Dissociation and dissociative disorders

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What are the causes?

Dissociation is a normal defence mechanism that helps us cope during trauma. For example, some people dissociate after experiencing traumatic events such as war, kidnapping or an invasive medical procedure.

But this can become a dissociative disorder if your environment is no longer traumatic but you still act as if it is, and if the dissociation you needed to protect yourself means you haven't been able to process past traumatic experiences.

Dissociative disorders are usually caused when dissociation is used a lot to survive complex trauma over a long time, and during childhood when the brain and personality are developing. Examples of trauma which may lead to a dissociative disorder include:

• physical abuse
• sexual abuse
• severe neglect
• emotional abuse.

You may get so used to using dissociation as a coping strategy that you do not develop other strategies and you start to use dissociation to deal with any kind of stress.

How does trauma cause dissociation?

Trauma can cause dissociation because of the way we respond to threat. There are different theories about how exactly this leads to different dissociative disorders.

You may have heard of fight or flight. They are instinctive ways that we respond to threatening situations. But if you can't do these things (for example if you are very young) then you may respond by 'freezing' or 'flopping'.

• The freeze response makes the body immobile and releases chemicals which 'numbs' your body and mind. You might feel paralysed or unable to move.
• The flop response is where lots of the thinking processes in the brain are shut off. Your muscles become floppy and you act a bit like a zombie - doing what you are told without protest.

Our instinctive reactions to threat are the basis of dissociative experiences.

"It became uncontrollable and it would happen in various places when I felt stressed or under threat."

One theory suggests that whenever we think there is a threat, our body reduces blood flow to areas in the front of our brain (the thinking, analytical, rational part) and 'turns on' areas in the back of our brain (the automatic, instinctive part).

Using the back of our brain to freeze or flop helps protect us from trauma that we can't prevent or run away from. But reducing the blood flow to the front of our brain can make it more difficult to process what happens and may mean we experience dissociation.

The front of our brain includes areas which help us:

• understand where we are in time and space
• use language and speech
• feel connected to our body
• store memories
• make sense of information coming through our senses.

You might separate different parts of an experience so you do not have to deal with them all together. Different parts of the experience (such as actions, memories, feelings, thoughts, sensations and perceptions) may not be 'joined up'.

"I would disconnect myself from being in the room where the abuse was happening. I almost felt like I was watching it happen to me but I wasn't feeling it or wasn't part of it. It became something that happened automatically."

For example, you might store an experience in a way you can't access day to day (this is usually called amnesia). Or you might remember what happened but don't feel the emotions or sensations that were part of it (this is usually called derealisation).

If you experience dissociative identity disorder (DID), you might feel as if different memories, sensations or beliefs happened to different people (usually called identity states) inside you.

This can help you cope if the things that happened would be too much for you to deal with all together as a child - but may prevent you from developing one clear identity as you grow up.

For more support you can contact these organisations:

• The National Association for People Abused in Childhood (NAPAC) offers support for adults who were abused as children.
• Survivors UK provides support for men who have been abused.
• Childline is there to help children who are upset or scared about anything, including abuse.
• If you are worried about a child you know, the National Society for the Prevention of Cruelty to Children (NSPCC) can help.
• The Survivors Trust provides contact with local organisations which offer support for people who have experiences sexual abuse.
• For other organisations which may be able to help you, see our useful contacts page.

This information was published in March 2019. We will revise it in 2022.

References and bibliography available on request.

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