________________________

*****

Remember, your dissociative responses to trauma were adaptive at the time that the traumas happened to you; that is, they were behaviors that helped you survive. They may still be adaptive at times, when you need to protect yourself. However, it is up to you to try to decide when and where that occurs and, if dissociating seems to be maladaptive (harming rather than helping you), it is up to you to implement some of the exercises in this workbook or find some other way to get help in bringing your typical responses under control.