Dissociation as Protection and Burden
Sexual Abuse, Fragmentation, and Professional Responsibility
Dissociation is one of the most demanding phenomena in the understanding of long-term consequences after the sexual abuse of children. The concept may refer to a diagnosis, a condition, a process, and a defence mechanism. It may describe relatively common experiences, such as when a person acts automatically without full attention, but also severe conditions in which coherence, memory, bodily presence, and the experience of identity are disturbed. In relation to sexual abuse, dissociation must therefore be understood with both professional precision and ethical care.
The crucial point is that dissociation should not primarily be understood as a strange or incomprehensible symptom. In traumatic situations, dissociation may be a necessary form of protection. When a child is subjected to something too overwhelming, too painful, or too threatening to be integrated into conscious experience, the child may in various ways create distance from what is happening. The child may become numb, experience themselves as outside the body, lose the sense of time, withdraw mentally, or store the experience in fragments rather than as a coherent narrative.
This does not mean that dissociation is desirable or harmless. It means that the phenomenon must be understood in light of its original function. The child who cannot flee physically may nevertheless attempt to flee psychologically. The child who cannot stop the abuse may attempt to shut something out. The child who lacks language for what is happening may divide the experience into sensory impressions, bodily reactions, images, moods, or fragments. In this way, dissociation may function as a form of survival under conditions where coherent consciousness would have been too painful.
This protection may, however, later become a burden. What made survival possible may make living difficult. When experiences are stored in fragmented form, they may return as flashbacks, bodily reactions, sudden anxiety, numbness, feelings of estrangement, loss of time, or experiences the person themselves does not understand. Breaks may occur between past and present, between body and language, between event and meaning. The person may experience something happening in the body or consciousness without being able to explain it in any simple way.
This makes dissociation a phenomenon that challenges ordinary assumptions about personhood, memory, and responsibility. In everyday understanding, one often assumes that a person has a coherent identity, a relatively stable memory, and a more or less continuous experience of themselves. Traumatic experiences may disturb this continuity. The person may remember something, but not everything. The narrative may lack coherence. The body may react as if danger is still present, even when the situation is objectively safe. The person may feel estranged from themselves or experience the world as unreal.
Depersonalisation and derealisation are central examples. In depersonalisation, the person may experience themselves from the outside, as an observer of their own actions or experiences. In derealisation, the world may appear distant, artificial, or unreal. Such experiences may be frightening, especially if they are not understood. They may also be misunderstood by others. What, for the person concerned, is a reaction to overwhelm may appear from the outside as oddness, absence, lying, attention-seeking, or psychosis. Here lies a significant risk of misinterpretation.
Misdiagnosis is therefore an important professional and ethical issue. Children and adults with dissociative reactions may present symptoms resembling other conditions: attention difficulties, learning difficulties, behavioural problems, mood swings, psychosis, seizure-like episodes, or hyperactivity. In some cases, such conditions may also co-occur. But if the traumatic context of dissociation is overlooked, help may be misdirected. The person may be treated as difficult, unstable, or psychotic, while the underlying traumatic experiences remain unrecognised.
This does not mean that professionals should explain all difficulties by trauma. Such reductionism would be irresponsible. But it does mean that trauma-informed understanding must be a necessary part of assessment, especially when the symptom picture is complex, unpredictable, or marked by breaks in memory, presence, and identity. The question should not only be which diagnosis best fits, but also which experiences the symptoms may be connected to, what function the reactions may once have had, and what is needed for the person to experience safety.
Dissociation also shows that memory does not always function as an orderly narrative. Traumatic experiences may be stored as fragments. A smell, a sound, a gaze, a bodily posture, or a particular relational situation may activate reactions without the person immediately understanding the connection. This may create confusion both for the person subjected to abuse and for professionals. In legal and institutional contexts, lack of coherence in a narrative may be interpreted as weak credibility. Clinically, however, fragmentation may be compatible with traumatisation. This requires a sober balance: fragmented memories are not in themselves proof of what has happened, but neither can they simply be dismissed as signs of unreliability.
The professional task is therefore not to force coherence too early. For people with dissociative reactions, too rapid exposure, excessive demands for narrative, or direct confrontation with traumatic material may be destabilising. Before processing can take place, safety, stabilisation, predictability, and the ability to regulate arousal often need to be established. These are not merely technical principles of treatment. They also have ethical significance. The person who previously lost control over their own body, attention, and situation must not once again lose control in the name of help.
This is particularly crucial in work with children. Children who dissociate need, first and foremost, protection and care. If the child is still in an unsafe situation, therapeutic interventions alone cannot solve the problem. The child cannot be expected to integrate experiences while danger is ongoing. The first professional obligation is therefore to secure the child’s care situation. Psychotherapy may be important, but it cannot replace protection. Without safety, treatment becomes language without foundation.
The connection between dissociation, neglect, and abuse also shows how deeply relational trauma may affect the child’s development. When the child is dependent on an adult who simultaneously harms or fails them, the child may be caught in an insoluble conflict. Attachment must be preserved, but the experience of the adult is dangerous. One way of handling this may be to split the experience. The child may attempt to preserve the image of the adult as a necessary caregiver, while the violating experiences are separated off or made inaccessible. This can be understood as a form of psychological survival in a relational impossibility.
Here lies an important practical-philosophical point. Human identity is not merely an inner entity. It is formed in relationships, in bodily experiences, in language, and in the recognition of others. When these conditions become threatening or contradictory, self-experience may also become divided. Dissociation may therefore be understood as a sign that the human need for coherence has been subjected to pressure it could not bear. Fragmentation is not only an individual symptom, but may also be a trace of relational and moral ruptures.
Professional work with dissociation is therefore not only about reducing symptoms. It is also about contributing to the restoration of coherence. Coherence does not necessarily mean complete memory or a total narrative of everything that has happened. For some, this will not be possible or desirable. Coherence may also mean that the person gradually gains a more intelligible relationship to their own reactions: that numbness, loss of time, restlessness, or feelings of estrangement are no longer experienced only as signs of madness, but as understandable reactions to overwhelming experiences.
Such understanding may reduce secondary shame. Many people who dissociate may feel shame about their reactions. They may experience themselves as weak, unreliable, damaged, or abnormal. If professionals meet these reactions with suspicion, irritation, or simplified explanations, shame may be intensified. If, by contrast, the reactions are understood as possible survival strategies, the person may gain a different language for understanding themselves. This does not make everything simple, but it may open the way toward a more dignified self-understanding.
This requires the helper to tolerate complexity. Dissociation does not fit easily into quick explanations. It challenges systems that seek clarity, efficiency, and linear progress. It may also challenge the helper’s need for control. Encounters with dissociative reactions therefore require professional humility. The helper must be able to acknowledge that not everything can be understood at once, that the narrative may emerge in fragments, and that safety often has to be built before insight can be expected.
At the same time, such caution must not become passivity. To understand dissociation as protection does not mean leaving the person alone in fragmentation. It means working slowly and structurally with stabilisation, safety, orientation in the present, regulation, relational trust, and gradual integration. Professional help must not dismantle defences before the person has other ways of protecting themselves. But neither should it romanticise the defence. What once saved may later hinder.
The ethical responsibility lies in this balance. Dissociation must be met as meaningful, but not harmless. It must be understood as protection, but also as burden. It must be taken seriously without being made into the whole person. The human being is more than their dissociative reactions. The person subjected to abuse is not a collection of fragments, but a human being who has attempted to survive experiences that broke coherence. The aim of help is not to impose a particular normality, but to support a gradual restoration of safety, coherence, and room for agency.
This also has significance for institutions. Schools, child welfare services, health care services, and the legal system may all encounter children and adults with dissociative reactions. If these reactions are understood only as behavioural problems, lack of cooperation, attention deficits, or unreliability, institutions may end up repeating the original failure. A trauma-informed institution does not only ask: How do we gain control over this behaviour? It also asks: What might this reaction express? What does this person need in order to be safe enough to be present?
Dissociation reminds us that human coherence cannot be taken for granted. It is something that develops through safety, protection, bodily integrity, language, and recognising relationships. Sexual abuse may break this coherence. Help after such experiences must therefore be more than symptom-oriented intervention. It must contribute to the person gradually experiencing themselves as present in their own body, in their own history, and in relationships that no longer require the self to be divided in order to survive.
When dissociation is understood in this way, it is neither mystified nor reduced. It becomes a sign of both harm and survival. It shows what a child may have had to do in order to endure the unendurable. But it also shows what professionals and society must later help to restore: safety, coherence, dignity, and the right to be a whole human being.
References
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International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115–187. https://doi.org/10.1080/15299732.2011.537247
Pettersen, K. T. Consequences of sexual abuse (PowerPoint lectures between 2002 - 2024) .
Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. Guilford Press.
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Spiegel, D., Loewenstein, R. J., Lewis-Fernández, R., Sar, V., Simeon, D., Vermetten, E., Cardeña, E., & Dell, P. F. (2011). Dissociative disorders in DSM-5. Depression and Anxiety, 28(9), 824–852. https://doi.org/10.1002/da.20874
van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. W. W. Norton.
World Health Organization. (2022). ICD-11: International classification of diseases (11th rev.). https://icd.who.int/
This essay was developed from my own professional practice as a social worker and my many lectures on sexual abuse over a periode of more than 40 years (1981-2024). The text was written in a conversation with OpenAU/ChatGPT.
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