Structural Dissociation of the Personality

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Structural dissociation of the personality is an elaboration of accepted theories brought forth by a multitude of experts on the subject of trauma and dissociation [1] and explains the etiology and expression that results from a lack of integration in the personality. [2]:4

Primary, secondary and tertiary 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 EP. <ref name=HauntedSelf/>{{Rp|5-7}} {{See also| Structural dissociation}} consists of the DSM-5 disorders of PTSD and simple dissociative disorders. 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. [3] [2]:6-8
  • Secondary structural dissociationDDNES and borderline personality disorder are examples. <ref name=HauntedSelf/> An individual with secondary structural dissociation will usually have one ANP and more than one EP. <ref name=HauntedSelf/>{{Rp|5-7}} {{See also| 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 less elaborate and autonomous than in tertiary structural dissociation. Ccomplex (chronic) PTSD, other specified dissociative disorder and borderline personality disorder make up this category. [2]:6-8
  • 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 EP. <ref name=HauntedSelf/>{{Rp|5-7}} <ref name=Hart1996/> is reserved for dissociative identity disorder which also has two or more EP, but this is the only disorder with more than ANP. Many of the parts will often be elaborated and autonomous, and in fact they often have their own sense of self, own name, gender and preferences. [2]:6-8

    Developmental pathways

In primary structural dissociation, childhood integration is assumed. [2]:7 Secondary and tertiary structural dissociation, on the other hand, result from chronic and early traumatization in childhood resulting in integration deficiencies. [2]:7

Normal integration - No structural dissociation of the personally

An individual is not born with a unified personality, but instead infants havebiological determinants that integrate through a process of experience andrelationships. There are four autonomic emotional systems (anger, pleasure, sadness, fear ) thatare present at birth, and they integrate to develop a task and emotional lifesystem.

Tertiary structural dissociation (TSD) example: DID

Type III (infant to early childhood traumatization) 2 or more ANP, 2 or more elaborate, emancipated and distinct EP In TSD an infant is traumatized prior to integration of the autonomic emotional systems, which then results in structural dissociation. This is not splitting, but instead is a lack of integration. Emotional traumatized parts in these overwhelmed infants become separate EP - small emotional systems that stay in trauma time and are void of EP integration. In TSD emotional systems will also developseparately as ANP - EP task and emotional action systems. The four autonomic emotional systems can partially integrate with each other. For example, anger and pleasure integrate, and sadness and fear integrate resulting in two ANP - EP action systems. Over time those systems become more dominant eventually resulting in autonomic functioning ANP - EP actionsystems. In TSD, if the current systems can't handle the EP load then more ANP can be created.

Secondary structural dissociation (SSD) example: complex PTSD, OSDD

Type II (childhood traumatization)1 ANP, 2 or more semi-elaborate EP SSD can result instead of TSD when there has been sufficient integration in early life. In this case structural dissociation results in only one ANP, but as with TSD there are always two or more EP, however the EP in SSD are less elaborate, emancipated and distinct than in TSD.

Primary structural dissociation (PTSD, simple dissociative disorders)

Type I trauma (post childhood) 1 ANP, 1 primitive EP In this case the personality sufficiently integrated early in life, but later when a trauma occurs that cannot be integrated then structural dissociation occurs resulting in one ANP and one primitive EP.

Partial and full dissociation

In all forms of structural dissociation there can be full or partial dissociation.

  • Example of full dissociation is when the ANP doesn’t remember a thing of the traumatizing experience
  • Example of partial dissociation is when the ANP can remember parts of the traumatizing experience but it doesn’t feel real, or that it is their own experience. The EP holds a part of the traumatizing experience.

Parasympathetic nervous system and limbic systemA group of interconnecting pathways and centers in the brain that includes the hippocampus, hypothalamus, amygdala, paraolfactory area and epithalamus among the subcorticial structures, and the portion of the cortex which includes hippocampal gyrus and the orbitofrontal area. - assumed to play an important role in emotion, motivation and memory. <ref name=Basavanna2000/>{{Rp|232}}

The parasympathetic nervous system and the limbic system are what actually convey feelings from the body to the brain and from the brain to the body. Without those you would never have actually had the feelings that needed to be dissociated.

Action Systems: mediators of ANP and EP

In response to trauma an ANP becomes phobic of trauma and fixated on the routine activities of daily life. [4] As both defense and daily living goals are required for long periods of time a rigid division of the personality between ANP and EP is created to deal with the discrepant goals of daily life and defense. [2]:4 An action system is a term to describe the goal of ANP which is daily life, and of EP who is dedicated to defense.

  • ANP's action system typically take on the tasks of reproduction, attachment, caretaking, and exploration. They are fixated by the action systems of daily life. [4]
  • EP's action system is to avoid or escape adverse stimuli and perceived threat. They are fixated in the action systems activated at the time of traumatization, such as sexuality and defense. [2]:3-4,31-40
Action systems regulate action tendencies such as walking and speaking. Both ANP and EP might share an action tendency, but each will still be stuck in their own goal oriented behavior: daily life or defense. [4][2]:3-4
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Hierarchy of action tendencies

Action tendencies are ordered as low, intermediate and high, and are used in clinical practice to help to understand which actions need to be improved upon For example, an individual may be unable to finish something because they lack "mental energy" - the ability to focus energy. [2]:9, 169-170

Maintenance of structural dissociation of the personality

Structural dissociation is maintained by many factors, but most importantly when ANP is phobic of an intruding EP the problem cannot resolve. Utmost is the phobia of integration (synthesis) and the full realization of the traumatic experiences. While an individual is afraid of their inner life they cannot integrate it. [5] EP can also become phobic of ANP if ANP is perceived as harming, ignoring, or neglecting the EP. [2]:13-14,301-353

Integrative capacity

Mental level (integrative capacity) is the ability to focus and use available mental energy in any given moment. [2]:9-10

Mental health is characterized by a strong capacity to integrate.

Integration is important to daily functioning, and it takes the highest levels of mental energy and mental efficiency for the process. [5]

Adverse behavior

Traumatized individuals often indulge in adverse behavior including eating disorders, alcohol abuse, drug abuse, harm to their bodies, compulsions, and physical agitation. The overwhelming emotions of an EP can also be seen as adverse and lead to profound denial, disavowal, and projection.

References

  1. ^ ESTD conference Levels of structural dissociation of the personality.
  2. ^ a b c d e f g h i j k l van der Hart, Onno (2006) (coauthors: Ellert, Steele). The Haunted self : structural dissociation and the treatment of chronic traumatization. NewYork:W.W. Norton.ISBN 978-0-393-70401-3.
  3. ^ van der Hart, Onno; Nijenhuis, Ellert R.S.; Steele, Kathy. Dissociation: An insufficiently recognized major feature of complex posttraumatic stress disorder. Journal of Traumatic Stress, volume 18, issue 5, October 2005, page 413–423. (doi:10.1002/jts.20049)
  4. ^ a b c Nijenhuis, Ellert. TRAUMA -RELATED STRUCTURAL DISSOCIATION OF THE PERSONALITY. retrieved on 26 April 2014
  5. ^ a b Steele, Kathy; van der Hart, Onno; Nijenhuis, Ellert R. S.. Phase-Oriented Treatment of Structural Dissociation in Complex Traumatization: Overcoming Trauma-Related Phobias. Journal of Trauma & Dissociation, volume 6, issue 3, 13 September 2005, page 11–53. (doi:10.1300/J229v06n03_02)