Structural Dissociation of the Personality

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The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization is the landmark book that fully introduced the "theory 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. 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}}". The three authors are Onno van der Hart, Ellert Nijenhuis (pronounced Nee-An-Hoff) and Kathy Steele. Structural Dissociation is a process that, along with other factors, is literally the final determinant of the following disorders: dissociative identity disorder, other specified dissociative disorder, and posttraumatic stress disorder. Borderline personality disorder is not caused by Structural Dissociation, but it can be affected by it once the disorder is already in existence. Acute stress disorder (ASD) and the simple Dissociative Disorders were part of Onno van der Hart, Ellert Nijenhuis and Kathy Steele's original theory, but it's unclear if they still feel these disorders should be included since they have not addressed them in any journal articles in the last couple of years. Structural Dissociation is a neurological process, where an accumulation of unprocessed trauma memories result in "splitting" the personality into two separate divisions. [1] [4] [5] One division is phobic of trauma memories, but is highly capable of attending to daily life tasks, but only because it's buffered from trauma memories. [5] The other division is highly affected by 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}}, and to what extent trauma plays a role, truly depends on the 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 results. [1] [5] The making of two divisions is the only time a "split" will ever occur; there is not a split when any future state is created. Which mental disorder an individual with Structural Dissociation ends up with depends on factors that occurred before the split; they include the following: extent and duration of early childhood trauma, relationship with primary caretakers, innate ability to handle stress, and perhaps most important is the age that Structural Dissociation takes place.

What you are looking at in the left image is a minute section of a 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 showing activity as a switch results in one distinct state (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}}) 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 another distinct state (ANP). The images catches the leaving distinct state before it fully exits consciousness, which is a process that is only possible in 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}}). In other specified dissociative disorder (OSDD) only one distinct state exists, and so obviously a switching of distinct states will never be seen on an fMRI. In both dissociative identity disorder and other specified dissociative disorder there will be at least two, and usually several - less than distinct states (EPAn state that holds trauma memory. A term used in structural dissociation. <ref name=HauntedSelf/>{{Rp|38-39}}) switching with each other. In posttraumatic stress disorder (PTSD) there is only one less than distinct state and only one distinct state, and both states will remain lit up until something triggers the less than distinct state, and then the distinct state is no longer visible. That triggerA reactivating stimulus in trauma disorders. A stimulus in the present which is a reminder of a part of a traumatic [[memory]], which can cause the part of an individual that hold the trauma (EP) to feel as if it is reliving past trauma experience. <ref name=Boon2011/>{{Rp|166-186}} Also known as a trauma trigger. resulted in some sort of reaction (flashbackA flashback is a reactivated traumatic memory experienced as intrusive thoughts, feelings, or images associated with past trauma, but lacking a sense of being from the past. <ref name=Siegel2012/>{{Rp|30}} It is experienced by the state referred to as the EP. {{See also | Grounding techniques}} or exaggerated startle - for example) to their unprocessed memories. When an individual has posttraumatic stress disorder, with the dissociative symptoms of depersonalization and derealization, then there is always two less than distinct states (EP), which can be identified on an fMRI scan, but both will not always be visible together. The authors of the theory of Structural Dissociation call this form of PTSD, complex-posttraumatic stress disorder (C-PTSD). Borderline personality disorder is an odd ball in this bunch because the disorder is not caused by Structural Dissociation, but after the disorder already exists, the individual with BPD can be overwhelmed by trauma memories resulting in Structural Dissociation and then they will have dissociative symptoms. On their fMRI scans we see one distinct state and one less than distinct state, but the distinct state (ANP) is the only part visible until the individual is in distress, and then the less than distinct state (EP) shows up. This state will not take over as is seen in posttraumatic stress disorder and so there are no flashbacks or similar symptoms, but instead are the dissociative symptoms of derealization and depersonalization. [6] [7] [5] [8] [4] [9] [10] [11]

In posttraumatic stress disorder (PTSD) the two divisions hold one state each; one contains a distinct state known as an "apparently normal part 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}}" (ANP) and the other a less than distinct state, known as an "emotional partAn state that holds trauma memory. A term used in structural dissociation. <ref name=HauntedSelf/>{{Rp|38-39}} of the personality" (EP). [1] [5] This is primary Structural Dissociation, and it can occur at any time in an individuals life. [5] It has been proposed that those with a "subjectively happy childhood" are immune to ever having posttraumatic stress disorder, but more research is needed before this can be said with much confidence.

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. [7]:243-493 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 trauma than it can handle. [4] 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 that it matures, then trauma memories leak to the ANP, and another EP is created in response. [7]:243-493 Both ideas entertain good thinking, and time will have to sort out who is right.

Other specified dissociative disorder is a complex disorder, whose base to flourish from is more often than not established through some sort of child 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/>, neglect and unresolved trauma, and a lack of 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}} with a primary caregiver, and results in a confused child who is unable to feel safe. In this disorder, there is always one distinct state (ANP), just like all the other disorders discussed so far. When childhood trauma is involved, the EP are required to hold an enormous amount of trauma 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}}, and the two or more EP's in this disorder are needed to function as a seemingly whole individual, unlike any other disorder under the Structural Dissociation spectrum. [7]:243-493 [12]:121-238

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 criteria B-D describe another variety of other specified dissociative disorder all together, and if the individuals that fit these criteria are all victims of childhood trauma, it is yet unknown. This type of disorder includes adults or older children who are long term political prisoners, recruits into cults or terror organizations, prisoners of war, kidnap, 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) washing and thought reform victims; all of whom can form temporary states. They symptoms can express themselves at anytime, but it's been hypothesized that this disorder if it ever shows itself, did exist in childhood. [7]:243-493Borderline personality disorder (BPD) is the third mental disorder considered under the umbrella of secondary Structural Dissociation. The disorder itself is not caused by Structural Dissociation, but in some individuals with borderline personality disorder there is a great deal of trauma, and the trauma memories build up, and it's at this point that Structural Dissociation occurs. It's important to note that this disorder comes first, and is followed by the Structural Dissociation. [12]:3-120

The final level of complexity is called tertiary Structural Dissociation, and only dissociative identity disorder is thought to exist in this realm. [5] The reasons are as complicated as the disorder, but to put it in simple terms, it's the fact that 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. [12]:3-120 [1] [5] Like other specified dissociative disorder, dissociative identity disorder has at least two less than distinct states (EP) and usually many more. [12]:3-120 [1] [5] 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 throughout the next "phase of childhood" there are massive changes to the brain and mind. [10] [12]:1-190 The individual with dissociative identity disorder is altered severely, and they are no longer like the person they were genetically born to be. [12]:3-120 [7]:243-493 There are always two or more EP in individuals with dissociative identity disorder due to the overwhelming trauma memory content and volume, and if an EP carries too many trauma memories then a new EP is created to hold trauma memories. [12]:3-120 The mind and brain work in unison to keep those memories from the ANP's so the individual can survive. [12]:3-316 [5] The ANP are disturbingly phobic of the trauma memories, even though they don't "act" like it, which is due to a strong boundary between the ANP and the trauma memories. The ANP's seem strong and confident, but that is far from reality.

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}}

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}}

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)
  • Disorder: dissociative identity disorder (DID)

Structural Dissociation explained using examples

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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 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. 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 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 part" (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. [5]

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, [13] and borderline personality disorder and otherwise specified dissociative disorder (OSDD). [5] 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. [5]

  • 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. [14]: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. [5]

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 attachment. 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. [5]

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. [5]

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. [15] 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, 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 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}} 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. [5]

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.

Dissociative boundariesA dissociative boundary separates dissociated states. <ref name=Spiegel2011/> <ref name=DSMIV/> <ref name=DSM5Deskref/> {{See also | Amnesia}}

PierreJanet.jpg

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. [16] Without their work the contributions made by the man behind all this, Pierre Marie Félix Janet would have probably been lost. [5] 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. [6] (Dorahy, 2014) [17] 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. [14]: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. [8] 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. ([14]:3-26 [4]

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. [18] [6]

Vignette of the 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 name=ISSTD.org/> 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. [19] [20] 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. [5] [15] It's not how much a child was abused that matters. It's when and how. [21] [22] [23] 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.

An example explaining Chart C

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. [24] Eve's brain would need to react in one of three ways as seen in the chart: flight, freeze or fight. [24] 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.

Van-der-Hart-2008.jpg

Trauma interfering with the normal integrative process (Chart A)

The 3 charts on this page were taken from an oral presentation in 2008 at an ESTD conference presentation by Onno van der Hart and adapted to show updates to the theory and other aspects of Structural Dissociation than the original chart showed.

Chart A shows how trauma interferes with the integrative developmental process that occurs after Structural Dissociation takes place. Look at the left side of the chart which shows the activity of the EP in a single ANP/EP life system. "Seeking" means that the EP are seeking out information. [7]:29-50 [8] The box below the one marked seeking is "play." This box indicates the minds need for input. If the individual is scared while watching a horror flick, then the EP will get a signal that the individual is scared, but not threatened, and it will be on alert, but will not come forward. [8] "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}} to caretaker" is very important, and it might seem out of place, but it's really perfectly set. [8] [7]:29-50 If during childhood an attachment with a primary caregiver was not obtained, then the individual is going to react differently than someone that did form an attachment with their caregiver. [8] Why is unknown, but many researchers think it's because the part of the brain needed to process this information was never developed, and the individual cannot develop this as an adult. [8] [7]:51-68 At the bottom of the chart, there is again a box marked "seeing;" the individual's mind is seeking input from the brain. [8] [7] The brain cannot give the mind what it needs right now, and so the mind keeps seeking until it finds something and when it does, it's old unprocessed trauma. [8] [7] [5] [25]

The process of Structural Dissociation (Chart B)

B-structural-dissociation.jpg

Chart B explains the actual process of Structural Dissociation. The top of the chart indicates an individual with a normal personality, but the mind of this individual holds trauma memories it has not yet dealt with. A new trauma event begins and this, along with the other unprocessed trauma overwhelmed the mind; the mind is seeking help, but the brain does not respond. The EP gives up and stops seeking, and it attempts to interacts with other parts of the personality systemAll states that make up the personality in an individual., which is what is meant by the "play box". All the EP finds is a highly phobic ANP, which creates a dissociative boundaryA dissociative boundary separates dissociated states. <ref name=Spiegel2011/> <ref name=DSMIV/> <ref name=DSM5Deskref/> {{See also | Amnesia}} around itself to keep the EP from interacting with it. If the infected individual, as a child, was able to form a secure attachment with a caregiver, then the part of the brain which is needed at this point is available and Structural Dissociation will not take place. If the individual never did develop an attachment with a primary caregiver, then the individual moves to the next step and again is seeking. This time the EP is seeking anything at all, and looks to the mind for input, but the mind is still busy attending to the trauma situation that the individual is experiencing. Next the EP looks to the brain for input and gets nothing. It is this point when Structural Dissociation takes place. Now the cycle keeps repeating itself as shown in Chart A, but the actual process of Structural Dissociation only ever takes place one time.

The never ending trauma cycle of an ANP/EP life system (Chart C)

Van-der-Hart-2014.jpg

Chart C shows the never ending trauma cycle of an ANP/EP life system. First look at the path of the ANP. The top right corner of the chart refers to Stephen W. Porges' polyvagal theory, [13] [13] and the additions to Porges' theory which were contributed by Lanius, Paulsen and Corrigan, as reported in their recent book. This is a great topic in itself, but suffice to say, it's beyond the scope of this page. When there is overwhelming fear the brain responds in at least one of five ways: flight, fright, freeze, faint, fight. [7]:29-50 If the brain freezes then Structural Dissociation could likely be imminent. [8] There are not a lot of circumstances where the body literally is unable to move, but when this happens the individual is usually in a near death experience. [8] [14] If they survive, and they had past trauma that they were unable to process, then it's very likely they will obtain Structural Dissociation. [7] Whatever the route is, when enough unprocessed trauma builds up, then Structural Dissociation takes place. This is indicated by the "hour glass," and the box that says, "play." Play refers to neuronal action that is responding to both new and old unprocessed trauma. Once Structural Dissociation takes place the ANP's will keep repeating the cycle of flight, freeze, fright, freeze, faint, fight in response to neuronal play, and neuronal play in response to flight, fright, freeze, faint and fight. [7]:29-50 Now look at the left side of the chart which shows the activity of the EP. The box "seeking" means that the EP is seeking out information. Which type of information depends on what is happening at any given moment. If the individual is hurt, and relatively helpless, then the EP will respond quickly. [7]:29-50 [5] [8] If the individual is scared while watching a horror flick, then the EP will get a signal that the individual is scared, but not threatened, and it will be on alert, but will not come forward. [8] If the EP is needed and responds, then the neuronal reaction is to act, and the part of the brain that reacts comes into play. [8] [7]:243-340 This is what the box "play" means in this regard. The next box, "attachment to caretaker," is very important. It seems out of place, but it's really perfectly set. [8] [7]:29-50 If the individual's brain is reacting to a threat, and if the individual, during their childhood, did not obtain an attachment with a primary caregiver, then they are going to react differently than someone that did form an attachment with their caregiver. [8] [7]:29-50 Why is unknown, but researchers tend to think it's because the part of the brain needed to process this information was never developed, and the individual cannot develop this as an adult. [8] [7]:51-68 What's done is done. Beyond this point, this chart is no longer about posttraumatic stress disorder and complex-posttraumatic stress disorder. [8] [5] Notice that the next box says "seeking," which the mind is doing once again as the individual's mind seeks input from the brain. [8] [7] The brain is overwhelmed, however, and it is malfunctioning. [8] [7] [14] It cannot give the mind what it needs right now, and so the mind remains seeking, and when it finally finds something, it's trauma. [8] [7] [5] [14] It's not new trauma; it's old material that was never processed. [8] [7]:131-212 [14] The mind desperately tries to get the brain to give it what it needs, but the brain is overwhelmed and cannot at that time. What is going on at the moment is too overwhelming for the brain to literally manage. Later, when the event has calmed down, then, and only then, can and will the brain send the information to the mind that it's been signaling for. [8] [7]:131-212 [14]

Let's look at some more details about the brain and mind relationship during trauma. The mind keeps something akin to a list of things it has to do, and that list can pile up. Depending on an individual's relationships with their perceived environment, the traumas not on the "workload list" of the mind will either be processed or put on a "waiting list. These lists are important to human survival because immediate threats must be dealt with immediately, rather than having the mind lost in the past, instead to present danger. [8] [25] As explained at the top of this page, Structural Dissociation is literally a "split" of the personality resulting in two divisions. One division will be isolated from trauma memories and will attend to the normal activities of daily life, while the other division will hold all accumulated trauma memories. [1] [5] [8] If traumatic events continue then the portion of the personality that isolates trauma memories can change and EP will be created to help the mind deal with continued traumas. [1] [8] 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". [26] [1] They will not show up on an fMRI scan as a distinct part. [1] The most complex form of 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] [6]

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Other branches of the Trauma and 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}} Project

Dissociative Identity Disorder.org is a multi-authored peer written site, reviewed by a health care professional.

References

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