“As an undergraduate student in psychology, I was taught that multiple personalities were a very rare and bizarre disorder. That is all that I was taught on ... It soon became apparent that what I had been taught was simply not true. Not only was I meeting people with multiplicity; these individuals entering my life were normal human beings with much to offer. They were simply people who had endured more than their share of pain in this life and were struggling to make sense of it.”
― Deborah Bray Haddock, The Dissociative Identity Disorder Sourcebook
Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. New York: W.W. Norton.
Summary: ... In this book, three leading researchers and clinicians share what they have learned from treating and studying chronically traumatized individuals across more than 65 years of collective experience. Based on the theory of structural dissociation of the personality in combination with a Janetian psychology of action, the authors have developed a model of phase-oriented treatment that focuses on the identification and treatment of structural dissociation and related maladaptive mental and behavioral actions. The foundation of this approach is to support patients in learning more effective mental and behavioral actions that will enable them to become more adaptive in life and to resolve their structural dissociation. This principle implies an overall therapeutic goal of raising the integrative capacity, in order to cope with the demands of daily life and deal with the haunting remnants of the past, with the “unfinished business” of traumatic memories.
Of interest to clinicians, students of clinical psychology and psychiatry, as well as to researchers, all those interested in adult survivors of chronic child abuse and neglect will find helpful insights and tools that may make the treatment more effective and efficient, and more tolerable for the suffering patient.
Mosquera, D., Gonzalez, A., & Hart, O. (2012). Borderline personality disorder, childhood trauma and structural dissociation of the personality. Revista Persona, 11(1), 44-73.
Abstract: Borderline personality disorder and dissociation are strongly related. DSM-IV-TR criteria of BPD, for instance, include isolated dissociative symptoms (APA, 1994). Two thirds of BPD may be diagnosed of a dissociative disorder (Korzekwa, Dell and Pain, 2009). Both diagnoses have been related with high rates of childhood trauma. The close relationship between trauma, dissociation and borderline features can be understood from the perspective of the theory of structural dissociation of the personality (Van der Hart, Nijenhuis & Steele, 2006/2008) which transcends the traditional approach of describing "comorbidity". In this article we will review the empirical data which support the relation between early traumatizing and attachment disruption situations, and both borderline and dissociative symptoms. Borderline personality disorder will be explained in terms of structural dissociation of the personality.
Nijenhuis, E.R.S., Van der Hart, O., & Steele, K. (2010). Trauma-related structural dissociation of the personality. Activitas Nervosa Superior, 52(1),1-23.
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 (Van der Hart, 2000). 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.
Ross, C. A. (2014). Unresolved problems in the theory of structural dissociation. Psichiatria E Psicoterapia, 33(3), 285-292.
Abstract: The author discusses a series of unresolved problems in the theory of structural dissociation as enunciated by Nijenhuis (2014). These include: 1) how rudimentary can an emotional personality (EP) be and still qualify as structural dissociation? Do all cases of PTSD have an EP?; 2) should only structural dissociation be regarded as true dissociation?; If yes, should dissociative amnesia be classified as a dissociative disorder?; 3) is depersonalization-derealization disorder an example of structural dissociation?; and, 4) what other disorders could be based on structural dissociation? Although the theory is an important contribution to the mental health field, it should not be regarded as complete or immutable.