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“I feel like I do not exist” - Adolescent Dissociative Experiences and the Importance of Trauma Type, Attachment, and Migration Background

Gusic, Sabina LU (2017)
Abstract (Swedish)
Vissa ungdomar som upplevt potentiellt traumatiserande händelser kan utveckla dissociationssymptom. Under gynnsamma förhållanden har människor en förmåga att integrera känslor, tankar, sinnesintryck och minnen av livshändelser in i en adaptiv och sammanhängande självbild och berättelse om självet. Dissociation i samband med trauma kan beskrivas som ett sammanbrott av denna förmåga. Dissociativa upplevelser innefattar upplevelser av förlorad kontroll över mentala processer och/eller information samt upplevelse av att vara främmande och avskärmad från självet och/eller omgivningen. Dessa upplevelser är av sådan natur att de går bortom vad som kan förväntas vara normalt hos en person utifrån hens kognitiva utveckling. Syftet med denna... (More)
Vissa ungdomar som upplevt potentiellt traumatiserande händelser kan utveckla dissociationssymptom. Under gynnsamma förhållanden har människor en förmåga att integrera känslor, tankar, sinnesintryck och minnen av livshändelser in i en adaptiv och sammanhängande självbild och berättelse om självet. Dissociation i samband med trauma kan beskrivas som ett sammanbrott av denna förmåga. Dissociativa upplevelser innefattar upplevelser av förlorad kontroll över mentala processer och/eller information samt upplevelse av att vara främmande och avskärmad från självet och/eller omgivningen. Dessa upplevelser är av sådan natur att de går bortom vad som kan förväntas vara normalt hos en person utifrån hens kognitiva utveckling. Syftet med denna avhandling var att utforska dissociativa upplevelser och deras relation till traumatyp, anknytningsstil och erfarenheter av krig och migration hos ungdomar. Studie I och II undersökte en icke-klinisk grupp ungdomar med heterogen migrations- och socioekonomisk bakgrund, vilket är typiskt för större svenska städer. Studie III och IV omfattade två grupper av ungdomar som flytt krig och anlänt till Sverige. Avhandlingens studier använde sig av både kvantitativa och kvalitativa metoder för att öka såväl bredden, som djupet och den ekologiska validiteten inom detta forskningsfält.

Studie I undersökte förekomsten av dissociativa upplevelser hos svenska ungdomar i en storstad där en stor andel hade migrationsbakgrund. Självrapporterad ekonomisk sårbarhet och föräldrars krigsupplevelser var kopplade till högre dissociation. Studien visade också att dissociativa upplevelser i högre grad var kopplade till psykisk misshandel, specifikt mobbning i skolan, än till fysisk misshandel. Slutligen visade studien att tonårsflickor som uppgav en emotionell upplevelse som deras värsta livshändelse (t.ex. mobbning, separation eller att leva med en svårt sjuk familjemedlem) hade de högsta nivåerna av dissociation i relation till upplevda traumatiska händelser i livet. Detta i jämförelse med dem vars värsta livshändelse var av fysisk natur, eller de som inte kunde eller ville uppge någon. Motsvarande mönster fanns inte hos pojkar.

Studie II visade att självrapporterad ängslig och/eller undvikande anknytningsstil var mer förbunden med dissociation än vad endast traumatiska upplevelser var. Vidare visade studien att de som enligt självrapporten hade en otrygg, ängslig anknytningsstil hade en starkare koppling mellan trauma och dissociation. Slutligen visade resultaten att ungdomar som både hade en otrygg anknytningsstil och hade erfarenheter av psykisk misshandel, såsom mobbning, hade starkast samband mellan trauma och dissociation.
Studie III presenterade och jämförde förekomsten av trauman, värsta livshändelser, posttraumatiska stressreaktioner och dissociativa upplevelser hos två grupper av flyktingungdomar i Sverige: nyanlända och ungdomar som levt länge i Sverige men undflytt krig tidigare i livet. Trauman omfattade både sådana som är direkt kopplade till krig och flykt och sådana som inte är det. Båda grupperna hade varit med om många hemska upplevelser och förekomsten av posttraumatiska stressreaktioner och dissociativa upplevelser var hög. De som var nyanlända hade utsatts för fler svåra händelser under flykten och av omsorgspersoner än gruppen som levt längre i Sverige.

I Studie IV intervjuades krigsutsatta flyktingungdomar om deras mentala upplevelser och hur dessa varierade med graden av dissociation. Resultaten visade att de med mycket höga nivåer av dissociation hade kvalitativt annorlunda upplevelser. Exempel på dessa upplevelser är skrämmande kontrollförlust, upplevelse av frånkoppling, intensiva känslor och svårigheter att hantera känslorna, negativ syn på sig själv och sin kropp, samt en bestående nedstämdhet. Två dissociationstyper kunde urskiljas. En dimensionell typ med dissociativa upplevelser som ökar kontinuerligt i grad och besvär och en patologisk typ med upplevelser som nästan uteslutande beskrevs av de ungdomarna med mest och svårast dissociation.

Denna avhandling ökar vår kunskap om dissociation hos ungdomar genom att peka på sambandet mellan dissociation och faktorer såsom ekonomisk sårbarhet, migrationsbakgrund, anknytningsstil samt individens uppfattning om vilket som varit det värsta traumat som hen genomlevt. Avhandlingen bidrar också med kunskap om omfattningen och typen av dissociativa upplevelser hos krigstraumatiserade ungdomar. Med denna kunskap kan kliniker som möter krigstraumatiserade flyktingungdomar lättare upptäcka och utreda dissociativa symptom.
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Abstract
After experiencing potentially traumatic events (PTEs) some adolescents develop pathological dissociation. Trauma-related dissociation can be described as a break-down of the individual’s capacity to integrate emotions, thoughts, sensations, and memories about traumatic or other events into an adaptive and coherent self-image and self-narrative. Dissociative experiences (DE) include experienced loss of control over mental processes or information, and experiential detachment, beyond what would be expected in relation to the person’s cognitive development. This dissertation sought to investigate
DE and their relation to trauma type, attachment style, and experiences of war and migration among adolescents. Study I and II included a... (More)
After experiencing potentially traumatic events (PTEs) some adolescents develop pathological dissociation. Trauma-related dissociation can be described as a break-down of the individual’s capacity to integrate emotions, thoughts, sensations, and memories about traumatic or other events into an adaptive and coherent self-image and self-narrative. Dissociative experiences (DE) include experienced loss of control over mental processes or information, and experiential detachment, beyond what would be expected in relation to the person’s cognitive development. This dissertation sought to investigate
DE and their relation to trauma type, attachment style, and experiences of war and migration among adolescents. Study I and II included a sample of non-clinical Swedish adolescents with socioeconomic and migration background diversity, representing the demographics of larger Swedish cities. Study III and IV included two samples of war-exposed refugee adolescents resettled in Sweden. The dissertation studies used quantitative and qualitative methodologies to enhance the breadth, depth, and ecological validity in this research area.

Study I evaluated the prevalence of DE among Swedish adolescents with a high proportion of migration-background. Self reported economical vulnerability and parental war-experiences related to higher dissociation. The study also showed that emotional abuse, specifically bullying by school peers, related more strongly to DE than psychical abuse. Finally, adolescent girls appraising primarily emotional experiences as their worst lifetime traumas (e.g., bullying, separation, or living with a severely sick family member) had the highest DE rates in relation to overall PTE exposure, as opposed to those that reported a primarily physical experience as the worst trauma, or those with no worst trauma. This pattern was
not found in boys.

Study II showed that self-reported attachment anxiety and/or avoidance related more strongly to DE than PTE exposure alone. Furthermore, insecure anxious attachment styles enhanced the relation between overall PTE exposure and DE, and adolescents reporting an insecure attachment style and the experience of emotional abuse, such as bullying, had the strongest relation between PTE exposure and DE. Study III provides rates of general and war/refugee specific PTEs, worst lifetime experiences, posttraumatic stress reactions, and DE among two groups of refugee adolescents in Sweden: newly arrived and students with childhood war experiences. Both groups of war-exposed youth reported considerable rates of PTEs, DE, and posttraumatic stress symptoms, with the newly arrived reporting more caregiver abuse and adverse events during the refugee journey.

Study IV includes newly arrived war-exposed refugee youth’s narratives of their mental experiences related to dissociation. This study showed that high dissociators reported qualitatively different experiences including frightening loss of control, detachment, high frequency and severity of emotional dysregulation and emotional intensity, negative self- and bodyperception and a pervasive depressive mood. Two types of dissociation, a dimensional one and a separate pathological type, were found among the dissociating refugee adolescents, and seem to incorporate somewhat different experiences.

The results of this dissertation expand our knowledge by showing that factors such as economical vulnerability, migration background, type of traumas experienced and appraised as the most negative, and attachment style are related to dissociation in adolescence. The dissertation also contributes by presenting information about the amount and type of dissociative experiences in war-exposed refugee youth, giving information to clinicians to more easily assess these difficulties among traumatized refugee adolescents. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Trond Heir, University of Oslo
organization
alternative title
"Jag känner som att jag inte finns" – Dissociativa upplevelser hos ungdomar och betydelsen av traumatyp, anknytning och migrationsbakgrund
publishing date
type
Thesis
publication status
published
subject
keywords
adolescent, dissociation, trauma, attachment, war , refugee, posttraumatic stress, ungdomar, dissociation, trauma, anknytning, krig, flyktingar, posttraumatisk stress
pages
162 pages
defense location
Palaestra Nedre (Lower), Lund
defense date
2017-04-21 13:00
ISBN
978-91-7753-219-4
978-91-7753-218-7
language
English
LU publication?
yes
id
e2c2bbac-a01a-4a18-95b7-3a0940bea1e1
date added to LUP
2017-03-23 10:20:17
date last changed
2017-03-23 15:22:27
@phdthesis{e2c2bbac-a01a-4a18-95b7-3a0940bea1e1,
  abstract     = {After experiencing potentially traumatic events (PTEs) some adolescents develop pathological dissociation. Trauma-related dissociation can be described as a break-down of the individual’s capacity to integrate emotions, thoughts, sensations, and memories about traumatic or other events into an adaptive and coherent self-image and self-narrative. Dissociative experiences (DE) include experienced loss of control over mental processes or information, and experiential detachment, beyond what would be expected in relation to the person’s cognitive development. This dissertation sought to investigate<br/>DE and their relation to trauma type, attachment style, and experiences of war and migration among adolescents. Study I and II included a sample of non-clinical Swedish adolescents with socioeconomic and migration background diversity, representing the demographics of larger Swedish cities. Study III and IV included two samples of war-exposed refugee adolescents resettled in Sweden. The dissertation studies used quantitative and qualitative methodologies to enhance the breadth, depth, and ecological validity in this research area.<br/><br/>Study I evaluated the prevalence of DE among Swedish adolescents with a high proportion of migration-background. Self reported economical vulnerability and parental war-experiences related to higher dissociation. The study also showed that emotional abuse, specifically bullying by school peers, related more strongly to DE than psychical abuse. Finally, adolescent girls appraising primarily emotional experiences as their worst lifetime traumas (e.g., bullying, separation, or living with a severely sick family member) had the highest DE rates in relation to overall PTE exposure, as opposed to those that reported a primarily physical experience as the worst trauma, or those with no worst trauma. This pattern was<br/>not found in boys.<br/><br/>Study II showed that self-reported attachment anxiety and/or avoidance related more strongly to DE than PTE exposure alone. Furthermore, insecure anxious attachment styles enhanced the relation between overall PTE exposure and DE, and adolescents reporting an insecure attachment style and the experience of emotional abuse, such as bullying, had the strongest relation between PTE exposure and DE. Study III provides rates of general and war/refugee specific PTEs, worst lifetime experiences, posttraumatic stress reactions, and DE among two groups of refugee adolescents in Sweden: newly arrived and students with childhood war experiences. Both groups of war-exposed youth reported considerable rates of PTEs, DE, and posttraumatic stress symptoms, with the newly arrived reporting more caregiver abuse and adverse events during the refugee journey.<br/><br/>Study IV includes newly arrived war-exposed refugee youth’s narratives of their mental experiences related to dissociation. This study showed that high dissociators reported qualitatively different experiences including frightening loss of control, detachment, high frequency and severity of emotional dysregulation and emotional intensity, negative self- and bodyperception and a pervasive depressive mood. Two types of dissociation, a dimensional one and a separate pathological type, were found among the dissociating refugee adolescents, and seem to incorporate somewhat different experiences.<br/><br/>The results of this dissertation expand our knowledge by showing that factors such as economical vulnerability, migration background, type of traumas experienced and appraised as the most negative, and attachment style are related to dissociation in adolescence. The dissertation also contributes by presenting information about the amount and type of dissociative experiences in war-exposed refugee youth, giving information to clinicians to more easily assess these difficulties among traumatized refugee adolescents.},
  author       = {Gusic, Sabina},
  isbn         = { 978-91-7753-219-4 },
  keyword      = {adolescent,dissociation,trauma,attachment,war ,refugee,posttraumatic stress,ungdomar,dissociation,trauma,anknytning,krig,flyktingar,posttraumatisk stress },
  language     = {eng},
  month        = {03},
  pages        = {162},
  school       = {Lund University},
  title        = {“I feel like I do not exist” - Adolescent Dissociative Experiences and the Importance of Trauma Type, Attachment, and Migration Background},
  year         = {2017},
}