Complex PTSD is sometimes accompanied by chronic dissociation. It means being in a permanent state of disconnection from our body, our emotions, our needs and sensations and the people around us. We are still functioning in everyday life, but certain areas of our awareness are offline. That’s why this is also called functional shutdown. This state leaves us vulnerable to (body) flashbacks as well as new abuse or emergencies in the present. We are not aware of our ‘gut feeling’ when it comes to dangerous situations or harmful relationships, and we might not notice signs of sickness.
Dissociation means that we are somewhat separated from reality, and we need to be fully present for any kind of trauma processing. It is also suggested that there is a connection between functional shutdown and syndromes of chronic pain and autoimmune disease, feelings of chronic shame, isolation and loneliness. It is worth the effort to get out of this.
Before we go into exercises to get out of chronic dissociation we need a better understanding of what will happen. Most people with chronic dissociation have been asked to do mindfulness exercises like a body scan by their therapists and the result was a crisis situation. So they never want to try mindfulness again. They were fully unprepared for what could happen and the exercise was too intense to begin with. The process of getting out of chronic dissociation is not comfortable. Our nervous system moves through different stages until we reach a place that feels really good and relaxed. It is worth it, but it is not nice. That is why I want to describe possible reactions to you before you try it. You need to know what to expect.
Shutdown
Looking at the polyvagal ladder, chronic dissociation means we are in Shutdown (Moe). When we become more aware, we might start to sense what that actually feels like.
Shutdown can come with a feeling of deep emptiness that causes distress. There can be boredom and the intense need to do something different, to distract from this feeling. It might be difficult to stick with an exercise and focus, there might be a lack of interest in the exercise, the sense that it is not doing anything, impatience and low motivation. These are the expressions of our physiological state. (You might be familiar with it in your everyday life)
In some cases the physical sensation of Shutdown is triggering memories because we have been in Shutdown during TraumaTime and we remember what that felt like. It can get mixed with old feelings of helplessness and even the sense of dying. The moment we slip into a flashback experience we need to stop the exercise and work on orientation, then use distraction. The appropriate exercises are small and short to avoid this reaction but there is still a possibility.
Hyperarousal
Some people skip awareness of their Shutdown state (Moe); the mere act of doing an exercise sets the natural regulation into motion. On our way to a regulated, safe and social state (Bob) we need to pass sympathetic activation (Izzy).
That is why some people will start to feel restless, there is an activation in their legs, they feel the intense need to move or run out of the room. There can be some level of fear, from anxiety to panic. Some might get angry with this stupid exercise. Breathing might get faster, sometimes labored, the heart is pounding, energy is shooting into the body and there is a tension and a bracing in the body.
In some cases this physical experience is triggering too and gets mixed with memories from TraumaTime, when we were in a Flight/Fight response. Then we need to stop and return to orientation and distraction.
When the exercise was too big or too long and it becomes overwhelming we will spin back into dissociation and the stress is driven deeper into our nervous system. I hope I can convince you to take titration seriously. It keeps us from harm in these situations.
In my experience therapists rarely understand this dynamic unless they got some basic training in body work. Don’t let them push you to try mindfulness exercises that are too big for you. Trying harder will not make things better. If a random clinic T is pushing you into a flashback experience repeatedly you have my permission to fake it and pretend you are mindful. If it is your regular T, please try to get them interested in polyvagal concepts and titration for a better understanding.
Safe&Social
Once our body develops the capacity to regulate even more we will be able to get out of sympathetic arousal (Izzy) and calm down (Bob). Some people only brush hyperarousal before coming here. Our body functions normalize, and we get connected to our body and the world around us on a new level. For some people this is the first time in their life that they actually feel themselves. These sensations often include a warmth, maybe a tingling, a mild sleepiness that feels relaxed. (Some people only know this state from when they take drugs and they don’t know how to get there naturally.) Because this is so strange and we learned that it was not safe during TraumaTime we might spin back into sympathetic arousal. It needs time to experience that this can be safe to make it stick. At this point it might help to practice with a co-regulating person.
When the ventral vagus is activated our whole body comes online again. We might feel our digestion or breathing, places where the body is in pain or uncomfortable, physical needs like hunger or thirst or the realization that we are not dressed warm enough or that we need the bathroom. There might also be emotions coming up that we never experienced in this way. They are not stuck (like all the emotions we call ‘chronic’) but dynamically evolving. Emotional regulation becomes possible. It is also normal for memories to come up. These are not necessarily related to TraumaTime like flashbacks. The danger of flashbacks is actually reduced when we are present and grounded. It is more like remembering an appointment or other things of everyday life. Our brain is coming online too.
It can be intense to experience these things for the first time! It gets better when we get used to it, but it can be a lot to take in at first and some of the sensations might not feel safe at all. Another chance to spin back into hyperarousal. Sometimes we might need to ask others if what we are feeling is normal because we don’t know. If there is pain or somethings feels too strange we can ask our doctor to check it, sometimes it is not a flashback, the body needs real help and we’ve just never been aware of it before.
With DID, chronic dissociation often serves the purpose of avoiding our inner experience of having parts. When we get more present we will become more aware of what is happening inside of us. That is why we should never try to dissolve the dissociation unless we have the help of a specialized therapist. What comes up can give us access to some serious problems. We need that access to ever be able to work on the problems but it is also extremely difficult to balance.
Nobody will experience all of this. These are just possibilities to show you the kind of things you might encounter.
Regulation is not static. We won’t stay in our safe&social state all the time, but we will keep returning to it. It is for example healthy to show an orientation reaction. That’s when tension rises when there is a new sound or situation. When we stop dissociating all our experience we will encounter a lot of movement within our nervous system. There is healthy hyperarousal when situations are dangerous. When we get used to being more present we will have to learn how to tolerate feeling this natural regulation. I promise that the discomfort passes. It comes in waves that subside.
Having this inner movement of stress and relaxation is what makes us feel alive. We grow capacity to feel this while we work on being more grounded. With time, it becomes more natural. I know how much persistence is needed to overcome chronic dissociation and some might prefer to stay where they are because daily functioning isn’t limited too much. Sooner or later that will get in the way of trauma healing. Restoring healthy regulation is one of the foundations of getting better and feeling more alive.
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