Nowadays
Amnesia – inability to recall seemingly unforgettable events
Depersonalisation – alterations in perception of self
Derealisation – alterations in perception of world
Trance/drifting
Identity alterations
Pseudoneurological symptoms (temp. blindness, deafness, paralysis, anesthesia, pain)
Pierre Janet (1859-1947)
“a form of mental depression [i.e., lowered integrative capacity] characterized by the retraction of the field of consciousness and a tendency to the dissociation and emancipation of the systems of ideas and functions that constitute personality” (Janet, 1907, p. 332).
DissociationPrimary structural dissociation
Dividedness amongst dissociative self-aware systems
Trauma
Emotional part of the personality (EP)
Driven by animal defense-like psychobiological systems. E.g.,• Fight • Freeze• Flight • Submit• Attachment cry
Apparently normal part of the personality (ANP)
Driven by psychobiological systems of daily functioning• Attachment • Play• Seeking • Self definition
Survival of the individual,Functioning under threat
Survival of the species,Functioning in daily life
Van der Hart et al., 2006; Nijenhuis, Van der Hart & Steele, 2002
Breuer & Freud (1893)
…we have become convinced that the splitting of consciousness which is so striking in the well known classical cases [of DID] is present in a rudimentary degree in every hysteria… In these views we concur with Binet and the two Janets...
What is dissociation?
Symptom/phenomenology (continuum model)
Process (breakdown in integrative functioning), corollary defense
Structure of the personality/identity/mind
Dissociative disorders
Secondary structural dissociationDividedness amongst dissociative self-aware systems
Trauma
Emotional part of the personality (EP): e.g.,
Apparently normal part of the personality (ANP)
Driven by psychobiological systems of daily functioning• Attachment • Play• Seeking • Self definition
Van der Hart et al., 2006; Nijenhuis, Van der Hart & Steele, 2002
Fight
flightFreeze
Submit
Dissociation
Tertiary Structural dissociation
Emotional part of the personality (EP)
Apparently normal part of the personality (ANP): e.g.,
Van der Hart et al., 2006; Nijenhuis, Van der Hart & Steele, 2002
Fight
flightFreeze
Submit
__________________________ functions dedicated to the
survival of the species & daily life
________________________________functions dedicated to
the survival of the individual
MotherWorkerLover
Core features of DID The existence of 2 or
more personalities/ identities that take recurrent control of behaviour
Psychogenic amnesia for seemingly unforgettable autobiographical events
Dissociative identities Identities: cognitions,
emotions, behaviours, defenses -Trauma fixated & trauma avoidant.
Two-way (symmetric) amnesia
A I B
One-way (asymmetric) amnesia
A I B
Mutual awareness A B(Janet, 1907; Ellenberger,1970; Putnam, 1989; Huntjens et al.,
2003, 2012)
Dissociative disordersDSM-IV/DSM-IV-TR DSM-5
Dissociative amnesia Dissociative amnesia• Without Fugue• With Fugue (purposeful travel
with amnesia for identity/autobio mem.)
Depersonalisation disorder Depersonalisation/derealisation disorder
Dissociative Fugue With amnesia
Dissociative Disorder NOS (DDNOS)
Other Specified Dissociative DisordersUnspecified dissoc. disorders
Dissociative Identity Disorder (DID; Formerly MPD
Dissociative identity disorder
Pathways to dissociation
Adult Dissociation
Child A&N
Disrupted parent-infant
dialogue
Psychological
unavailability of
caregiver-Lack of positive maternal affective involvement/attunement-- maternal flatness--disrupted communication
- Flashback- Amnesia- Deperson
al.-Derealisat
.
Attachment & Dissociation
Disorganised/disoriented attachment strong predictor of dissociative symptoms (e.g., Ogawa et al., 1997; Lyons-Ruth, 2008)
Conflictual (non-fluid) behaviours in infant in presence of parent
Quality of early maternal care (emotional unavailability) predicts ≈ 50% of variance in dev.of dissociative symptoms
Therefore abuse not only causal factor for dissociation, but also infant disorganisation/parental emotional withdrawal
Attachment and dissociation (cont).
How does D-type come about
Frightened or frightening care giving (‘fright without solution’)-parents communicating fear (Main, Hesse)
Failure to serve as source of comfort/containment after fear - Thus fear from anyone/anything and failure of parents to soothe (Lyons-Ruth)
Dissociation as intrapsychic defense/process and interpersonal phenomena (way of relating to others) - not to know (intrapsychic), not to speak (interpersonal)
Thus, dissociation is fragmentation of coherent relational self (Lyons Ruth, 2008)
Frightened & Frightening caregiving
Frightened
Backing away
Frightened voice
Dazed expression
Exaggerated startle
Withdrawn
Non-responsive
Frightening
Looming, attack posture
Sudden movements
Mocking, teasing
Intrusive
Emotionally reactive
Loud, startling noises
Lyons-Ruth, 2000; Fisher, 2003
Dissociation in the transference
Thus, dissociative experiences become a means of regulating interpersonal contact and therefore become transferentially important
Experiences like trance, drifting, switching (or even flashback, bodily pain) are evident in transference
Experiences like amnesia, depersonalisation and derealisation may not be evident, and need to be inquired about