Structural Dissociation of the Personality History

Integration is at the core of the theory of structural dissociation. Pierre Janet "characterized mental health in terms of the capacity for differentiation and integration" ^[1]:2. In other words, the ability to see the 'big picture' and the ability to not over-generalize things. Dissociation happens when experiences get too overwhelming they cannot be integrated directly. It may take a while (the more overwhelming or traumatizing the experience, the more difficult it is to integrate and it may never succeed.

EP and ANP - origins

An EP ("emotional" part) is the part that takes the trauma. Sometimes, it is still 'stuck' in trauma, but it may also be able to function in daily life (in the case of DID). It does not remember the trauma like a story, like a personal history, but rather like it happened at exact that moment (flashback). When such a memory comes back, the whole event is re-experienced like before. Memories can still have some small inconsistencies.^[1]:5-6. See also amnesia.

An ANP ("apparently normal" part) is (usually) not (much) aware of the trauma or is detached from the trauma (feels no connection to it).

The ANP is not always that "apparently normal". Some are indeed as if there's nothing wrong. The consequences of the trauma (like amnesia and lower level of functioning) are well hidden or not that strong/obvious. But others may have far more problems with amnesia and continuing intrusions by the EP(s). ^[1]:2-3,6-7.

Primary structural dissociation - Acute Stress Disorder and simple Posttraumatic Stress Disorder

In simple PTSD, the EP is originally the collection of memories that could not be integrated into the core person. A part of the personality has been dissociated. The memories were too heavy to integrate. This EP may get a rudimentary sense of self. ^[1]:2-3,5 In complex PTSD the EP is divided further^[2]. This was first described by Myers (1940) in his studies of acutely traumatized World War I combat soldiers.^[2]

Secondary structural dissociation - complex PTSD, Disorders of Extreme Stress and OSDD

There remains a single ANP, but there are several Emotional Parts Complex PTSD (also known as Disorder of Extreme Stress, DESNOS) and Other Specified Dissociative Disorder (formerly known as DDNOS).^[2] This is also the case in trauma-related borderline personality disorder. The EPs can include freeze responses such as analgesia (inability to feel pain) and anesthesialoss of sensory awareness; all sensory modalities, touch, kinesthesia, smell, taste, hearing, vision. {{Rp|261-262}} A negative symptom of somatoform dissociation (loss of a physical ability) (numbness/loss of feeling).^[2]

Tertiary structural dissociation - DID

In Dissociative Identity Disorder, there is no 'core', or unified sense of self, to begin with. ^[3] In childhood, there was no single, unified personality. Children start out basically separated. They do not have an integrated personality yet. Up until roughly the age of seven, children integrate the different personality states they have until they have one, unified personality. Before that, they can forget from one moment to the next what they were doing. Early insecure attachment to the primary caregiver, particularly disorganized attachment, increases the likelihood of a child having dissociative reactions to later trauma, creating a pathway to trauma-related disorders including DID.^[4]:17

When trauma occurs, this integration may fail if the child does not have a secure attachment - most commonly this is due to neglect or abuse.^[4]:17 The different parts then develop separately and each can later form into a separate sense of self (in varying degrees of complexity). The distinction between EP and ANP is now more blurred, because there was no part that was split off (as EP) to begin with, and all can have different levels of traumatization. ^{(citation needed)}

But what is such a part, exactly? Difficult to explain (read the references for a complete explanation), but basically, it are what are called "action systems". Psychobiological systems that execute various tasks in daily life. For example, systems "that control control attachment of offspring to parents, parental attachment to and care for offspring, exploration, and play". In simple PTSD, an action system of fear can be split off. In Dissociative Identity Disorder, there can remain a divide between these action systems. (See also: ego states). ^[1]:7-10

References

1. ^ a b c d e Nijenhuis, Ellert R.S.. Trauma-related structural dissociation of the personality. retrieved on 28 January 2014
2. ^ a b c d Nijenhuis, E.R.S., Van der Hart, O. & Steele, K.. David Baldwin's Trauma Information Pages: Trauma-related structural dissociation of the personality. Trauma Information Pages. retrieved on 29 January 2014
3. ^ Middleton, Warwick. Owning the past, claiming the present: perspectives on the treatment of dissociative patients.. Australasian Psychiatry, volume 13, issue 1, page 40-49. (doi:10.1111/j.1440-8.x)
4. ^ a b Liotti, Giovanni. Trauma, Dissociation, and DisorganizedAttachment: Three Strands of a Single Braid. Psychotherapy: Theory, research, practice, training, volume 41, issue 4, page 472-486. (doi:10.1037/0033-3204.41.4.472)