Depersonalization Disorder And The Instinctual Trauma Response
Depersonalization is a state of mind that makes life seem unreal. In depersonalization disorder the feeling doesnt just come and go as it does when smoking pot or when a persons survival is suddenly threatened. When ones normal self seems lost and the world forever changed that is part of a mental condition that affects millions of people worldwide. It is a misery that is poorly understood and has no generally accepted treatment. It is classified as one of the dissociative disorders that are treated by psychiatrists or mental health therapists.
In this condition a person may feel numb and half paralyzed, emotionally and physically. There may be a continuous out-of-body sensation or a feeling of living in a dream or a movie. The external world may seem strange or unreal. Often individuals with depersonalization disorder have great difficulty describing their experience and they are often afraid to even think about it because it makes them feel crazy. However, they do know their experience is only a feeling and they do not actually lose contact with reality. Many people who suffered silently found information and support from others on websites devoted to depersonalization disorder.
Many dissociative disorders and anxiety disorders (particularly panic disorder) give rise to the symptom of depersonalization. The symptom may never occur again after the person recovers from the primary disorder. When depersonalization occurs as the primary problem it seems more difficult to treat. Psychiatric medication does not seem to be a solution. When medication helps it does so only temporarily. The usual psychotherapy approaches have been nonspecific and long-term.
The Mount Sinais Brief Psychotherapy Program in New York has put together a multistep program that has been effective for certain individuals suffering from depersonalization disorder. The program includes education about the condition, cognitive correction techniques, grounding, and general behavioral techniques. This approach focuses on controlling the symptoms of the disorder. There is another brief treatment program that focuses instead on the cause of the disorder. The Intensive Trauma Therapy Inc. program >http://traumatherapy.us< in Morgantown, West Virginia assumes the cause to be trauma.
The causative trauma seems to be extreme pain. When it happens during preverbal life (birth to age three) it may be during surgery or painful medical procedures or in unrelieved colic. It may happen by violent assault such as smothering or shaking. The infants initial instinctual survival strategy of fight/flight by screaming and clutching fails to stop the pain. The baby lapses into the more primitive survival response, the instinctual freeze state with its near-death experience of total numbing and immobility. Although dangerous this state does finally stop pain. The emergence from the freeze progresses through a gradual grounding in the body that reverses the void of lost spatial orientation. The transition usually involves a period of robotic submission before the full return of bodily orientation. This phased recovery represents the instinctual response to severe trauma at all ages.
In adults and children beyond age three transitioning from the freeze state typically involves an altered state of consciousness that produces the most common symptom of depersonalization disorder, the out-of-body experience. In fact, all of the symptoms of depersonalization disorder can be understood as persisting reenactments of phases of the instinctual trauma response. When the freeze state is triggered and re-experienced the person is gripped by physical and emotional numbing. A person feels unreal and sees the world as unreal when in the grip of reenacted altered consciousness. The transitional state of automatic submission paralyzes the will and imposes a sense of robotic compliance.
When an adults traumatic reaction to pain reaches a freeze state the memory of the experience escapes verbal coding and is stored the same as in preverbal times. Nonverbal perceptions are like flashbulb memories, fragmented and clustered without narrative order. Lacking narrative closure the experience seems unfinished and forever in present tense. When the trauma intrudes into current consciousness the phases of the instinctual trauma response seem like current active experience. In depersonalization disorder the intrusions become fixed states that dont make sense in the present world.
In this light the treatment of depersonalization disorder is straightforward. Narrative processing of the instinctual trauma responses in both verbal and nonverbal realms promotes closure and conversion of the traumatic experience to past memory. This is the nature of the treatment offered by the Intensive Trauma Therapy program. Verbal narrative processing can be accomplished rapidly under hypnosis. Nonverbal processing is accomplished by a novel procedure, the graphic narrative. The final relegation of the memory to past history is promoted by external dialogue with the past self frozen in the trauma. The external dialogue may use video recording and replay or written exchange often with automatic writing or play therapy measures to permit dialogue by proxy. The program uses these procedures in an outpatient marathon treatment over five to ten days.
Louis W. Tinnin, MD
Psychiatric Consultant
Intensive Trauma Therapy, Inc.
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