Perinatal Trauma+Dissociation

Are you feeling “zoned out”, disconnected from your body, or distanced from what 's happening around you?

Dissociation is something that occurs during a traumatic event AND is a symptom of trauma/PTSD that’s Very often misunderstood and unrecognized. Knowing the signs of dissociation can help you begin to heal from your trauma and help you connect with yourself, your baby and the people most important to you.

One of the most important things to understand is that dissociation is a neurobiological response that help you survive or endure a traumatic experience. In other words, it's protective and helps you adapt so that you can get through the overwhelming, traumatizing experiences. When you dissociate in the aftermath of a trauma, this is your nervous system’s way of helping to distance yourself from- or avoid- reminders of the trauma. Dissociation is your brain's way of trying to protect you, happens involuntarily and changes your awareness of and access to your thoughts, feelings, perceptions or memories of a traumatic event (Briere &Scott, 2006). While it's helpful when you're facing a threatening or dangerous situation, dissociation that continues to occur after a traumatic event is over can cause problems with your emotional well-being, strain your relationships (for example, bonding with your baby) and interfere with day-to-day functioning.

Dissociation after a perinatal trauma may sound like:

• “I felt like I was outside my body, watching what was happening.”

• “I just had to keep breathing: I couldn't hold my baby or ask questions, I felt frozen and all I could do was breathe.”

• “Sometimes I feel overwhelmed with the urge to escape, run away, leave. I must be a monster to not want to stay with my baby.”

• “I fly into a rage; it happens so quickly, I can't stop it; I feel so out of control sometimes.”

• “I feel like I'm underwater; everything feels fuzzy. When I'm like that, I can't move, I can't get anything done.”

• “I don't remember what happened after my baby was born; I felt dead, I couldn't feel any emotions.”

• “I know in my head that she's my baby, but it doesn't feel real.”

In the book Traumatic Childbirth (Beck, Driscoll, Watson 2013), dissociation during childbirth was described:

“in Nicole's case, she dissociated from her body and describes a “near death experience”...She does not describe any interpersonal connection with any of her providers; they are taking from her but not giving anything back to her, especially in the form of empathic connection. The nurse was defensive and did not speak out very loudly to the physicians. Nicole's dissociation, where she left her body, is the mind's protective ability to remove her from a life-threatening experience. Events were happening but it felt like she was outside of her body” (page 59).

Some helpful things to Understand about Dissociation

• There is a range of dissociative symptoms/responses- the severity of your level of dissociation will be unique to you. For some, dissociation is more subtle or mild (changes in the way you hold your body, feeling dizzy or lightheaded or nauseous) compared to the most severe forms of dissociation such as having lapses of memory, “lost time” or the development of dissociative identity disorders(DID).
  

• Dissociation is an involuntary response to a reminder of the trauma and is believed to be your brain's way of protecting you or allowing “escape” from upsetting emotions, thoughts, physical sensations and memories associated with the trauma.
  

• Not everyone who develops PTSD or experiences a trauma will have dissociative symptoms.
  

• Dissociation can occur when you are in either a hypo or hyper aroused state.
  

• When you are dissociating, you are no longer grounded in the present.
  

• Dissociation can occur when you are exposed to a reminder of the trauma
  

• Dissociation can occur both during the traumatic event as part of the fight, flight, freeze response; it is also a symptom of PTSD which can develop months or years after the threat is no longer present.
  

• If you dissociated during the traumatic event, you're more likely to experience dissociation after the threat or trauma is over.

Signs of Dissociation:

• De-personalization-feeling numb, detached -emotionally and physically- from what you're feeling or observing

• De-realization-”out of body” experiences, feeling like you're watching what's happening around you as if you're watching a movie or tv, or that things are fuzzy or at a distance from you.

• Dissociative amnesia- “losing time”, not remembering how you arrived at a certain place, unable to remember important details of childbirth or the moments following, or blanking out on personal information like you name, your partner's name or your address.

• Flashbacks- flashbacks or intrusive memories can happen unpredictably, and bring back the same emotions, physical reactions, images and beliefs or perceptions that you had during the traumatic event. Flashbacks can occur in the form of nightmares, or feeling like the event is happening all over again. Flashbacks can also be more subtle and come in the form of emotional states (the rage or numbness described above) or physical responses to a reminder of the trauma.

Getting Help for Dissociation

Dissociation is your nervous system working very hard to keep you safe, and to help you cope with trauma. But when you are able to recognize this symptom as a traumatic stress response, you can learn new—more helpful— ways to cope with the distress and pain of trauma. The key is to find what will work for you. Everyone is different and you’ll need to figure out coping strategies that are right for you:

◾Breathwork- While this sounds easy, learning some simple breathing exercises to help you feel more present in your body takes practice. Box breathing is a commonly taught technique: breathe in for 4 counts, hold for 4 counts, breathe out for 4 counts, hold for 4 counts.

◾Grounding Techniques- Using your senses to orient yourself in the present moment is one of the most common mindfulness skills to help you manage dissociative symptoms. Pausing to focus on what you notice-for example, what you see, hear, smell, feel or taste-can help anchor your body and mind back to NOW.

◾Move Your Body- Movement is a fast and effective way to disrupt dissociative processes. Rather than just thinking of working out, practice taking time to walk around the block, stretch, touch your toes, stand up and walk to a different room. If you can make it a yoga class or go on a nice long walk, that’s great. But start small. Just move.

◾Get Support - Get clear about who you can trust to love and support you. Check in with them, set times to talk or meet up. Ask for help. Whatever you can do to decrease your sense of isolation will be helpful in coping with dissociation and other effects of trauma

◾Find a therapist who provides trauma focused therapy—Dissociation can be unsettling, even scary. Trauma focused therapies such as EMDR begins by teaching you coping skills to help you manage symptoms of dissociation & other effects of trauma. If you're concerned about how you're feeling, help is available.

Sources:

Traumatic Childbirth, Beck, Driscoll and Watson (2013)

Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment, Briere & Scott (2006)

The Complex PTSD Treatment Manual: An Integrative, Mind-Body Approach to Trauma Recovery by Arielle Schwartz, PhD (2021)