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Terminology related to Dissociative Disorders

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Trauma terminology related to Dissociative Disorders. As per this sites guidelines, the terminology used is up to date.

The literature on trauma and dissociation is complicated, and it has a long history, and although there is an inherent verbal confusion due to this, here in this "Trauma and Dissociation Wiki" an attempt to offer the newest and most precise definitions of terms, as they relate to trauma and dissociation will take precedence. For instance, take the word consciousness, which is used interchangeably with terms like personality, mind, psyche and ego to explain specific dissociative phenomena. [1]:3-4 In this wiki we will use the words as they are most recently used in relation to trauma and dissociation.

  • Alter (Altered States of Consciousness)
Exchangeable terms include parts, states, identities, selves, or ego states. An alter is present only in those with Dissociative Identity Disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. [2]:55-67 Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. [2]:55 An individual with Dissociative Identity Disorder may have few or many alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and communication can be limited to one direction. (one way amnesia) [1]:301
  • Alter Creation: Alters are created over time, it is not an instant "splitting" that produces an alter. (see splitting) When a very young child, who has been severely and constantly abused contains their abusive experience (trauma memories) in compartmentalized states, then alters can result. [3] (see types of alters)
    Amnesic Boundary (Dissociative Boundary)
Interidentity Autobiographical Amnesia must be present, and obvious, in at least two alters to meet the DSM criteria for Dissociative Identity Disorder. It is the dissociative boundary that separates alters resulting in a lack of communication. [4] [5] [6]
  • Antagonism
Alters often have opposing views due to compartmentalization, allowing contradictory beliefs and ideas to exist together. Early in life, traumatic dissociated experiences were not internalized, which can also lead to antagonism between alters. [2]:56-57
The APA is a scientific and professional organization that represents psychologists in the United States. The American Psychiatric Association publishes the DSM. (see DSM) [5] [6]
The 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." [7]: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) [8] [9]:85 [2]:97
► Reactive Attachment Disorder (RAD)
The only attachment disorder listed in the DSM.
  • Betrayal Trauma Theory (BTT)
Betrayal trauma theory reports that a negative event enacted by a primary caregiver will influence how events are processed and remembered. The child is more likely to recall abuse by a stranger than by a caregiver. [3]
  • Brain
The 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. [10]:9 (see attachment)
When two or more alters share the same mental, affective and/or perceptual space at the same time. This does not mean that the alters are behaving as one. [2]:187 In Dissociative Identity Disorder coconsciousness can be experienced in various ways.
► Consciousness: The internal state of knowing that something is happening in the present moment. [10]:9 In Dissociative Identity Disorder awareness of other alters varies with each alter. Some alters are fully aware of all others, and some are only aware of themselves. [11]:26
► Coparticipation: When therapy consists of several alters participating together. [2]:187-201
  • Core or Original
Siegel calls the core of all individuals their "suchness", and goes on to say that the core is the part that is "beneath narrative and memory, emotional reactivity and habit." [12]:208-209 This is a complicated subject, but the core is not what other parts "split" from. It's not that simple. Many also incorrectly assume the host is the core. [2]:59 [9]:80, 87-88 (see personality and alters) (see personality)
Dissociation is a compartmentalization of experience, where elements of a trauma are not integrated into a unified sense of the Self. [1]: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. True or pathological dissociation requires an experiencing Self. [1]:233-234
► Full Dissociation (switching): Full dissociation is when an alter switches with the alter currently in executive control, resulting in amnesia for that alter. (see executive control) [2]:4-6 In full dissociation, there is complete amnesia between alters, which is a [1]:228 criteria for a diagnosis of Dissociative Identity Disorder in the DSM.
► Partial Dissociation (Intrusion): This 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. [11]: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. [11]:18 In partial dissociation, amnesia is not present. [1]:228 Switching is not equivalent to amnesia. [1]:228-229
► Switchy: A term used by some with Dissociative Identity Disorder to describe a feeling that a switch to another alter is about to occur, or switching between alters happens frequently.
(see amnesic boundary)
► Dissociative Amnesia: (DA) Previously called psychogenic amnesia is a form of temporary amnesia that presents often in traumatic situations; for example in car accidents or victim or witness of a violent crime. Dissociative Amnesia is described in the DSM as a disorder that causes significant distress or impairment in functioning, such as when a person cannot remember significant events that happened to them. [13]
■ Dissociative Fugue: A temporary loss of personal identity due to trauma, reclassified as Dissociative Amnesia within the DSM-5. Dissociative Amnesia includes Dissociative Fugue as a subtype, since fugue is a rare disorder that always involves amnesia, but does not always include confused wandering or loss of personality identity. [5] [6] [14]
► Depersonalization Disorder: A sense of detachment from the Self. Depersonalization Disorder includes derealization, since the two often co-occur. [14]
► Dissociative Disorders Not Elsewhere Specified (DDNES): Dissociative Disorder Not Elsewhere Specified replaces DDNOS in the DSM-5. The DSM-IV TR gives four situations where a NES category is appropriate: 1.) symptoms are below the criteria for a diagnostic threshold. 2.) symptoms cause distress, but do not adhere to a specific pattern. 3.) etiology is unclear. 4.)incomplete symptom collection by the therapist. [5]:4
■ DDNES type 1: This encompasses "partial forms" of Dissociative Identity Disorder. [1]:415 The distinction between Dissociative Identity Disorder and not elsewhere specified in the DSM can be made either on the basis of presence/absence of amnesia and having or not having two or more distinct parts. Dissociative Identity Disorder has to have both; lacking amnesia, the individual is diagnosed as not elsewhere specified. [1]:386
► Dissociative Identity Disorder (DID) : According the DSM, Dissociative Identity Disorder is a disorder of mental states, where a individual has amnesia due to switching. [1]:319-321 (see overt)
■ Overt (or florid): This is the criteria for Dissociative Identity Disorder in the DSM. 1.) Some type of amnesia must be present. The DSM does not specify how frequent or extensive, or if it means present day amnesia or childhood amnesia. [1]:419 2.) Spontaneous complete switching. [1]:419 Individuals with overt or florid Dissociative Identity Disorder present with dramatic alters and full dissociation when switching. [8] These florid presentations occur in only about 5 % of patients with Dissociative Identity Disorder. [15]
■ Polyfragmented Dissociative Identity Disorder: Most individuals with Dissociative Identity Disorder have less than a dozen alters, however the far end of the spectrum is those individuals who are polyfragmented, having many alters which are subdivided into subsystems. [2]:57 "In general, the complexity of dissociative symptoms appears to be consistent with the severity of early tramatization." [16] In a polyfragmented system the alters are broken into subsystems (see systems) as a method of self-preservation and organization of trauma memories. Polyfragmentation often develops in children who suffered very early (as an infant) and extreme abuse, either at home or from ritual abuse.
■ Covert Dissociative Identity Disorder:DES scores are lower in those with covert Dissociative Identity Disorder than with overt Dissociative Identity Disorder. These individuals are skilled at hiding overt symptoms. The overwhelming majority of individuals with Dissociative Identity Disorder have this version. [1]:424
■ Subtle Dissociative Identity Disorder: Less frequent and severe dissociation than individuals with either overt or covert Dissociative Identity Disorder. [1]:424
  • DSM (Diagnostic and Statistical Manual of Mental Disorders)
Published 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. [5] [6] [1]:384
  • EMDR (Eye Movement Desensitization and Reprocessing)
A valid psychotherapeutic approach for treating trauma. [17] [13]
The study of the cause of a disorder or disease. In the case of Dissociative Identity Disorder, early and severe childhood abuse and disorganized attachment is considered to be the cause. [13] (see alter, cause)
  • Executive Control (Alter in Control of an Individual)
The alter that has control of an individual at the moment has executive control, and the alter most often in executive control is commonly called the host alter. [11]:27
A 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. [10]:30
  • Front (fronting)
A 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)
A basic, but important skill for those with Dissociative Disorders. which allows an individual to feel less spacey, foggy, fuzzy, or without realizing it, experience past negative feelings. [11]:4-6
  • Hyperaroused (hypervigilant)
A pattern presenting with fight or flight reactions is common in individuals with unprocessed trauma memories. [11]:217
  • Hypoaroused
To cope with and avoid feeling that are both internal and external. [11]:221 The hypoaroused individual appears detached, avoidant, unemotional, exhibiting numbing, analgesia, derealization, depersonalization, catatonia and fainting, along with low heart rate, bradycardia." [2]:113
  • Hysteria (Hysterical Neurosis)
The DSM-II (1968) listed Multiple Personality Disorder as a symptom of hysterical neurosis, dissociative type.
The DSM-IV uses the term identity in its definition of dissociation. (see identity) [1]:127
  • Inner Reality/World (Closed System)
Each alter has its own inner reality, while at the same time there is a common inner reality where alters have a distinct, phantom appearance that is unchanging. [1]:301 A closed system is a self care system that helps a child manage traumatic attachments, and provide as a supplement to the scarce supplies available in an abused child's interpersonal environment. [2]:71
  • Inner Child
Other common terms include: child within, divine child, wonder child, true self, child. This concept is not an alter and is not associated with Dissociative Identity Disorder. The inner child is a concept used in popular and analytical psychology to describe child-like aspects of an adult's psyche. It is those feelings and memories from childhood that are left unresolved.
Integration occurs in the minds of all individuals. "If such 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." [10]: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 an integrated personality when born, in fact, they need years of sufficient nurturing for the parts of their personality to integrate. (see multiple) [10]: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." [10]: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. [2]: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 personality into one unified Self. [18]:141-144
  • Intrusion
(see Dissociation, Partial)
"Memory is not a static thing, but an active set of processes." [7]: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." [7]:11
► Implicit Memory: (Mental models, behaviors, images and emotions)
"Implicit memory involves parts of the brain that do not require conscious processing during encoding or retrieval." [19] This form of memory is available in infancy and, when retrieved, it is not thought to carry an internal sensation that something is being recalled." [7]:51 Implicit memory is the first layer of encoded memory to be laid down. [20] The encoding literally shapes a child's architecture of the Self. [7]:55 At 18 months old, the hippocampus develops and this region of the brain matures and begins to integrate the building blocks of implicit memory together to form explicit memory.
■ Earliest form of memory.
■ Devoid of the subjective internal experience of "recalling," of Self, or time.
■ Involves mental models and "priming."
■ Focal attention is not required for encoding.
■ Mediated via brain circuits involved in the initial encoding and independent of the medial temporal lobe/hippocampus. [7]:57
► Explicit Memory: (Facts, events and autobiographical consciousness)
Explicit Memory is the second layer of encoded memory to be laid down. Both factual and autobiographical memory develop after 18 months of age. [20] The narrative process is one way that the mind attempts to integrate. "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. Within these representa­tional processes, generalizations or mental models of the Self (see Self) and the Self with others are created; these form an essential scaffold for the minds growing interactions with the world." [7]:11 It is late memory - present beginning in the first year of life
■ Semantic (factual) memory: Initial development by one or two years of age.
■ Autobiographical (collections of episodic memory): Progressive development with onset after second year of life.
■ Requires conscious awareness for encoding and having the subjective sense of recollection (and, if autobiographical, of Self and time).
■ Focal attention required for encoding.
■ Hippocampal processing required for storage and initial retrieval. Cortical consolidation makes selected events a part of permanent memory and independent of hippocampal involvement for retrieval. [7]:57
  • Mental Health Professional (MHP)
The various mental health professionals provide services basked on their training and area of expertise.
► Psychiatrist:
Professionals who are medically trained doctors. They can prescribe medication, diagnose and conduct research, but without psychology training they cannot work in a clinical setting.
► Psychologist:
Professionals with a master's or doctorate degree. They specialize in mental health, education, occupational psychology and they often conduct research. They are qualified to work with patients in a clinical setting.
► Psychotherapist:
These professionals may be a psychiatrist, psychologist or other mental health professional who have specialist training in psychotherapy. They are qualified to work with patients in a clinical setting.
► Social worker:
In the United States a Licensed Clinical Social Workers (LCSW) are professionals who have either a bachelor, master's or doctoral degree and perform assessment and treatment of psychiatric illnesses and case management. They are qualified to work with patients in a clinical setting and to perform a variety of roles including counseling.
  • Mind
The mind exist independently of the brain, is made up of various parts, and is a mental, rather than a physical organ like the brain. [21] It relates to our inner subjective experience and the process of being conscious or aware. In addition, the mind can also be defined as a process that regulates the flow of energy and information within our bodies and within our relationships, an emergent and Self organizing process that gives rise to our mental activities such as emotion, thinking, and memory." [10]:1 (see integration)
  • Multiple
All humans are multiple. The idea of a unitary continuous Self is actually an illusion our minds attempt to create, when in fact, the mind has many distinct parts which are needed to carry out the many and diverse activities of life. [7]:209
Prior to the DSM-IV, [5] [6] Dissociative Identity Disorder was known as Multiple Personality Disorder. The International Classification of Diseases,(ICD) still uses this label, [22] even though it is misleading and well known that no one can have more than one personality. (see multiples)
  • Out
see front
  • Original
(see core)
  • Original Abuser
The actual abuser, rather than an internal introject of the abuser. [23]
Every individual has a personality that is composed of many diverse, fragmentary and generally illusory images of Self. (see multiples) [18]
Personality 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. [18]:1
Personality States, Dissociated
The highly dissociated and compartmentalized personality states found in Dissociative Identity Disorder are called alters, but dissociated personality states occur in other instances such as Dissociative Disorder Not Otherwise Specified. Other terms meaning the same thing include: dissociated part, dissociated part of Self and disaggregate Self-state, but often the same terms used for non-dissociated state are used for dissociated states. (see personality state)
Personality System
All alters that make up the personality in an individual with Dissociative Identity Disorder.
  • Phobia of dissociative parts (active non-realization)
Most of the time, the host alter denies existence of other alters, rather than those other alters hiding from the host alter. [9]:80 Alters will avoid each other and their painful memories and experiences, or they tend to have strong conflicts with each other. [11]:31
Each alter can have PTSD, which is the most common comorbid disorder in Dissociative Identity Disorder. It can display in alters as either hypoaroused, hyperaroused or both. [2]:113-114 In Structural Dissociation PTSD is primary dissociation (1 EP and 1 ANP), where Dissociative Identity Disorder is tertiary dissociation (2 or more ANP and 2 or more EP).
Common in those with Dissociative Identity Disorder. A non-epileptic seizure is psychogenic rather than epileptic. Symptoms of pseudoseizures include "side-to-side shaking of the head, bilateral asynchronous movements (eg, bicycling), weeping, stuttering, and arching of the back." These pseudoseizures can be "predicted by preserved awareness, eye flutter, and episodes affected by bystanders (intensified or alleviated). [8]
  • Psychophysiological
  • Neurobiophysiological
Alters often vary in neurobiophysiological ways such as how they talk, look, allergies they have, vision, voices they speak with, handwriting and electrical brain activity. Many parts will have names. [2]:57
A term mostly used by the False Memory Syndrome Foundation and their followers, that is meant to refer to when memories are willfully, although unconsciously, suppressed. This is not the same as dissociation. [2]:34-35
Sense of Self
Normal sense of Self is experiences 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. [1]:160
  • Sociocognitive (fantasy)
An idea that Dissociative Identity Disorder is caused by therapists (iatrogenesis) and/or is role-playing, rather than caused from childhood abuse. This theory has no evidence to support it, and is discounted by those who seriously research Dissociative Identity Disorder.
  • Singleton (Integrated Personality)
An individual with a unified personality. A term used by some with Dissociative Identity Disorder to refer to a person that does not have alters. (see multiples)
  • Somatic
A clinical term referring to physical symptoms. Bodily sensations related to past trauma that has often been dissociated and not a part of the individual's conscious memory. Sometimes referred to as body memories, but of course that does not mean the body has memory, it is simply a term.
  • Split (splitting)
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. [2]: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 present, as well as the child having a disorganized attachment with their caregiver(s). [1]:302-306
Structural Dissociation is one of the three accepted models for the etiology of Dissociative Identity Disorder. [9] [1]:158-165
Primary Structural Dissociation (PSD)
Acute stress disorder (and Posttraumatic Stress Disorder are examples. An individual with Primary Structural Dissociation will have one ANP and one EP. [9]:5-7
Secondary Structural Dissociation
DDNES and Borderline Personality Disorder are examples. [9] An individual with Secondary Structural Dissociation will usually have one ANP and more than one EP. [9]:5-7
Tertiary Structural Dissociation
This is Dissociative Identity Disorder, and is defined as an individual usually having more than one ANP and more than one EP. [9]:5-7 [24]
  • System
This term refers to all alters in a personality in an individual with [Dissociative Identity Disorder]]. It is possible to have multiple subsystems. (see polyfragmented)
Subsystem
A subsystem, within a system, is seen in polyfragmented systems.
It's memory loss for some bounded period of time. If time-loss occurs in Dissociative Identity Disorder, it is when an alter takes completely over for another alter, so that the host alter has no memory of the time the other alter was in executive control. (see full dissociation and executive control) [1]:232-233
  • Trauma (psychological trauma)
The most fundamental effect of trauma is dissociation, so we define trauma as the event(s) that cause dissociation. [2]:75 The original trauma in those with Dissociative Identity Disorder was failure of secure attachment with a primary attachment figure in early childhood. [2]:83
Where an abused child bonds with their abuser due to the misuse of fear and other feelings by the abuser. [2]:87
Dissociative Identity Disorder is caused by early and severe childhood trauma and neglect as supported by the three accepted models recorded in the 2011 ISSTD guidelines. [25]
A stimulus in the present which is a reminder of a part of a traumatic memory, which can cause an individual to feel as if they are reliving past trauma experience. [11]:166-186

References[edit]

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