How is PTSD Treated: Understanding Dissociation in Complex Trauma and PTSD

Keywords: How is PTSD Treated.

On a physiological level, trauma is the high energy arousal of the nervous system that hasn't had the possibility to discharge. It, thereby, interferes with the normal functioning of the nervous system. That "interference" is most often accompanied by physical symptoms and mental/emotional disturbances.

The impact that leads to high energy arousal of the nervous system can either be incidental, like surgery or a car accident, or develop over time; for example, feelings of incompetence, lack of self-worth, and so forth.

How is PTSD Treated and which Body-Mind Reactions are Present

The body is wired to self-regulate back to health. When we are overwhelmed by threat without having the possibility to regulate the high energy arousal of the nervous system through fight or flight, the body freezes the energy as an ultimate survival strategy. When there is no further interference, the body/nervous system will release this energy when space, time, and allowance for it are given and available.

On a physiological level, trauma is the high energy arousal of the nervous system that hasn't had the possibility to discharge.

What often happens, however, is that thought interferes with our self-regulating mechanisms thereby keeping trauma alive within the body and mind. When a value judgment is given to an incidence of high energy arousal we dissociate from embodiment and move into emotion. In turn, the emotion is coupled to the object, person, experience or circumstance thereby furthering the dissociation process.

How PTSD is Treated and How do Coupling Dynamics Affect Us?

To illustrate this with an example: Marie has to press on the brakes suddenly for a car stopping in front of her. When she checks in the mirror she sees the car behind her about to impact hers. She braces herself. As there is no time to regulate the energy arousal caused by the impact into fight or flight, her system freezes the high energy arousal of the nervous system. Apart from physical symptoms of the impact, she starts suffering anxiety attacks, sleeplessness, and severely disturbed digestion.

As she is not aware of how to allow the body to release its surplus energy, she is overcome by feelings of helplessness, self-pity and a sense of loss of control, which is accompanied by thoughts on the causal nature of the accident:  "Why did this happen to me?" "What have I done wrong?" " If only that other driver had been a bit more alert!"

In turn, these feelings stimulate her replaying of the event in her memory and dreams. Self-pity and helplessness isolate her from interacting with others and further reaffirms her state. As she is not able to regulate herself back to health and her condition persists, she is not able to commit herself to regular working hours and has started smoking again after not having smoked for more than ten years. The above example gives a clear view of the impact of trauma, coupling dynamics and dissociation processes. Furthering dissociation leads to more complexity and coping habits.

The Pathway of Dissociation in PTSD and How PTSD is Treated

The first dissociation happens when there is a negative value judgment given to the high energy arousal in the body. This happens at an unconscious level and can be instantaneous upon the event of the car accident. When that happens, the high energy arousal is coupled through a negative judgment value ("I don’t want to feel like this"," I don’t like this"), to emotion such as feelings of helplessness, self-pity, and loss of control (guilt, blame and self-reproach).

The second dissociation is when the event, in this case, becomes interpreted and colored by her emotional state. Thus her emotional state of self-pity ("why me?"), helplessness and blame ("If only the other driver had been more alert!") is coupled to the event itself (recurrent replaying of the event in her memory and dreams infused with feelings of self-pity/guilt, helplessness/self-reproach and blame).

When working with trauma one must address these coupling dynamics. By doing so, you bring into awareness how trauma is kept in place.

Dissociation prevents one from self-regulating back to health. It is the work of the patient and therapist to explore dissociation. Together, they can work towards release or integration of the high energy arousal of the nervous system and help towards how PTSD is treated successfully.

How does dissociation present itself for you? Leave your comment below.

  • Hele says:

    Roland, does dissociation in young children (say…age 4-5 years old) begin this way, as well? Can little ones feel self pity and or guilt in response to sexual abuse? or does dissociation begin later when developmentally the child knows the difference between what is right and wrong.

  • Roland says:

    Hi Hele. Good question. I think there are different stages of dissociation which are all started when an impact, emotionally or from a nervous system perspective, are too much to handle. What you see first is a ‘split’ emotionally. As a child when fight or flight does not have any effect what you can resort to is ‘freeze’ or ‘pleasing’ in order to cope. Guilt, blame, self-reproach or shame further compounds the dissociation process often internally as reaction towards freeze or please and the sense of helplessness of not being able to exercise control over the situation and emotional responses.

  • Shelly says:

    What if you suspect a loved one was sexually abused as an infant by their own mother? Will dissociation occur then and what can be done to get them out of denial? There is good reason to believe this happened. His mother took classes on sociology and had highlighted passages on these topics. This was discovered after he was diagnosed with PTSD from early childhood trauma due to the emotional abuse. Very definitely enmeshment issues as well, which there is also denial of. He has very drastic signs of body memories. It’s hard to discern if he dissociates or not because he is an alcoholic. There is a change in his eyes that does occur when he is not drinking as well. I believe he dissociates. He recently stopped therapy and I’m afraid he will never get the help he needs. His therapist encouraged him to see a specialist in his issues, he is dragging his feet. My fear is if she (his mother) did this to him, did she also do this to our children?

  • Petra says:

    Very interesting .. thank you !
    I’m beginning to understand … something like that happened with me, when I was told in a group of bereaved parents, that “what I have” is too much for everyone else. Understandable. They needed to be protected of what I have to live with. I was told to please stop talking. I left. No one reached out and offered help for me to find a way how to live with the loss of cancer of our child and then two weeks after the funeral of my husband. It was like being hit by something huge. I was ready to give up. I felt destroyed and helpless and was scared. I knew, that I wouldn’t be able to deal with all of that without professional help. I had been in therapy with a regular psychologist for two years – we both had to admit, that no “progress” was made. After that incident I searched for a therapist who is specialized in trauma therapy. I was lucky to find a private therapist who was not afraid of what I have to deal with. Regards and thank you for sharing so much of helpful insights to Trauma and PTSD !

  • Louise says:

    After the initial fight or flight and the adrenaline and energy is still all pent up in the body i find i disassociate and freeze. Its like feeling you have left your body and hidden or shrunk into your mind more and when you finally feel the adrenaline subside you start to slowly come back and feel your body and can get up, it is so weird

  • Louise says:

    It isnt quick either, 4 hours have passed on occasions before i feel i can come back down if you get that

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