Tag Archive: amnesia

Trauma disorders, Borderline- and Dissociative Disorders

(c) Nique(c) Nique TRTCenter NLI did receive the question:

Could you try to explain in your own words and average understandable language; the different types of Trauma disorders (diagnoses), versus a Borderline Personality Disorder and the relation of both with Dissociative Disorders – without the interference of the understanding of a Structural dissociation of the personality.

And my answer to it is: Yes I feel very honored to give it a try in my own words.

underline

I. TRAUMA and Posttraumatic Stress Disorders – PTSD & CPTSD

Very simplified we know 3 main groups of diagnoses to a mental disturbance caused by Trauma:childabuse

1 an acute short term mentally disturbance (ASD)
2 a middle long term mentally disturbance (PTSD)
3 a long term e.g. chronically disturbance (CPTSD)

a bit more defined:

  1. Acute Stress Disorder
    an acute short term mentally disturbance / reaction to a one time experienced Traumatic event
    for example: witnessing a very heavy train accident
  2. PTSD
    Post-Traumatic Stress disorder – middle long term mentally disturbance caused by experiencing a dead scary Traumatic event
    for example: a kidnapping or a onetime rape experience, or other dead scary experiences
  3. C-PTSD
    Complex Post-Traumatic Stress disorder – a long term e.g. chronically mentally disturbance caused by experiencing more than one Traumatic event
    a. Childhood trauma like sexually and or physically abuse
    for example: incest or other repeated child molestation e.g. child abuse
    b. War experiences (veteran care), etc.

To simplify: above we have mentioned the different types of Trauma disorders (diagnoses).

And keep in mind that those diagnoses can be given to everyone who experienced a Traumatic event. So also to people with Borderline, with Autism, with no mental disorder, etc.. From the policeman to the house wife – they can all experience a dead scary traumatic event which can lead to a post traumatic stress disorder.

underline

II. DISSOCIATIVE DISORDERS – DD

The Second mental disorders I want you all to get acquainted with is the category
Dissociative Disorder – abbreviation = DD (watch out, it’s no DID)

  1. Dissociative identity disorder – DID a trauma related polysymptomatic condition which is characterized by a hidden presentation
  2. Other Specified Dissociative Disorder – OSDD
  3. Dissociative Amnesia
  4. Depersonalization/Derealization Disorder
    sub group:
  5. Unspecified Dissociative Disorder (DDnos)

Are dissociative disorders with switching behavior to different personality states always related to a Dissociative Identity Disorder (DID)………   :  NO

Switching between personality parts is not a phenomenon that only belongs to a Dissociative Identity Disorder (trauma related).There are other disorders that have symptoms of identity problems and switching behavior between personality states such as a theatrical personality disorder, a Borderline Personality disorder, a bipolar disorder or schizophrenia.
A Dissociative Disorder (DD) has a wider range of being a co-morbidity disorder.

PTSD and it’s relation to Dissociative Disorders (OSDD and DID):
Within the category Dissociative Disorders, we know two types of diagnoses which are related to Psychologically-Trauma:

1. Otherwise Subscribed Dissociative Disorders (OSDD) and
2. the Dissociative identity Disorder (DID) – caused by Psycholotically-Trauma

Those two Dissociative disorders are both categorized by Trauma specialists as Complex Psychologically-Trauma disorders.
Sometimes also knows as a Trauma type – II and type – III

And both disorders are known with a wide range of dissociative problems. From Amnesia, Depersonalization to Derealization to somatic dissociation, etc.. The difference between a trauma related OSDD and DID is the comorbidity of disorders and the presentation of the Switching behavior. Both disorders are likewise severe and don’t tell a thing about more or more severe Trauma experiences – because both disorders are categorized as likewise very severe disorders ! they cause severe clinically distress and agony in life.

A Trauma related diagnose tells you only something about the complexity of the disorder(s).

underline

III. BORDERLINE PERSONALITY DISORDER – BPD

not C-PTSD related – Abbreviation BPD

A Borderline personality disorder is a personality disorder which causes severe agony to life. It’s also a disorder which very often is misunderstood and stigmatized. People with a BPD suffer a lot, so please don’t judge them by the disorder but try to understand them.

BPD is a diagnose of a mental disorder which points out a list of ongoing disturbed, unstable and or harmful symptomatically behavior caused by a broad range of influences during childhood and a biologically given mental weakness. Examples of causes:

  • too less love and attention (negative child neglect)
  • too much negative love and attention (positive child neglect)
  • broth up by parents with harmful addictions
  • broth up by parents with social problems
  • broth up in a harmful e.g. stressful living environment
  • etc.
  • and the most upper handed cause to develop BPD:
    is most likely a mental weakness given by biologically genes (Borderline structure).
    A by nature given, not being able to handle or coupe well with stressful situations. A biological basis to develop a BPD.
    Note: Not everyone born with the biologically genes will develop a Borderline Personality Disorder during life –  A Borderline structure (is not a BPD) only tells something about the mental straight to coupe or handle with stressful situations.

Some psychologist e.g. mental clinicians like to call the causes to the development of a BPD – ‘childhood trauma’. But if you understand the clinical definition of Trauma you can’t place those causes in a direct line of Traumatic experiences. So I fully disagree with people who think and or declare that a Borderline Personality disorder is per definition caused by Trauma, and or is always trauma related, because it isn’t.

A Borderline Structure or a Borderline Personality Disorder by itself isn’t caused by Trauma !

underline

And now we end up to the most spoken CLINICAL DISPUTE * * *

BPD and It’s relation with Dissociative Disorders  (OSDD and or DDnos):

attentionOf course it all needs research and a global acceptance to define the difference and or relation of causes and the influences of different comorbidity disorders, but I will give you a bit of an explanation in the line of both clinical streams which are still arguing about the cause and understanding of a BPD in combination with Dissociative Disorders and or dissociation caused by Trauma:

A bit Freudiaans and a bit Janetiaans – I think; both theoretically streams do have a point

                      1. BPD + DDnos not Trauma related
                        BPD + Dissociative symptoms and switching behavior to different emotional personality states NOT Trauma related
                        (BPD + comorbidity DDnos)

People who suffer a Borderline Personality Disorder very often can’t coupe (independently) with stressful situation. They clamp on to addictive behavior to escape the inner stress and daily life stress, and or they clamp on to other people which can guide them through a stressful situation of life. If stress comes in to (such) a relation someone who suffers a BPD wants also to escape this relation (again) by clamping on to another person. They don’t attach on a healthy way and it’s not uncommon that someone with a BPD has a storrmy history of different relationships or switches back and forward towards and between more than one relationship. They easily panic if they are left alone. And they show very often impulsive and or addictive behavior.  It’s also not uncommon that someone who suffers a BPD seeks attention, I prefer to call it   they seek HELP because they are scared – they do this to escape the inner stress and the fear of being left alone. Life itself is sometimes even too much to handle and the fear of loneliness then also gets enormous, almost unbearable.
Graphed by this fear they sometimes develop different somatic problems with no physical cause, or they even start to develop their own internal family and play mates to escape the fear of being left alone. They start to Dissociate by the development of emotional personality parts.

                      1. BPD + (CPTSD) OSDD Trauma related
                        BPD + Dissociative symptoms and switching behavior under the influence of emotional personality parts:Trauma Related
                        (BPD + CPTSD + OSDD)

Like every human being also someone who suffers a BPD can experience a dead scary traumatic events or have suffered also Childhood sexual and or physical abuse which leads to the symptoms of a PTSD or a CPTSD with dissociative symptoms.
It’s also not oncoming that you see also severe Dissociative symptoms and dissociative Switching behavior in this category of a double mental disturbance and category of diagnosis.

But it’s also very difficult for diagnosticians to diagnose BPD + Dissociative Symptoms and the Switching behavior to other personality states of this category, because they need to determine if the Dissociative symptoms are caused by the BPD or by trauma related Dissociation (OSDD). And that is not an easy thing to do.

 

Fact or Factious:
ptsd vrijSomeone who suffers a BPD + Dissociative symptoms (DDnos and or OSDD) suffers severe agony in life. We know that this group is also the most difficult group to treat because of the underlying BPD and wide range of dissociative symptoms. Prognosis of treatment aren’t much positive because of the severity of the combinations of disorders. And although researches are doing their best to develop better diagnostically instruments (differential instruments) and treatment possibility’s, it’s still a group which gets to less global attention and understanding.

For the difference between a OSDD and DID dissociative disorder
I refer to the following link: The difference between OSDD and DID

(c) Nique

Complex Trauma PTSD

Autonomic functioning ANP and EP’s

Someone asked me ‘can an ANP/EP systems finds its existence later on in life’?
autonomic ANP and EP
abuseMmmm good question.

Let me give you all something to think about…

Of course that is possible, because every person can be traumatized by a very nasty experience that the personality can’t handle without starting off to dissociate. But if the emotional systems were already synthesized to one autonomic functioning life system, than you can’t develop more than one autonomic handling system. But EP’s can develop itself unlimited during all sorts of nasty life events.

So ANP/EP systems don’t fall out of the blue sky by every new daily life task or nasty experience.

 

We are all born with biological determinants and four autonomic emotional handling systems (the 4 head emotions).

Emotional systems which immediately after birth are able to react by instinct or reflex. And although those emotional systems are autonomic by birth, they are by nature ‘team players’ so they start directly to interact with the environment and to synthesize with each other. And from there they build an own biological autonomic life system that is able to form an own normal identifiable autobiographic personality.

But how can you develop a level I or II of the structural dissociation? (Trauma type I and type II)
If your life starts out fine as a baby and all systems did synthesize normally, than it is still possible to develop a trauma related ANP/EP act system. But only with one ANP an apparently normal personality part because the autonomous emotional systems already did synthesize and can no longer start off an autonomic functioning – they already connected to each other during baby time.
So, yeah, it is possible that a normal synthesized life system (normal personality) starts to dissociate after a traumatic event. The traumatic experience which is to much for the personality to handle will not integrate and the personality starts to dissociate – we now have one ANP and one EP, a traumatized emotional personality part. We call the personality no longer normal, but  ‘apparently normal’ because it’s no longer a psychological healthy personality, although it acts normal. And there we have a clinical psychological disturbance of the personality after suffering a traumatic experience. A post-traumatic stress disorder, type-I, a primary structural dissociation of the personality (SD) level I.

And if there occurs all sorts of traumatic events over and over again during childhood which the personality can’t handle, then there will be more than one EP.  A complex post-traumatic stress disorder, type-II, secondary structural dissociation of the personality (SD) level II.

Do we now have two personality’s?
No, of course not

* * *

Let’s go back to the newborn little baby and the 4 head emotions.

abuseDirectly after birth a baby has emotional feelings and it reacts by instinct, or with a reflex to those feelings
  1. a baby can feel anger and it reacts by instinct, or with a reflex on this feeling (autonomous)
  2. a baby can feel pleasure and it reacts by instinct, or with a reflex on this feeling (autonomous)
  3. a baby can feel sadness and it reacts by instinct, or with a reflex on this feeling (autonomous)
  4. a baby can feel scared and it reacts by instinct, or with a reflex on this feeling (autonomous)

And again:
Right after birth those autonomic elements of nature start out to add themselves together. They synthesize with each other. And as healthy team players they interact on the environment and learn how to function together as one autonomic life system.

But what happens if those autonomic emotional birth systems don’t, or can’t, synthesize/emerge together because they are from day one continuously over-stimulated with nasty sensations and pain experiences. They don’t synthesize and they stay separated from each other. They don’t learn to function as team players of a bigger life system. They grow out to be separate emotional personality parts (EP’’s). Maybe two of them synthesize together like anger en grief. And also the two emotional systems stick together such as joy and fear. Than the little child starts off with 2 separate emotional handling systems. And those systems grow stronger and stronger until they are able to function autonomic.

Do we now have two personality’s?
No, of course not
We now have two apparently normal personality ‘parts’. Two ANP/EP handling systems

To explain with identifiable stable and recurring recognizable behavior (no mood swing):
The child can have a identifiable stable and recurring anger and rebellious behavior that also can switch in a instant to a totally different very sad and quiet behavior (2 emotional systems in one ANP handling system). And on the other hand the child can behave very joyful, call itself with another name, do things that it normally doesn’t dare to do and talks with another voice sound, but it also can switch in an instant to a very scared child (also here, 2 emotional systems in one ANP handling system).
Now we have two autonomic emotional life systems that take care of daily life emotions and tasks (ANP/EP act systems)
A childhood trauma type-III a Tertiary structural dissociation of the personality – a Dissociative Identity disorder.

The more traumatic experiences to store, the more EP’s finds its existence. So the system grows bigger and bigger. And if one of those two ANP/EP systems can’t handle more EP’s, than another emotional systems can split of and start out to function autonomic (they didn’t synthesize after birth so they can split) So than we have an ‘angry daily life system’, ‘a sad daily life system’, ‘a joyful but also fearful daily life system’. Now we have three daily life ANP/EP systems. And again the EP’s can develop itself unlimited during all sorts of nasty life events.

Those systems do function together as team players, but they didn’t synthesize with each other. We now have a disturbed and broken personality, but it appears normal at moments and tasks of daily life they are best in to handle. The ANP’s protect the personality against the influence of nasty EP’s. If a system doesn’t like an emotion, another systems jumps in and takes over. The personality gets a chaotic mix of life systems with all sorts of nasty emotions and memories (EP’s) that didn’t learn how to synthesize traumatic experiences.

When the system eventually gets more and more overloaded during life, the body and mental personality starts to react with all sorts of psychical en psychological dysfunction and disturbance.

We now have DID
I would call it a trauma related development disorder

 And now I dare to write

Very early traumatized autonomic emotional systems are responsible for not be able to synthesize traumatic experiences later on in life and during child development. And you all can go there with every theory and thinking you want, it fits all in there ! The missing piece of a very big trauma puzzle are those early stage traumatized 4 autonomic functioning emotional systems such as given by birth.

 It’s not likely that there can be more than 3 with a max  of 4 ANP/EP life systems within DID, the Dissociative Identity disorder – the tertiary structural dissociation of the personality such as explained and given by The Haunted Self and all those Janet’iaans pioneers of traumatology.
If those systems don’t synthesize in early stage of life, and don’t learn to function properly as team players of a big personal life system, they become survival systems (not life systems).
They don’t live, they survive!

Those four emotional life system are the big team players of our own personality.

 

SD00 SD01 SD02 Type 3

Forms of Dissociative Amnesia

Onno van het Hart, Ph.D.
Forms of Dissociative Amnesiaamnesia o.vh.hart

Written by Ph.D. O.v.h.Hart
The DSM-IV [7] refers to possible degrees of complexity in the presentation of dissociative amnesia, defining it as a dissociative disorder in its own right and as a symptom of more complex dissociative disorders. The DSM-IV defines the negative dissociative symptom (or disorder) of dissociative amnesia as “one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness” [7, p. 481].dissociative amnesia

This definition contains a number of inaccuracies and inadequacies, including being overly abstract, vague , nonspecific, incomplete [8]. For instance, it gives clinicians no concrete signs or symptoms with which to determine the presence of amnesia; it omits any mention of the essential feature of dissociative amnesia, i.e., its reversibility. The inclusion of the expression “too extensive” is problematic: there can be many instances of dissociative amnesia with regard to brief periods of time—for instance, during the most threatening moments of traumatic experiences. And in patients with DID, most episodes of amnesia do not directly involve traumatic experiences, but rather apparently mundane actions such as buying something or writing something [8].

Adopting Pierre Janet’s categorization of dissociative amnesia [9], the DSM-IV [7] distinguishes the following types (see also [6,8,10,11]): localized amnesia; generalized amnesia; continuous amnesia;  systematized amnesia; and, not mentioned by Janet, selective amnesia. Localized amnesia pertains to the inability to recall all events that occurred during a circumscribed period of time. A basic example would be amnesia for a specific traumatizing event such as a violent rape; Janet [12] reports a young woman’s amnesia for the death of her mother that she witnessed. Generalized amnesia consists in the failure to recall encompasses the person’s entire life. This type of dissociative amnesia may occur in various degrees of severity. In some cases, it seems that the patient has to learn over again all that she or he had learned before and doesn’t seem to recognize his or her partner and family members [13,14]. Continuous amnesia, the inability to recall events subsequent to a specific time to and including the present, is rarely diagnosed. Neurological factors might be involved [15]. Systematized amnesia pertains to the loss of memory for certain categories of information. For instance, the patient is amnesic for everything that related to her or his family. Janet [9] mentioned a woman who, after confinement, forgot not only the birth of her child, but also the facts connected with it. Selective amnesia, finally, pertains to the inability to recall some, but not all, of the events during a circumscribed period of time. On a micro-scale this might, for instance, pertain to remembering a rape, but not the most threatening part of it, i.e., the pathogenic kernel [6] or “hot spot” [16]. The existence of this pathogenic kernel also may have caused amnesia to develop for the entire event; the resolution of this kernel then is essential in the recovery of the memory [17].

read the original document posted by Ph.D.: Onno van het Hart