Complex PTSD and the Realm of Dissociation


“Louise often feels like part of her is “acting.” At the same time, “there is another part ‘inside’ that is not connecting with the me that is talking to you,” she says. When the depersonalization is at its most intense, she feels like she just doesn’t exist. These experiences leave her confused about who she really is, and quite often, she feels like an “actress” or simply, “a fake.”

― Daphne Simeon (Feeling Unreal: Depersonalization Disorder and the Loss of the Self, New York, NY, US: Oxford University Press; 2006)

The majority of the clients I treat have been exposed to repeated traumatic episodes and threats during childhood. For many of these men and women their heinous histories of emotional, psychological and sexual abuse at the hands of trusted caregivers, have led to their suffering from complex PTSD. C-PTSD is more complicated than simple PTSD as it pertains to chronic assaults on one’s personal integrity and sense of safety, as opposed to a single acute traumatic episode. This chronic tyranny of abuse results in a constellation of symptoms, which impact personality structure and development.

The symptom clusters for C-PTSD are:

  • Alterations in Regulation of Affect and Impulses
  • Changes in Relationship with others
  • Somatic Symptoms
  • Changes in Meaning
  • Changes in the perception of Self
  • Changes in Attention and Consciousness

When one is repeatedly traumatized in early childhood, the development of a cohesive and coherent personality structure is hindered. Fragmentation of the personality occurs because the capacity to integrate what is happening to the self is insufficient. The survival mechanism of dissociation kicks in to protect the central organizing ego from breaking from reality and disintegrating into psychosis. Hence, fragmented dissociated parts of the personality carry the traumatic experience and memory, while other dissociated parts function in daily life. Consequentially, profound symptoms of depersonalization and dissociation linked to c-ptsd manifest. (Herman JL. Trauma and Recovery. New York: BasicBooks; 1997)

Dissociative disorders are conditions that involve disruptions or breakdowns of memory, awareness, identity or perception. In the context of severe chronic abuse the reliance on disassociation is adaptive as it succeeds in reducing unbearable distress, and warding off the threat of psychological annihilation. The dissociative disorders a survivor of chronic trauma presents with vary and are inclusive of dissociative identity disorder (formerly multiple personality disorder), dissociative amnesia, Dissociative fugue, and depersonalization disorder. Identify confusion is also deemed a by-product of dissociation and is linked to fugue states when the traumatized person loses memory of their past and concomitantly, a tangible sense of their personal identity. (Onno Van der Hart, Ellert R.S. Nijenhuis, Kathy Steele Dissociation: An Insufficiently Recognized Major Feature of Complex PTSD, Journal of Traumatic Stress, 2005, 18(5))



The treatment process for those afflicted with c-ptsd and attendant dissociative disorders is extensive and comprehensive. Depending on the severity of the repetitious traumas, even in progressed stages of recovery a client may find himself grappling with persistent feelings of detachment and derealization. Given that the brains mediation of psychological functions is dramatically compromised by the impact of chronic trauma, this neurobiological impact may be a strong contributing factor regarding lingering dissociative symptoms in survivors of c-ptsd. When a child’s brain is habitually set to a fear response system so as to survive daily threat, brain cells are killed and the inordinate production of stress hormones interferes with returning to a state of homeostasis. Turning to dissociative states to relieve the pain of hyperarousal, further exacerbates the effective use of one’s executive functions, such as emotional regulation and socialization. Accordingly, neuroimaging findings reveal that cortical processing of emotional material is reduced in those presenting with c-ptsd and an increase in amygdala activity, where anxiety and fear responses persists.


In spite of the harrowing repercussions of prolonged traumatic abuse and neglect, those suffering from c-ptsd and dissociative disorders profit from working through overwhelming material with a caring seasoned professional. Treating the sequelae of complex trauma means establishing stabilization, resolving traumatic memory and achieving personality (re)integration and rehabilitation. Integrating and reclaiming dissociated and disowned aspects of the personality is largely dependent on constructing a cohesive narrative which allows for the assimilation of emotional, cognitive, and physiological realities. And finally when fight/flight responses diminish and an enhanced sense of hope and love for self and others results from years of courageous pain staking hard work, the survivor reaps the rewards of this capricious and harrowing journey; one’s True Self.

Complex Relational Trauma

“To be lonely is to feel unwanted and unloved, and therefore unloveable. Loneliness is a taste of death. No wonder some people who are desperately lonely lose themselves in mental illness or violence to forget the inner pain.” –Jean Vanier (Becoming Human)

Many of the men and women I treat evince the agony of loneliness rooted in incessant relational trauma. Relational trauma pertains to a “violation of human connection” (Judith Herman 1992), which result in attachment injuries. These relational traumas encompass a vast range of violations, inclusive of childhood abuse, domestic violence, entrapment, rape, infidelity, bullying, rejection, psychological/emotional abuse, and complex grief rooted in unresolved loss of important human connections. The consequences of these relational traumas are profound, particularly when they are the result of generational patterns passed on to children.

Psychodynamic theorist Gerald Adler attributed an early failure in nurturing to the experience of annihilation. He contended that the absence of a primary positive soothing introject/caregiver creates an insatiable emptiness that impedes the development of an organized Self. Additionally, the ongoing exposure to negative persecutory introjects such as abusive parents, further exacerbates the threat of annihilation.

Furthermore, the relational bond between an infant and its primary caretaker impacts the structure and function of the developing infant’s brain. Abuse and neglect within the child-parent attachment bond is absorbed as cellular memory, causing neural dysregulation and consequentially an imprint of trauma that may be reenacted throughout life. Likewise, if primary bonding is characterized by safety and mirroring, neurological integration can develop normally and an imprint of relationships as affording safety and pleasure occurs.

Consequently, the psychological repercussions of relational trauma are manifold. Impairments with relatedness to others, affect regulation, difficulties with emotional self-regulation and behavioral control, alterations in consciousness, self-destructive behaviors, and a nihilistic world-view embody the plight of complex relational trauma. The relationally traumatized individual vacillates between pseudo-autonomy and needy desperation, relentlessly seeking rescue and rejecting real intimacy. Unable to empathically attune to others, vocalize intrinsic needs/desires, and fearful of hurt and rejection, yet hungry for attachment (s)he repetitiously recreates the destructive cycle of maltreatment and disorganized ambivalent attachment. Difficulties with regulating emotions and affect manifest in aggressive posturing, behavioral problems and addictive disorders.  Ubiquitous despair, self-hatred, and hopelessness contribute to a radically cynical perspective, which asserts life is devoid of all meaning and purpose.

The paradox of healing from relational trauma is that it is what is most feared which will repair and restore. Psychologist Carl Rogers emphasized the essential elements of unconditional positive regard, genuineness, and empathy as the reparative force inherent in a successful client-therapist relationship. Rogers wrote, “When a person realizes he has been deeply heard, his eyes moisten. I think in some real sense he is weeping for joy. It is as though he were saying, “Thank God, somebody heard me. Someone knows what it’s like to be me.” As philanthropist Jean Vanier points out “when we love and respect people, revealing to them their value, they can begin to come out from behind the walls that protect them.”

Thus, when a relationally traumatized client engages in a therapeutic process with a clinician who offers the opportunity for corrective connection, healing occurs. In the context of such a relationship, traumas can be effectively processed. Successful treatment necessitates allowing sufferers of relational trauma to safely know and experience all which has been disowned and silenced. The heroic and arduous journey of recovery for the relationally traumatized individual means repairing fragmentation, stabilizing the consequences of somatization and limbic system dysregulation, cultivating life skills, and developing a cohesive meaningful narrative that lends itself to a life-affirming sense of identity and an inspired frame of reference. Only then can the survivor of relational trauma experience the birthright she was denied; to give and receive love.

Addiction and The Holy Hunt

Where there’s emptiness there’s hunger. Passionate hunger fuels a need for connection and completion. We are innately driven to fill emptiness in a self-transcendent way through whatever we can attach to that offers us the promise of fulfillment.  In our desperation, the longing for wholeness, cohesion, connection, power, and love may cause us to compulsively latch onto a drug, a thing or a person.  There may be a momentary illusion of wholeness that results, and that compels us onward to acquire more.  We get caught up in a relentless pursuit of that moment of ecstasy, ignoring the destructive consequences of seeking this addictive connection.

The late psychoanalyst Carl Jung wrote to the founder of AA, Bill W, that alcoholism is a spiritual disease, which has at its base a drive for wholeness. In the misguided pursuit of wholeness the addiction becomes the primary connection. All other connections lose meaning and become inconsequential.  If we conceptualize spirituality as having to do with the experience of connectedness to whomever or whatever is most essential in one’s life, we can surmise that the addiction itself becomes a misguided spiritual quest. The object of the addict’s desire is the primary connection affording false hope and a magical sense of temporary cohesion/wholeness.

At first life seems manageable. The addiction is the magic formula that ends inexplicable pain. The addict succumbs to a temptation, which is greater than one can resist, and a power submission dynamic emerges.  In this dynamic the hidden wish  to not be responsible for choice, creates a relationship in which there is a denial of the soul’s capacity to move towards wholeness. The addiction hinders the soul’s capacity to choose and assume responsibility. In relinquishing the spiritual choice to align with the soul’s capacity towards wholeness, the addict finds less and less of himself and seeks out isolation as the best circumstance to enjoy his high.

Gary Zukav wrote, in “The Seat of the Soul”, “For the addict physical reality is not aligned with the reality your soul wishes to create. The suffering of the addict leads to a recognition of the need to release this form of learning and to choose the entrance of Divinity to shape one’s world. “ It is generally at this point of dark despair that a moment of Grace occurs. In AA this is known as a ‘bottom’. Freud referred to it as an “ego death’. St. John of the Cross, wrote of his “dark night of the soul”, whereby demystifying choice allows for a conversion experience. In this process Jung conveyed that opposite extremes are synthesized in a balanced way. The lower impulses inherent in the pursuit of the addiction are embraced and integrated so that more complete personality and an authentic sense of self results. It

is our very ‘shadow’, meaning the disowned parts of our selves, that potentially teach us what we need.

Framing recovery in the context of one’s place in the circular larger scheme of inter-connecting life helps make one conscious of one’s existence as a spiritual being, and catalyzes the grieving process in which memories of the soul’s abandonment becomes conscious. Our connection to the spiritual is only achieved as we come to see ourselves as extensions of God/Goddess and as channels for God/Goddess’s will. This involves choice. The notion of original sin in non-dualistic spirituality relates to our rejection of who we are as God’s children in God’s world. It is the notion of original sin that is originally sinful. Jung related that it is our alienation from who we are that is the source of our brokenness. Hence, in embracing, not dividing, we heal. Our sense of wholeness and connectedness reminds us of our sacredness. Its absence fosters the belief that we are disconnected from our divinity. This process of reclamation involves challenging and altering spiritual world-views, which reinforce addictive behavior. It is through self-knowledge of one’s shattered ness/separation that we are led to reclamation of self and wholeness.

Ways to Overcome Self-Doubt

About halfway through my Ph.D. program, I was accepted into a club where distinguished graduate students, decorated faculty, and social elite gather for intellectual conversation over expensive wine and exotic meats. While being a good student was a key component to gaining admission—and I had always thought of myself as one—it wasn’t until I started speaking with my peers that I began to feel like a fraud; I was sure I was not nearly smart enough to be among them. My thoughts were consumed with ideas of being “found out,” and I would often tell myself that my application must have somehow slipped into the “accepted” pile. It was a mere feat of luck, nothing more, and it was only a matter of time before someone took notice.

What was interesting was how quickly these thoughts created behavioral consequences. I was much quieter than my usual extroverted self and I rarely voiced my opinions. It became harder and harder to attend club events without feeling as though I wouldn’t be able to hold my own next time. It wasn’t until speaking with a colleague from the club one night that I realized I was not alone. As we walked home, she turned to me, defeated, and said, “You know, I really have no idea why they accepted me.” A proverbial “aha!” moment ensued.

The Impostor Phenomenon describes the experience of feeling like a phony, unable to internalize success. The concept, first described by Suzanne Imes and Pauline Rose Clance in 1978, proposes that people “who experience the impostor phenomenon persist in believing that they are really not bright and have fooled anyone who thinks otherwise… Numerous achievements, which one might expect to provide ample objective evidence of superior intellectual functioning, do not appear to affect the impostor belief.”

As it turns out, even the most accomplished among us can feel this way. In Sheryl Sandberg’s book, Lean In: Women, Work, and the Will to Lead, the Chief Operating Officer of Facebook shares that only after hearing a speech on the subject did she gain insight on why she often felt like a fraud: “Despite being high achievers, even experts in their fields, women can’t seem to shake the sense that it is only a matter of time until they are found out for who they really are—impostors with limited skills or abilities.”

At first, Imes and Clance thought feeling like a phony was unique to women alone, but countless studies since have shown that it can be a common experience for anyone who might feel like an outsider—and profession makes little difference. Take Oscar and Golden Globe-winning actor Don Cheadle, who said, “All I can see is everything I’m doing wrong that is a sham and a fraud.” Or, famed author Maya Angelou: “I have written 11 books, but each time I think, ‘uh oh, they’re going to find out now. I’ve run a game on everybody, and they’re going to find me out’.” Even the chief of the World Health Organization, Dr. Margaret Chan, remarked, “There are an awful lot of people out there who think I’m an expert. How do these people believe all this about me? I’m so much aware of all the things I don’t know.”

How does feeling like an impostor come about? Being raised in a home where one siblingis designated the “smart” one and the other “social” one could cause issues down the line. Despite gaining achievements throughout life, the “social” sibling may attribute his or her success to simply being social, not worthy or smart. Alternatively, any effort that the “smart” sibling puts into achieving a goal can result in feeling guilty for having to work to be perceived as smart. Members of minority groups are also prone to feeling like phonies, attributing their success to factors like affirmative action policies instead of their own abilities. Essentially, any scenario where you think that a factor other than your own abilities might have resulted in an achievement—like being nice, charming, or attractive—can bring about feeling like an impostor. This is because you believe the praise you receive for one ability (being smart) is wrongly attributed to another (being nice).

People who experience the Impostor Phenomenon often tend to dwell on their failures. They also experience greater stress, lower feelings of self-worth, and greater self-doubt and they’re more likely to self-handicap (avoid engaging in fearful activities in order to circumvent potential failure and maintain self-esteem). Luckily, there are ways to manage feelings of phoniness. With effort and guidance, change is possible.

1. Find a Mentor

Seek someone you admire and with whom you can be open. According to recent research, feeling like a phony is common, yet these feelings decline with age and experience. Chances are a mentor will be able to enlighten you on his or her own experiences and reassure you that you are worthy of your success. Not only will this help you realize that no one is perfect, but that you are not alone.

2. Take Time to Reflect

Find time to reflect on your own experiences. Keeping a “positive feedback” journal, in which you make a list of your accomplishments, any positive feedback you’ve been given, and the factors around your success will help you see the link between your own expertise and your success. This will help you internalize your worth.

3. Speak to a professional.

Find a good executive coach, therapist, or psychiatrist who is equipped with the tools you need to help you break out of negative thinking patterns to march on, fraud-free.


  • Clance, P. R., & Imes, S. A. (1978). The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 15(3), 241.
  • Clance, P. R., & O’Toole, M. A. (1987). The imposter phenomenon: An internal barrier to empowerment and achievement. Women & Therapy, 6(3), 51-64.
  • Want, J., & Kleitman, S. (2006). Imposter phenomenon and self-handicapping: Links with parenting styles and self-confidence. Personality and Individual Differences, 40(5), 961-971.

© Mariana Bockarova, Ph.D.

Cognitive Music Affects Cooperation, Productivity

A plethora of past research indicates that music truly has an effect on us: It has been shown to help middle schoolers develop higher verbal IQ; to reduce heart rate, blood pressure, and anxiety in patients with cardiovascular disease; and it can even allow us to perceive the faces of strangers as happier—provided we are listening to happy music, of course.

Now, newly published research in the Journal of Organizational Behavior titled “The sound of cooperation: Musical influences on cooperative behavior”, suggests that listening to happy music has a significant and positive effect on our willingness to be cooperative, as well.

In the first of two experiments, Cornell University researchers randomly assigned 78 participants to either Happy Music condition or Unhappy Music condition. The song selection in the Happy Music condition consisted of “Yellow Submarine” by the Beatles; “Walking on Sunshine” by Katrina and the Waves; “Brown Eyed Girl” by Van Morrison; and, the theme song from “Happy Days”), and “Smokahontas” by Attack Attack! and “You Ain’t No Family” by Iwrestledabearonce for the Unhappy Music condition. The selection of songs were previously rated by 44 undergraduate students for their warmth or coldness, as well as other variables.

Participants were asked to indicate certain demographic characteristics, such as age and major. They were then given tokens and asked, while listening to either happy or unhappy music, what portion of their tokens they would allocate for their own private use, versus give to a group pool, which consisted of two other participants. They could give between 0-10 tokens, and the contributions would be multiplied by 1.5, before being divided between the three participants in the group pool. This type of experiment is known as the Voluntary Contribution Mechanism. The results of the first experiment found that participants in the Happy Music condition contributed nearly one third more than those in the Unhappy Music condition.

In order to ensure that the Unhappy Music condition did not create a negative bias, such that the finding was due to participants listening to unhappy music may have become more moody and selfish versus happy music having a positive effect on mood and cooperation, the researchers added a control condition, where no music was played. The results were the same as the first experiment, which allowed the researchers to conclude that happy music indeed had a positive effect on a person’s willingness to cooperate, and contribute to the public good.

While it is difficult to find ecological validity in the study’s conclusions, given its experimental and highly structured design, the researchers nevertheless conclude that this work adds to the growing emphasis put on the physical features of workplace environments, and “draw[s] attention to the importance of soundscapes in relation to employee behavior,” as well.


Kniffin, K. M., Yan, J., Wansink, B., & Schulze, W. D. (2016). The sound of cooperation: Musical influences on cooperative behavior. Journal of Organizational Behavio

Parental Alienation: A risk factor for depression

Parental alienation is a family dynamic in which one parent engages in many of the 17 primary parental alienation strategies, behaviors likely to foster a child’s unjustified rejection of the other parent. Not all children are susceptible to this form of emotional manipulation, but some are.

When successful, the PA strategies can result in a child claiming to hate and fear a parent who has done nothing to warrant the child’s vitriol, fear, and hostile rejection. Over the past ten years I have conducted a number of research studies on adults who were exposed to PA strategies when they were children. In each study I and my colleagues have found a statistically significant association between exposure to parental alienation in childhood and depression in adulthood.

These findings have been replicated in studies in New York, Texas, US national samples, and in Italy. The findings have been replicated with various depression inventories, and in different age groups. Even high school students will report higher depression when exposed to PA strategies. This association can be understood in light of attachment theory in that the child exposed to PA is being forced to forgo a relationship with an attachment figure and to deny that the loss the relationship has any meaning. The child is denied the opportunity to make meaning of the loss, which is a known risk factor for depression. In one of my studies, a respondent reported that when he was a young boy he came home from school one day and found an unknown man in his living room. His mother announced that this was his new daddy since the old daddy was a bad man.

For the next forty years the boy was not allowed to talk about his father, ask what happened to him, or even refer to him as “Daddy.” Unable to make sense of what happened and forbidden to process the loss, this young boy grew up to experience a multitude of problems as an adult, including depression. Another respondent in that same study told how her father would come to visit every Sunday but she was not allowed to open the door to greet him. In fact, she was forced to stand inside the house yelling at her father through the door to go away and never come back. When the father stopped trying to spend time with her, she was devastated and shared with me that many days – even years later – she felt so sad she couldn’t get out of bed.

What I have learned from stories like these as well as from my statistical studies is that parental alienation is a form of emotional abuse of children and it is, therefore, associated with may negative outcomes for children, including but certainly not limited to depression. Adults who had his experience as children should become educated about parental alienation in order to have a framework for understanding what happened to them.

Likewise, mental health professionals working with such adults should be informed about the phenomenon of parental alienation so that they can be as helpful as possible to this vulnerable population.