A sensorimotor approach to the treatment of trauma and dissociation.

Psychotherapists who work with survivors' of psychologic trauma recognize the almost inevitable clinical complexity of trauma-related disorders. Traumatized individuals do not just suffer memories of tragic and horrifying experiences-they demonstrate a number of complicated and debilitating signs, symptoms, and difficulties consisting primarily of bodily responses to dysregulated affects. These bodily responses often have no clear subjective connection to their fragments of narrative memory [I). Most traumatized individuals fulfill the criteria for a number of coexisting diagnoses that usually include mood disorders, anxiety disorders, substance abuse and dependence disorders, eating disorders, somatoform disorders, and medically unexplained symptoms [2-4). These complications are reflected in the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, revised) by the inclusion of more than 12 associated features of post-traumatic stress disorder (PTSD) [5]. The formal diagnosis of PTSD contains three diagnostic post-traumatic symptom clusters: symptoms indicative of intrusive reliving of the trauma, avoidance and numbing symptoms, and symptoms of increased autonomic arousal. The episodic alternation between the avoidance and reliving symptoms "is the result of dissociation: traumatic events are distanced and dissociated from usual conscious awareness in the numbing phase, only to return in the intrusive phase" [6]. Triggered by stimuli reminiscent of the trauma, these dissociated fragments of past experience return unbidden in the form of psychologic symptoms (amnesia, cognitive schemas of badness or worthlessness, intrusive images,