Understanding Shame-Induced Dissociation in Trauma Survivors

woman looking on wall mirror — Photo by Vinicius "amnx" Amano on Unsplash

POV: You're looking in the bathroom mirror when an old shameful memory suddenly surfaces. A sense of detachment creeps in and you feel like you're staring at a stranger. Your reflection stares back at you, unfamiliar. This is what shame-induced dissociation can feel like—a sudden rupture between the self and the present moment, often triggered by past trauma. For mental health providers, this visceral survival response to traumatic experiences is one we must understand to help our clients navigate it.

Shame is a deep sense of self-judgment that comes from believing one has failed or broken important social or moral rules (Cunningham, 2020). This emotion, intimately tied to identity, often triggers withdrawal and avoidance behaviors. For trauma survivors, particularly those exposed to interpersonal violence during childhood, shame can become pervasive and overwhelming (Matos & Pinto-Gouveia, 2010).

Research by Kouri et al. (2023) demonstrated that recalling shame-related memories elicited significantly higher dissociation levels than neutral memories. Participants reported experiences of depersonalization and emotional numbing when revisiting these moments, suggesting that shame operates as a gateway to dissociative coping mechanisms. Dissociation, in this context, acts as a mental escape from the pain of confronting a diminished self-image. For example, a person might find themselves zoning out during conversations, losing track of time, or feeling emotionally numb when reminded of past shameful experiences.

Clinicians must create a nonjudgmental space for clients experiencing shame-induced dissociation. This means fostering an environment where clients feel comfortable discussing difficult emotions without fear of criticism. It involves validating their experiences, using dual awareness techniques to keep them present, and gently challenging avoidance patterns while maintaining a compassionate stance.

The Moderating Influence of Experiential Avoidance

Experiential avoidance is the tendency to resist distressing thoughts, emotions, or sensations. This avoidance plays a key role in the connection between shame and dissociation, often intensifying dissociative responses. Kouri et al. (2023) found that individuals with high levels of experiential avoidance were more likely to dissociate when recalling shameful memories compared to those with lower avoidance levels.

This phenomenon is particularly pronounced in trauma survivors who internalize shame. As Dorahy et al. (2017) highlighted, internalized shame fosters a desire to withdraw from an internalized ‘contemptible self,’ amplifying the need for dissociative escape. In therapy, avoidance can present as “resistance” during sessions.

Reducing experiential avoidance helps lessen dissociation. Individuals with high experiential avoidance often struggle to remain present in therapy, reinforcing shame-driven dissociative patterns. Integrating approaches such as EMDR can help clients process distressing memories safely while fostering an increased tolerance for difficult emotions. Mindfulness-based strategies may also support clients in gradually confronting and integrating their experiences, ultimately reducing the need for dissociative coping mechanisms.

The Psychological Impact of Self-Reflection

For individuals with a history of interpersonal violence, literal and metaphorical mirrors can become sources of alienation. Studies have shown that mirror-viewing tasks—where participants confront their reflections while recalling traumatic memories—can heighten feelings of shame and dissociation (Caputo, 2010; Kouri et al., 2023). In these moments, the reflection becomes a painful reminder of a fragmented self.

Kouri et al. (2023) hypothesized that the mirror might amplify dissociative experiences. While their findings did not show a significant increase in dissociation compared to control conditions, participants often described a profound discomfort and estrangement from their reflections. Prior research (Freysteinson et al., 2018) also links sexual trauma histories to mirror-related disconnection.

Therapists might consider using controlled mirror-exposure techniques as part of interventions, helping clients re-establish a compassionate relationship with their self-image. For example, a therapist might guide a client through a mirror-viewing exercise where they describe what they see without judgment, gradually shifting their focus from self-criticism to self-acceptance. Over time, this approach can help reduce avoidance and foster a more integrated sense of self. Gradual desensitization and narrative therapy can support this process by providing structured opportunities to process shame while fostering a sense of safety and self-acceptance.

shallow focus of person holding mirror — Photo by Vince Fleming on Unsplash

Shame-induced dissociation represents a complex challenge for trauma-informed care. Its roots lie in the interplay between identity, avoidance, and self-perception, creating a cycle of withdrawal and fragmentation. As Kouri et al. (2023) emphasize, addressing these dynamics requires clinicians to focus not only on the traumatic events but also on the emotional states and self-concepts that perpetuate dissociation.

By incorporating approaches that target shame, reduce experiential avoidance, and repair fractured self-images, mental health providers can help clients reclaim a sense of self. These strategies empower individuals to confront and integrate their experiences, fostering greater emotional resilience. The journey is arduous, but with the right tools—such as EMDR, mindfulness practices, and compassionate self-inquiry—it can lead to healing and resilience.

References:

Kouri, N., D'Andrea, W., Brown, A. D., & Siegle, G. J. (2023). Shame-Induced Dissociation: An Experimental Study of Experiential Avoidance. Psychological Trauma: Theory, Research, Practice, and Policy.

Cunningham, K. C. (2020). Shame and guilt in PTSD. In M. T. Tull & N. A. Kimbrel (Eds.), Emotion in Posttraumatic Stress Disorder: Etiology, Assessment, Neurobiology, and Treatment. Elsevier Academic Press.

Dorahy, M. J., McKendry, H., Scott, A., et al. (2017). Reactive dissociative experiences in response to acute increases in shame feelings. Behaviour Research and Therapy.

Caputo, G. B. (2010). Apparitional experiences of new faces and dissociation of self-identity during mirror gazing. Perceptual and Motor Skills.

Freysteinson, W. M., et al. (2018). Body image perceptions of women veterans with military sexual trauma. Issues in Mental Health Nursing.

Where did you just go? An overview of dissociation

The British television series, Fleabag, offers a clever depiction of dissociation through its heroine's frequent asides to the camera. These moments extend beyond a dramatic device; they serve as a mechanism for the character to disconnect from her surroundings and shelter from the internal storm of her traumatic grief. This disconnection is further highlighted in the second season when her romantic interest, The Hot Priest, notices her in the middle of a quick aside to the audience and asks “What was that?” and points in the direction of the camera. “That thing you’re doing? It’s like you disappear.” Caught off guard, she looks at the viewer once more. “There!” he says. “Where did you just go?” “Nowhere,” she responds, but turns again to the camera with an alarmed look, perhaps knowing she’s been caught. I’ve often thought of the main character’s tendency to “disappear” during conversations as an expression of altered consciousness — a phenomenon known as dissociation.

Dissociation is a complex psychological concept with various definitions and interpretations that extend beyond the scope of this discussion. Historically, it was first described by theorists like Pierre Janet, who viewed it as the mind’s way of splitting off from trauma to protect against extreme pain. Janet’s theory laid the groundwork for many contemporary trauma theories that address healing through integration of the self (Schwartz, 2021). Modern psychology continues to grapple with defining dissociation. Different frameworks offer different perspectives ranging from ego state theory, various DSM-V diagnostic categories, to structural dissociation theory. Despite these theoretical divergences, dissociation generally refers to a disruption in the normal integration of consciousness, memory, identity, or perception.

Dissociation can occur in everyday life, such as becoming completely absorbed in a book or "spacing out" while driving on a familiar route. These quotidien moments of dissociation involve a normal, albeit temporary, disconnection from immediate surroundings. For example, the process of getting deeply immersed in a social media feed may be considered a form of dissociation (McQuate, 2022). During these moments, the brain remains active and engaged, often referred to as being on "autopilot" (Hamzelou, 2017).

Dissociation resulting from trauma is distinct and more profound. Traumatic dissociation involves unique physiological processes. Research indicates that traumatic dissociation is accompanied by hypoarousal—a state where the nervous system reduces its activity to a minimal level as a survival mechanism. This is part of an immobilization response to extreme threat, where the brain and body essentially "shut down" to protect the individual and preserve energy (Lanius et al., 2014).

Traumatic dissociation involves unique physiological processes.

To clarify the specific type of dissociation related to trauma, the term "dissociative hypoarousal" is sometimes used. This term encompasses both the psychological splitting of the self due to trauma and its biological manifestations. Dissociative hypoarousal can be defined as a biological phenomenon resulting from trauma that manifests in a fragmented self. It is characterized by alterations in consciousness, emotional numbing, and a presentation indicative of both personality splits and hypoarousal.

“That thing you’re doing? It’s like you disappear.”

When Fleabag’s protagonist appears to "disappear," she exemplifies dissociative hypoarousal. Her direct addresses to the audience are attempts to remain detached from her trauma. Each time she encounters reminders of her painful past, she shifts away from the experience, demonstrating the hallmark of dissociative hypoarousal.

Dissociative hypoarousal is often an internal experience, largely unnoticed by others. Like physical pain, it is subjective and can be difficult to articulate. Trauma survivors may find it beneficial to recognize their experiences as dissociative hypoarousal, a specific type of dissociation unique to their trauma.

Dissociative hypoarousal is often an internal experience, largely unnoticed by others.

In conclusion, dissociation is a multifaceted concept that ranges from everyday experiences of altered consciousness to profound disruptions resulting from trauma. Understanding the nuances of dissociative hypoarousal helps acknowledge the unique ways trauma can affect individuals, ultimately aiding in their healing and integration processes.

Shame as a Catalyst for Dissociation

The Moderating Influence of Experiential Avoidance

The Psychological Impact of Self-Reflection

References: