Trauma & Dissociation

A few weekends ago I attended a workshop all about trauma and dissociation that a professor recommended. The irony in this was that I filled the majority of a Saturday with trauma and dissociation..might be exposing some masochistic tendencies. Anyways, it was rather interesting, especially for me with wanting to focus on trauma in my future career, and I wanted to share with you guys what we covered. First, it was put on by The New England Society for the Treatment of Trauma and Dissociation or NESTTD. I know, a mouth full, right!? So glad they have an acronym, because who wants to say that full name all the time?

The day began with a lecture by Dr. James A. Chu, MD, entitled Fundamentals of Complex Trauma and Dissociation: What Every Clinician Needs to Know. Here are a few points that I found particularly interesting:

1) PTSD is found more in females – this is thought to be due to PTSD being more likely to develop for those who have experienced sexual trauma, particularly forcible trauma. Women are more likely to experience these types of trauma, which leads to increasing in PTSD. Side note with this: victims of forcible rape have close to a 100% rate of developing PTSD.

2) Men are more likely to experience trauma that involves physical attack or use of weapons, which apparently has a decreased risk of leading to PTSD.

3) Those who are experiencing dissociative symptoms with PTSD are not likely to respond to exposure therapy due to their ability to dissociate from the memories, instead of staying present to process the memories. (This seemed like one of those “ooooh, well duh!” moments, but I had never thought of this before.)

4) “Normal” types of dissociation was discussed, which includes imaginative involvement, trances, meditation, and hypnotic states. Interesting thought with this was that dissociation is actually a very normal part of childhood. Children spend quite a bit of time in their imaginative world, which is (clinically) considered a form of dissociation. Really, the learning point here is that dissociation is a normal part of our lives, from spacing out to being absorbed in a tv show or book, and it only becomes pathological when it interferes with our ability to function in our daily activities or is used to avoid painful memories or feelings.

5) One of the most powerful statements in the presentation was, “Self-care has little meaning for those whose bodies have been abused by others.” This was another one of those statements that made sense once it was heard but just made me feel sad about the amount of damage that trauma can have for individuals. He talked about how people who have been abused often feel disconnected from their own body and can see it in a very negative light, because it was the object that was used to carry out the abuse. He also tied this into self-harm and how this can often lead to clients cutting as a source of self-soothing and because the mindset of protecting their bodies has little meaning.

6) Lastly, often when working with clients who have experienced trauma, they can feel as though they have been through so much already that healing should just be handed to them. While this mentality is understandable, it doesn’t lead to much progress and can come with defensiveness. One line that he gave us that I’ll carry throughout my entire career was: What happened to you is horrible and in no way are you responsible for it; however, your treatment and recovery is your responsibility. This was one of those, “ooh, that’s a good one!” moments!

After a yummies lunch, we broke out into smaller lectures with specific topics. The one that I chose was about trauma and personality disorders and was lead by my professor (the one that recommended the workshop)! First off, this professor is kind of the embodiment of what I hope to become as a future clinician. She is all about trauma and views things such as dissociation and self-harm as coping mechanisms or survival skills for the pain that we feel after a trauma. So, the underlying theme in this talk was that the symptoms of personality disorders are simply survival skills that one learned through experiencing trauma. Individuals who are experiencing PTSD or personality disorders haven’t been able to let go of the past and the skills they learned in those moments to survive; they are living in the present as though they are still in the past. Whatever your thoughts are on personality disorders, viewing them through this lens allows (I believe) far more empathy towards understanding their situation, motivation and helping them to overcome the past. This is especially powerful when thinking about how difficult it can be to work with those who have borderline personality disorder. For those of you that have, you know how difficult and frustrating it can be to work with someone is constantly in crisis, loves you one minutes, and hates you the next.

So, even though it was on a Saturday (one of my precious days to either relax or catch up on everything that got brushed to the side during the week), it was worth giving up the day and again reaffirmed my desire to go into trauma work. I’m also pretty certain that it got me brownie points with that professor. The way she converses with me in class afterwards makes me believe that I have a special, if small, place in her now. If you want more information than what I went into, I attached both packets of lecture notes along with a recommended book list that they handed out. You better believe I’ll be getting me some of those! I’m specifically interested in these:
Traumatic Stress by Bessel van der Kolk
The Body Keeps the Score by Bessel van der Kolk
Creative Arts and Play Therapy for Attachment Problems by Malchoidi
Attachment-Focused Parenting by Daniel Hughes

Ones that I can recommend:
Treating Traumatic Stress in Children and Adolescents by Margaret Blaustein
Brain-Based Parenting by Daniel Hughes
Both are amazing books with actual examples. I would highly recommend reading either one if your interested in learning more about trauma. The first is designed specifically for clinicians and is filled with examples to use in therapy. They second is very readable and focuses on neuroscience in parenting, can be read by both clinicians and parents.

I know this might be a bit dry for some of you guys, but hopefully you found some parts interesting. Have you read of any of these books and would recommend them? How do you see the link between trauma and dissociation or trauma and personality disorders? Let me know your thoughts below!

Trauma & Dissociation
Trauma & Personality
Book List

4 Replies to “Trauma & Dissociation”

  1. For Point 1 – Isn’t it entirely possible that PTSD exists equally in both men and women, but practitioners just have explicit and implicit biases towards diagnosing women with PTSD? Isn’t it also possible that the “100%” rate is partially influenced by “leading” people to believe that they actually have PTSD? PTSD is just a label. If you are culturally told that people who go through the same thing you did develop PTSD at a rate of 100%, you’re probably going to believe you have PTSD as well (and therefore will almost assuredly get diagnosed with it). I think PTSD is a real thing, for sure. However, I am skeptical of anything that is “close to 100%.” I also think PTSD is becoming another ADHD. See generally people who claim they developed PTSD because people were mean to them on Twitter.

    For Point 2 – This seems odd to me. Isn’t rape a physical attack? The counter would be that yes, rape is a physical attack but that it is more about subjugation. However, most physical attacks are precisely about subjugation. If someone stabs someone, their goal isn’t the act of stabbing, it’s to subjugate the other person. It’s just variable forms of dominant behavior.

    For Point 6 – I like that. Its a much nicer way of saying “The world doesn’t owe you shit.” 🙂

    1. Point 1 & 2 Response – It is definitely possible that there is a societal or professional bias in diagnosing PTSD in females more than males. We tend to view men as being stronger and females as vulnerable, which can affect either side – diagnosing and presentation of symptoms. The culture in the United States might lead us to diagnose PTSD more for females and with certain types of trauma. Culture plays a huge role in diagnosis. For instance, what we consider traumatizing in the United States might not be traumatizing (or as much) in other countries, which leads to different views of handling traumatic events and diagnosing mental illness. For the 100% occurrence, I do think that anything with a 100% occurrence should be questioned. There will always be outliers, so you can never say that X will 100% of the time lead to Y. One of the explanations to why PTSD becomes an issue more often for forcible rape is because it not only is a traumatic event that is violent and forced on the victim, but it also violate the individual on a very deep level. Rape victims often struggle with how they view their body after rape, because it can be seen as something that was violated and taken from them. So, while trauma from things such as combat or natural disaster is very legitimate, rape can just be a whole deeper level of trauma. Lastly, I also agree that PTSD can very easily be over diagnosed, just like ADHD. That’s why it’s really critical to take the whole situation of the symptoms into consideration and make sure that there’s not something else (or diagnosis) that would better explain what’s happening.

      Point 6 Response – “The world doesn’t owe you shit” is something that I have wanted to use with clients before when they get stuck on blaming others for their issues, because it’s really not helpful to the recovery process. They line that he gave us that day is such a more therapeutic way of saying it.

  2. Well, that was a very interesting post miss Kelly. Here’s my thoughts: jeez, I got interrupted and now my thoughts aren’t as organized. Oh well.

    So the traumatized individual is likely to be diagnosed with PTSD, and more likely based on the type of trauma inflicted upon them. I think that trauma work is a tricky business. On one hand, there is so much information available about how to work with individuals who have been traumatized. SO MUCH INFORMATION. Now, before I get into my point please bear with it to the end.

    What if traumatized individuals seek additional traumatization? Is it possible that we, as providers are allowing individuals the forum to re-traumatize themselves? I don’t suggest that sweeping it under the rug could possibly be the correct solution. What I suggest is that there is a limit. Yes, the traumatized individual develops tools to cope. I smoke, I drink, I eat too much, these are some of my developed coping skills to deal with my childhood trauma. I also have PTSD from being attacked several years ago. Do I get treatment for these things?

    I did for the childhood issues. It helped and I got healthier. But NOT ONCE was the focus on my being victimized or traumatized by the experiences of my childhood. The focus was on how I could function today, and on the things that could be holding me back from functioning well.

    I would be interested to know the statistic about how many providers choose to work with trauma after having dealt with their own trauma? My guess would be a lot. Then I wonder what it is about being traumatized that leads some people to want to continually engage in interacting with trauma.

    Point 1) Culturally you’re supposed to find forced sexual interaction reprehensible. You’re supposed to react strongly. You’re supposed to not be okay with it. So you aren’t. BB’s point above is interesting about PTSD being similar to the (fake) ADHD epidemic in the United States.

    Point 2) this makes too much sense to me. It’s about where we are taught (culturally) that our value lies. Men, our strength, our independence, our ability to protect others, ourselves, and our ability to inseminate someone. Where does a woman’s value come? From her ability to bear children. These aren’t the correct answers but they are answers that are instilled in our children. The “action” of attacking someone’s value center is probably really the issue not whether the person is female or male.

    3) I agree, ooooh!… well duh!

    4) What are children if not adaptable and elastic? Really. The problem with the coping skills that children employ is that they are beaten out of people through the education system. We are so regimented about what a person should be (in our society) that we seek to program everyone to be the same. Thus issues like ADHD and perhaps PTSD becoming over-diagnosed. Let’s face it, okay? We are living and raising children in the most technology based society that has ever existed. We have more access to many things that children didn’t have access to previously. Worse, we EXPECT our children to be able to cope with these new things while we continue to hammer home outmoded ideals. Of course they aren’t going to be attentive. Of course they aren’t going to adapt well when we are seeking to STEAL their best forms of defense.

    5) Again, trauma seeks trauma. It enables and allows and all of that. I honestly and all the way believe that nearly all mental illness has a functional connection to addictions. So this really makes sense from that light, trauma seeks trauma.

    6) Recently my daughter had a lot of trouble dealing with the death of our dog Baxter. She began being aggressive and moody and wouldn’t talk to anyone but me about her feelings. Obviously this was an issue at school and at her mother’s house. It got so bad that she got kicked out of her pre-k. Finally we had a conversation where I said something that I swore I would never say to my children. “Grace, I can see that you’re having a hard time with this and I can tell that you don’t know how to move on. But it’s time to put your bad Baxter feelings away. That’s what we have to do sometimes. We feel our feelings, and we talk with people we trust and love. Then we have to put our feelings away and keep on having life. Just because the bad stuff happens, we don’t get to stop having life.”

    Talk about feeling like a horrible dad. but you know what. She didn’t know she was allowed to be done grieving. She continues to talk about him occasionally but seems to be doing much better after our conversation so maybe it wasn’t a horrible thing 🙂

    Whew! That was wordy as all hell. Oh well! Miss ya Kelly!

    1. Chris, first off, miss you too! I’m sorry to hear that Grace is having a hard time with the passing of Baxter. While I’m sure that conversation with her was incredible hard as her poppa, but like you said, it sounds like she just needed permission to end the grieving process and move on. She might have thought that she should continue to grieve and be angry about it, maybe that was the expectation she thought she was supposed to uphold. I know I’m never around when you actually parent your little one, but it always sounds like you do an amazing job with her. And, if your conversations with her mirror the conversations we’ve had together, I know that you’re doing an amazing job with her!

      Now, to go through your comment, point by point..yay, organization!

      I also would be curious to know how many people who end up working with trauma victims experienced trauma themselves. I know that’s what got me interested in the field and often is the source of my motivation in my work. It’s interesting that you bring up the thought of not focusing on the trauma in therapy. I’m finding that this is apparently a pretty common way to go about therapy. Many believe that it’s not productive to focus on what’s happened because it can’t be changed, so focusing on the present and how you can improve from here on out is a better use of time. Once I heard this idea, it made a lot of sense. Honestly, in the therapy that I’ve had over the years, there are times that I want to focus on the past..maybe to reprocess it, maybe to work through, maybe to just remember where I’ve come from. So, I think spending time on the past can be useful to some people, some times. But, I will admit that the most progress has come from focusing on how I’m currently doing and what can be done to have a better tomorrow.

      Your thoughts on trauma and many mental illnesses being based in addictions (#5) is very interesting..and new to me. I’m going to have to let it sit a bit, but I can see some truth in that. I can definitely see this in trauma. It doesn’t seem to make much sense why someone would continue to seek out trauma/victimization after having experienced trauma, but it’s actually a pretty common occurrence (as I’m sure you know). Heck, I’m still trying to work through my issues on continually going back into self-destruct mode or being victimized. Personally, I think it has a lot to do with comfort. While there is nothing comfortable about being traumatized, I think for some it’s the known, which makes it feel safe in some strange way. It also could be tied to thoughts that we have about ourselves (i.e. “I deserve this.” I’m no good.”) or just falling back into patterns that feel familiar.

      Lastly, your point on adaptability (#4), I completely agree. I think all human beings are adaptable; we all find ways to have the best life that we know how to have. These adaptive coping styles don’t always serve us very well, but it’s the best that we have in the moment. I’m a pretty firm believer in the thought that we humans don’t do things just for the randomness of it. We all are doing things that allow us to life the best life that we can and have reasons for everything we do..even if we’re not quite sure of those reasons consciously. If we weren’t gaining anything from our behaviors, why would we continue to do them?

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