Trauma-related Structural Dissociation of the Personality

Abstract

Many traumatized individuals alternate between re-experiencing their trauma and being detached from, or even relatively unaware of the trauma and its effects. At first sight one may be inclined to conceptualize detachment from trauma and reexperiencing of trauma as mental states. However, on closer scrutiny it becomes apparent that in both cases a range or cluster of states rather than a singular state is involved. For example, being detached from trauma does not itself exclude being joyful, ashamed, sexually aroused, or curious at times, and re-experiencing trauma can encompass states such as fleeing, freezing, and being in pain or being analgesic. In this paper we relate detachment from trauma and reexperiencing trauma to emotional operating systems (Panksepp, 1998) and functional systems (Fanselow & Lester, 1988), briefly addressed as action systems. Action systems control a range of functions, but some are more complex than others. Reexperiencing trauma will be associated with the inborn and evolutionary derived defensive system that is evoked by severe threat, in particular threat to the integrity of the body. As a complex system, it encompasses various subsystems, such as flight, freeze, and fight. Detachment from trauma, in our view, is associated with several action systems (Panksepp, 1998), i.e., the ones that control functions in daily life (e.g., exploration of the environment, energy control), and the ones that are dedicated to survival of the species (e.g., reproduction, attachment to and care for offspring). In this context we will maintain that severe threat may provoke a structural dissociation of the premorbid personality ( . In its primary form this dissociation is between the defensive system on one hand, and the systems that involve managing daily life and survival of the species on the other hand. To summarize the essence of the theory of structural dissociation of the personality, we argue (1) that traumatic experiences, especially when they occur early in life and involve severe threat to the integrity of the body, may activate psychobiological action systems that have been developed by evolution, and (2) that due to extreme stress levels and classical as well as evaluative conditioning to traumatic memories these systems may remain unintegrated to varying degrees.

Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder

“…These symptoms thus suggest a causal relationship with this adversity. Indeed, sensorimotor dissociative symptoms were moderately to strongly correlated with reported adverse events, and in particular threat to the body and life itself, in every study with the Somatoform Dissociation Questionnaire (SDQ-20; Nijenhuis et al 1996;Nijenhuis 2009). The correlation was not mediated by absorption (Näring and Nijenhuis 2005), and existed in a variety of populations and cultures (e.g., Van Duijl et al 2010).…”

“…Sensorimotor dissociative symptoms strongly correlate with cognitive-emotional dissociative symptoms (Müller et al 2010(Müller et al , 2013Nijenhuis 2009), and PTSD symptoms (Nijenhuis et al 2004;Schild and Dalenberg 2012). Cognitive-emotional and sensorimotor dissociative symptoms, PTSD symptoms, and reported adverse events were all negatively correlated with the hippocampal and parahippocampal gyrus volume (Ehling et al 2008).…”

Trauma, Dissociation, and Chronic Shame – Reflections for Couple and Family Practice: An Interview with Kathy Steele

“…In the structural theory of dissociation, some parts are focused on everyday living and daily functioning, and other parts are stuck in trauma time, focused on defence (fight, flight, freeze, and faint) in the face of threat (van der Hart et al, 2006;Nijenhuis et al, 2010). The more severe the trauma and the younger the developmental age, the more parts may develop: the structure of the personality may develop primary, secondary, or tertiary dissociation, which have respectively an increasing number of dissociative parts.…”

“…She has written many books and articles, won numerous awards, and is a sought-after speaker, consultant, and clinical expert. Her extensive work includes the co-development of The Structural Theory of Dissociation, which posits dissociation as a structure of the personality (van der Hart, Nijenhuis, & Steele, 2006;Nijenhuis, van der Hart, & Steele, 2010). In addition, Steele has highlighted the limitations of 'top-down' cognitive talk-therapy and emphasised the importance of somatic 'bottomup' approaches, given that many traumatic memories are somatosensory, that is, held in the body as internal sensory experience (Steele, Book, & van der Hart, 2016).…”

Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders

“…Patients with PTSD generally experience increased levels of dissociative symptoms compared to trauma-affected people without PTSD (Carlson, Dalenberg, & McDade-Montez, 2012; Dorahy & van der Hart, 2015), while a dissociative subtype of PTSD patients (DPTSD) is characterized by pervasive symptoms of derealization and depersonalization and often related to childhood abuse (Lanius, Brand, Vermetten, Frewen, & Spiegel, 2012; Lanius et al, 2010). In addition, PTSD symptoms such as flashbacks and trauma-related amnesia are regarded by many theorists as dissociative phenomena (Dell, 2006b; Frewen & Lanius, 2015; Nijenhuis, Hart, & Steele, 2010). Patients with dissociative disorders, which are characterized by pervasive and severe dissociative symptoms, almost invariably also suffer from PTSD, with comorbidity rates from 88% to 97% (Foote, Smolin, Neft, & Lipschitz, 2008; Rodewald, Wilhelm-Göling, Emrich, Reddemann, & Gast, 2011).…”