Tag Archive: Ellert Nijenhuis

OPROEP lotgenoten Regio Groningen


Ik zou graag in contact komen met
lotgenoten in de regio Groningen

Ik moch al vele malen Caleidoscoop een verzoek zenden om in contact te worden gebracht met de lotgenotengroep provincie groningen, toch dit mocht tot op heden nog geen enkele respons ontvangen anders dan de antwoorden zoals op alle mails: Uw antwoord is doorgestuurd.

Dus ik probeer het ook nog maar een keer via deze weg

Ik zou dolgraag in contact komen met lotgenoten Dissociatieve Stoornissen prov Groningen.


Ik hoop dat het me nog gaat lukken om dit via onze landelijke vereniging geregeld te krijgen, toch daar wordt nagenoeg op geen enkele mail gereageerd.


lotgenoten contact


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ICD-11 PTSD & Complex PTSD

ICD-11  PTSD & Complex PTSD

PTSS, CPTSS and BPS – A latent class analysis
Published: 15 September 2014

There has long been debate about whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) comorbid with PTSD. Part of the difficulty in this evaluation has been the lack of clear and consistent characterization of Complex PTSD. The World Health Organization (WHO) Working Group on the Classification of Stress-Related Disorders has proposed the inclusion of Complex PTSD as a new diagnosis related to but separate from PTSD (Maercker et al., 2013). Both of these disorders are viewed as distinct and separate from BPD. An emerging and accumulating empirical literature is demonstrating consistent and clear differences between ICD-11 PTSD and Complex PTSD. In addition, it is important to determine the construct validity of Complex PTSD as empirically distinct from BPD particularly among those with a trauma history. This investigation evaluated whether ICD-11 Complex PTSD could be distinguished from DSM-IV BPD in a treatment-seeking population of women with childhood abuse.
The WHO proposed that the development of ICD-11 be guided by the principle of clinical utility. Characteristics of clinical utility include the organization of disorders that are consistent with clinicians’ mental health taxonomies, that contain a limited number of symptoms so that they can be easily recalled and used in the field, and that are based on distinctions important for management and treatment (Reed, 2010). The distinction between ICD-11 PTSD and Complex PTSD are consistent with these guidelines (see Cloitre, Garvert, Brewin, Bryant, & Maercker, 2013; Maercker et al., 2013). For example, ICD-11 PTSD is construed as a fear-based disorder and symptoms are limited to and consistent with fear reactions and consequent avoidance and hypervigilence. In contrast, Complex PTSD has been described as typically associated with chronic and repeated traumas and includes not only the symptoms of PTSD but also disturbances in self-organization reflected in emotion regulation, self-concept and relational difficulties (see Cloitre et al., 2013) a symptom profile that has been demonstrated as associated with prolonged trauma (Briere & Rickards, 2007).

Three studies have found evidence supporting the validity of the ICD-11 PTSD versus Complex PTSD distinction (see Table 1 for description of the diagnoses). Recently, in order to evaluate whether PTSD and Complex PTSD could be empirically distinguished from each other, Cloitre and colleagues (2013) performed a latent profile analysis (LPA) on assessment data from 302 treatment-seeking individuals with diverse trauma histories, ranging from single events (e.g., 9/11 attacks) to sustained exposures (e.g., childhood or adult physical and/or sexual abuse). The results were consistent with the ICD-11 formulation for Complex PTSD, with the best fitting LPA model delineating three classes of individuals: (1) a Complex PTSD class, with high levels of both PTSD symptoms as well as disturbances in self-organization related to affect regulation problems, negative self-concept, and relational difficulties; (2) a PTSD class, with high levels of PTSD symptoms but relatively low on the disturbances in self-organization that define Complex PTSD; and (3) a class relatively low on symptoms of both PTSD and Complex PTSD. Notably, these identified classes were identical when including an additional 86 participants with BPD, providing further support for the stability of the identified classes. Cloitre et al. (2013) also found that chronic trauma was more predictive of Complex PTSD than PTSD and that Complex PTSD resulted in significantly greater functional impairment than PTSD.

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The diagnostical reality of a SD-DID sufferer

Are all DID diagnoses a tertiary structural dissociation?

  • SD * Structural dissociation
  • MPD * Multiple Personality Disorder
  • DID * Dissociative Identity Disorder
  • BPD * Borderline Personality Disorder

Are all MPD/DID diagnoses the same as a tertiary structural dissociation of the personality ?

A very complex Post Traumatic Stress Disorder

  • Technically and to SD diagnostically instruments: YES
  • Reality to the present time of a global diagnostically acceptance and understanding of the SD: NO

Because until now the three levels of a Trauma related Structural Dissociation of the personality are not globally recognized or used as a diagnostically instrument to diagnose a (Complex) PTSD and a Trauma related dissociation.Three levels: primary, secondary and tertiary.

  1. PSD – a PTSD a primary Structural dissociation of the personality
  2. SSD – a Complex Trauma related Dissociative Disorder, in combination with a attachment or severe personality disorder, a secondary SD
  3. TSD – a Complex Trauma with severe dissociative symptoms a tertiary SD

Until this moment level 2 and 3 are a diagnostically mess. Because there is still no suitable diagnostically DSM category to define a Complex Trauma (CPTSD) with severe dissociative symptoms.

Result: Level 2 and 3 of the SD are totally mixed up as a Dissociative Identity Disorder.

To this matter I want to share a personal note:
Last February I had a nice and also educative conversation with Professor Ph.D. Onno van der Hart. During this conversation we also spoke about the frequency DID is diagnosed. And that to my opinion to many people get diagnosed with a DID while they suffer more likely a level 2 of the Structural dissociation of the personality. And to this personal observation and conclusion I asked him some feedback and he answered to me:

Dutch respons:
” Nique ik ben het met je eens dat mensen veel te snel ook van DID (of Dis) spreken als er in feite van secundaire dissociatie van de persoonlijkheid sprake is–terwijl dat waarcshijnlijk ook vaker voorkomt dan tertiaire dissociatie van de persoonlijkheid. Kortom, ik ben mij er zeer van bewust dat de dissociatieve stoornissen (DD) méér omvatten dan alleen DIS, en dat dit vaak onvoldoende wordt aangegeven. Ik ben bang dat het spreken in termen van niveaus–primaire, secundaire en tertiaire–van dissociatie van de persoonlijkheid, zoals wij dat doen, niet gangbaar is. Want dan moet men ook onze theorie accepteren, en niet iederene kent hem of wil in die termen gaan denken.“. (Onno van der Hart, February 2014)

Prof. Ph.D. Onno vd HartWhich means (Eng translation): 

“Nique, I agree with you that people much too quickly speak of a DID when in fact they talk about a secondary dissociation of the personality — as it shows that though is more common than tertiary dissociation of personality. In short, I am very aware that the dissociative disorders (DD) include more than just DID, and that this often insufficiently is indicated.
I’m afraid that speaking in terms of primary, secondary and tertiary levels — of a structural dissociation of the personality, as we do, not generally is accepted. Because then one must also accept our theory, and not everybody knows him or want to start thinking in those terms.“. (Prof. Ph.D. Onno van der Hart, February 2014)

To me this also explains the difficulty to find fellow sufferers and good informative websites about SD.
I’m diagnosed with a diagnose where all sorts of mentally disorders are mixed up with each other, because globally and diagnostically there is no diagnostically system to define a Complex Trauma related disorder. And also there is a severely lacking of understanding to the theory of a Structural Dissociation such as given by The Haunted Self a (study book). So people like me, who suffer a complex Trauma with severe dissociative symptoms but also free of a personality disorder, we aren’t recognized by a global diagnostically system. I suffer no symptoms of a Borderline or other personality disorder. I suffer a complex Trauma with severe dissociative symptoms (ANP switching) – a Tertiary structural dissociation of the personality.

In may 2014, I also had a shared conversation with my own personal CPT and Ellert who both go in the same Dutch traumatology team and which also diagnosed my case. I spoke to them about the mixed up diagnoses — personality disorders, SD DD and level 3 as a DID, and Ellert answered  (Literal text translation):

Ellert Nijenhuis, Ph.D.

“Sometimes the facts are more strongly than the theory. I mean: about 40% of the current DID
 population meets the criteria of BPD. An even larger group has a personality disorder (approximately 60%). BPS also develops in early childhood, sometimes BPD seems trauma-related, sometimes it seems not. You could also say that BPD is a sign of a certain imbalance of the personality.
Very general: on axis II diagnoses are not made out on the basis of a development, but on the basis of symptoms.
(Ph.D. Ellert Nijenhuis, may 2014)”. 




My personal conclusion
lots of info which you can find on the internet and which is carried out by people who were diagnosed with classical MPD in the past and now declare themselves as diagnosed with DID as a Trauma related tertiary structural dissociation of the personality;
lots of them don’t even understand the theory of a Structural dissociation – – the difference between ANP and EP and realted switching behavior – – and inform you totally wrong. Until now I could not find one website who informs you right about the structural dissociation of the personality such as given by: Kathy Steele, Ellert Nijenhuis and Onno van der Hart.

My words are probably rough to take in and lots of people hate me by it, but a diagnose is also not meant to please but to point out the reality of symptoms, behavior and a the mental disorder(s) someone is suffering.  So again I answer to the question: is all the info on the internet about DID – – related to a Tertiary Structural dissociation of the personality?  NO !
ecause to make such a statement we would need to re-diagnose all the MPD/DID sufferers which were diagnose for the 21st century and which aren’t diagnosed by the diagnostically instruments and knowledge (interviews and differential D instruments) which define a diagnose of a Trauma related Structural Dissociation of the personality – the three levels.

Knowledge does change and has changed.
But in all those years they never adjusted diagnoses given in the past.

The Internet and all given information that comes with it
is it trustworthy

shutterHow to know if the information you read on Blogs or personal managed websites is trustworthy to the understanding of a Structural dissociation of the personality or a DID related tertiary structural dissociation of the personality (the three levels)?

Most people who are diagnosed during the 21st century by the expertise of a Trauma center and or by a clinical psychologist which is specially trained to work with the instruments to diagnose a structural dissociation of the personality (SD theory), will have no problems to mention where they were diagnosed. Because they have no reason to make a secret of it.

Websites written by people who refuse to mention who diagnosed them and when they were last diagnosed with DID or otherwise, are often also the websites where you will get misinformed about DID and the Structural Dissociation of the personality – SD theory.


Also websites where you find information which is most indicated to the (EP not in though with the present time) switching and alternation behaviors are not the websites where you get objectively informed about a structural dissociation. There focus is too much orientated on the acceptance of unrealistic Switching behavior which isn’t a realistic match to how someone suffers a Tertiary Structural Dissociation of the personality.

That sort of websites do carrie out a stigmatizing profile of a classical MPD/DID diagnose which are more damaging than educative to the understanding of a Trauma related Structural Dissociation of the personality.

If someone pretends to share educative information about a disorder as DID then they will also have no problems with you asking ‘when and by whom were you diagnosed?’ If you talk about knowledge and you write a whole website to give meaning to a diagnose in order to help out a global understanding of a ‘diagnose’, then the diagnose and who diagnosed him/her has to be also no secret! If they send you away with an answer ‘you are out of line with that question because that is private’ or ‘It doesn’t matter which diagnose I carry’ than you have the wrong website to inform yourself about a Structural Dissociation of the Personality.

Also keep in mind: A big and over active website does not always mean ‘trustworthy information’.

Love and understanding to you all

attentiona note of attention:

To all the professional mental caretakers and psychotherapists out there
please inform yourself on a professional way about the trauma related structural dissociation of the personality such as given by Kathy Steele, Onno van der Hart and Ellert Nijenhuis.

And to all readers pleas note
In order to correctly understand the explanation of my own personality systems, you need some knowledge of the summary of a SD. Be ware: Switching between personality parts is not a phenomenon that only belongs to a trauma related Structural Dissociation (SD) – such as a very complex PTSD the dissociative identity disorder (DID) – or a complex PTSD Secondary SD (OSDD) – or a less complex Post traumatic stress disorder PTSD.

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. And also the tertiary SD, DID, the trauma related Dissociative Identity disorder is a polysymptomatic condition which is characterized by a hidden presentation (S.Boon & N. Draijer).
So keep in mind: Diagnoses of a ‘trauma related’ structural dissociation of the personality can only be done by an experienced clinical trauma psychologist/psychotherapist which is specially taint to do so. 

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Complex Trauma PTSD