Dissociative disorder

Which Part of You is Driving Your Bus?

Image by David Henderson

When my clients tell me, ‘I really hate myself today!’ or ‘I need him to call me, even though I know he will just hurt me again,’ I often ask them, ‘Which I?’. So, which I hates and which feels hated? And which I is so attached to this guy that she doesn’t care if she’s hurt – or perhaps finds that hurt familiar, because it reminds her of her painful relationship with mum or dad.

And people often look at me with a bewildered expression on their face, because we are all used to thinking of ourselves as just me. So of course, I feel like I am Dan all the time. I think Dan thoughts and have Dan experiences and everyone who speaks to me calls me Dan. Just me. Just one, homogeneous self.

We all have many parts

But we now know that this is not how the human brain works. Your brain creates many selves, which fulfill different roles in your internal system. For example, you may have a self that goes to work every day, even when you would rather stay in bed, and can be assertive and deal with your prickly, critical boss. But you have another self that is much less confident and secure when you are in romantic relationships (which is, of course, deeply frustrating and mystifying! ‘Why am I so confident at work but crumble when my boyfriend’s mean to me?’).

You find yourself feeling and behaving differently when you go back to your family home, when you are with this (kind, supportive) or that (abrasive, critical) friend, and so on. You have many selves, or parts (and in schema therapy we call these modes). This is just how the brain works, even if we are fairly healthy and high-functioning.

But if you have experienced trauma, your brain will have created many more parts to help you cope. One part may hold particular traumatic memories, enabling you to get on with school, or work, without being flooded by painful memories and feelings all the time. Another part makes you drink to numb painful emotions. Another might push you to self-harm, or restrict food, or whatever it is you need to get through the day.

We know that trauma survivors have many parts and that these parts might be more separate and distinct than for those lucky enough not to have experienced trauma. At its most extreme, this separation of parts leads to a dissociative disorder, where people frequently move between their parts, with little awareness of this change or the other parts in their system, which clearly makes life very difficult. This can lead to ‘dissociative amnesia’, where people lose parts of their day, not remembering where they have been or what they were doing.

One bus, many passengers

Whether you are a trauma survivor or not, it’s helpful to know the bus metaphor, which my clients really like. It goes like this… There you are, driving along, with all of your parts on board a bus. There may be one or more child parts, some happy, some sad, some running around and causing all sorts of trouble. There might be a Critical Part, giving you a hard time about something or other.

Maybe there is an avoidant part, who doesn’t want to be on the bus at all – too many people! Too much noise! Or even an entitled part, who thinks he’s pretty great (certainly better than all the other loser parts on the bus). The point is, all of these parts are on your bus. And you need to make them all welcome, whether you like them or not, because they’re not getting off any time soon!

But there is only one part you want driving the bus – and that’s your Healthy Adult. He or she is the strong, resilient, mature, wise part that knows what’s best for you. And loves you – even those parts of you that are a bit hard to love. And your Healthy Adult is, or should be, in charge of all the other noisy, opinionated, impulsive parts – like the teacher in a nursery, or parent of a large family. The kids can have their say, but mum or dad should be the one making all the big decisions.

Don’t let these guys drive

Because if the angry part if driving, you might find yourself letting your irritation bubble up and snapping at your kids, which feels horrible. Or if the part who wants you to drink is at the wheel, you find yourself in the pub, alone, on a sunny Saturday morning, drowning your sorrows. And if the Critical Part is driving, it will park up, turn around and berate you about your latest ‘failing’ for an hour.

You get the idea. All of your parts are welcome to be passengers on your bus. They can all shout out ideas, opinions, suggestions. And your Healthy Adult listens, takes note, then he or she makes the decisions. Wisely. Calmly. Sensibly. And so you drive off down a road that leads to a happier, more fulfilling life – not the familiar roads that end up in dead ends or dark alleys.

If you want to know more about how to help your Healthy Adult take charge, do keep reading my blog (for example, here’s a post about using mindfulness to quiet a noisy mind), see a good schema therapist; or check out Internal Family Systems therapy, another great model which is all about getting to know, integrate and have compassion for every part in your system.

Warm wishes,

Dan

 

Try this Simple Grounding Technique to Help with Dissociation

Image by David Pisnoy

Image by David Pisnoy

Dissociation is one of the most confusing, disturbing and often frightening experiences we can have. It is also extremely common – especially, but not only, if you are a trauma survivor. When explaining dissociation to my clients, I often use the analogy of a circuit breaker.

So think about a circuit breaker, which is designed to deal with sudden surges of electricity. When there is a surge, the switches get tripped, shutting down the electrical circuit and protecting all of your devices (kettle, toaster, computer, etc) from burning out.

That’s how dissociation works in your brain. If you experience something completely overwhelming, like any kind of trauma, your brain flips a few switches (metaphorically) and shuts down various circuits, to protect you from lasting damage. At the time of the trauma, this is a helpful, adaptive and potentially lifesaving strategy.

Imagine you are in a bad car crash. If you are injured, your brain flips those switches to, for example, disconnect you from the physical pain in your body. This might help you survive, by allowing you to escape the crash site. Or just to cope with the experience, by protecting you from the pain until you’re in hospital and can get treatment. As with so many of the coping strategies we use for any kind of traumatic experience, this is a good, healthy, protective thing to do.

When dissociation is not helpful

The problem with dissociation is that, over time, it becomes an unconscious and habitual response. Especially if you are a trauma survivor, with a heightened sensitivity to anything that feels scary or threatening, you might dissociate on a daily, or even hourly basis. And it’s clearly not helpful to find parts of your brain shutting down if you are driving a car, in a meeting or speaking to your child’s teacher at school.

A common dissociative experience is when your prefrontal cortex (PFC), or ‘thinking brain’, shuts down. That’s why your mind goes blank when you feel anxious, because anxiety signals threat, so your brain triggers the fight-flight-freeze response to help you survive, and shuts down your (relatively slow, overthinking) PFC so you can act, fast. This is a dissociative response, which can be scary and confusing when the only threat is that teacher telling you that your daughter is a bit naughty in class.

Try this grounding technique

Mindfulness is a wonderful skill, for many reasons, but it’s especially helpful if you’re prone to dissociation. It will help you bring the PFC online; realise that you are here, now and not there, then; and bring you back to the present, to your body, to the safe place you currently inhabit – not the scary memories you might be stuck in when you experience trauma-related dissociation.

  1. You can use any of your five senses to help ground you in the present moment, but this technique involves sight. Look around the room and pick three objects (for example, a painting, plant and book). Focus all of your attention on each one in turn, describing them in as much detail as you can.

  2. With the painting, that might be something like, ‘I see a large painting in a silver frame. It’s a rectangle, about two feet wide by four feet long. The painting is of a woman with a small dog on her lap. I can see strong greens and reds in the woman’s dress; and the dog is a small pug, with a shiny, dark-grey coat.’

  3. Keep going, finding as much detail as possible (for this exercise, it’s never too much) and then do the same for the plant and the book.

  4. After you have described all three objects, notice whether you feel more mindful and present – in your body, mind and moment-to-moment experience. I’m confident that you will be at least a bit more present, but if you still feel a bit spacey or weird pick another three objects and repeat the exercise. Again, check on your phyiscal and mental state – this should help you feel calmer, more grounded and in your body.

I really hope this helps. As ever, when offering you these techniques as part of my Heal Your Trauma project, I want to stress that if you are a trauma survivor, you will need the help of a skilled, trauma-informed professional. And if so, use these techniques alongside, rather than instead of, your treatment.

Warm wishes,

Dan

 

Listen to this grounding technique on Insight Timer

 

Why Every Part of You Deserves Love and Compassion

Image by Jude Beck

Image by Jude Beck

One of the key discoveries in neuroscience over the past 20 years has been that we are not one, homogenous self – we are not just ‘Sally’ or ‘Jim’, even though it very much feels that way. Instead, this new theory argues for a ‘multiplicity of self’, which basically means we have lots of different parts of our personality. And in some ways, this is just common sense.

You might have a part that wants to diet and lose weight, but another part that really wants that extra bowl of ice cream, or slice of cake. You may have a part that hates all the boring, humdrum stuff of daily life (vacuuming, washing up, doing your tax return) but another part that helps you get all that stuff done, however much you don’t want to.

Disliking parts of yourself

In schema therapy, we call these different parts ‘modes’. In other models of therapy, they are called parts, sub-personalities or self-states, but it’s essentially the same thing. And something I often see in my therapy practice is that people might dislike or even hate some of their modes, while liking others. For example, we might get really frustrated with the mode that has us reaching for the ice cream, even though we’re desperate to lose weight and know we will feel guilty and ashamed after wolfing another bowl.

We may also hate the part of us that makes us feel vulnerable, or overwhelmed with emotions when we’re at work and want to appear cool, calm and professional. In schema therapy, we call this mode the Vulnerable Child; and we then name it ‘Little Sally’ or ‘Little Jim’. We all have this part – I have a Little Dan inside me – and it is the emotional, vulnerable part of us, that gets triggered by stressful or threatening people or events.

This part of you also holds a lot of upsetting memories from your childhood, as well as images, body sensations, emotions and beliefs. For example, your little self might believe ‘I am worthless’ or ‘I am unlovable’, because that’s how you felt as a child. Nobody wants to think that way, or feel painful emotions like sadness, anxiety or shame that these beliefs might trigger in you. So you may try to ignore this part, or detach from it and all those upsetting feelings, shutting it away in a part of your brain you try hard to avoid.

Self-compassion is a superpower

But here’s the thing – whether you love, hate or ignore this part of you, it’s always there. As I often tell my clients, it’s like disliking your left hand. How ever much you might hate it, find it annoying, want to get rid of it, your hand is still there! So it’s much better to develop compassion for this part (and all other parts) of you. There is a huge amount of research now showing that self-compassion is a superpower when it comes to healing past hurts (if you’re interested in that, check out Kristin Neff’s work at self-compassion.org – she is the world’s leading researcher/expert on self-compassion).

Sadly though, it’s not easy to be compassionate to yourself. You may have been taught as a child that this was weak or self-indulgent. If you experienced trauma when you were young, this may be especially hard, as you learned to cope by shutting that little part of you away in a room somewhere, so the last thing you want is to think about him or her, let alone be kind to that part of you.

But here’s a technique to help you along the path to greater self-compassion. As ever with techniques I will teach you, there is no right or wrong, no doing it well or badly – just have a go and see what happens.

  1. Change posture. Let your shoulders roll back so your chest is open. Then lengthen your spine – sit upright but relaxed, with your head, neck and spine in alignment.

  2. Breathe. Take deep, slow breaths in and out — roughly four seconds in, four seconds out, but find a number that works for you (two in, two out; three in, three out…). We want nice diaphragmatic breathing, so let your stomach rise and fall with each breath. This activates your parasympathetic nervous system, which in turn activates the ‘rest-and-digest’ response, the opposite to fight-flight-freeze.

  3. Use supportive touch. Gently place a hand over your heart, touching yourself the way you would a friend who was upset — in a friendly, supportive manner. Feel the warmth under your hand and imagine it trickling down until it reaches your little self inside. Imagine that’s a warm, kind, healing energy that soothes this frightened or upset part of you.

  4. Add compassionate self-talk. Now talk to your little self the way you would to that troubled friend. Try to use a voice tone that’s warm, slow and reassuring. Say things like ‘Oh, Little Sally/Jim, I know you’re struggling right now – I really see how scared/upset/angry you are. But I want you to know that you’re not alone. I’m here with you. I care about you. I’ve got you. And we will get through this together...’

Try using this technique every time you feel hurt, sad, upset, anxious or otherwise ‘triggered’ by life events. As with any technique, remember that it may take time to be helpful. It’s like yoga or meditation – there’s a reason they call those having a ‘practice’. So practice every day until it starts to help you feel kinder to and more accepting of yourself.

Warm wishes,

Dan

Why Might You Experience Dissociation?

Image by Joseph Frank

Image by Joseph Frank

Dissociation is a self-protective mechanism in the brain that we all experience from time to time. It’s what happens when you feel overwhelmed and your brain shuts parts of itself down so you can cope with the situation. For example, when people have a car crash, they often report strange things happening, like time slowing down, floating above the scene of the accident, or not feeling any pain despite being injured. These are symptoms of dissociation, as the brain has shut down a bit to help them deal with the overwhelming and upsetting situation.

Think of dissociation like a circuit breaker being triggered. If there’s an electrical surge, a circuit breaker gets tripped to switch circuits off, so no electrical devices get damaged. That’s what happens in your brain when you dissociate.

If you experienced traumatic events as a child, your brain will have shut down to protect you. This was a healthy, ‘adaptive’ response to overwhelming feelings and sensations that your little self could not handle. But over time, dissociation becomes a habitual response, so your brain shuts down even when you experience much milder feelings, like a little anxiety.

Symptoms of dissociation

Unfortunately, dissociation causes various problems for us – we may feel spacey, empty, numb or weird in some other way (this is called ‘depersonalisation’). We might go blank, or struggle to hear what someone’s saying to us. Some people say everything looks far away, or it’s as if they are looking through a thick glass wall at the world (known as ‘derealisation’). When we dissociate we struggle to concentrate or remember important information. Not helpful if you are in a meeting, or about to take an exam.

You might experience dissociation when your anxiety is high – it’s a common symptom of panic attacks, for example. Or when you feel threatened in some way, your schemas getting triggered by a stressful event or situation that reminds you of something threatening from your past. I recently wrote a post about the ‘Detached Protector’ mode which we work with in schema therapy – this is a dissociative mode.

The good news is that dissociation can be treated – I have helped many people with dissociative problems using schema therapy – so find a good therapist who understands dissociation and can help you be more present in the precious, unfolding moments of your life.

Warm wishes,

Dan