Academic journal article European Journal of Psychotraumatology

Trauma-Related Dissociation and Altered States of Consciousness: A Call for Clinical, Treatment, and Neuroscience Research

Academic journal article European Journal of Psychotraumatology

Trauma-Related Dissociation and Altered States of Consciousness: A Call for Clinical, Treatment, and Neuroscience Research

Article excerpt

Copyright: © 2015 Ruth A. Lanius. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

Received: 18 March 2015; Revised: 16 April 2015; Accepted: 16 April 2015; Published: 19 May 2015

Competing interests and funding: There is no conflict of interest in the present study for any of the authors.

*Correspondence to: Ruth A. Lanius, Western University, 339 Windermere Road, PO Box 5339, University Hospital, London, ON N6A 5A5, Canada, Email: Ruth.Lanius@lhsc.on.ca

This paper is part of the Special Issue: Trauma and PTSD: setting the research agenda . More papers from this issue can be found at www.ejpt.net

For the abstract or full text in other languages, please see Supplementary files under 'Article Tools'

Formative work by Janet (1901) identified "dissociation" of traumatic material from consciousness as a central defense against overwhelming experience. Here, dissociation provides a critical psychological escape from emotional and physical distress associated with overwhelming traumatic experience, including childhood maltreatment, war trauma, and torture, from which no actual physical escape is possible (Kluft, 1985; Nijenhuis, Vanderlinden, & Spinhoven, 1998; Putnam, 1996; Spiegel, 1984; Vermetten, Doherty, & Spiegel, 2007; also see Carlson, Yates, & Sroufe, 2009; Liotti, 2009; Schore, 2009). This type of escape can involve compartmentalization where "aspects of psychobiological functioning that should be associated, coordinated, and/or linked are not" (Spiegel, 2012; Spiegel et al., 2011, p. E19; also see Van der Hart, Nijenhuis, & Steele, 2006) and detachment , including depersonalization, derealisation, and emotional numbing (Allen, 2001; Brown, 2006; Holmes et al., 2005; Spiegel & Cardena, 1991; Steele, Dorahy, Van der Hart, & Nijenhuis, 2009; Van der Kolk & Fisler, 1995). Downstream, however, as an individual attempts to resume normal functioning in the aftermath of trauma, chronic dissociation can have devastating consequences for all aspects of life (Brand et al., 2009; Jepsen, Langeland, & Heir, 2013).

Currently, the Diagnostic and Statistical Manual (DSM) defines dissociation as "a disruption and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior" (American Psychiatric Association [APA], 2013, p. 291). Clinical presentations of dissociation may include a wide variety of symptoms, including experiences of depersonalization, derealisation, emotional numbing, flashbacks of traumatic events, absorption, amnesia, voice hearing, interruptions in awareness, and identity alteration. Researchers have argued that the use of a single term, "dissociation," for such phenomenologically distinct experiences can be confusing and that the term dissociation should instead be deconstructed into multiple factors, thus allowing for a more accurate examination of the different phenomenological constructs (Bryant, 2007; Frewen & Lanius, 2015; Spiegel et al., 2013).

Despite the wide range of dissociative phenomenology observed, one underlying theme that spans both current theoretical constructs and observed clinical presentations of dissociation centers around trauma-related altered states of consciousness (TRASC). Putnam (1996) notes succinctly that "The more severe the trauma ..., the greater the likelihood that an individual will be driven into an altered state of consciousness" (p. …

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