Dissociation Following Traumatic Stress

Abstract

We postulate that the cascade “Freeze-Flight-Fight-Fright-Flag-Faint” is a coherent sequence of six fear responses that escalate as a function of defense possibilities and proximity to danger during life-threat. The actual sequence of trauma-related response dispositions acted out in an extremely dangerous situation therefore depends on the appraisal of the threat by the organism in relation to her/his own power to act (e.g., age and gender) as well as the perceived characteristics of threat and perpetrator. These reaction patterns provide optimal adaption for particular stages of imminence. Subsequent to the traumatic threats, portions of the experience may be replayed. The actual individual cascade of defense stages a survivor has gone through during the traumatic event will repeat itself every time the fear network, which has evolved peritraumatically, is activated again (i.e., through internal or external triggers or, e.g., during exposure therapy).When a parasympathetically dominated ‘‘shut-down’’ was the prominent peri-traumatic response during the traumatic incident, comparable dissociative responses may dominate responding to subsequently experienced threat and may also reappear when the traumatic memory is reactivated. Repeated experience of traumatic stress forms a fear network that can become pathologically detached from contextual cues such as time and location of the danger, a condition which manifests itself as posttraumatic stress disorder (PTSD). Intrusions, for example, can therefore be understood as repetitive displays of fragments of the event, which would then, depending on the dominant physiological response during the threat, elicit a corresponding combination of hyperarousal and dissociation. We suggest that trauma treatment must therefore differentiate between patients on two dimensions: those with peritraumatic sympathetic activation versus those who went down the whole defense cascade, which leads to parasympathetic dominance during the trauma and a corresponding replay of physiological and dissociative responding, when reminded. The differential management of dissociative stages (“fright” and “faint”) has important treatment implications.

Victims of rape show increased cortisol responses to trauma reminders: A study in individuals with war- and torture-related PTSD

“…Based on current theoretical models of PTSD (Lang, 1979;Foa and Kozak, 1986;Schauer et al, 2011), studies investigating physiological responses to trauma-related cues generally assume that the physiological reactivity in response to trauma reminders observed in the laboratory should recapitulate the physiological reactivity that occurred during the trauma (Keane et al, 1985;Pole, 2007). Whereas earlier studies proposed heightened autonomic responses of PTSD patients to trauma reminders in general (Orr and Roth, 2000), more recent investigations suggest that PTSD patients who responded to trauma with a drop in arousal, such as immobility or fainting -a response set which we refer to as ''dissociative shut-down'' (Schauer and Elbert, 2010), show reduced autonomic psychophysiological activity and reactivity when confronted with trauma reminders (Griffin et al, 1997;Lanius et al, 2002;Pole, 2007). If trauma reminders replay aspects of the peritraumatic response mode, different physiological response patterns should also be seen during exposure treatment depending on whether the original traumatic situation had predominantly activated the sympathetic ''flight-fight'' or had likely driven the defensive system into immobility and ''shut-down'' (Schauer and Elbert, 2010).…”

“…Whereas earlier studies proposed heightened autonomic responses of PTSD patients to trauma reminders in general (Orr and Roth, 2000), more recent investigations suggest that PTSD patients who responded to trauma with a drop in arousal, such as immobility or fainting -a response set which we refer to as ''dissociative shut-down'' (Schauer and Elbert, 2010), show reduced autonomic psychophysiological activity and reactivity when confronted with trauma reminders (Griffin et al, 1997;Lanius et al, 2002;Pole, 2007). If trauma reminders replay aspects of the peritraumatic response mode, different physiological response patterns should also be seen during exposure treatment depending on whether the original traumatic situation had predominantly activated the sympathetic ''flight-fight'' or had likely driven the defensive system into immobility and ''shut-down'' (Schauer and Elbert, 2010). This assumption has been confirmed by neuroimaging studies, showing differential neural activation patterns for the two response types in response to trauma-related stimulation (Lanius et al, 2006(Lanius et al, , 2010.…”

Commentary on Scheidell et al. (2018): En‐counting adversities; the ‘building blocks’ of psychopathology

“…the trauma, depends upon several factors. These include the type, proximity and frequency of traumata and previous experiences as well as the genetics, epigenetics, resilience, gender, age or cognitive capacity of the individual who encounters trauma [1][2][3][4][5].Given this variation, it is surprising that merely counting traumatic exposures can predict detrimental consequences for psychological functioning. This was, however, shown in the seminal Adverse Childhood Experiences (ACE) studies, and now Scheidell and colleagues demonstrate that it also occurs for substance use and abuse [6].…”

“…the trauma, depends upon several factors. These include the type, proximity and frequency of traumata and previous experiences as well as the genetics, epigenetics, resilience, gender, age or cognitive capacity of the individual who encounters trauma [1][2][3][4][5].…”

The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder

“…In the context of life-threatening events (see Schauer & Elbert, 2010, for a review), dissociative reactions have been associated with parasympathetic activity. Lazarus and Folkman (1984) define coping as ‘constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing’ (p. 141).…”