Dissociation as a Transdiagnostic Lens
The Wounded Healers Institute advocates for a paradigm shift in mental healthcare, emphasizing dissociative-informed care, recovery-focused care, and holistic healing. This approach prioritizes understanding the underlying mechanisms that drive psychological distress rather than merely addressing surface-level symptoms. This report adopts a transdiagnostic perspective, which is an evolving model in mental healthcare that transcends traditional diagnostic boundaries. Rather than focusing on disorder-specific symptoms, this approach targets common underlying processes that contribute to the onset, maintenance, and exacerbation of symptoms across multiple psychological disorders. Key principles of this model include emotion dysregulation, cognitive and implicit biases, and qualitative avoidance.
The shift from traditional nosology, which categorizes symptoms into distinct disorders as seen in diagnostic manuals, to a transdiagnostic approach represents a fundamental reorientation in mental health understanding. Traditional diagnostic systems, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), have historically grouped hypothetical sets of signs and symptoms into taxonomies. However, research consistently demonstrates that no single biological marker or individual cognitive process is uniquely associated with a specific mental diagnosis; instead, these markers and processes are implicated across numerous diagnostic categories. This observation suggests that interventions focusing solely on isolated symptoms may be less effective than those addressing shared underlying mechanisms. Consequently, the transdiagnostic model offers a more integrated and potentially more effective approach to managing complex comorbidity, aligning with the Wounded Healers Institute’s mission of holistic healing.
Central to this transdiagnostic framework is the concept of dissociation. Dissociation is defined as a disruption and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. It originates as a psychological defense mechanism, particularly in response to overwhelming stress or trauma. This adaptive response allows individuals to mentally “shut off” or compartmentalize traumatic experiences, thereby coping with unbearable pain or fear. Dissociation exists on a continuum or spectrum (O’Brien, 2023a), ranging from common, everyday experiences, such as becoming deeply absorbed in a book or film, to pathological states that significantly impair functioning.
While dissociation initially serves as an adaptive mechanism for survival during traumatic experiences, its persistence beyond the immediate threat can become maladaptive, interfering with recovery and integration. Research indicates that dissociation, when it continues into adulthood after the danger has passed, can actively impede or even prevent healing from trauma. Furthermore, this dissociative response can generalize from severe traumatic situations to relatively minor stressors, becoming a chronic and unhelpful coping pattern that interferes with treatment efficacy. This highlights a critical paradox: the very mechanism that once offered protection can later become a significant barrier to well-being, rendering its “untreated” nature a central problem in various psychological presentations.
This series posits that many conditions, often diagnosed as distinct disorders, can be more comprehensively understood as manifestations of untreated dissociation. The subsequent sections will explore how the unaddressed presence of dissociation can perpetuate and shape the symptoms observed in learning disorders, auditory processing disorder, apophenia, personality disorders, and universal addictions.
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References
O’Brien, A. (2023a). Addiction as Trauma-Related Dissociation: A Phenomenological Investigation of the Addictive State. International University of Graduate Studies. (Dissertation). Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/
O’Brien, A. (2023b). Memory Reconsolidation in Psychedelics Therapy. In Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/
O’Brien, A. (2023c). Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/
O’Brien, A. (2024a). Healer and Healing: The re-education of the healer and healing professions as an advocation. Re-educational and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/
O’Brien, A. (2024e). Path of the Wounded Healers for Thrivers: Perfectionism, Altruism, and Ambition Addictions; Re-education and training manual for Abusers, Activists, Batterers, Bullies, Enablers, Killers, Narcissists, Offenders, Parents, Perpetrators, and Warriors. Re-Education and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/
O’Brien, A. (2025). American Made Addiction Recovery: a healer’s journey through professional recovery. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/
*This is for informational and educational purposes only. For medical advice or diagnosis, consult a professional.
