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Blog

Resources on 'dissociation'

Posted on April 22, 2013 at 6:48 AM Comments comments (94)
From Louis Cozolino “The Neuroscience of Psychotherapy” [2o1o] 

Dissociation is a result of high levels of stress associated with traumatic experiences. It occurs when the fight or flight response would be maladaptive, or when there is no response to one’s distress. It is a switch from hyper-arousal to hipo-arousal. In infants it is manifested as a gradual lack of protest [this is the reason why until recently it was believed that infants were insensitive to pain and so surgery was performed on infants without anaesthesia It is characterized by “a disconnection among thoughts, behaviours, sensation and emotions; dissociation demonstrates that the coordination and integration of these functions is an active neurobiological process.” [p. 2o-21] 

“Dissociation allows the traumatised individual to escape the trauma via a number of biological and psychological processes”. [p.269] The brain releases endogenous opioids which create a sense of wellbeing. The explicit processing of overwhelming traumatic situations is decreased [hippocampus]. “Derealization and depersonalization reactions allow the victim to avoid the reality of his or her situation, or watch it as a detached observer. These processes can create an experience of leaving the body, travelling to other worlds, or immersing oneself in other objects in the environment…” [p.27o] 

“General dissociative defences resulting in an aberrant organization of networks of memory, fear, and the social brain contribute to deficits of affect regulation, attachment and executive functioning. The malformation of these interdependent systems result in many disorders that spring from extreme early stress. Compulsive disorders related to eating or gambling, somatization disorders in which emotions are converted into physical symptoms, and borderline personality disorder all reflect complex adaptations to early trauma” [van der Kolk, 1996 in Cozolino, 2o1o, p. 27o]

The neuroscience of borderline personality disorder [p.282-283] [Also see Zero degrees of empathy by Simon Baron-Cohen]
-       An overactive amygdala, primed to react to any indication of abandonment.
-       Easily triggered fight or flight reaction [hypothalamus- pituitary –adrenal axis resulting in the release of adrenaline and cortisol]
-       Orbitofrontal cortex inadequately developed so it cannot successfully inhibit the amygdala. Self-soothing is not possible.
-       Orbitofrontal dissociation may result in disconnection between right and left hemisphere and top-down processing leading to dramatic shifts between positive and negative appraisals of relationships.
-       The absence of internalized models of affect regulation so the patient cannot draw on these to self-soothe
-       Rapid fluctuations between sympathetic and parasympathetic states
-       Chronic high levels of stress hormones [cortisol] which compromise the functioning of the hippocampus, decreasing declarative, explicit memory and the capacity to control the amygdala.
-       Lower levels of serotonin resulting in greater risk of depression and irritability.-       Self-harming results in endorphin release and sense of calm 

 TREATMENT

“Dissociation in reaction to trauma represents a breakdown of neural integration and plasticity. In therapy, we use moderate levels of arousal to access cortical mechanisms of plasticity in controlled ways with specific goals. The safe emergency of therapy provides both the psychological support and the biological stimulation necessary for rebuilding the brain. Much of neural integration and reorganization takes place in the association areas of the frontal, temporal and parietal lobes, serving to coordinate, regulate and direct multiple circuits of memory and emotion… narratives embedded within an emotionally meaningful relationship are capable of resculpting neural networks throughout life. Through the use of autobiographical memory, we can create narratives that bridge processing from various neural networks into a cohesive story of the self” [Cozolino, 2o1o, p. 343]

From Daniel Siegel’s “The Mindful Threapist: A clinician’s Guide to Mindsight and Neural Integration”“Dissociation involves various elements along a spectrum including a sense of being unreal, feeling numb or disconnected from one’s body, feeling depersonalization or a kind of distance from being grounded in oneself, and outright amnesia for events in one’s ongoing life.” [Siegel, 2o11, loc. 1377] 

These experiences recur mainly under stress and are associated with unresolved trauma and loss and a disorganized attachment style. Dissociation is a protective state in a situation in which there is no escape from terror  or “fear without solution” [Main, Hesse, Yost-Abrams and Rifkin, 2oo3 in Siegel 2o11]
 
The opposite of a dissociated or disorganized state is an integrated state. There are different levels of integration, just as there are different levels of dissociation.
Vertical integration – mind/body is facilitated by interoceptive awareness [posterior insula] Being aware of what is happening inside one’s body and using this information to make sense of our reality
Bilateral integration – left hemisphere/right hemisphere [logic, verbal/metaphoric, implicit, non-verbal] 
Being able to use logic but also metaphor. [See Iain McGilchrist- the Master and his Emissary]
Memory integration – implicit memory/explicit memory [amygdala/hippocampus]
Narrative integration- the existence of a coherent autobiographical story

Additional resources:  “The History of Dissociation and Trauma in the UK and its impact on treatment by Remy Aquarone and William Hughes” available online at:  http://www.dissociation.co.uk/research.asp
Stephen Porges - "The polyvagal theory". Porges talks about incapacitation [fainting, passing out] as a distinctive coping mechanism, neurologically very different from sympathetic arousal [fight or flight response]