Why Do People Dissociate and How Can It Be Managed in Trauma Recovery?
- willcowey
- Feb 17
- 6 min read
Summary of PTSD
Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition that develops in response to experiencing or witnessing life-threatening events. PTSD is characterized by flashbacks, nightmares, emotional numbness, hyperarousal, and avoidance of trauma-related stimuli. The more recent ICD-11 refines this definition, emphasizing re-experiencing the trauma in the present (e.g., intrusive memories, flashbacks), persistent avoidance, and an exaggerated startle response. A subset of individuals develops Complex PTSD (C-PTSD), featuring emotional dysregulation, negative self-perception, and interpersonal difficulties.
A crucial but often overlooked feature of PTSD is dissociation—a neurobiological survival mechanism that can either amplify (undermodulation) or suppress (overmodulation) emotional and physiological responses to trauma. Understanding dissociation provides key insights into how trauma affects the brain and body, guiding more effective therapeutic interventions, as some people do not suffer visual flashbacks and relive the memory as such, but have "emotional flashbacks", a reliving of the emotional experience and dissociation can explain this phenomenon.
The Defense Cascade: A Rabbit’s Survival Response
The Defense Cascade (Schauer & Elbert, 2010) describes the body’s progressive survival responses to threat. These responses occur in distinct stages:
➡ Freeze – The initial assessment phase; the body halts all movement to detect danger.
➡ Flight – If escape is possible, the organism flees.
➡ Fight – If escape is impossible, the organism fights.
➡ Fright – If overwhelmed, the body enters a state of panic and confusion.
➡ Flag – The nervous system slows, resulting in emotional detachment.
➡ Faint – The final stage, where the body shuts down completely, often leading to dissociation.
Example: A Rabbit in the Headlights
Imagine a rabbit caught in a car’s headlights. Initially, it freezes, muscles tense, heart rate spikes, and all focus is on the incoming threat. If it detects a way out, it bolts (flight). If cornered, it may attempt to attack (fight). If escape seems impossible, the rabbit enters fright, paralyzed by fear. If the threat persists, the rabbit flags—its heart rate slows, and it may appear limp to feign death (faint), a last-ditch effort to avoid being eaten.
Escaping the Trauma & The Aftermath
Now, imagine the rabbit escapes into a burrow. Though safe, its body remains on high alert. It replays the event—reliving the moment the car approached, heart pounding, muscles trembling. This post-trauma replay mirrors human experiences of intrusive memories and flashbacks in PTSD. The rabbit's nervous system alternates between hyperarousal (undermodulation)—tense, jumpy, unable to sleep—and shutdown (overmodulation)—motionless, detached, staring blankly.
These responses are not maladaptive—they’re survival strategies. The same mechanisms occur in humans with PTSD, where the nervous system struggles to reintegrate the traumatic experience, leading to dissociation.
Fear Circuits, Neurobiology & Dissociation: Understanding PTSD’s Impact on the Brain
Dissociation in PTSD arises from disruptions in fear and memory circuits, particularly:
Amygdala – The brain’s alarm system, responsible for detecting threats and triggering fear responses.
Ventromedial Prefrontal Cortex (vmPFC) – Regulates emotional responses; in PTSD, its control over the amygdala is weakened.
Hippocampus – Processes memory; in PTSD, dysfunction leads to fragmented trauma recollections.
Periaqueductal Grey (PAG) – Governs the freeze response; in PTSD, it may be overly reactive.
Bed Nucleus of the Stria Terminalis (BNST) – Regulates sustained anxiety; heightened activity may perpetuate fear.
Plain English Explanation
Imagine your brain is like a security system. The amygdala is the alarm, the vmPFC is the manager deciding when to turn the alarm off, and the hippocampus is the system storing video footage. In PTSD, the alarm (amygdala) gets stuck on high alert, the manager (vmPFC) is overwhelmed, and the footage (hippocampus) is scrambled, making it hard to distinguish past danger from present safety. This leads to hyperarousal, flashbacks, and dissociation.
Evolutionary Perspective: The Cavewoman & The Saber-Tooth Tiger
Imagine a cavewoman gathering food when a saber-tooth tiger attacks. She instinctively freezes, assessing the danger. Realizing she can’t outrun it, she fights, throwing stones (fight response). She’s wounded but manages to escape to her cave (flight response). Safe but shaking, she replays the event—hyper-aware of every sound outside. This is emotional undermodulation, keeping her on high alert in case of future attacks.
Now imagine another scenario. The cavewoman is attacked, but after escaping, she completely shuts down emotionally, struggling to recall the event. She feels disconnected from her surroundings. This is emotional overmodulation, preventing her from being overwhelmed by fear. Both responses were evolutionarily adaptive—some survivors needed to remain hypervigilant, while others coped by emotional detachment. However, in modern PTSD, these survival responses persist long after the threat has passed, interfering with daily life.
Cognitive Theory of Dissociation and CBT Interventions
The Cognitive Theory of Dissociation, developed by Dr. Kennedy and colleagues (2004), is rooted in Aaron T. Beck’s cognitive model of personality and other key thinkers’ work on the self (Pleydell-Pearce, Stopa, Brewin). This theory provides a valuable clinical framework for understanding dissociation, as it often underlies presentations such as severe anxiety, depression, C-PTSD, BPD, depersonalisation disorder, DID, somatoform/conversion disorders, and more.
Dissociation, as per this model, is an evolved set of responses triggered when a person experiences trauma and helplessness—especially when the trauma is perpetrated by a caregiver. Learned in childhood, these responses often persist into adulthood, where instead of being adaptive, they become problematic.
The CBT model of self-states, based on Aaron T. Beck’s 1996 work, introduces the concept of ‘orienting schemas’—our brain’s pattern-recognition systems that identify the context and demands of the current situation. These schemas activate modes of responding, which include thoughts, emotions, bodily sensations, and physiological responses (known as CBT’s ‘hot cross bun’ model). For instance, if someone with a lift phobia is invited to the top of the Eiffel Tower, their orienting schemas identify this as a threat, triggering a self-state called "lift phobia mode," which can override rational thinking and control.
CBT helps individuals identify these self-states and develop coping strategies to ground themselves, challenge maladaptive beliefs, and transition into more adaptive, present-focused modes of functioning. This model offers a structured and effective approach for addressing dissociation by integrating cognitive restructuring, mindfulness, and grounding techniques.
Practical Tools for Reducing Dissociation
To help PTSD patients regain control, interventions should focus on re-establishing a sense of safety and body awareness:
✔ Grounding Techniques – Engage the senses (e.g., smell pine, feel textured objects, listen to calming sounds). The 5-4-3-2-1 method helps anchor individuals in the present.
✔ Noticing Triggers e.g. Heart Rate Monitoring – Wearable devices can detect early signs of hyperarousal, as this is a strong physical response, prompting grounding exercises.
✔ Trauma Processing – TF-CBT, EMDR, and somatic therapies can help integrate traumatic memories.
✔ Sensorimotor Therapy – Yoga and movement-based practices reconnect the body and mind, improving emotional regulation.
✔ Trigger Records – Identifying and tracking triggers aids in developing stimulus discrimination and coping strategies.
Conclusion
Dissociation is not a flaw—it is a survival strategy deeply rooted in neurobiology and evolution. Whether seen in a rabbit escaping a predator or a cavewoman surviving an attack, these responses were once adaptive. However, in PTSD, they persist beyond their usefulness, leading to distress. By understanding the Defense Cascade, fear circuits, and dissociation’s adaptive origins, clinicians and patients can work towards recovery through tailored interventions that restore balance between the body and mind.
If you anwser yes to more than three of these questions, or if any of these experiences cause you distress, reach out for help.
Question | Yes/No |
Have you experienced moments where your surroundings seem unreal, distant, or dreamlike? | |
Do you have difficulty remembering important parts of a traumatic event, beyond normal forgetfulness? | |
Do you find yourself zoning out or losing track of time, especially in stressful situations? | |
Have you felt emotionally numb or disconnected from your feelings for extended periods? | |
Do you experience sudden shifts in awareness, where you feel disconnected from reality or confused about where you are? | |
When thinking about a traumatic event, do you ever feel as though it is happening again, with physical sensations and emotions as if you are reliving it? | |
Have you noticed significant gaps in your memory, particularly around stressful or traumatic experiences? | |
Do you ever feel detached from your body, as though you are watching yourself from the outside? |
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