The phenomenon of dissociation It has been explored since the birth of psychological disciplines, developed, abused and then set aside together with the concept of trauma.
The interest found for psychotraumatology has reopened the way to research in this area and produced a large number of knowledge, especially in the neurobiological field, regarding trauma and dissociation.
In its broadest sense, with the term dissociation It is simply meant that two or more mental processes or content are not integrated. Usually it is assumed that these dissociated elements should be integrated into conscious awareness, memory and identity.
However, this non -integration may also concern thought processes, emotions, sensomotor functionality and behaviors.
There dissociative symptomatology It consists primarily of five clinical components: amnesia, depersonalization, derealization, identity confusion and the alteration of identity.
They are often complex phenomena, both to be identified and diagnosed and to make aware of the patient within the therapeutic process.
What is now established is that i dissociative disorders They can be conceptualized as a dysfunctional method of self -postation from the threat, as opposed to self -regulation as a primary method of operation within a safe environment.
Hence the conception, not entirely shared, that the dissociation is a condition related to traumatic situations. Depending on the duration (a single event or prolonged exposure) and the period of life (for example that of development) of thetraumatic experience There may be more or less damage to the mechanisms of integration of the experience that all of course we have.
This led to deepen the concept of trauma and the symptoms related to it. To the general definition of trauma as a sudden event that endangers our safety (an accident, an aggression, etc.) which, as in post -traumatic stress disorder can cause hyperarousal symptoms, depressive symptoms and flashbacks of the lived event, a more articulated conception of trauma is added as prolonged exposure to stressful or disorganizing events within interpersonal relationships that should instead. represent the safe environment that stimulates, shapes and maintains self -regulation.
This second conceptualization of trauma has aroused more and more interest in the years leading many clinicians to propose new nosographic categories that could include wider characteristics, so much so that in theInternational ranking of desease, 11th Version (ICD-11), in the next exit, the category of Post traumatic disorder from complex stress.
This nosographic expansion leads to consider criteria that help to include more complex aspects of the clinical reality of trauma, as alterations in the regulation of emotions and behavior, disturbances of consciousness and attention, somatizations, alteration of self -perception, relational disorders and alteration in personal meanings.
Expand helps to understand, and understand helps to elaborate new Treatment strategies which facilitate the management of complex symptoms situations through new and increasingly integrated tools.
There psychotraumatology contemporary uses this new corpus knowledge to integrate various interventions more and more Evidence Based.
Cognitive-behavioral therapy has always used valid tools for understanding and failing post-traumatic symptoms Even for complex post-traumatic disorder, such as psychoeducation on symptoms and their causes, the exploration of pathogenic beliefs, guided discovery and exhibition techniques, which can help the patient to face with greater awareness of the emotional and cognitive manifestations to which he can face, is also mutable.
However, in recent years, with third generation approaches, we have focused a lot on the processes Bottom-uptaking into consideration not only the aspects of the higher mental functions (minutes) but starting from the mind-body integration and the ability to observe one’s body experience (preverbal) as a key to access to the functional regulation of emotions.
Therapy based on Mindfulnessfor example, increases the ability to experience sensations, emotions and painful thoughts discouraging their avoidance and resulting effective for managing the symptoms of emotional hyperactivation or body depersonalization.
The EMDR approach (Eye Movement Desensitization and Reprocessing) is one of the most used techniques in the DPTS and has also proved to be very useful for complex post-traumatic disorder and for i Dissociative disorders.
Further integrating these two ways with cognitive-behavioral and psychodynamic techniques has evolved, taking more and more field in the treatment of complex traumatic experiences, the Sensomotor psychotherapy.
This aims, as the first purpose, to improve the patient’s ability to self -regulate the somatic hyperactivation caused by traumatic emotional discomfort, and to prevent this from causing inaccessibility to some problematic mental states and cause difficulties in the therapeutic path.
By helping the patient regulating the sensorial functions, they favor both a better emotional regulation than the growth of metacognitive skills (of self -reflection and master’s degree).
Therefore, the integration of the experience is promoted which, even at the somatic level, often fails, changing the starting point (feeling rather than thinking) but reaching the same, and perhaps more complete, goal.
