Structural dissociation

Structural dissociation of the personality describes events that ensue when trauma cannot be moved into memory. "The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization" authored by Onno van der Hart, Ellert Nijenhuis (pronounced Nee-An-Hoff), and Kathy Steele, is the landmark book that brought enough reason to known neurological factors that researchers, at that time took notice as the authors introduced the "theory of structural dissociation of the personality." The theory has advanced in many ways since 2006, and van der Hart and Nijenhuis have been strong advocates for its advancement.

Exposure to multiple types of trauma over multiple developmental epochs is associated with a wide range of clinical problems including emotion dysregulation (numbness, dissociation alternating with hyperarousal and emotional flooding); behavioral dysregulation (impulsive, self-destructive and aggressive behavior); identity problems including difficulties with body image and eating disorders; disruption in meaning (e.g., feeling life has no purpose); interpersonal problems; and somatization and medical problems including chronic fatigue, heart disease and autoimmune disorders. -Bethany L Brand and Ruth A Lanius

Structural dissociation is the mechanism that brings all crucial childhood "endured" elements to culmination, ultimately resulting in the following disorders: posttraumatic stress disorder, other specified dissociative disorder, and dissociative identity disorder. Borderline personality disorder is the exception in that it is not caused by structural dissociation, but some with the disorder fall victim to it. Structural dissociation is a "neurological process", where an accumulation of unprocessed trauma events overwhelm the mind, brain and the individual as a whole, causing a separation in the functions of the personality. One area of the personality is phobic of unprocessed trauma events, but being buffered from them it is capable of routine, daily activities. The other area which is barricaded off from the first, is emotionally affected by unprocessed trauma events and the lack of effective communication that is cycling between the mind and brain. Structural dissociation is the only time a "split" will ever occur; there is never any action that could be properly called a split during state (ANP/EP) creation. Which mental disorder results when structural dissociation takes place is dependent on many factors including the chronological age of the earliest traumas, the value of the traumas, and if a secure attachment was formed with a primary caregiver or not during childhood. A secure attachment defines what results in the brain, and perhaps even the mind when a child's basic needs are met by any primary caregiver in the earliest years of childhood. If a child's needs were not met, then both the mind and brain were affected enough that the individual suffers an inability to process trauma events, which ultimately results in one of a few select mental disorders. The innate ability to handle stress has been suggested as a contributing factor by some researchers, but as of late that idea is not very popular. Acute stress disorder (ASD) and the simple Dissociative Disorders have not been associated with structural dissociation in recent literature and so will not be addressed here.

Primary, secondary and tertiary Structural Dissociation
As already explained, all mental disorders that subside within the "Structural Dissociation umbrella" officially begin when the personality is segregated, with one division containing a distinct state known as an "apparently normal part of the personality" (ANP) and the other division holding a less than distinct state, known as an "emotional part of the personality" (EP). If there are no more states created the individual maintains "Primary Structural Dissociation," which involves the well known disorder posttraumatic stress disorder. To be clear, there is only one ANP and one EP in Primary Structural Dissociation, and thus in posttraumatic stress disorder. This disorder can present at any time in an individuals life, but an abundance of evidence has been presented in an attempt to prove that individuals who were able to obtain a secure attachment during their childhood, with a primary caregiver are immune to ever having posttraumatic stress disorder.

Primary Structural Dissociation
The next level of complexity is "Secondary Structural Dissociation," which consists of a complex form of posttraumatic stress disorder, other specified dissociative disorder and one more mental disorder that, because it complicates things, will be explained separately. For whatever reason, some individuals with posttraumatic stress disorder are able to create exactly one additional EP, and only one. Onno van der Hart and Ellert Nijenhuis have recently hypothesized that the second EP might be created as a necessity when the original EP is burdened with more unprocessed trauma events than it can handle. The authors of "Neurobiology and Treatment of Traumatic Dissociation toward an embodied self," Ulrich F. Lanius, Sandra L. Paulsen, Frank M. Corrigan, have a slightly different thought on why the personality of individuals with posttraumatic stress disorder have the capacity to evolve and create an additional EP. They hypothesize that when the original EP is active enough, it matures and then unprocessed trauma events leak to the ANP, and another EP is created in response. Both ideas entertain good thinking, and time will have to sort out who is right.

Secondary Structural Dissociation
Other specified dissociative disorder is a complex Dissociative Disorder, which establishes itself securely during the childhood years, and it's thought it is caused by child abuse, and a lack of a secure attachment. An absence of these two important childhood accomplishments, eventually result in an accumulation of unresolved trauma, which determine structural dissociation. In this disorder, there is always one distinct state (ANP), however there are always two or more EP. What makes this disorder unique from all other mental disorders is the EP, of which there are usually far more than two, are highly capable of functioning as a seemingly whole individual, with the ANP acting like a "front." The EP in many with this disorder can take over executive control and mimic dissociative identity disorder, but this is not a disorder that is "almost like" dissociative identity disorder in any respect, other than the fact that the EP in both disorders have the capabilities in some individuals to take over "full control." The EP do not have this ability in any other mental disorder. This disorder probably always exists in childhood, but sometimes does not show itself until an individual is in an extreme situation. Examples include individuals who are long term political prisoners, recruits into cults or terror organizations, prisoners of war, kidnap victims, or involved in brain washing and thought reform programs. } Borderline personality disorder (BPD) is considered under the umbrella of Secondary Structural Dissociation, but the disorder is not caused by structural dissociation. Some individuals with borderline personality disorder do have unprocessed trauma events that build up, and it's that build up that overwhelms the mind, brain and the individual causing structural dissociation. It's important to note, that this disorder comes first, and is followed by structural dissociation, and not the other way around.

Tertiary Structural Dissociation
The most complex level of Structural Dissociation is called "Tertiary Structural Dissociation", and only dissociative identity disorder is thought to exist in this realm. The reasons are as complicated as the disorder, but to put it in simple terms, it's the fact there are two or more distinct states, which are, of course, the apparently normal parts (ANP) of the personality, and only this disorder has two or more distinct states. Like other specified dissociative disorder, dissociative identity disorder has at least two less than distinct states (EP) and usually many more. Onno van der Hart and Ellert Nijenhuis strongly believe the reason for the two or more distinct states is that this disorder manifests itself during infancy, and then during the next "phase of childhood" during which, massive changes to the brain and mind take place. The individual with dissociative identity disorder is altered severely, and is no longer the person they were genetically born to be, in very important ways including their thought patterns and their innate way of being. There are always two or more EP in individuals with dissociative identity disorder, due to the overwhelming unprocessed trauma events and associated content and volume, and to put it simply; if an EP carries too many unprocessed trauma events then a new EP is created to hold the unprocessed trauma events. The mind and brain work in unison to keep unprocessed trauma events from the ANP's so the individual can literally survive, but not survive the pain of the unprocessed trauma events; they need to survive how disrupted the brain and mind have become due to unprocessed trauma events. The ANP are disturbingly phobic of the unprocessed trauma events, even though they don't "act" like it when they are in "executive control" of the individual. As a result of the dissociative boundaries, the ANP in executive control can and usually does appear strong and confident, but that is far from reality.

Quick reference to Structural Dissociation
Primary Structural Dissociation Secondary Structural Dissociation
 * 1 distinct part of the personality (ANP) and 1 less than distinct part of the personality (EP)
 * Disorder: posttraumatic stress disorder (PTSD)
 * 1 distinct part of the personality (ANP) and 2 or more less than distinct parts of the personality (EP)
 * Disorders: posttraumatic stress disorder) that has evolved and created exactly 2 EP, which is commonly known as complex-posttraumatic stress disorder (C-PTSD), other specified dissociative disorder (OSDD), and borderline personality disorder, (BPD).

Tertiary Structural Dissociation
 * 2 or more distinct parts of the personality (ANP) and 2 or more less than distinct states (EP)
 * Disorder: dissociative identity disorder (DID)

True dissociation
This is a direct quote by Ellert R.S. Nijenhuis which brilliantly defines dissociation. Dissociation in trauma entails a division of an individual’s personality, i.e., of the dynamic, biopsychosocial system as a whole that determines his or her characteristic mental and behavioral actions. This division of personality constitutes a core feature of trauma. It evolves when the individual lacks the capacity to integrate adverse experiences in part or in full, can support adaptation in this context, but commonly also implies adaptive limitations. The division involves two or more insufficiently integrated dynamic, that is changeable, but excessively rigid subsystems. These subsystems exert functions, and can encompass any number of different dynamic configurations of brain, body, and environment. These different configurations manifest as dynamic actions and implied dynamic states. The dissociative subsystems can be latent, or activated in a sequence or in parallel. Each dissociative subsystem, i.e., dissociative part of the personality includes its own, at least rudimentary person perspectives, that is, its own epistemic pluralism and epistemic dependency. As each dissociative part, the individual can interact with other dissociative parts and other individuals, at least in principle. Dissociative parts maintain permeable biopsychosocial boundaries that keep them divided, but that they can in principle dissolve.Phenomenologically, this division of the personality manifest in dissociative symptoms that can be categorized as negative or positive, and cognitive-emotional or sensorimotor.

To summarize, Ellert R.S. Nijenhuis is saying that dissociation is only present when unprocessed trauma events have built up to the point they have overwhelmed an individual and as a result there is not a compromised personality system with dissociative barriers separating the distinct and less than distinct states from one another.

Dissociative boundaries
Without the contributions by Onno van der Hart, Ellert Nijenhuis and Kathy Steele, the prototype of this theory outlined by Pierre Marie Félix Janet would have probably been lost and psychology would have continued down the wrong path. Ellert Nijenhuis and Onno van der Hart, in particular, have updated Janet's ideas and have taken into account modern day fMRI imaging, neurochemistry, interpersonal neurology, and of course the accumulated knowledge contributed by the field of developmental psychology. A basic lesson in neurochemistry is needed before moving on, which can be summed up by saying what goes in does not always come out, and of course, visa versa. The dissociative boundaries around "parts of the personality" (states) in the various disorders involved in Structural Dissociation, differ as much as if you were to pour a pulp filled glass of orange juice through a tight knit sieve and compare it to pouring a corrosive acid through the same sieve. You can imagine the pulp of the juice would stay outside the boundary for the most part, where the acid would not only go right through, but it would destroy the sieve in places where it has contact. With that simple understanding, you should now be able to see that it's not only the parts of the personality that differ among the disorders encompassed by Structural Dissociation, but the boundaries around them as well. In addition, there are neurological and psychological differences, so open your mind and think about more than psychology. (

Both ANP and EP appear to have dissociative boundaries associated with them consisting of various different chemical, physical, neurological and psychological makeups, and as a result, they respond to different stimuli. This is fascinating in other specified dissociative disorder as the ANP remains in "executive control," while the various EP take over enough to make the ANP do their "bidding". It's a complex system of one distinct state controlled by many less than distinct states. There is dissociative amnesia between the states, at times, but there is only one distinct state in other specified dissociative disorder, and true amnesia only exists between two or more distinct states, so it is only seen in dissociative identity disorder.



True amnesia
There are many ways that time loss can be experienced, but the only "true amnesia" is that experienced between two distinct states, and only dissociative identity disorder has two or more distinct states. Individuals with posttraumatic stress disorder sometimes don't remember traumatic events, people with other specified dissociative disorder might forget where their car keys are left, or they might have no memory of what a less than distinct state (EP) does when it switches with the ANP, but that is still is not true amnesia. Again, true amnesia can only occur between two distinct states (ANP).

The formal cause of trauma
Few could explain this better, so in the words of Ellert R.S. Nijenhuis: The formal cause of trauma is the existence of two or more conscious subsystems of the personality as a whole biopsychosocial system. Integration includes several actions: synthesis, personification, and presentification. Synthesis stands for creating cohesion and coherence among current sensorimotor, emotional, cognitive, and behavioral actions. The connection must be such that the actual present is experienced and known as the most real. The near past and anticipated future should also be quite real for the individual, and generally more real than the distant past and anticipated future. Presentification of the past commonly implies putting experiences in symbols. Normal autobiographical memories are thus mostly stories told, that is, narratives. Realization is more than experiencing and knowing that an event or fact is real. It includes acting responsibly on the basis of the experienced and conceived reality. Trauma involves major problems of integration. These symptoms relate to a lack of integration of the personality in trauma when that which traumatized individuals do not synthesize, personify, presentify, and realize is not gone from them.

Cyclic trauma processing in the traumatized mind, and overwhelming of the brain, mind and individual resulting in structural dissociation of the personality
Each bullet refers to an item on Chart A, which demonstrates the unyielding cycle of psychological trauma, referred to here as the "trauma cycle," which impairs individuals who are unable to stop this cycle. These individuals share common "environmentally caused characteristics," which revolve around a confusing childhood. A common aspect is none were able to form a secure attachment with a primary caregiver during childhood. The authors of Neurobiology and Treatment of Traumatic Dissociation have reported that this results in inadequate develop to a part of the brain that is normally developed in childhood, but Ellert Nijenhuis disagrees with them. It is possible that the disturbance is in the mind, rather than the brain.


 * "Mind seeking input" - A "trauma event" commences; the brain deals with the actual trauma event, and the unprocessed trauma events are processed in the hippocampus of the brain either immediately or within the next 30 days or so; at least that's what is normal, however the individual who had a confusing childhood and did not form a secure attachment does not fare as well.  For these people, a trauma event commences, and the brain deals with it, but it leaves the brain confused as how to deal with the unprocessed trauma events. Their mind went into flight, freeze, fight, fright, faint "Polyvagal responses" during the trauma event, but after it's over the mind, which should not have, stayed stuck there. The person might appear calm on the outside, but inside it's a whole other story. After the trauma event has ended, their mind is seeking a signal from the brain so it knows what to do. If all were to be working well, the brain would have sent a signal in reply to the minds inquiry, telling it a unprocessed trauma event has been processed. In individuals who are unable to process unprocessed trauma events correctly, the brain sends a confusing signal back to the mind, and in response the mind sends a signal back to the brain asking for clarification.


 * "The brain is unable to respond to the mind" - The brain sends another signal to the mind indicating it does not know what the mind is trying to communicate, and a repeating and exhausting "trauma cycle" ensues, which takes valuable energy from the mind and the brain that could be spent elsewhere. This trauma cycle leaves a person exhausted, confused and even rattled. They are anxious, to one degree or another, but they don't know why. If the individual is able to process trauma, but just needs some time, this is called acute stress disorder (ASD). If the acute stress disorder does not resolve itself, then therapy is needed to bring those unprocessed trauma events that are rattling around in the head, to consciousness and process them. If acute stress disorder does not resolve, the brain and mind will continue the "trauma cycle".


 * "A secure attachment was never made with a primary caregiver during childhood" - Anyone that obtained a secure attachment as a child should never go beyond acute stress disorder, but everyone else will continue along the path of the trauma cycle.


 * "The brain seeks information from the mind" - After a while of the trauma cycle repeating itself, the signal from the brain to the mind becomes slight, until it all but disappears, and this alerts the hippocampus, which is where in the brains unprocessed trauma events would travel for processing if the mind and brain could get their signals straight. The hippocampus is also where explicit memory is stored. In response to the alert, the hippocampus sends a signal out asking what is happening, and it gets a confusing reply. The hippocampus takes this information and interprets it to mean that it is not to process any more unprocessed trauma events, so it stops even trying.


 * "Both the brain and mind are overwhelmed, and the individual becomes overwhelmed" - Now even slight trauma that should be easily processed is left unprocessed, as the brain, including the hippocampus, reject all unprocessed trauma events. Unprocessed trauma events now stay in the mind, and the mind always services the present, prior to accessing stored information and therefore, the unprocessed trauma events are ignored by the mind until they are purposefully brought to consciousness, which can be done in therapy. As unprocessed trauma events accumulate in the "to do box," the mind is filled with unprocessed trauma events, resulting in overwhelming the mind, then the brain, and then the individual as a whole.


 * "Structural dissociation takes place" The personality is now no longer normal as it now has a barrier with two divisions, with one part only able to attend to daily life activities, and the other is left to hold and react to all the emotion of the unprocessed trauma events. Now the individual has a changed personality with an apparently normal part (ANP) and an emotional part (EP). The ANP find ways to avoid the EP who carry the unprocessed trauma events. The EP are confused, alone and isolated, and so they keep trying to contact the ANP. The mind is also trying to contact the ANP's, but they won't respond. The ANP's want no part of unprocessed trauma events at all and they are building dissociative boundaries around themselves. These boundaries, depending on the disorder have a different chemical, biological, neurological and physiological makeup. No disorder in the Structural Dissociation umbrella has ANP, EP or the boundaries around them that are the same, or even similar. Each is unique to it's own disorder. One disorder is not, "almost like another."


 * "The EP become exhausted from trying to contact the ANP which are getting harder to reach all the time" In dissociative identity disorder (DID), they are almost impossible to contact. The mind knows that it must contact both parts of the personality, but it's unable to, and the mind and brain are stuck in a constant, repetitive process of seeking and never making that essential contact." The ANP become more distant, distracted and dissociated as time goes on because that part of the personality cannot deal with the unprocessed trauma events it is phobic of, which leaves the EP feeling even more shunned.


 * "ANP are unable to respond to the signals from where explicit memory is stored, and so cannot recall those facts" - "Memory bits" are stored as explicit memory in the hippocampus, which is a unique problem after structural dissociation has resulted in one of the following disorders: posttraumatic stress disorder (PTSD), complex-posttraumatic stress disorder (C-PTSD), other specified dissociative disorder (OSDD), or dissociative identity disorder (DID), because now the individual has a lot of other symptoms that are also affecting them. Unprocessed trauma events being held in the mind and it will stay there until the individual, as a whole, is calm and ready and can mindfully work on processing those unprocessed trauma events in the hippocampus. In the meantime, the unprocessed trauma events cannot be accessed by the ANP, which now actually try, but are doing so now from a very protective area within their dissociative boundary. Some bits of unprocessed trauma events are not accessible by the EP either, even though they try, because even the EP can only handle so much. The hippocampus responds to the inquiries by the ANP and EP by sending signals out to both, which result in a response by the EP in the form of flashbacks, depression, startle response, night terrors, insomnia, restlessness, apprehension, angry outbursts, violent thoughts and even body pain. The ANP respond by isolating itself even more. Which mental disorder an individual gets depends on fairly consistent factors which are addressed on the pages of this site that focus on that disorder. This larger cycle now ensues, with the smaller, "trauma cycle" still taking place, and overtime, depending on the mental disorder that resulted when structural dissociation took place, the ANP and EP become more or less able to respond to the hippocampus and the unprocessed trauma events that belong to the individuals are sometime too vivid and other times not accessible at all.



Cyclic unprocessed trauma events in the individual with structural dissociation
Chart B begins with structural dissociation already having taken place and the individual has some form of posttraumatic stress disorder, or one of the two complex dissociative disorders other specified dissociative disorder or dissociative identity disorder. These people are ill, and although they might put one foot in front of the other and go about their day, they are like a time-bomb ready to blow. Day to day life for them requires a great deal of energy, which exhausts their mental processes as well as their body. Overall health, longevity, stress levels, physical health, mental health is threatened or in effective. They are unable to gracefully address the entire spectrum of relationships and all that entails, and the very manner in which they think and act is affected, as well as how they function in society, and perhaps most important, how they react and interact with their children. Their very right to be normal has been taken from them. Processing trauma is normal and natural and anything else is a problem.


 * "The mind seeks input from the brain" - Due to structural dissociation, the communication between the mind and the brain is next to nothing, and so the trauma cycle continues. The individual is no longer able to function normally, and they put on a facade, often unknown even to them, but it's just a mask. They can't feel, or experience life like they once did, or worse those that had this happen to them in infancy or in childhood have never really known what it's like to have a mind and brain and are not traumatized. They are encapsulated in trauma, and that trauma is controlling who and what they are. They might feel edgy, antsy, anxious, angry, sad, seething, hopeless, pathetic or guilty and shameful. They are confused, and they have no idea why. In no other mental disorder is the person so imprisoned as they are when trauma directs their mood, thoughts and feelings. Sadly, they are puppets, directed by past traumatic events.


 * "The brain is dependent on the mind, and the mind is unable to respond" - The brain needs a decipherable signal from the mind before it can help with a unprocessed trauma event, and if the mind is sending any signal at all, It's a broken and confused one. When the brain does respond to a signal it becomes a source of pain to the individual. This horrible trauma cycle will continue until unification takes place. All this confusion leads to somatic illness. This so called "phantom pain" is very real pain, but it has no biological source. It's caused by all the miscommunication in the brain and mind. The brain can also cause fear, panic, and a wide arrays of physical symptoms that range from blindness and deafness, down to a simple itch. Needless to say, the brain's response is not helpful at this stage, and it's response can linger until the unprocessed trauma event is eventually processed, and all states (ANP and EP) have unified.


 * "Structural dissociation stops all memory processing and EP now hold the unprocessed trauma events" - After structural dissociation produced an EP, which can think for itself, by the way, there are more problems. Imagine how confusing dissociative identity disorder and other specified dissociative disorder must be with all the EP's they usually have.


 * "The EP become more distinct and elaborate" - EP wander through the mass of the mind looking endlessly for purpose, and responding to signals (triggers), more or less, depending on their degree of elaboration and isolation due to dissociative boundaries.


 * "In dissociative identity disorder another ANP is created" - As if one ANP is not enough of a problem, individuals with dissociative identity disorder create a second one, and can create as many as they need to carry out daily life tasks. Having more than one ANP is the ultimate punishment among the disorders that are encompassed by structural dissociation. It causes all sorts of problems.


 * "EP live in a constant cycle of flight, freeze, fight, fright, faint reactions response" - While the ANP are dealing with daily life, the EP are busy responding to all sorts of signals that come in the form of triggers. This results in a fluctuation of emotions that are experienced by the ANP, and the EP.


 * "Information flow from EP to ANP" - ANP attempt to limit all contact, but some signals from the brain still get through and result in physical symptoms such as blindness, deafness, varied eye sight, hearing, allergies and long term illness. Due to these signals, ANP can also feel frail, sick, clumsy and over ridden with intense guilt and shame. Most of the extreme symptoms are limited to the most complex of the disorders, which is dissociative identity disorder. The gold star on this chart goes to those that can grasp the difference between a less than distinct state (EP) and a distinct state (ANP) and that true amnesia only occurs between distinct states (ANP).



Structural dissociation in borderline personality disorder
Each bullet addresses a "box" on Chart C, and this diagram shows how structural dissociation happens in an individual who has borderline personality disorder. The only major difference, at least that would be outlined in a brief form as is here, is that the person already has the mental disorder and it is not caused by structural dissociation.


 * An individual already has borderline personality disorder - It is important to understand that structural dissociation does not cause borderline personality disorder.


 * "The mind seeks input" - A trauma event occurs and the mind is unable to process it, and it sends a signal to the brain for more information.


 * "The brain is unable to respond to the mind" - The brain does not know what to tell the mind because it's confused.


 * "A secure attachment was never formed in childhood with a primary caregiver" - Any individual who has obtained a secure attachment with a primary caregiver during childhood will eventually be able to process trauma events even if it takes a few weeks, but not someone that never formed a secure attachment with a primary caregiver. For them the cycle continues.


 * "Trauma events are not processed" - The mind and brain attempt communication back and forth, until the signals fade to where they are almost negligible.


 * "The brain seeks information from the mind" - The brain asks for information from the mind and the mind does not answer, and so the brain sends out signals that cause the individual distress.


 * "The mind, brain and individual are overwhelmed" - The mind becomes overwhelmed, followed by the brain and then ultimately the entire individual.


 * "Structural dissociation occurs" - Overwhelming of the individual results in structural dissociation and the personality as a barrier forms creating two divisions, one part only dealing with daily life activities (ANP) and the other that handles unprocessed trauma events (EP).


 * "The trauma cycle repeats until the unprocessed trauma events can be processed, and the resulting ANP and EP have integrated" - It's important to understand that processing trauma events and integrating the ANP and EP will not fix borderline personality disorder, but it will relieve the dissociative symptoms the individual is experiencing.

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