In the mid-1980s, I had been treating for over a year, Eliza, an 8-year-old adopted girl who had been severely abused by her biological parents. In spite of her caring adoptive parents, Eliza was not making progress. One day, she walked into my familiar office at the local mental health center (now called Pathways), looked around at the bookshelves full of toys and books, and inquired what they were. I was stunned!
Serendipitously, a few months earlier, the clinic’s psychiatrist, Dr. Lu Kuhnhoff, who had just returned from a conference sponsored by the International Society for the Study of Dissociative Disorders, provided an in-service to a group of us interested clinicians. Dr. Kuhnhoff described signs of dissociation, including memory and identity disturbances, auditory and visual hallucinations, and a loss of consciousness (awareness). At this time, I had been specializing in treatment of sexually-abused children. I naively thought to myself that perhaps I would see one case with dissociation in my lifetime. Little did I understand that dissociation is a primitive, biological, automatic defense mechanism derived from reptiles and continued up the evolutionary chain to us mammals. Dissociation is activated when a child is faced with overwhelming fear when being abused or encountering other forms of trauma (e.g. painful medical procedures and illness), and when fighting and fleeing is simply impossible. In order to survive the frightening experience, the child segments off the horrifying event(s) from his or her consciousness as a way of escaping mentally when there is no actual way to escape.
Like other forms of mental conditions, there are different degrees of dissociation, such as: spacing out; amnesia to past traumatic events; distortion in environment in which things seem unreal or viewed through a tunnel; when the body feels numb or disconnected from self; or the child experiences a separation within the self with different identities, feelings, memories, behaviors and relationship preferences that influence the child or may take control of the body and present differently to others, as seen in Dissociative Identity Disorder-DID (formerly termed Multiple Personality Disorder). It is important to understand that those with DID are still one person with different states of consciousness or awareness. In my book Healing the Fractured Child: Diagnosing and Treating Youth with \Dissociation, I explain more thoroughly the ways dissociative symptoms can be expressed in numerous clinical cases.
Generally, traumatized children with dissociation can present with a myriad of symptoms due to shifting parts of themselves that become triggered by reminders of past traumas, e.g., smells, sights, sounds, touch. They can rapidly shift from being happy to sad to raging, and display aberrant behavior in which amnesia may be present. They can exhibit dramatic shifts in their abilities with activities such as schoolwork and sports, and in their preferences in food, dress, activities, and more. They can demonstrate severe attachment or relationship impairment due to a lack of trust and separate parts of the self not having a connection to their caregivers. These children can one moment seek out the parent and the next moment attack the parent. They often have severe attention problems marked by poor concentration and focus due to intrusive traumatic memories, or voices and images experienced in their mind that disrupt their ability to focus. They can exhibit aggressive behavior for which they have no memory, and therefore deny such behavior. Consequently, they are frequently viewed as liars. These changing moods and behaviors can confound caretakers and teachers.
I received a call from a grade school principal who told me Ryan, a 9-year-old boy (Waters, 2015) who’d been sexually abused, had turned around and suddenly hit a girl in line. When the principal witnessed this and confronted Ryan, he adamantly denied it, collapsing to the floor wailing. However, in this case, the astute principal related to me that Ryan really did not know he had done it. I knew Ryan depersonalized from his lower body since he was completely unaware of his chronic soiling problem. However, I did not know he had a more severe form of dissociation until this phone call. Upon further exploration, he, like Eliza, revealed hearing voices and seeing in his mind a separate identity that was a protector who hit the little girl who had unexpectedly knocked into him.
These traumatized, dissociative children can often receive more commonly recognized diagnoses, such as psychosis due to hallucinations, bipolar disorder due to extreme mood swings, attention deficit disorder due to poor focus, oppositional or conduct disorders due to their disruptive behavior. Unfortunately, while they have an abuse history, post-traumatic stress and dissociative disorders are often overlooked as the source of their symptoms.
Effectively parenting these children can be a daunting task. Porges (2011), who has studied how we respond to threat, discovered the crucial role of voice and eyes in fostering communication and bonding between parents and children. Porges noted that the mylenated vagal nerve, which regulates social engagement and goes from the heart to the ears and from the heart to the eyes, makes us very sensitive to loud, low sounds and angry eyes. We become threatened and our survival response system activates, causing us to disengage from the person by fighting, fleeing or freezing (a dissociative response). Therefore, Porges stresses that keeping your voice modulated and eyes warm can keep others engaged-a crucial strategy for parents to maintain a connection with their distraught child.
While it is challenging to raise a dissociative child, parents or caretakers can have a profound impact on helping their child heal. Their understanding, love, patience, and acceptance of all parts of their child provide the foundation for the child to progress in specialized treatment of his or her traumatic past and dissociation to become an integrated child. Having had the privilege of working in partnership with such parents to see their children transform into healthy, happy individuals, I can tell you the rewards of their helping their child heal are worth it!
Fran Waters is the author of Healing the fractured child: Diagnosis and treatment of youth with dissociation. She is the past president of the International Society for the Study of Trauma & Dissociation (ISSTD). She maintains a private practice in Marquette, MI.
Porges, S. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication and self-regulation. New York: W.W. Norton.
Waters, F. S. (2nd, 2015). Ryan (8 to 10 years old) –Connecting with the body: Treatment of somatoform dissociation (encopresis and multiple physical complaints). In Wieland, S. (Ed.), Dissociation in traumatized children and adolescents: Theory and clinical interventions (2nd ed.; pp.135-190). New York: Routledge.
Reprinted with permission from the Winter 2016-2017 issue of Health & Happiness U.P. Magazine.