Themes Sub-themes Codes
Social Support Networks
Lack of social support networks
Feeling misunderstood Feeling different Inability to communicate with/trust others Media showing misconceptions on DD Long histories of abuse
Lack of communication skills/self-expression
Inability to express themselves; the duress of being around people at times causes them to dissociate to protect themselves Identity being tied to trauma/mental illness—feeling too different
Fear of people
Inability to trust people even when they are genuine Long histories of abuse Fear of being judged Negative core beliefs
Dissociation as a Coping Mechanism
Inability to connect to one’s self
Severity of trauma dictates ability to connect/recover Lack of strong coping mechanisms to process trauma through Splitting self-states/depersonalizing/derealizing to avoid coping with trauma
Inability to feel connected to others/world
“Lonelier in crowds” Feeling too different to relate to Inability to connect to one’s self will lead to inability to connect to others
Discomfort in social settings causes the need to ‘hide’ or dissociate (e.g. switch alters, self-isolate, withdraw from reality, etc.)
Switching self-states Derealizing/depersonalizing themselves Self-isolating from outer world
Loneliness as a Trigger
Triggers as patterns & sequences
Causing a stress response that facilitates dissociation Triggers have patterns and sequences, and patients become accustomed to them, can give them a sense of safety due to familiarity
Triggers as words and phrases
Trigger words from past trauma can lead to feelings of loneliness Trigger words denoting the lack of having social support can cause loneliness
Triggers as behavioral activation (e.g. withdrawal, dissociation, etc.)
Seeking solitude when triggered and hating it Seeking solitude for comfort Solitude exacerbating dissociative coping mechanisms
Therapy
Therapeutic alliance
Models what relationships should be like Enables them to gain communication and expression skills Genuine empathy with patients Being yourself with patients Safety is the most important factor in the alliance
Therapeutic techniques to lessen the need to resort to dissociation
Projection Short, goal-oriented exposure exercises Targeting core beliefs developed since childhood
Therapeutic modalities
Moving away from cognitive therapies and exposure EMDR Parts Therapy IFS IPNB EFT Psychodynamic approaches and techniques