Structural Dissociation of the Personality

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Structural dissociationStructural dissociation (SD) is one of the three accepted models for the etiology of dissociative identity disorder. <ref name=HauntedSelf/> <ref name=Dell2009/>{{Rp|158-165}} {{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 is an elaboration of accepted theories brought forth by a multitude of experts on the subject of trauma and dissociation [1] and explains 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/> {{See also| Etiology}} and expression that results from a lack of integration in the personality. [2]:4

Primary, secondary and tertiary structural dissociationStructural dissociation (SD) is one of the three accepted models for the etiology of dissociative identity disorder. <ref name=HauntedSelf/> <ref name=Dell2009/>{{Rp|158-165}} {{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.

  • 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" (ANPAn alter who often acts as the host, does not hold trauma memories (has amnesia for trauma). Dissociative identity disorder is the only mental disorder where an individual can have two or more ANP. <ref name=HauntedSelf/> A term used for the part that often acts as the host alter in individuals with dissociative identity disorder according to the model of structural dissociation. {{See also| structural dissociation}}) and one "emotional partAn alter (or identity fragment) whose main job is to hold unintegrated trauma memory. A term used in structural dissociation. <ref name=HauntedSelf/>{{Rp|38-39}}" EPAn alter (or identity fragment) whose main job is to hold unintegrated trauma memory. A term used in structural dissociation. <ref name=HauntedSelf/>{{Rp|38-39}} 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 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. [2]:6-8

    Developmental pathways

In primary structural dissociation, childhood 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. (see multiple) <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 and disorganized attachment, the child may not be able to integrate, resulting in a dissociative disorder. <ref name=Howell2011/>{{Rp|143}} As an adult, when therapy is sought out, an individual who has unresolved trauma and lacks integration, can finally get the help needed to process the trauma memories, which needs to be done prior, and to finally [integrate the alters making up the ersonality into one unified self. <ref name=Noricks2011/>{{Rp|141-144}} 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 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}}, 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 splitting1. In dissociative identity disorder - the part of the personality that will take abuse already exist in a child inner world (see inner world). What occurs is an ongoing separation of parts, rather than a "split or fracture" of one part from another. <ref name=Howell2011/>{{Rp|87-88}} The term "splitting or fractured" used when describing dissociative identity disorder is a misnomer. For example: a child on the ceiling watching a disturbing event, has not "split off" from the part of the personality that is enduring that trauma event, however the individual might develop Acute Stress Disorder (ASD) or posttraumatic stress disorder (PTSD). In dissociative identity disorder a long history of chronic abuse is almost always present, as well as the child typically having a disorganized attachment with their caregiver(s). <ref name=Dell2009/>{{Rp|302-306}} <br />2. Not in DID - Viewing oneself or others as being all good or all bad, common in borderline personality disorder. A psychological defense mechanism.<ref name=Seligman2004/>{{Rp|121}} {{See also| Borderline personality disorder}}, 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 dissociationFull 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 alters, which is a <ref name=Dell2009/>{{Rp|228}} criteria for a diagnosis of Dissociative Identity Disorder in the DSM. {{See also| Dissociation}}

In all forms of structural dissociation there can be full or partial dissociationThis is not limited to those with dissociative identity disorder. Parts of the [[personality]] influence each other, whether they are aware of others or not. Any part may intrude on, and influence the experience of the part that is functioning in daily life, without taking full control of functioning. <ref name=Boon2011/>{{Rp|27}} In dissociative identity disorder dissociative symptoms are felt when one alter intrudes into the experience of another. Intrusions occur in perceptions, ideas, wishes, needs, movements and behaviors. <ref name=Boon2011/>{{Rp|18}} In partial dissociation, amnesia is not present. <ref name=Dell2009/>{{Rp|228}} [[Dissociated|Switching]] is not equivalent to amnesia. <ref name=Dell2009/>{{Rp|228-229}}.

  • 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"specific, unconscious, intra-psychic adjustment that occurs in order to resole emotional conflict and to reduce an individual's anxiety. A mental mechanism, an ego defense mechanisms, or an adjustive technique."<ref name=Hook2004/>{{Rp|97}} 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, 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}}, 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 denialPsychology - Defense mechanism in which the existence of unpleasant realities is disavowed; refers to keeping out of conscious awareness any aspects of external reality that, if acknowledged, would produce anxiety <ref name=Sadock2008/>{{Rp|24}}Crime - "various processes by which individual actors, social groups or states either 'block, shut out, repress or cover up certain forms of disturbing information [about wrong doing] or else evade, avoid or neutralize' its consequences (Cohen, 1995, 19)" Refers to the denial of a perpetrator of a crime, for example denying the crime or the impact of the crime, denying the victim, counter-attacks and appealing to "higher loyalties".<ref name=CrimeDict/>{{Rp|125}}, disavowal, and projectionUnconscious defense mechanism in which persons attribute to another unconscious ideas, thoughts, feelings, and impulses that are in themselves undesirable or unacceptable, as a form of protection from anxiety arising from an inner conflict; by externalizing whatever is unacceptable, they deal with it as a situation apart from themselves <ref name=Sadock2008/>{{Rp|29}}.

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. ISBN 978-0-393-70401-3. NewYork: W.W. Norton
  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)