Dissociation in Traumatized Children and Adolescents: Notes
Dissociation, the absence of awareness, is a very normal process when it occurs from time to time.
o Fantasy stories and friends take on a separate reality
o Imaginary friends may be an enjoyable fantasy, expansion of experience, a way to fill loneliness or boredom. They can also be a process for working out fears and ambivalent feelings.
o Adults may experience a similar type of dissociation when driving but their minds are preoccupied with other thoughts.
o Adults and children may experience depersonalization—seeing or experiencing themselves as if from the outside—when they are caught in a frightening situation (i.e. getting bitten by a dog, being in a car accident, etc.) or going through a particularly stressful time.
o Dissociative experiences that are part of the normal development do not cause a fragmentation of experiences or self.
o The child can be aware of what happened and can talk to others about what happened.
o If the child’s experience continues to be frightening or nonsupported (not having an opportunity to process what happened), dissociative experiences are likely to continue.
o The more dissociation continues, the more it affects the child’s perceptions, feelings, physical sensations, or knowledge of the world that is stored outside of the active awareness.
o Problematic dissociation rarely occurs alone. It is often present with other things such as posttraumatic stress, childhood depression or severe anxiety.
o Dissociation can often look like Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), a conduct disorder, a reactive attachment disorder, a bipolar disorder, or may be comorbid with one of these disorders.
o Dissociation in a child may be mild, moderate, or extreme.
o Presents as a type of “spacing out” which is different from lethargy from depression or withdrawal from anxiety.
o Abrupt changes in emotion or behavior may occur with mild dissociation.
o Most children who become upset experience a building of distress or other negative feelings to the point where the child no longer has complete control over her or his behavior.
o The child with mild dissociation is more like an infant or toddler who moves directly to extreme states of reacting: the mid-states of moderate emotion are missing or minimal.
o Children with moderate dissociation may experience a numbing of emotions or body sensations.
o The child can block out frightening experiences, strong emotions, body states, emotional needs, and even severe pain.
o The child may have the feeling that a situation is not happening, that her or his surroundings or events are not real—this is known as derealization.
o Depersonalization and/or derealization usually first occurs during a frightening event, and it may reoccur whenever something in a child’s world is similar in some way the frightening event.
o New frightening experiences that remind children of the original frightening experience trigger a fright response and consequently triggers the protective response of dissociation.
o Depersonalization and derealization are used to avoid distress.
o This occurs when, in order to feel safe, the child needs to separate the emotions, physical sensation, or experiences so completely from her or his awareness that the child, outside of consciousness, “creates” separate parts of herself or himself to hold these emotions, sensations, or experiences.
§ These are known as dissociative parts or dissociative self-states.
o Children may experience these parts or self-states as voices telling them what to do or experience a shift insides themselves or such that the children are consumed with the emotion or sensation or reexperiences the age of they experienced the frightening experience(s).
o The difficulty is that while in a dissociative state the child may be unaware of all the other learning and experiences that the child has had in her or his life.
o The child may be unaware that years have passed and that she or he is now in a safe place.
o Fear, anger, and sense of loss all may be experienced without any moderation.
o What a child does in a dissociative state will not necessarily be remembered when the child is not in that state.
o Each state (the emotion-state, the younger child state, the “now” state) is likely to have separate memory.
§ There is, however, an awareness within the child that there are other states or ways of being. The diagnostic term for this level of dissociation is known as Dissociative Disorder Not Otherwise Specified (DDNOS) (American Psychological Association, 2009).
o The angry or deprived-feeling child may steal or break things, but later in another state—perhaps, the part of the child that wants to be close to others—the child may not have access to the memory of lying and acting irrationally, while the child feels misunderstood and mistreated.
§ This type of interaction together with the intense emotions associated with feelings mistreated will often end of intensifying the use of dissociation.
o New experiences are not necessarily experienced across all dissociative or self-states. Therefore, infant or toddler parts are not modified by later experiences held in the child or adolescent part.
§ For some children, there are numerous parts within each age group. One part may be loving while another is fearful.
o The child’s facial expressions, movements, and general demeanor can vary greatly from state to state. Therefore, the child appears as if she/he are separate people.
o The child is not capable of recognizing when in one state or that other parts exist.
o This makes it difficult for the child to control which part is present at any given time.
o The switches between parts tend to be very sudden and often without the child or the people around the child being able to recognize what triggered the switch. This is referred to as Dissociative Identity Disorder (DID) (American Psychological Association, 2000).
Children may or may not give specific names or other defining attributes (age, gender, feelings) to these parts.
Source: Wieland, S. (2010). Dissociation in traumatized children and adolescents: Theory and clinical interventions. New York: Routledge.
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