Tag Archive: Ph.D. Nijenhuis

Levels of structural dissociation

PTSD and the levels of trauma related
Structural Dissociation of the personality

An explanation of those levels in my own words.

Important notice:
Switching between personality parts is not a phenomenon that only belongs to DID. There are other disorders that have symptoms of identity problems and switching behavior between personality states.
Diagnoses of the structural dissociation of the personality can only be done by an experienced clinical trauma psychologist who is specially trained to do so.


Level 1 
Daily live Act system – one ANP¹ and one EP²
Primary structural dissociation of the personality (PTSD)
There the traumatized ANP has stored one EP that carries traumatized information caused by one traumatic experience (a rape or a heavy accident etc.).
This can manifest itself as a
Full Dissociation: The ANP doesn’t remember a thing of the traumatic experience, the EP carries the whole memory.
Partial Dissociation: The ANP knows some of the experience but not all – or the ANP remembers but emotionally it doesn’t feel like an own experience, the EP carries that part.

Level 2 
Daily live Act system – one ANP and more EP’s
Secondary structural dissociation of the personality (Complex PTSD)
There also can be an EP(’s) that is partial dissociated with a memory of looking at the traumatic event – like an out of body experience. An EP like this can grow very strong and observe again and again a traumatic event that is repeating itself. Such EP we call an observer EP. They can tell a lot about the traumatic events, and sometimes they even grow out to an EP observer and communicator. It can communicate with other inner EP’s. People with this form of traumatization suffer a severe agony.

Very recent research has also concluded that this group has a high variety of all sorts of dissociative symptoms.

Level 3
Daily live Act systems – more than one ANP and more than one EP
Tertiary structural dissociation of the personality (Complex PTSD)
Here the traumatization of the ANP started at a very young age. And the little child did not yet developed an ability to link emotion to event eo experience. Although it responded on pain and anxiety that caused severe trauma that was stored by EP’s. A repeatedly traumatization of the young child made that some of those EP’s could grow out with the ability to function as an ANP. Such an EP later splits of and starts to functioning as an ANP that carries own responsibilities to daily tasks were this ANP functioning best.
Now there are two or even three (or more) stable functioning ANP + EP’s systems that handle daily live events and each have their own responsibilities to daily live tasks. Between the functioning systems of more than 1 ANP is not a lot of space left for EP’s who want to dominate daily live. The ANP’s are protecting each other. A person with this severe disorder didn’t learn how to put things together (synthesize-linking image, physic and emotion) as one experience. It makes a mess of remembering the past and functioning in daily live, and often they are not capable of understanding the full meaning of psychological feelings.
In the past this system was functional to bare pain and suffering, but in the present this system makes a mess of their daily live.

Written by DisNique
DID Client at the Trauma center, health care department Drenthe-Assen the Netherlands
And very grateful for all the patience and explanation by my own clinical psychologist and therapist, he did a great job in helping me out to understand my own being and daily functioning.
Il m’a donné une raison d ‘ être

type 1,2 and 3 PTSD

ANP¹ Apparently Normal Personality (lives in the present time)
EP² Emotional Personality part (trauma related to the past)

For more clinical info see:
Ph.D. E.R.S. Nijenhuis working at the Mental health care department Drenthe-Assen
Ph.D. Onno van der Hart, Psychotraumatologist
K. Steele, MN, cs

Book advise: The Haunted Self

Nique on Google+

Educating Structural Dissociation

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10

May

2014

DID and BPD in one? (Pag.1)

Part I: DID and BPD in oneDD-BPD-DID

Is DID a form of a Borderline Personality disorder?
And can a person have both BPD and DID at the same time?

My own answer to both of these questions is: No 

but these are serious and often asked questions that needs more attention, but sometimes seems a forbidden subject to talk about. Why? Personally I think, it’s a problem because this subject goes under the influence of 4 groups with different meanings and opinions.

  1. One group says: ‘No DID doesn’t exists it’s an therapeutic iatrogenic artifact, and the disorder is a severe form of a BPD
  2. Another group says: ‘Yes DID exist as a trauma related tertiary structural dissociation (only level 3)
  3. Another group says: ‘Yes DID exist but level 2 and level 3 are the same (BPD+DDnos the same as DID)’ and the disorder goes always hand in hand with a personality disorder such as BPD
  4. And another group diagnosed BPD+OSDD (DDnos) clients can’t accept the diagnoses and dominates al sort of community’s in presenting: ‘we don’t have BPD-OSDD (DDnos), we are the same as those with a DID because we also suffer of an identity problem and switching behavior between personality states, so I also have an identity disorder

In the middle of that ongoing discussion goes stuck: DID and BPD-OSDD (DDnos) traumatized clients with the highly need for more effective (therapy) treatment possibilities at the appearance of their own distinctive and specific trauma related disorder that causes severe agony and daily suffering. But to see that happen there needs to be more research in declaring the difference between the secondary en tertiary dissociation of the personality.

There has been enough research that says both levels (secondary and tertiary) are without a doubt trauma related. But then a less they are distinctly different from each other. So treatment policy should also be different and I will try to explain why I’m that meaning.

I will start with writing a little bit more about my own 48years of psychiatric experiences with both of those live time disorders, and the distinctly difference between those disorders DID and BPD (+DD). Also both have identity problems and switching behavior between different personality states. But the switching behavior within those two disorders are distinctly different from each other.

In my writing I will point out:

  • Borderline Personality Disorder as BPD mature cause: psychological neglect of the young child
  • Dissociative Disorders (very divers) as DD² (OSDD) mature cause: Al sorts of Traumatic experiences during childhood and or teens
  • Dissociative Identity Disorder as DID³ mature cause: repeatedly psychical and or sexual abuse during the very premature stage of live (very young child)

levels of trauma related Structural Dissociation of the personality:

  • BPD+OSDD² as SSD the secondary SD (traumatized level 2)
  • DID³ as TSD the tertiary SD (traumatized level 3)
  • Both disorders are Trauma related Complex PTSD type II and III.

* * * *

end of part I go to part II can BPD and DID accur at the same time

Nique on Google+

Educating Structural Dissociation

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09

May

2014

DID and BPD in one? (Pag.2)

Part 2: DID and BPD in one?DD-BPD-DID

Before you read this page, you first need to read Part 1:  DID and BPD in one?

 So can BPD and DIS occur at the same time

BPD:
A Borderline personality disorder finds its origin in psychological neglect of the younger child. A child that has to fight over and over again to be seen, heard and loved. Or had to prove itself over and over again to feel worthily. Such a child develops an unbearable need to fill the gap of emptiness caused by the psychological and mental neglect in which it develops an ongoing hunger for love and attention that even more results in previous and repeatedly painful deceptions: I’m not worthy to be loved, I’m not worthy to been seen, love is not trustable, etc. The child loses the ability to trust and attach to other people although it suffers an ongoing, unbearable and insatiable hunger for love and attention.
Now the first question could be: Where do we draw the line of defining ‘trauma eo traumatized experiences to a (C)PTSD’. Not everyone with an BPD had to go through childhood traumatic experiences such as sexual or severe physical abuse. Although they are severe psychological and mentally wounded by neglect it doesn’t lead directly to a Complex PTSD in the order of a structural dissociation of the personality.

So perhaps we could define (C)PTSD as:
If there had been psychological and physical abuse, extreme anxiety sensations and or bodily injury, than you speak of severe trauma that can lead to the category ‘Dissociative Disorder’ in the order of a structural dissociation of the personality:
3 levels: PSD, SSD and TSD

And define the trauma related structural dissociation as:
A Structural dissociation of the personality in order of a PTSD and CPTSD is based on trauma with psychological- and physical abuse, severe anxiety sensations and or bodily injury.

the rock of live

PIII

Then we could point out the most striking difference between BPD and DID:

  1. BPD is caused by psychological neglect: too little positive attention
    The child no longer knows how to beat the ongoing hunger for love and attention, and how to deal with both. The child loses the ability to trust and attach although it suffers an ongoing, unbearable and insatiable hunger for love and attention to fill the gap of psychological emptiness. The personality (the inner self) stays intact but is suffering a personality disorder that dominates the whole person at all times.
  2. DID too much negative and abusive attention
    The very young child learnt by instinct to take care of the psychological en emotional self, and developed handling systems to bare the ongoing suffering from pain and anxiety that it couldn’t couple to a person, a moment or an explicit experience at that time, because it didn’t yet reached the age to do so. The child learns by instinct how not to be seen, because then it risked to be physically and or sexual abused (pain and anxiety suffering). The child loses the ability to listen to its own needs for love and caring. And did not learn how to ask for help or love, and it also didn’t learn how to trust in the safety of love and attention. It trusts only on his/her inner self.

* * *

Now we can declare:
Every person has only one personality!
That personality dominates at all times the behavior of the person, so also how a disorder express itself.

So can a child develop DID and later also a BPD?
I would say ‘No‘
Because a child develops DID in a premature and very early stage of life (I would almost say: a trauma related development disorder). Such a child doesn’t wants to get attention, because attention means suffering. It learnt only how to survive, how to bare, how to be safe by itself and how to trust on the own inner self by developing handling (act) systems (ANP’s and EP’s). It loses the ability to listen to the own needs for warmth, love and attention. The inner self has fallen apart (ANP’s and EP’s).

Can a child that developed a Borderline personality disorder also develop a Dissociative Disorder?
I would say without a doubt: ‘Yes’.

Also someone that suffers a BPD can be severe traumatized and develop all sorts of dissociative symptoms (DD) up to a level II of the structural dissociation of the personality, except DID because a child that develops a BPD has already past the age to develop a DID. The switching behavior of someone that is suffering a BPD will also behave under the influence of that personality disorder. And a Borderline Personality can’t handle stable act e.g. handling systems (more than one ANP’s) where is not a lot of room for emotional switching behavior (EP switching) such as you can see by a DID.

A mature symptom of BPD is ‘impulsive and acting out behavior’ the host (1 ANP) suffers under the high influence of emotional personality parts (EP’s). But that isn’t a recognizable symptom of a DID disorder, where the most recognizable symptom is: more than one very stable Act (handling) systems over time, place, thinking, feelings, memories and task that they are the best in to handle or to manage (in daily live), and which act like apparently normal personality’s (more than one ANP and EP’s systems).. This kind of handling systems are not manageable for impulsive and acting out personality’s such as a Borderline personality. 
There the Borderline personality can develop all sorts of symptoms (DD) as far as can go; a level 2, BPD+OSDD the secondary structural dissociation of the personality.

In order of text summary:
How to fit in the difference between BPD and DID in the theory of the structural dissociation of the personality level 2 and level 3: Stable act eo handling systems, more than one ANP and more than one EP with not a lot of space for EP switching behavior such as you can find within DID personalities are NOT manageable for Borderline personality’s (also a BPD dominates the host at all time). One significant disorder symptom of a Borderline personality is a lack of stable handling, this makes the EP influence very high – and also impulsive behavior that goes under the influence of EP’s.

 My own quest to understand continuous…

@Nique

Follow or take part of discussion: Google+ DID

* * * *

end of part II
can BPD and DID accur at the same time

Nique on Google+

Educating Structural Dissociation

, , , , , , , , , , , , , ,

09

May

2014