Trauma, Dissociation, and Somatization: A Self-Psychological Perspective

This article discusses the history of a 6-year, and still ongoing treatment of a woman who suffered a heart attack 3 months after she was subjected to a sexual assault. Both of these traumas occurred while she was in treatment. This coincidence enabled an in-depth exploration of the correlation between these events, the split between her mind and her body, and the contribution of her early traumatic history to the emotional and physical distress that she suffered as an adult.

The case illuminates the multiple strands that are seen as contributing to the somatization of psychic trauma. Considered in this context are the effects of genetic and biosocial vulnerabilities, early and severe emotional and physical abuse, repeated heartbreaking trauma, and the use of dissociation in the process of somatization. As will be discussed, although some repression may have occurred as well, the concept of dissociation provides greater explanatory power of the patient's experience. Specifically, it is hypothesized that dissociation occurred resulting in a split between her body-self and her mental-self.

Using a self-psychological perspective, this woman's experience is conceptualized in terms of a fantasy of heartbreak that was psychosomatic in nature and expression, hence the term “psychosomatic fantasy” (see Ulman and Paul, in press).

A review of the extensive literature on psychosomatic illness, trauma, and the body-mind interface is beyond the scope of this article. Rather, only that literature which bears directly on the central argument of this study is considered.