Structural Dissociation of the Personality

From Dissociative Identity Disorder, Dissociation and Trauma Disorders
Jump to: navigation, search

The basic idea of structural dissociationStructural dissociation (SD) is one of the three accepted etiological ideas for the etiology of dissociative identity disorder. <ref name=HauntedSelf/> <ref name=Dell2009/>{{Rp|158-165}} It also explains other specified dissociative disorder, dissociative forms of borderline personality disorder, and dissociative posttraumatic stress disorder {{See also| Structural dissociation}}Structural dissociation of the personality is a theory that describes the effect of trauma on the personality. It applies to PTSD, complex PTSD, other specified dissociative disorder and dissociative identity disorder. is the following. A subjective trauma that cannot be processed over time results in an altered personality system due to the brainThe brain is a approximately a 1300-gram organ containing 100-billion neurons. It is the control center of the central nervous system. The mind and brain are not the same thing. (see mind) The mind emerges out of interactions between the brain and relationships during the earliest years of childhood. Different child-parent attachment relationships form differing physiological responses, patterns for interpersonal relationship and how an individual views the world. <ref name=Siegel2012/>{{Rp|9}} (see attachment)'s inability to "accept" that traumaThe most fundamental effect of trauma is dissociation, so we define trauma as the event(s) that cause dissociation. <ref name=Howell2011/>{{Rp|75}} The original trauma in those with dissociative identity disorder was failure of secure attachment with a primary attachment figure in early childhood. <ref name=Howell2011/>{{Rp|83}}. The task to "accept" is transferred to the minds workload. [4] [5] Depending on an individuals relationships and their perceived environment, the traumas not on the "workload list" of the mind will either be processed or put on a "waiting list which is important to human survival because immediate threats must be dealt with rather than attending to those that have passed. If new trauma is perceived by the human and again the brain cannot accept it, then that too is "transferred" to the mind to be put on a waiting list until the individual is able to process it. [4] If that time does not come "soon," then structural dissociation will result. [4] [5] Structural dissociationStructural dissociation (SD) is one of the three accepted etiological ideas for the etiology of dissociative identity disorder. <ref name=HauntedSelf/> <ref name=Dell2009/>{{Rp|158-165}} It also explains other specified dissociative disorder, dissociative forms of borderline personality disorder, and dissociative posttraumatic stress disorder {{See also| Structural dissociation}}Structural dissociation of the personality is a theory that describes the effect of trauma on the personality. It applies to PTSD, complex PTSD, other specified dissociative disorder and dissociative identity disorder. is literally a "split" of the personality resulting in two sections. One section will be isolated from the trauma memories and will attend to the normal activities of daily life, while the other section will hold the trauma memories. [1] This is the simplest form of structural dissociation. After this event there is never anything that can be called split or fracture, but instead what happens is parts are manufactured or created. [6]

If traumatic events continue then the portion of the personality that isolates trauma memories can change and parts will be created to help the mind deal with continued traumas. [1] These are not distinct parts of the personality even though they "act" as if they are. [1] They can be thought of as "less than distinct parts" or as "discontinuities in the agency of self". [7] [1] They will not show up on an fMRIA type of neuroimaging. Neuroimaging is an approach that allows researchers to view areas of the brain that become active during behavioral events such as emotion, perception and cognition. It is part of the science of in psychophysiology.<ref name=Andreassi2010/> scan as a distinct part. [1] The most complex form on structural dissociation involves the portion of the personality that is isolated from the parts that hold the trauma memories. When this portion of the personality creates new parts, they are distinct parts of the personality and will show up on an fMRI scan as such. [1] [8]

There are categories of structural dissociation: primary, secondary and tertiary. All the disorders of structural dissociation are horrific in their own right, and each comes with an array of disturbing symptoms. Within primary structural dissociation there is the DSMPublished by the American Psychiatric Association as the standard classification of mental disorders used by US mental health professionals. It consists of diagnostic classification, the diagnostic criteria sets, and descriptive text. The DSM-II listed multiple personality disorder as a symptom of hysterical neurosis, dissociative type. The DSM-III (1980) moved Multiple Personality Disorder from a symptom to its own disorder. The DSM-IV changed the name to dissociative identity disorder (1994) and the DSM-5 (May 2013) updated the listing to current standards. <ref name=DSMIV/> <ref name=DSM5/> <ref name=Dell2009/>{{Rp|384}}-5 trauma-stressor disorder known as posttraumatic stress disorder (PTSD). [9] Secondary structural dissociationOther specified dissociative disorder, dissociative forms of borderline personality disorder are examples. <ref name=HauntedSelf/> An individual with secondary structural dissociation will usually have one ANP and more than one fairly elaborate EP. <ref name=HauntedSelf/>{{Rp|5-7}} {{See also| structural dissociation}}, while less complex than tertiary structural dissociation is complex enough to cause a great deal of the misdiagnosis that is seen among the dissociative disorders. Within the parameters thoughts of as secondary structural dissociation is a form of PTSD that is thought to derive from childhood trauma. [6] The closest thing in the DSM-5 are the PTSD specifiers. Another DSM-5 disorder is borderline personality disorder, (BPD) which is probably not dissociative in its etiologyThe study of the cause of a disorder or disease. In the case of dissociative identity disorder, early and severe childhood trauma, especially abuse is considered to be the cause. <ref> {{See also| Etiology}}, but it is accompanied by an array of dissociative symptoms. [1]

The final DSM-5 mental disorderThe DSM-5 psychiatric manual defines this as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expected or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above."<ref name=DSM5Deskref/>{{Rp|20}} that is considered to be secondary structural dissociation is a re-thought disorder which was known as DDNOS in the DSM-IV, but the problematic and unspecific category had now be rewritten and replaced by more specific criteria. It's important to understand that DDNOS is not the same thing as what's in the DSM-5. Otherwise specified dissociative disorder (OSDD) is a disorder with one distinct personality statePersonality state - Many terms are used that have the same meaning including: parts, selves, part of the Self, subselves, selves, parts of the personality, subpersonalities, sides, internal Self-states, identities, states, ego states, part of the mind, and entity. The personality is an agglomeration of many personality states. <ref name=Noricks2011/>{{Rp|1}} and two or more discontinuities is self. This can be demonstrated with the use of fMRI technology. In structural dissociation these parts are called "emotional parts of the personalityEvery individual has a personality that is composed of many diverse, fragmentary and generally illusory images of [[Personality|self]]. (see multiples) <ref name=Noricks2011/>The DSM-IV uses the term identity in its definition of dissociation. (see identity) <ref name=Dell2009/>{{Rp|127}}" (EPAn state that holds trauma memory. A term used in structural dissociation. <ref name=HauntedSelf/>{{Rp|38-39}}). They do react with what are best described as vehement emotion. [6]

The final category of structural dissociation is tertiary, which is the most complex of them. The only DSM-5 disorder in the tertiary category is dissociative identity disorder (DIDDissociative identity disorder is a disorder of mental states, where a individual switches from one distinct state to another distinct state, which distinguished it from OSDD/DDNOS, BPD and PTSD. <ref name=Dell2009/>{{Rp|557-570,487-494,471-486}} {{See also| Dissociative Identity Disorder}}). This final category will always have two or more distinct personality states, which are clearly identified on an fMRI scan. In structural dissociation these parts are called "apparently normal parts of the personality" (ANPA distinct state who performs the job of daily activities and does not hold trauma memories. Dissociative identity disorder is the only mental disorder where an individual can have two or more ANP. <ref name=HauntedSelf/> {{See also| structural dissociation}}). These parts react to events with "somewhat normal emotion." All categories of structural dissociation will have at least one part that lacks self agency - a less than distinct part of the personality. [10]

Quick reference to structural dissociation

Primary structural dissociationAcute stress disorder and Posttraumatic stress disorder are examples. An individual with primary structural dissociation will have one ANP and one very limited EP. <ref name=HauntedSelf/>{{Rp|5-7}} {{See also| Structural dissociation}}

1 distinct part of the personality (ANP) and 1 less than distinct part of the personality (EP) DSM-5 category: (posttraumatic stress disorder (PTSD)

Secondary structural dissociation

1 distinct part of the personality (ANP) and 2 or more less than distinct parts of the personality (EP) DSM-5 categories: posttraumatic stress disorder) with the dissociative specifiers, otherwise specified dissociative disorder (OSDD), and borderline personality disorder, (BPD).

Tertiary structural dissociationThis is present in dissociative identity disorder, and is defined as an individual usually having more than one ANP and more than one highly distinct and elaborate EP. <ref name=HauntedSelf/>{{Rp|5-7}} <ref name=Hart1996/>

2 or more distinct parts of the personality (ANP) and 2 or more less than distinct parts of the personality (EP) DSM-5 category: dissociative identity disorder (DID)

Primary structural dissociation (PSD)

Primary structural dissociation
1. Posttraumatic stress disorder (PTSD)

Let's look at an example of an individual as they develop posttraumatic stress disorder.

Vignette of primary structural dissociation of the personality Dan is 22 years old and he is a soldier on the battle frontA term sometimes used by those with dissociative identity disorder to refer to the alter who is either in executive control of the individual, or who has come close to the one that is in executive control. (see executive control) in a war and his best friend, who is next to him gets shot, and now Dan is also in trouble. His mind is racing as he decides what to do. At the same time his brain is deciding if it can deal with this trauma, while it is also busy doing other things. Dan has to survive and figure out how to get this best friend to safety. His friend is still alive, but barely. Dan's brain doesn't have time to integrate the memory"Memory is not a static thing, but an active set of processes." <ref name=Siegel/>{{Rp|51}} "Our earliest experiences shape not only what we remember, but also how we remember and how we shape the narrative of our lives. Memory can be seen as the way the mind encodes elements of experience into various forms of representation. As a child develops, the mind begins to create a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future." <ref name=Siegel/>{{Rp|11}} of seeing his friend shot with the memories from before or after the trauma, so the memory goes to the mind where it's stored until the mind gets around to working on it. Ten years later Dan's mind has not yet taken the time to process the memory. Dan was shipped home, and he got married, had a family, started a career, and all that was given priority to working on the memory that was still sitting there in his mind waiting for him to decide it was important enough to deal with.

That's posttraumatic stress disorder, a DSM-5 category that meets the criteria for primary structural dissociation. In any form of structural dissociation there will be one "apparently normal part" (ANP) and one "emotional partAn state that holds trauma memory. A term used in structural dissociation. <ref name=HauntedSelf/>{{Rp|38-39}}" (EP) as a minimum, and this category is the baseline for that criteria consisting of one EP that lacks extensive elaboration and autonomy and one ANP that is the majority of the personality. [6]

Secondary structural dissociation

Secondary structural dissociation
1. Posttraumatic stress disorder with dissociative symptoms
2. Borderline personality disorder
3. Otherwise specified dissociative disorder (OSDD)

In secondary structural dissociation of the personality the affects of unprocessed memory are more obtrusive to an individual than in primary structural dissociation. The DSM-5 disorders that fit here are posttraumatic stress disorder with the dissociative specifiers, [11] and borderline personality disorder and otherwise specified dissociative disorder (OSDD). [6] In "The Haunted SelfThe DSM-IV uses the term identity in its definition of dissociation. (see identity) <ref name=Dell2009/>{{Rp|127}}," printed in 2006 there was mention of acute stress disorder (ASD) and the simple dissociative disorders being included in the category of simple structural dissociation. [6]

  • Dissociative posttraumatic stress disorder (D-PTSD)
Vignette of secondary structural dissociation: D-PTSD Looking at the example above for primary structural dissociation, let's change things a bit and say that a year after Dan's initial unprocessed trauma he and his young son are in a car accident. Again Dan is too preoccupied with his daily life for his mind to deal with his past unprocessed trauma, as well as his new trauma. Now he is on the path to having posttraumatic stress disorder with dissociative symptoms, which means he probably has more than one trauma to deal with now and his unprocessed memories will cause a wide array of undesirable symptoms such as flashbacks, irritable behavior, hyperarousalIncreased arousal response, which is a diagnostic criteria for PTSD.<ref name=DSM5Deskref/> Symptoms include "hypervigilance, exaggerated startle, sleep disturbance, concentration difficulties and anger"<ref name=Howell2011/>{{Rp|82}} plus physical tension, and emotions include anxiety and fear, a feeling of "experiencing too much" <ref name=Boon2011/>{{Rp|3,40,213}}. and startle, and often an inability to sleep well. [1]
  • Borderline personality disorder

Not all forms of borderline personality disorder are subject to dissociationDissociation is a compartmentalization of experience, where elements of a trauma are not integrated into a unified sense of the self. <ref name=Dell2009/>{{Rp|4-810, 127}}The lay persons idea of [[dissociation]], that which exists in the normal mind, is not what is referred to in this document. <ref name=Dell2009/>{{Rp|233-234}}, but the type related to childhood trauma tends to be. Here is an example of how borderline personality disorder can develop dissociative symptoms.

Vignette of secondary structural dissociation: John is 6 years old and he falls out of a truck because the door was not shut all the way. He is traumatized, and laying in the road crying, cut, bruised and in pain. His father gets out of the truck and yells at him for "being stupid" and throws him into the back of the truck. John is confused and his brain can't make sense of what happened. The memory of the event goes to John's mind to be integrated with other memories, but instead the memory is buried and it changes John's personality development. He is developing a personality disorder. [12]:487-506
  • Otherwise specified dissociative disorder (OSDD)

Otherwise specified dissociative disorder (OSDD) is interesting because it has a more complex development than the other disorders described so far. In the case of otherwise specified dissociative disorder, the memories affect"a person's present emotional responsiveness, which can be inferred from facial expressions" including both the degree and range of expressive behavior. This can also be shown in tone of voice, hand and body movements. <ref name=Sadock2008/>{{Rp| 6}} the individual differently than they do with primary structural dissociation, and even differently than the other secondary structural dissociation disorders. In other specified dissociative disorder, it's the very presence of unprocessed memories that cause a flooding of emotions and creates other symptoms that are hard to ignore, such as flashbacks, irritability, and parts of the personality that are often distinct enough to communicate between each other in a way that is not the norm. Again, let's look at an example. [6]

Vignette of secondary structural dissociation: OSDD Mary, a 9 year old was neglected and emotionally abused as an infant. She lived in a single parent household and her mother was a drug addict who could not give Mary the care she needed, and as a result Mary laid down the framework needed to have a mental disorder, because she could not form an attachmentThe communication of emotion between an infant and their primary caregiver(s) is essential to shaping the developing mind. "Emotion serves as a central organizing process within the brain. In this way, an individual's abilities to organize emotions - a product in part, of early attachment relationships directly shapes the ability of the mind to integrate experience and to adapt to future stressors." <ref name=Siegel/>{{Rp|9}} Interruption in the attachment pattern of young children with their caretaker(s) has been shown to be a primary precursor to Dissociative Disorder pathology. (see etiology) <ref name=Medscape/> <ref name=HauntedSelf/>{{Rp|85}} <ref name=Howell2011/>{{Rp|97}}. She has had posttraumatic stress disorder since she was 3, so she already has structural dissociation of the personality. At 9 her Mother brings home a man who sexually abuses the young girl and then throws her aside. Her mind can't cope, but her brain can. She knows full well what this man did to her and that it was wrong. The event is on her mind often, and later, she dissociates the memory. It's not forgotten, but it has been moved from the brain to the mind, since the brains attempt to cope with it failed. Now it's the minds turn and it's not dealing with it well either, so to the bottom of the to do list it goes, and there is sits until Mary is old enough to decide she wants to find help to focus her attention on it. [6]

Secondary structural dissociation consists of one ANP and at least two EP. The EP are more elaborate and autonomous than those seen in primary structural dissociation, but usually less elaborate and autonomous than in tertiary structural dissociation. [6]


Tertiary structural dissociation

Tertiary structural dissociation
1. dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder, which was from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading. No one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual switches from one distinct state to another distinct state, which distinguished it from OSDD/DDNOS, BPD and PTSD. <ref name=Dell2009/>{{Rp|557-570,487-494,471-486}} {{See also| Dissociative Identity Disorder}}

The most complex of the structural dissociation disorders is dissociative identity disorder.

Vignette of tertiary structural dissociation: DID Our example will be of an infant because unlike the other disorders, this one must begin very early in life, probably before age 2, and always early enough that there has been little to no integrationIntegration (state of unification) occurs in the minds of all individuals and is a process rather than an end product. "If integration is impaired, the result is chaos, rigidity, or both. Chaos and rigidity can then be seen as the red flags of blocked integration and impaired development of the mind." <ref name=Siegel2012/>{{Rp|9}} The natural process of the mind is to link differential parts (distinct modes of information processing) into a functional and unified self. No child has unified personality when born, in fact, they need years of sufficient nurturing for the parts of their personality to integrate. <ref name=Siegel2012/>{{Rp|394}} "Integration is more like making a fruit salad than like making a smoothie: It requires that elements retain their individual uniqueness while simultaneously linking to other components of the system. The key is balance of differentiation and linkage." <ref name=Siegel2012/>{{Rp|199}} Integration is the normal process that occurs in early childhood, but if interrupted by trauma, the child may not be able to integrate. <ref name=Howell2011/>{{Rp|143}} between the parts of the personality. [10] Betty is a new born baby girl who like all babies needs love, care, nutrition and to be held and taken care of. Betty is ignored all day with the exception of being screamed at if she dirties her diaper and she is fed just enough to stay alive. She is a neglected, abused infant with a disorganized attachment. She has the groundwork laid down to create dissociative identity disorder already before she can even walk. She has been beat many times, and has learned to dissociate during abuse"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" <ref name=VandenBos2007/>, as well as during most of her awake time. She is becoming a master at the skill of dissociation since it's her only means of survival. Her brain has not been able to deal with much that has gone on in her life, and her mind does the best it can with what it's given, but this child's life pretty much exists just in her mind. By age 2, Betty already has several parts of her personality that have become malfunctioning parts. Each of these has the potential to be autonomous and very distinct. In Mary's case the change from a normal personality state to an abnormal one resulted in six parts. Two of them are distinct parts who are "Mary" most of the time and the other four are less than distinct part and they hold trauma memories for her. [6]
What you are looking at is an fMRI scan. The image on the left shows two distinct state caught in the act of switchingFull dissociation is when an alter switches with the alter currently in executive control, resulting in amnesia for that alter. (see executive control) <ref name=Howell2011/>{{Rp|4-6}} In full dissociation, there is complete amnesia between dissociated states, which is a <ref name=Dell2009/>{{Rp|228}} criteria for a diagnosis of dissociative identity disorder in the DSM-5. {{See also| Dissociation}} with each other. The small colorful dot is a less than distinct state. If a series of images were displayed here you would see the distinct state remains constant until it switches with another distinct state, while at the same time, although not shown in this image, less than distinct states are switching in the background like a symphony of lights.
The right image shows the same thing but only one distinct state can be seen.]]

Tertiary structural dissociation is reserved for dissociative identity disorder which has two or more EP, as does secondary structural dissociation, but this is the only disorder with more than one ANP. Many of the parts will be elaborated and autonomous, and in fact they often have their own sense of selfNormal sense of self is experienced as alterations in consciousness, but the sense of self remains stable and consistent. In individuals with a Dissociative disorder the sense of self alternates and is inconsistent across time and experience. <ref name=Dell2009/>{{Rp|160}} There is no unified sense of self., own name, gender and preferences. What really sets dissociative identity disorder apart from the other complex dissociative disorder, otherwise specified dissociative disorder is not only are there two or more ANP in dissociative identity disorder, the phobia between the parts of the personality are far more exaggerated than in any other disorder. The individual with dissociative identity disorder is not going to be able to acknowledge they even have it for most of their life, unlike individuals with otherwise specified dissociative disorder. In addition, individuals with dissociative identity disorder have amnesiaMemory loss. {{See also| amnesia}} between the distinct parts of the personality. Distinct parts do not hold trauma memory. This is the main distinction between otherwise specified dissociative disorder and dissociative identity disorder since only dissociative identity disorder has two or more distinct parts of the personality.

In a brain scan, such as seen in the image on this page, the parts of the personality that are distinct light up areas in a fMRI scan in an identifiable way. In a series of scans they are seen alternating from one to another. This is only seen in dissociative identity disorder. An fMRI scan of an individual with otherwise specified dissociative disorder will only show one main part and then moving behind that distinct part is a symphony of other less distinct parts. As a side note, a fMRI scan is not showing the actual part of the personality, but instead is showing an indication of the part.

Structural dissociation in depth

Let's look more in depth and use the terminology of the three people that are responsible for today's theory of the structural dissociation of the personality, Onno van der Hart, Ellert Nijenhuis, and Kathy Steele. [13] Without their work the contributions made by the man behind all this, Pierre Marie Félix Janet would have probably been lost. [6] Nijenhuis and van der Hart, in particular, have updated Janet's ideas and have taken into account brain imaging, neurochemistry, neurofiring, relationships that mold the mind and of course the accumulated knowledge of developmental psychology. [8] (Dorahy, 2014) [9] 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 in the various DSM-5 (DSM5, 2013) 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 with an acid filled container poured through the same type of sieve. You can imagine the pulp of the juice would stay outside the boundary, where the acid would not only go right through, but it might also destroy the sieve. [12]:709-826 With that 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. [4] In addition, there are neurological and psychological differences, so open your mind and think about more than psychology and the basic ideas involved in dissociation. ([12]:3-26 [14]

Two of the main terms used in this theory are "emotional part of the personality" (EP) and "apparently normal part of the personality" (ANP). An ANP is the part of the personality that maintains a presence of normality, but only because that's all this part knows. It has no memory or knowledge of the trauma; everything appears normal to it, and it has a normal range of emotions. On the other hand, The emotional part (EP) has vehement emotions that respond to unprocessed trauma memories and, unlike the ANP, they are not distinct personality parts. Both the ANP and EP appear to have very different dissociative boundaries around them, and they respond to different stimuli.

Although the EP can take over full control of an individual, that is rarely seen except in dissociative identity disorder. It appears to occur in otherwise specified dissociative disorder, but what's really happening is the ANP remains in charge, while the EP takes over enough to make the ANP do their "bidding". This can result in memory loss for the ANP, but it does not meet the DSM-5 criteria for dissociative identity disorder because the EP are not distinct states. In dissociative identity disorder the ANP's can switch from one to another, and they can also exchange places with EP, both resulting in memory loss. This brings up an interesting point, and that is why is an EP not a distinct state. Briefly, it can be explained like this.

The "normal" personality is made up of distinct states, but when structural dissociation occurs it's the whole personality that "splits" and this occurs only once. At no other time should the term splitting be used to describe any disorder in structural dissociation, because splitting is taking something and breaking a piece off of it and that does not happen after the initial split. Then the individuals states become altered. In the 1800's, Janet explained that each state must be altered to where it has two faces; a face for daily life activity (ANP) and another to deal with the trauma memory (EP).

Again, an example might be the easiest way to explain, but it's going to be an example of preposterous conditions. [15] [8]

Vignette of the etiology of DID, BPD with dissociative symptoms, PTSD with dissociative symptoms

A baby is born and his parents are neglectful, and otherwise occupied with their own lives. They lead a life of crime and drug use and although they don't purposefully abuse this baby, they don't give the infant what it needs to thrive either. Those important things are mirroring, adequate nourishment, cuddling, soothing, attention and a strong relationship with at least one caregiver. Let's call this baby Adam. The couple has a second baby, nine months later. This baby came at a bad time and the mother is angry and going through many of her own problems. Let's call this baby Eve. Eve not only has the same neglect that Adam went through, but she is battered and always kept in her room alone, except when she is being verbally and physically abused. The same couple has a third baby, again 9 months later. This baby came at a good time for the mother. Things had calmed down in her life and she was ready to try and care for a child, but she has limited abilities to do so. The child is not neglected, isolated or beat, but there is still something missing that she needs. She sees how her siblings are treated and that affects her. Eve is beat and always kept locked up and starved almost to death. Adam is less abused than Eve, but it's clear to him that his mother wished he did not even exist. Of course it's obvious to both Adam and Eve that their mother cherishes the youngest. Let's call this child Appleseed.

The next child to come along is born 18 months after Appleseed, and the children's mother does not seem to be able to care for this one at all. It dies. The next to be born is 9 months later and this time the Father makes sure it's basic needs are attended too, but love is lacking. This child, which we will call tree, has a different upbringing than the other three survivors because the Father called in a nanny to keep an eye on the mother and raise the infant. This child is fed regularly, held, and given basic attention, but certainly not what a child needs to thrive and have a healthy mind. The ground work is laid down for all four children. Adam becomes a difficult child who cannot read, but is afraid of almost everything, and he is complacent, having lost his will to fight. His Father abuses him regularly and in many ways. The boy would be classified as having a antisocial personality disorder, and he lacks any morsel of regret and compassion. He is a threat to society. So what does this have to do with structural dissociation? Nothing at all. This is the point. Not all abuse results in structural dissociation. Eve on the other hand, spends almost all her time in her room locked up, starving and listening for anyone to approach the door, which almost always means abuse for her. Eve has developed dissociative identity disorder. Appleseed is very different and appears to be a replica of her mother. She has borderline personality disorder with dissociative symptoms. She is not a threat to society, but she should never be around a child. Finally there is Tree. Tree is the luckiest of the bunch because his father interceded on his behalf and made sure he got enough care to survive. He does not have any structural dissociation, but he is not mentally healthy either. He has the ground work laid down so that when he was traumatized at the age of 18 he developed posttraumatic stress disorder. Then a year later he suffered another trauma and his simple structural dissociation became more complex. He dissociative symptoms.

As you can see from the examples, it's not easy to predict what the outcome of abuse or neglect will be. [16] [17] This next example will show the difference in etiology between someone with dissociative identity disorder and other specified dissociative disorder. Keep in mind that the dissociative boundaries in the two complex Dissociative Disorders are quite different in chemical makeup, neurological adaptation, and the ANP's in dissociative identity disorder are highly distinct. [1] Dissociative identity disorder is not a disorder caused from more suffering than what causes other specified dissociative disorder. [6] [10] It's not how much a child was abused that matters. It's when and how. [18] [19] [20] Here is an example of how that could work.

Vignette of OSDD and DID

The same mother in the other examples is the mother here, but now it's 15 years later, and she goes through a divorce while giving birth to a baby girl who she names Constance. The mother is a single mother as soon as the baby is born, and she is still mentally incapable of raising a child with the tender love and care that's needed, but still this child is loved by her, and she cares for Constance in the only way she knows how. Constance is chastised constantly, but not because she is a bad child, but because she has a mentally ill mother. The child is unsure of herself and is incapable of knowing right from wrong due to her relationship with her Mother. What happens later in life will interact with it the earliest years of her childhood. Ten years later the same Mother is again married, but this time to another man, and she gives birth to another baby. This one is a boy named Earl, and his father is a surgeon and has religious ideas that are inconsistent with main stream religion. The boy is brutally abused almost nightly by his father, including surgical abuse. Earl is a boy without fear, and he has antisocial personality disorder, but he also has dissociative identity disorder. Earl has already decided his path in life and that's the same path as his Father, but his sister Constance has not developed a mental disorder, but after years with her brother, who does abuse her, she develops other specified dissociative disorder.

This last vignette will show how programmingMind control programming only exists is specific to other specified dissociative disorder. It is not seen in dissociative identity disorder except under rare cases. Programming is the act of installing internal, pre-established reactions to external stimuli so that a person will automatically react in a predetermined manner to things like an auditory, visual or tactile signal or perform a specific set of action according to a date and/or time. This is achieved through using extreme, usually life-threatening trauma such as torture to create disassociated identities during childhood. <ref name=Miller2012/>{{Rp|viii, 19}} These states are created to be programmed so that the person with otherwise specified dissociative disorder engage in activities chosen by the abusive group (for example, a cult) without any conscious awareness of it and without a conscious choice on behalf of a state, for example activities like sex slavery, murder or spying. {{See also| Ritual_abuse}} This is not possible to do with people with dissociative identity disorder, and thus is the reason for cults creating members with otherwise specified dissociative disorder. and organized abuseNo precise definition of organized abuse exists, but definitions typically refer to situations with multiple victims and multiple perpetrators (abusers), particularly involved sexual abuse alongside other types of abuse.<ref name=Salter2013/>{{Rp|1-2}} can result in what appears to be, but are not distinct parts of the personality in individuals with other specified dissociative disorder.

Vignette of OSDD and DID Earl's Father not only has religious ideas that are not consistent with mainstream religion, he is part of an organized group. Constance fits right in and is exactly what they want in their organization. She is programmed and as a result her EP's are worked with and become far more distinct than is seen in a typical case of other specified dissociative disorder.

Earl is a whole other matter. He can be programed, but his programing does not react like others in the group because he has the ability to switch from one ANP to another ANP, unlike the others in the group. The goal of ritual abuseTypically involves a combination of extreme abuses, including sexual, physical, emotional, psychological and spiritual abuse and is usually carried out by groups rather than lone individuals. May include murder and torture, often to near death. Torture may be used along side mind control and brainwashing techniques; combined these can be used to further control a person who has developed dissociative parts or identities in order to cope with the abuse. Survivors of ritual abuse report that most groups force them to commit horrific acts including harming others, including other children, vulnerable adults or pets, and being drugged. Miller (2012){{Rp|12}} Types of abuse used have been compared to the torture and brainwashing techniques used on political prisoners. (Matthew (2001)) is to create other specified dissociative disorder in the members. Earl is a mistake that is not wanted in the group and programers are well trained in understanding the difference between the two disorders.

Understanding the processes of structural dissociation

This chart was taken from a 2008 presentation by Onno van der Hart and adapted to show the updates that he and Ellert Nijenhuis have written about since 2008 and since their book, "The Haunted Self," was published in 2006. This chart shows how trauma interferes with the integrative developmental process, starting after structural dissociation has taken place. That prior process was explained thoroughly in the examples above. Let us first look at the path of the ANP since it's less complex. Examples are a wonderful way to explain things simply, so once again let's use an example.


Switchingrefers to identity alteration in dissociative identity disorder and otherwise specified dissociative disorder, it occurs with a person changes from one identity to another. {{See also| Alters}} in dissociative identity disorder

Eve,if you remember from her last vignette was kept in isolation and when she is with her parents she was usually abused. Today is a special day however, and her father is taking her on an outing. She is going to dinner with Father and a friend of his who wants to meet her. It's one of Eve's EP's that is out because whenever her father is around she is in constant danger, and an EP is on alert. At the restaurant the waitress talks to Eve and the child feels she has a confident, and so she blurts out that she is abused by her Father and begs the waitress to rescue her. Needless to say, everyone is now on their toes, but none so much as Eve's EP is, until time goes by and she joins the conversation at the table and eats her food. She has no control over when she switches from the EP that is equipped to handle this situation to an ANP that has no idea what is going on except she is out to eat with her father and his friend. The police arrive and Eve is asked if she is abused, but she has only a fuzzy idea what the policemen are talking about. She does report that she is lonely and almost always made to stay in her room, but that's nothing the police can use to rescue her.

Eve's ANP took over because while they were waiting for the police Eve and the two men went back to eating their food and that's a daily life activity which is the job of an ANP. If Eve had other specified dissociative disorder instead of dissociative identity disorder then the EP would have returned once the police arrived, or at least the ANP would probably know about the abuse and be able to report it.

The top right corner of the chart explains Stephen W. Porges' polyvagal theory. [5] Eve's brain would need to react in one of three ways as seen in the chart: flight, freeze or fight. [5] In this case, it would be hard to tell if she was in freeze or flight mode, but here both would result in her ANP finding a way to not anger her father any further. The bottom right of the chart shows the label submission, which indicates the result of her ANP's action. If as soon as the police showed up they took Eve to a back room where she felt free to talk, then the EP could come back out and again report the abuse.

Now let's look at the actions of the EP which are shown on the left side of the chart. The box called "seeking" indicates an EP is looking for a signal that will send a particular EP out. It can be a smell, a word, a song, a situation or even an idle mind that brings forth a certain EP. The box labeled "play" indicates what is going on in Eve's mind and the brain that ultimately results in bringing a certain EP forth to take over executive controlThe state that has control of an individual at that moment has executive control, and the dissociated state most often in executive control is commonly called the host. <ref name=Boon2011/>{{Rp|27}} of the individual. Here is a quick example of what could happen with the EP's starting at the beginning of our scenario. Eve's door opens and the ANP that is out switches to an EP, because anytime the door opens it means danger for Eve. Her mind is responding to a complex set of indications that danger is near because that's been what happened in the past when the door opened. The next box is labeled, "attachment to caretaker." The door opening means danger, but which EP responds depends on which caretaker opens the door and what mood"Pervasive and sustained emotion" which affects a person's perception of the world.<ref name=Sadock2008/>{{Rp|6}} that adult is in. In this case, it was the father that opened the door. Let's say that Eve has three EP and one comes out for her mother's abuse and the other two for abuse her father does. The next box is "seeking," which means the mind is seeking input to decide which of the two EP that respond to her father's abuse is best suited for the situation. Eve's Father tells her to change her clothes and that's enough input for the mind to decide which EP will be going out to dinner.


  1. ^ Bethany L. Brand (2012): What We Know and What We Need to Learn About the Treatment of Dissociative Disorders, Journal of Trauma and Dissociation, 13:4, 387-396
  2. ^ American Psychiatric Association, (2013). Desk Reference to the Diagnostic Criteria from DSM-5. APA.ISBN 0890425566.
  3. ^ a b c d e f g h i j Dorahy, Martin; van der Hart, Onno (2014). DSM-5’s PTSD with Dissociative Symptoms: Challenges and Future Directions. Journal of Trauma and Dissociation, volume 15, issue 1. (doi:DOI: 10.1080/15299732.2014.908806)
  4. ^ a b c d Siegel, Daniel (2012). The Developing Mind, Second Edition: How Relationships and the Brain Interact to Shape Who We Are. Guilford press.ISBN 13: 978-1462503902.
  5. ^ a b c d Porges, Stephan (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication and Self-Regulation. New Yord:Norton.ISBN 10: 0393707008.
  6. ^ a b c d e f g h i j k l Vanderhart, Onno (2006) (coauthors: Nijenhuis, Ellert; Steele, Kathy). The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. New York:Norton.ISBN 13: 978-0393704013.
  7. ^ Lanius, Ruth A.; Eric Vermetten, Richard J. Loewenstein, Bethany Brand, Christian Schmahl, Douglas Bremner, David Spiegel (2010). Emotion Modulation in PTSD: Clinical and Neurobiological Evidence for a Dissociative Subtype. Am J Psychiatry, volume 167, issue 6, 2010. (doi:10.1176/appi.ajp.2009.09081168)
  8. ^ a b c Schlumpf, YR; Reinders, AATS, Nijenhuis, ERS, Luechinger, R, van Osch, MJP, et al. (2014). Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study. PLoS ONE, volume 9, issue 6, 2014. (doi:10.1371/journal.pone.0098795)
  9. ^ a b Solomon, Roger; Nijenhuis, Ellert R. S.; van der Hart, Onno (2010). Dissociation of the Personality in Complex Trauma-Related Disorders and EMDR: Theoretical Considerations. Journal of EMDR Practice and Research, volume 4, issue 2, 2010, page 76-92. (doi:10.1891/1933-3196.4.2.76)
  10. ^ a b c Nijenhuis, Ellert; van der Hart, Onno (2011). Dissociation in Trauma: A New Definition and Comparison with Previous Formulations. Journal of Trauma & Dissociation, volume 12, issue 4, 2011. (doi:10.1080/15299732.2011.570592)
  11. ^ Armour, Cherie; Karen-Inge Karstoft, J. Don Richardson (2014). The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD. Social Psychiatry and Psychiatric Epidemiology, volume 49, issue 9, page 1297-1306. (doi:10.1007/s00127-014-0819-y)
  12. ^ a b c Dell, Paul (2009) (coauthors: Barlow, MR, Beere, DB, Bianchi, I, Blizard, RA, Bluhm, RL, Braude, SE, Bremner, JD, Bromberg, PM, Brown, LS, Bryan, RA, Butler, LD, Cardena, E, Carlson, EA, Carlson, E, Dalenbert, C, Dallam, S,Dell, PF, den Boer, JA, Dorahy, MJ, Dutra, L, Evans, C, Fairbank, JA, Farrelly, S, Ford, JA, Frankel, AS, Freyd, JJ, Ginzburg, K, Gold, SN, Howell, EF, Jager-Hyman, S, Jessop, MA, Kletter, H, Kluft, RP, Koopman, C, Lanius, RA, Lawson, D, Liotti, G, Lyons-Ruth, K, Moskowitz, A, Nijenhuis, ERS, Nurcombe, B, O'Neil, JA, Ozturk, E, Pain, C, Paulson, KL, Read, J, Ross, CA, Rudegeair, T, Saltzman, K, Sar, V, Schore, AN, Scott, JG, Seibel, SL, Siegel, DJ, Silbert, JL, Silvern, L, Simeon, D, Somer, E, Sroufe, LA, Steele, K, Stern, DB, Terhune, DB, van der Hart, O, van Duijl, Marjolein, Waelde, LC, Weiner, LA, Williams, O, Yates, TM, Zanarini, MC.). Dissociation and the Dissociative Disorders: DSM-V and Beyond. New York, NY:Routledge.ISBN 13: 978-0415957854.
  13. ^ Steele, Kathy; van der Hart, Onno; Nijenhuis, Ellert R. S. (2001). Dependency in the Treatment of Complex Posttraumatic Stress Disorder and Dissociative Disorders. Trauma & dissociation, volume 4, issue 1, page 79-116. (doi:10.1300/J229v02n04_05)
  14. ^ Nijenhuis, Ellert R. S.; van der Hart, Onno (2011b). Defining Dissociation in Trauma. Trauma & Dissociation, volume 12, issue 4, page 469-473. (doi:10.1080/15299732.2011.570599)
  15. ^ Obsuth, Ingrid; Hennighausen, Laura E. Brumariu and Karlen Lyons-Ruth (2014). Disorganized Behavior in Adolescent–Parent Interaction: Relations to Attachment State of Mind, Partner Abuse, and Psychopathology. Child Development, volume 85, issue 1. (doi:10.1111/cdev.12113)
  16. ^ Chu, James A. (2011). Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders. Hoboken, N.J.:John Wiley & Sons.ISBN 0470768746.
  17. ^ Siegel, Daniel (2010). Mindsight: The New Science of Personal Transformation. Bantam.ISBN 10.1521/ijgp.2010.60.4.605.
  18. ^ Brand, Bethany; Dorahy, Martin, Sar, Vedat, Krüger, Christa, Stavropoulos, Pam, Martínez-Taboas, Alfonso, Lewis-Fernández,Roberto, Middleton,Warwick (2014). Psychiatry Australian and New Zealand Journal of Dissociative identity disorder: An empirical overview. Aust N Z J Psychiatry, volume 48, issue 402, 2014. (doi:10.1177/0004867414527523)
  19. ^ Brand, B.; Loewenstein, Richard J. (2010). Dissociative disorders: An overview of assessment, phenomenology, and treatment. Psychiatric Times.
  20. ^ Brand, B.; Classen, C. C., McNary, S. W., Zaveri, P. (2009). A review of dissociative disorders treatment studies. J Nerv MentDis., volume 197, issue 9, page 646-54. (doi:10.1097/NMD.0b013e3181b3afaa)