Cutting off the pain and terror
Frewen and Lanius (2015) have explored the various deﬁ nitions of dissociation often subsumed into categories of detachment and compartmentalisation: altered states of consciousness and identity alteration would, respectively, be examples of these. There has been debate about whether non-pathological states of absorption or immersion in imaginary worlds should be grouped with altered states that have arisen from severe traumatic experience and it has been proposed that only the latter arise from structural dissociation (van der Hart et al., 2006). In these disorders, parts of the self which are holding action tendencies for defence – or getting on with normal life – function relatively independently. In the most severe disorder of structural dissociation, dissociative identity disorder (DID), there may be extensive amnesia for the behaviours of different parts of the system. Initially, consideration of parts of the self as “not me” may arise from a cognitive reappraisal strategy of identity alteration when standard restructuring techniques such as distraction are ineffective for reducing the peritraumatic distress (Frewen & Lanius, 2015). This shifts brain activation from the body awareness area of the insular cortex to the other-perspective areas such as the temporoparietal junctions. The more trauma a person experiences, the more there may be a tendency to automatically diminish the emotional impact of events:
. . . a repeatedly traumatised individual may chronically orient toward herself, others, and the world around her with an increasingly altered sense of time, thought, body, and emotions .