Trauma phobia, and what it has to do with dissociation
Let's start like this. Trauma is complicated and confusing, sometimes for clinicians and survivors alike. Is this PTSD or generalised anxiety? You might be anxious and avoid a lot, without knowing what you're actually afraid of. Are those panic attacks, or emotional flashbacks? Often it's all a bit muddled and layered, and the trauma itself is hard to see, because several phobias are covering it.
This article sheds some light on these invisible phobias.
Traditionally, phobias belong to the anxiety disorders and are understood as a fear of something outside us: heights, dogs, spiders, blood, people. Many of these fears have evolutionary roots and once had real survival value. Trauma can create phobias like these too. Someone who was in a car accident may become afraid of driving.
But phobias can also be an inner phenomenon. People who have lived through chronic trauma can become phobic of particular thoughts, feelings, fantasies, body sensations and memories. They become extremely fearful of their own inner experience, as well as of anything outside that reminds them of what happened. That's why I call these phobias invisible: nobody can see what is being avoided, and often the person can't either.
What is phobic avoidance?
Phobic avoidance means organising your life, often without noticing, around never coming into contact with what you fear. With an outer phobia it's easy to spot: you take the stairs instead of the lift. With trauma phobia it's quieter. You change the subject, go numb, get busy, suddenly feel tired, make a joke, or lose your train of thought whenever something comes close to the feeling. Each time, the avoidance brings relief, and that relief is exactly what keeps it going.
1. The phobia of inner experience
Avoiding the traumatic memory protects the survivor from fully realising what happened and what it has meant for their life. So both behavioural and mental avoidance are needed to keep away painful realisations about oneself, one's history and its meaning. The price is that structural dissociation is maintained.
Over time, more and more cues become linked to the trauma, a process called stimulus generalisation. The person starts to fear and avoid more and more of their inner and outer life, until almost any inner experience can feel dangerous: a particular feeling, a sensation, a thought that is consciously or unconsciously connected to the original trauma.
Often the core of the phobia is fear, disgust or shame about one's own inner experience: being disgusted by one's own neediness, for example, or ashamed of being angry. Dissociative parts of the personality can become phobic of each other in the same way. One part avoids another because it holds the memories or feelings the first part can't bear.
As long as survivors are afraid of their inner life, they can't integrate their experiences, and the dissociation continues. There's more on how this looks in daily life on my page about dissociative disorders.
2. The phobia of attachment and attachment loss
Phobias of attachment, and of losing attachment, develop easily when the people who hurt you were the people you depended on, especially caregivers.
A child who is hurt or neglected by a caregiver still has to attach to that caregiver to survive. So the fear of closeness often comes paired with an equally intense fear of being left. It shows up as desperate feelings and behaviour aimed at holding on to someone at any cost.
Usually different parts of the personality carry these opposite fears. One part longs for closeness and panics at any sign of distance. Another distrusts closeness and pushes people away. Chronic abuse and neglect in childhood create this pull towards and away from the caregiver, and it tends to spread to many later relationships.
The two phobias set each other off in a vicious circle. Any change in closeness or distance triggers one of them, which is what disorganised attachment looks like from the inside. You can often hear it in a mixed message like this one.
“I hate you. Don't leave me.”
3. The phobia of normal life
Generalisation can spread even further, to everyday life itself. Normal life involves at least some healthy risk and change, so many ordinary experiences start to be avoided as well.
Survivors of chronic trauma often link taking a risk with failure. They're afraid of healthy risks because they expect them to end in humiliation, shame and disaster, which is what so often happened in childhood. Paradoxically, many take dangerous, impulsive risks instead. But those aren't the calculated, reflective risks that real change needs.
And because most chronic trauma happens in relationships, the more mature forms of closeness, such as intimacy, are avoided too. Too many of the feelings and needs that come with intimacy have become signals of danger.
What to do with these invisible phobias?
Overcoming trauma-related phobias is essential for treatment to work. Keeping up the avoidance costs survivors an enormous amount of energy and time, and over the years it tends to end in exhaustion and collapse.
The phobias are worked through gradually, at a pace the system can tolerate, with a trauma-informed therapist. In the phase-oriented approach that comes from the theory of structural dissociation, the first phase focuses on the fear of inner experience, of dissociative parts, and of attachment and attachment loss, often as it shows up with the therapist. The traumatic memories themselves come in the second phase, once there is enough stability to do it safely. Work on the fear of change, healthy risk and intimacy starts early and continues, at more complex levels, throughout treatment.
In my work this is integrative: schema therapy to understand the parts and what they need, attachment work within the therapy relationship, and EMDR, paced for complex trauma, when the system is ready. If some part of you shuts down at the very idea of looking at the past, that isn't resistance to push through. It's a protection that makes sense, and it's where the work begins. I've written more about this in What are psychological defences?
If you'd like to work on your own invisible phobias, a free call is a good first step.
This article draws on the theory of structural dissociation in The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization by Onno van der Hart, Ellert Nijenhuis and Kathy Steele (Norton, 2006).
