Dissociative Identity Disorder : To Know or Not to Know

Lyons-Ruth is particularly interested in the phenomenon of dissociation, characterized by feelings of being lost, bewildered, abandoned, disconnected from the world, and experiencing a sense of not feeling loved, emptiness, helplessness, entrapment, and overwhelm. She discovered a "remarkable and unexpected connection" — the lack of engagement and responsiveness from mothers during the first two years of their children's lives is linked to dissociative symptoms in adulthood. Thus, Lyons-Ruth believes, "If infants aren't truly understood and perceived by their mothers, they're likely to struggle to understand and perceive others in their adolescent years.

Infants in secure relationships not only learn how to cope with sadness and stress, but they also find themselves — their interests, preferences, and goals. Compassionate responses help infants (and adults) avoid extreme fear responses. However, if your caregivers neglect your needs or deny your existence, you learn to reject and withdraw. You deal with this as best as you can, seemingly unconcerned about maternal hostility or neglect, yet your body remains in a heightened state of vigilance, ready to fend off blows, deprivation, or abandonment. Dissociative states mean you both know and don't know.

John Bowlby wrote, “What cannot be communicated to the [m]other cannot be communicated to the self.” If you can't tolerate what you know or feel, your only options are denial or dissociation. The most disastrous long-term effect of doing so could be the inability to connect with reality. We often see this situation in children's hospitals. If you feel nothing matters to you, you're unlikely to protect yourself from danger. Perhaps you'll go to extremes to make yourself feel something — even cutting yourself with blades or getting into fights with strangers.

In Karen's research, it is suggested that dissociative symptoms are learned and formed during childhood; later abuse or other trauma do not cause dissociative symptoms to emerge in early adulthood. Abuse and trauma lead to many other problems, but they don't cause long-term dissociation or self-attack. These patients' lack of awareness on how to cultivate a sense of safety lies at the core of this issue. A lack of safety in early relationships with caregivers can result in a lack of internal reality, excessive dependency, or self-harming behavior. Poverty, single parenthood, or maternal mental health issues don't cause these symptoms.

This doesn't mean that childhood abuse is unrelated to dissociative symptoms, however, the quality of early caregivers remains separate from other traumas and is crucial in preventing future mental health issues. Therefore, therapy not only needs to address the imprint of traumatic events but also confront the consequences of being unacknowledged, lacking empathy, and experiencing the lack of sustained love: dissociation and a deficiency in self-regulation capabilities.

Extracted from ‘The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma‘

by Bessel van der Kolk