Trauma, particularly complex trauma, has long been recognized as a significant risk factor for the development of various psychological conditions. Among these, dissociative disorders—especially depersonalization and derealization—are of particular concern. These dissociative states, which involve disturbances in the perception of oneself (depersonalization) or the external world (derealization), have been found to have a strong association with trauma exposure, particularly early childhood adversity and complex trauma. Understanding the neurobiological mechanisms behind this link is crucial in developing effective treatment strategies for individuals suffering from these conditions.
The Role of Complex Trauma in Dissociation
Complex trauma refers to prolonged or repeated exposure to traumatic events, often occurring during the formative years of childhood. Such experiences can include chronic emotional, physical, or sexual abuse, neglect, or exposure to domestic violence (Van der Kolk, 2005). The effects of complex trauma are profound and wide-ranging, affecting not only the emotional and psychological well-being of individuals but also their cognitive, social, and physical functioning.
Dissociation, as a defence mechanism, is often employed by individuals who experience overwhelming stressors. It serves as a psychological response to avoid or disconnect from the emotional pain of traumatic events. Depersonalization involves a feeling of detachment from oneself, often described as an “out-of-body” experience, whereas derealization refers to a sense of the external world being unreal or distorted (Sierra & Berrios, 2000). While these experiences are common during moments of acute stress, chronic dissociation can indicate the presence of a dissociative disorder.
Neurobiological Mechanisms of Trauma and Dissociation
The brain’s response to trauma and dissociation is complex and multifaceted. Research suggests that trauma, particularly early childhood trauma, can result in long-lasting alterations in brain structure and function, specifically in areas involved in emotional regulation, memory processing, and self-awareness.
The hippocampus, amygdala, and prefrontal cortex are key brain regions implicated in trauma-related dissociation. Studies show that individuals who have experienced complex trauma often exhibit reduced hippocampal volume, which is associated with memory impairments and emotional dysregulation (Teicher et al., 2003). Furthermore, the amygdala, which plays a crucial role in fear and emotional processing, tends to be hyperactive in trauma survivors, leading to heightened emotional responses and difficulty distinguishing between past and present threats (Lanius et al., 2010). In contrast, the prefrontal cortex, responsible for higher-order cognitive functions such as decision-making and self-reflection, is often underactive in individuals with dissociative disorders, contributing to a reduced ability to process traumatic memories and regulate emotional responses.
The dissociative experience itself may be a result of the brain’s attempt to cope with overwhelming trauma. By detaching from the emotional and sensory experience of the trauma, the brain reduces the perceived intensity of the stressor, thereby minimizing immediate psychological pain. However, this protective mechanism can become maladaptive, leading to chronic dissociation and dissociative disorders (Bremner, 2006).
Trauma and the Development of Dissociative Disorders
Research has demonstrated that dissociative disorders, including depersonalization disorder and dissociative identity disorder, are closely linked to the early experience of trauma (Putnam, 1997). The development of these disorders is thought to be influenced by a combination of genetic, environmental, and neurobiological factors, with early traumatic experiences being a major contributing factor.
Depersonalization and derealization often manifest as a response to intense trauma, providing the individual with a temporary escape from the overwhelming emotional pain. In cases of complex trauma, these dissociative states may become chronic, resulting in significant impairment in daily functioning. Individuals with chronic depersonalization or derealization may report a persistent feeling of being disconnected from their bodies or surroundings, often leading to difficulties in maintaining relationships, holding down jobs, or performing everyday activities (Sierra & Berrios, 2000).
Furthermore, trauma-related dissociation may affect the processing of traumatic memories. Trauma survivors may struggle to integrate the memories of their traumatic experiences, leading to fragmented and dissociated memories that are not fully processed or understood. This dissociative memory processing is thought to contribute to the development of post-traumatic stress disorder (PTSD) and dissociative disorders, as the individual’s sense of self and reality becomes disorganized and fragmented.
Clinical Implications and Treatment
Understanding the link between trauma and dissociation is crucial for clinicians working with trauma survivors. Dissociation is often under-recognized and under-treated, yet it can be a key factor in the persistence of trauma-related symptoms. Effective treatment must address both the trauma and the dissociative experiences, aiming to help individuals re-establish a coherent sense of self and reality.
Psychotherapeutic approaches such as trauma-focused cognitive-behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), and sensorimotor psychotherapy have shown promise in treating trauma-related dissociation (Shapiro, 2001; Ogden et al., 2006). These therapies aim to help individuals process traumatic memories, reduce dissociative symptoms, and restore a sense of safety and self-awareness. Additionally, mindfulness-based approaches can help individuals develop present-moment awareness and reduce the tendency to dissociate during stressful situations (Van der Kolk, 2014).
In some cases, pharmacotherapy may be used as an adjunct to psychotherapy to address symptoms such as anxiety or depression, which commonly co-occur with dissociative disorders (Lanius et al., 2010). However, medication alone is not sufficient to treat dissociative disorders, as they require a comprehensive, trauma-informed approach.
Conclusion
The connection between trauma and dissociation, particularly in cases of complex trauma and early childhood adversity, highlights the significant impact of traumatic experiences on psychological and neurobiological functioning. Depersonalization and derealization serve as protective mechanisms in response to overwhelming trauma, but when these dissociative states become chronic, they can lead to significant impairments in daily life. Ongoing research is shedding light on the neurobiological mechanisms underlying this connection, which will ultimately inform more effective treatments for individuals suffering from dissociative disorders. By recognizing the link between trauma and dissociation, clinicians can offer more effective interventions, supporting trauma survivors on their path to healing and recovery.
References
Bremner, J. D. (2006). Trauma, memory, and dissociation. Journal of Traumatic Stress, 19(3), 419-428.
Lanius, R. A., Bluhm, R., Coupland, N., Hegadoren, K., & Williamson, P. (2010). The nature of dissociation in post-traumatic stress disorder: A critical review. The Canadian Journal of Psychiatry, 55(7), 440-448.
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. Norton & Company.
Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. Guilford Press.
Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd ed.). Guilford Press.
Sierra, M., & Berrios, G. E. (2000). Depersonalization: Neurobiological perspectives. Biological Psychiatry, 47(10), 889-890.
Teicher, M. H., Andersen, S. L., Polcari, A., & van der Kolk, B. A. (2003). Developmental neurobiology of childhood trauma. Journal of Affective Disorders, 74(1), 17-24.
Van der Kolk, B. A. (2005). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.
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