In 1899, Pierre Janet defined Dissociation as an apparent disruption in the normally integrated functions of memory, identity, perception and/or consciousness.
What I refer to as, Survival-Based Dissociation, occurs when the person is experiencing something that which the brain finds intolerable. This is due to the onslaught of distressing/traumatic/overwhelming stimuli. The brain is unable to adaptively process all of the information, so it focuses on the aspects of the experience that are more familiar/easily processed and stored. The rest of the experience is generally fragmented and maladaptively stored in such a way that the future encounters of the original sensory aspects associated with the original experience can trigger the emotional reactions that occurred during the original experience. The problem is that there is no context for the cause of future dissociative episodes because the actual narrative of that original experience is fragmented and is maladaptively stored in the memory.
Within a couple of weeks, this 11 years-old decides that pizza is fattening and she should stop eating it…and she should start eating more healthily…and she should lose some weight… Enter eating disorder.
For example, you have a 25 year-old client with an eating disorder. She is terrified of pizza, pineapple and green peppers. She tells you that she can’t even look at pizza without having a full blown panic attack. When you ask your client why this happens, she says, “It’s just not safe!” Now, you and I know that the pizza holds no threat at all, so you ask your client about this and tell her that it is safe. This is not at all helpful and she can say no more than, “I just know it will hurt me, and I can’t eat it”.
A Little History:
Her sister died when your client was 11 years-old. She’d been sitting at the dining room table eating dinner with her parents when there was a knock on the front door. It was a police officer. He’d come to notify the parents that their eldest daughter, with whom your client was very close, had been killed in a car accident. As your client recounts the story, she mentions that it had been pizza night, a meal that she and her sister had always looked forward to, especially because they got to order their own pizza to share and they both loved the same toppings. She shares that she had been mad at her sister for missing dinner that night because it meant that she had to eat her parents’ pizza which she didn’t really like because it didn’t include her favorite toppings, pineapple and green peppers.
Adding to this, the parents’ marriage was already on shaky ground when their eldest daughter was killed. During the weeks following the sister’s death, the parents are consumed with fighting; he blames her because she let their daughter go out with a friend on a school night, against his wishes. She blames him because he was screaming and yelling at their daughter about how irresponsibly she was behaving by going out on a school night. Meanwhile, the younger sister has not only lost her older sister, but now her parents are constantly fighting, neither one has asked her how she is doing or opened their arms to her when they’ve found her sobbing in her room or responded to her requests for help. She is only 11 years old and, without the needed support, she is not equipped to process the emotional experience brought on by the death of her sister. Her mind literally cannot tolerate the emotional experience in a way that allows for healthy processing and storing of the memory. Within a couple of weeks, this 11 years-old decides that pizza is fattening and she should stop eating it…and she should start eating more healthily…and she should lose some weight… Enter eating disorder. Her mind develops the eating disorder as a means of dissociating from the literally intolerable emotional experience of her sister’s death.
By the time she shows up in your office, her mind has developed to the point of being able to tolerate and process this past traumatic emotional experience, but she is terrified to do so because, despite her chronological age, the memory of the event is frozen at the age of 11, which means her present day reactions to triggers are that of her 11-year-old self.
People with eating disorders suffer from varying degrees of dissociative issues. It is our job to walk our clients through these previously intolerable emotions; to be with them when they start to dissociate and to help them come back to the present and to allow for and hold any emotions that come up for the client as a result of him or her staying present, not acting on the eating disorder urge and thus, not dissociating. It is important to remember that this is not a one-and-done corrective emotional experience, but rather that there is no set time range for the completion of this process, and our job is to simply continue to show up with supportive and accepting energy.
Your client will likely get to the point where she knows, cognitively, that pizza, pineapples and green peppers can’t hurt her, but she still has the visceral emotional panic reactions to them, and she has no idea why.
Let’s go back to the scenario. In one of your sessions, she is in a sobbing, desperate panic as she tells you she just can’t live in her fat, disgusting body anymore. You ask her from where this is coming because she’s not had such an intense emotional reaction about her body size for a couple weeks. She continues sobbing and says, “It’s coming from the FACT that I am FAT!” You ask her to do an Eating Disorder/Healthy Self Dialogue (which she’s been finding very helpful as of late). Sobbing, she yells at you saying, “That won’t yelp because all it does is trick me into thinking I’m not fat, BUT I AM!”
As clinicians, in situations where our clients suddenly seem to be going backward, it is important that we not get frustrated with them for lacking rationality when talking about their eating disorder related behaviors, food fears and rituals. Often, they don’t actually know the real reason for the trigger. Again, this is because they dissociated during the original event, and they were left with only the sensory memories and their associated emotional responses.
So, the client eventually calms down enough to tell you that she was just driving to session and listening to her radio when she suddenly felt overwhelmingly fat and disgusting. She immediately started beating herself up, frantically calculating how many calories she’s eaten that day, how many calories she’s burned at the gym that day, how many more she can eat, when and how she’ll eat them and so on. Sound familiar?
Let's Break this Down
During the split second before she is hit with the cognitions about being fat, a radio commercial comes on, during which, in the background, are played a few lines from a song. It so happens that this song was playing on the radio during that pizza dinner a few years ago at the moment when the police officer showed up at the door. The song was one of the sensory memories stored by the brain and thus, the song triggers the emotional experience that she had that night at the table. This all happens on a Subconscious level. From here, the information begins its journey to the Conscious Mind. The eating disorder lives in between the two. No information passes into the conscious mind without first getting the okay from the eating disorder, whose job it is to make sure that the information can be tolerated by the conscious mind. If it cannot, the eating disorder disguises the information in the form of an eating disorder thought or urge, and this is the version of the information that the conscious mind receives, and thus, reacts to.
The following references were not used in writing the above, but are given as suggested readings for further and more involved discussions of the brain, maladaptively stored memories and evidenced based treatment methods that can assist in our clients’ healing processes.
Bessel Van Der Kolk, The Body Keeps The Score (New York: Penguin Books, 2015) Daniel Siegel, The Developing Mind, Second Edition (New York: Guilford Press, 2015)