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

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 investigateDE 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 wasnot 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.