Dissociation is an ordinary human behaviour that takes place on a daily basis. Welland (2011) describes, "Dissociation is the absence of awareness of what one is doing or what is going on around one is a normal process that occurs from time to time". For example have you ever arrived at your destination and thought I can't remember the journey and how I got there? This is normal dissociation.  

However some children and young people will use dissociation as a protective strategy, to manage their overwhelming feelings at the time of a terrifying event such as trauma, abuse, neglect, medical interventions and accidents. It is particularly apparent if the child is not able to escape physically or is left unsupported, then they "escape" by blocking the memories, feelings and negative thoughts about themselves or others. For example, a child who daydreams and makes up all sorts of stories in her head, whilst the domestic abuse is occurring between her parents. This can be a very useful strategy at the time of the frightening event, however if this strategy continues to be used when there is no danger or if memories are triggered then it becomes a difficulty. Dysfunctional dissociation can impact on the child's ability to learn and to form and maintain relationships. It can leave the child or the young person experiencing gaps in their memory, feeling detached from the world, cut off from their feelings and body, and have rapid mood changes.

According to ISSTD (2008) there is a continuum severity of dissociation that a child or young person may experience, from mild, moderate or extreme.

Mild dissociation is described as "spacing out" or day dreaming and occurs when the child shuts down for a brief period and is unable to take in what is going on around them.

Moderate dissociation involves the child blocking out feelings sensations or pain in their bodies or 'cutting off' from emotions. For example, one child informed me that he had been beaten up by another child and showed me the bruises, but said that he hadn't felt anything and couldn't feel the bruises.

Another form of moderate dissociation is when a child cuts off from their surroundings to stop themselves from feeling the previous terrifying event. For example, a child in my Play Therapy room was triggered into moderate dissociation following a maintenance man knocking on the door. She believed she was back in the traumatic event and became unaware of the present environment.

Extreme dissociation is when the child has had to cut off so much from the overwhelming terror that they feel like they have separate parts. This is known as dissociative parts. These parts can impact on the child's behaviours, thoughts and feelings. The severest form of dissociation is known as Dissociative Identity Disorder and this is where the dissociative parts take control. For example, one child in class hit out at a member of staff, but afterwards had no recognition of hitting out. The child becomes or takes on only one aspect of the dissociative parts at a time. Their voice, persona and actions may change as they take on this part. They then can switch to another aspect of the personality, without remembering previous actions.

Dissociation strategies can appear similar to other childhood disorders, such as post traumatic stress disorder, attention deficit disorder and conduct disorders. Therefore it is important to have a full assessment undertaken to determine if the child has developed dissociation or their actions are to do with other issues.

A few helpful strategies to support a child with dissociation are:

• To reassure the child that they are safe.
• To acknowledge their feeling.
• To help the child to go to a safe space (previously identified).
• To enable them to express their emotions physically, i.e. to bounce a ball, run round the play ground, draw and play with sand or other sensory materials.

If you are interested in developing your knowledge in Dissociation to assist you in your practice, then please click on the course links below to find out more about an upcoming course.

Reference

Wieland S (2011) Dissociation in Traumatized Children and Adolescents, Routledge, New York.