PTSD: Dissociation & Depersonalization

Mid-August 2012. The sun shone on the lake. The warm breeze blew hair into my eyes. My husband put his hand on my waist. A motorboat zipped across the water far below our home.

But I wasn’t there.

I watched this scene as if it was on TV or a huge cinema IMAX scene. It was somehow not real. It was somehow flat, 2D, yet 3D at the same time.

Depersonalization episodes have come and gone over the past year in dealing with rape acceptance and recovery, but no episode since accepting the rape had been as surreal as that one. It was part of my brain processing the trauma. I’m unable to put it into words–how I felt removed from the world, yet there I stood in it. It was one of the most bizarre moments in my life.

Fortunately for my good friend Google and one of the two rape recovery counselors I was seeing at the time, I identified it as depersonalization, a common symptom of PTSD or RTS (Rape Trauma Syndrome).

For those readers who have followed my blog throughout the past three years, you might remember a post called “Embracing Surrender & Finding Peace” that I wrote shortly after the rapes in early 2012. This was before I accepted what had happened as rape, still of the “He loves me so it couldn’t have been rape” mindset, even though my body and my subconscious mind was already dealing with the trauma. My day of “Enlightenment” was just that: a symptom of PTSD. The mind coping with the overwhelming trauma of rape, humiliation, and abandonment by a deeply trusted lover.

That “Enlightenment” was in actuality a dissociative state in which I was experiencing depersonalization. Far more intense and extensive than the one described above, that one lasted over 24 hours, but I wouldn’t recognize it for what it actually was for another half a year.

A little about dissociation from trauma and abuse from Wikipedia:

Dissociation is a term in psychology describing a wide array of experiences from mild detachment from immediate surroundings to more severe detachment from physical and emotional experiences. It is commonly displayed on a continuum.^[1] The major characteristic of all dissociative phenomena involves a detachment from reality – rather than a loss of reality as in psychosis.^[2][3][4][5] …

Dissociation has been described as one of a constellation of symptoms experienced by some victims of multiple forms of childhood trauma, including physical, psychological, and sexual abuse.^[26][27] This is supported by studies which suggest that dissociation is correlated with a history of trauma…^[28]

Adult dissociation when comorbid with a history of child abuse and otherwise interpersonal violence-related posttraumatic stress disorder (PTSD) has been shown to contribute to disturbances in parenting behavior, such as exposure of young children to violent media. Such behavior may contribute to cycles of familial violence and trauma.^[30]

Symptoms of dissociation resulting from trauma may include depersonalization, psychological numbing, disengagement, or amnesia regarding the events of the abuse. It has been hypothesized that dissociation may provide a temporarily effective defense mechanism in cases of severe trauma; however, in the long term, dissociation is associated with decreased psychological functioning and adjustment.^[27] Other symptoms sometimes found along with dissociation in victims of traumatic abuse (often referred to as “sequelae to abuse”) include anxiety, PTSD, low self-esteem, somatization, depression, chronic pain, interpersonal dysfunction, substance abuse, self-mutilation and suicidal ideation or actions.^[26][27][31] These symptoms may lead the victim to erroneously present the symptoms as the source of the problem.^[26]

Child abuse, especially chronic abuse starting at early ages, has been related to high levels of dissociative symptoms in a clinical sample,^[32] including amnesia for abuse memories.^[33] A non-clinical sample of adult women linked increased levels of dissociation to sexual abuse by a significantly older person prior to age 15,^[34] and dissociation has also been correlated with a history of childhood physical as well as sexual abuse.^[35] When sexual abuse is examined, the levels of dissociation were found to increase along with the severity of the abuse.^[36]

A 2012 review article supports the hypothesis that current or recent trauma may affect an individual’s assessment of the more distant past, changing the experience of the past and resulting in dissociative states.^[37]

As with language in all fields of study and human interaction, it fails us. Please don’t confuse a Dissociative Disorder or Dissociative Identity Disorder (DID) with dissociative episodes due to PTSD. Totally different things. They are, like most things, part of a spectrum. Although DID is caused by severe trauma, a person can experience dissociative states or episodes in the aftermath of a trauma without fitting the criteria for a Dissociative Disorder and most certainly not DID.

Similarly, labels such as Borderline Personality Disorder (BPD) carry such a horrific stigma that it’s difficult to even discuss that type of experience without serious prejudice. Interestingly, BPD and complex (or chronic) PTSD are virtually indistinguishable. Twenty years ago, BPD was more readily diagnosed than chronic (or complex) PTSD, erroneously so. Recently, psychologists are starting to understand the relationship between chronic abuse and adult psychological and behavioral problems. At a minimum, they are saying there is a frequent comorbidity between the two labels. Seeing as how I’ve been misdiagnosed and labeled with five different things than don’t explain or help my life experience, I don’t trust labels. For me, C-PTSD is the closest, the only one that explains all the symptoms.

Psychologists like to label people.

Fortunately, more than a few therapists I’ve seen in the past year are doing away with labels, as they serve to stigmatize much more than they serve to define and help in recovery.

If we, as a culture, can understand and empathize with people who suffer from PTSD, C-PTSD, and other abuse-caused conditions, perhaps there can be more healing for everyone involved instead of compounding the trauma by ostracism and ridicule. PTSD has been almost exclusively discussed as a phenomenon experienced by soldiers after enduring war, but it is far more ubiquitous across our society. Even our soldiers, however, experience ostracism and cruelty at the hands of their loved ones, friends, coworkers, and communities, as everyone expects them to just “get on with it,” to “let it go,” after the unimaginably horrific things they’ve seen and done.

Empathy, education, and understanding is called for with those suffering from PTSD, whether from war, from rape, from emotional abuse, or from another act of violence, otherwise, we contribute to their suffering by creating secondary trauma. Being raped by a trusted lover was, understandably, horrific. As horrific and traumatizing was not being believed by my community. By watching them embrace him and thereby shun me. By the police who minimized and normalized the experience. By “friends” who greatly distanced themselves because they didn’t know what to say.

Yes, indeed. As traumatizing.

My current therapist says that empathy requires someone to step into another person’s hell for a few minutes, and most people aren’t willing to do that. It calls up images of the film What Dreams May Come, brilliant film, where at the end, when the protagonist is trying to rescue his wife (who committed suicide) out of hell, has to choose between staying there with her and losing his mind or saving himself and going to heaven. He stays with her. Even though they would not even know each other were there, he stayed with her. In that act of sacrifice, that metaphor of empathy, they both were beamed to heaven. Instead of dismissing her or abandoning her, he stayed with her. He saw her. He heard her.

That was enough.

Remember that next time when someone is hurting, suffering because of another person’s cruelty. Hear them. See them. Empathize. You don’t have to fix anything. You don’t have to say the “right” thing that will make it all go away. Nothing will make it all go away. Ever.

But…being believed. being accepted. being heard. being together…means more than I can ever express. Just hear me. Just see me. Just be here for a moment in this space with me.

There is little more healing than that.

~ by omgrey on May 1, 2013.