Tag Archive: Ph.D.vh.Hart

Summary of the structural dissociation


A small summary of the structural dissociation
such as I already did explain in my own wordspic-levels

What do we have already…

SD    = Structural Dissociation
ANP  = Apparently Normal Personality
EP    = Emotional Part of the Personality
DD    = Dissociative Disorder
DID   = Dissociative Identity Disorder *

Keep in mind, every person presents only ‘one’ unique personality !

A Trauma related Dissociative Disorder (PTSD+DD) can occur throughout whole your life.
Trauma is Trauma.
DID is just one Trauma Type but it isn’t the only diagnose that goes with Trauma.  

A Dissociative Identity Disorder is a Dissociative Disorder (DD)
But not every Dissociative Disorder is a Dissociative Identity Disorder (DID)

If an ANP doesn’t suffer a personality disorder you although can suffer a type 1, 2 or 3 Trauma related Dissociative Disorder (DD)
A Dissociative Disorder (DD) is a clinical Disorder (Axis I, DSM-IV)

The three levels of a trauma related Structural dissociation of the personality (SD) a Dissociative Disorder (DD):

  1. Trauma type-I primary SD
    an apparently normal personality ANP and a traumatized emotional part of the personality EP
  2. complex Trauma type-II, Childhood Trauma, secondary SD
    an apparently normal personality that switches between different traumatized emotional personality states ANP + EP’s
  3. very complex Trauma type-III, Infant to Childhood Trauma. tertiary SD
    an personality that switches between ’emotional- and daily life task systems ‘ ANP‘s + EP‘s
    The tertiary structural dissociation is the only level that is related to a Dissociative Identity Disorder *
    I would prefer to call this a trauma related development disorder. But then again I’m not a clinical psychologist, neuropsychologist or Ph.D. to define such a thing. But I can give some explanation to the existence and on how a tertiary structural dissociation of the personality can occur

Normal integration

normal integrationNo structural dissociation of the personally

A human is not born with a unified personality, but instead infants have biological determinants that were meant to integrate through a process of experience and relationships.  To let that happen there are four autonomic emotional systems that are present at birth which include anger, pleasure, sadness and fear. Team players by nature. These systems integrate to develop into one unified task and emotional life system which ultimately shapes our own personality.

Leg of integration

trauma type-3Tertiary structural dissociation TSD
a type-III trauma

2 or more ANP’s + 2 or more elaborate and distinct EP’s

The parasympathetic nervous system and the limbic system are what actually convey feelings from the body to the brain and from the brain to the body. Without those you would never have actually had the feelings that needed to be dissociated.

In TSD an infant is traumatized prior to integration of the  autonomic emotional systems,  which then results in structural dissociation.  This is not splitting, but instead is a lack of integration.  The emotional systems stay separate and starts to develop as ANP-EP task and emotional action systems.  If there were no trauma in infancy then dissociative identity disorder would not occur.

The four autonomic emotional systems can partially integrate with each other.  For example, anger and pleasure integrate, and sadness and fear integrate resulting in two ANP – EP action systems.  Over time those systems become more dominant  eventually resulting in autonomic functioning ANP – EP action systems.  Later on in life, in TSD and very rare: if the current systems can’t handle the EP load another emotional system can split of to functioning also as an autonomic ANP-EP action system. To give an example of such a rare situation; Experiencing the emotional and physical pain during childbirth and becoming a mother can cause an EP overload. Sadness and fear – or – anger and pleasure, can still split.
Now we have more than two ANP-EP action systems.

trauma type-2Secondary structural dissociation SSD
a type-II trauma

complex PTSD (+ OSDD)
1 ANP + 2 or more semi-elaborate EP’s

This type of trauma becomes very close to a type-III trauma
SSD can result instead of TSD when there has been sufficient integration in early life of the four emotional systems. In this case structural dissociation results in only one ANP, but as with TSD there are always two or more EP, however the EP in SSD are less elaborate, emancipated and distinct than in TSD.

trauma type-1Primary structural dissociation PSD
a type-I trauma
A trauma related dissociative disorder, a PTSD.
1 ANP + 1 primitive EP

In this case the personality sufficiently integrated early in life, but later when a trauma occurs that cannot be integrated then structural dissociation occurs resulting in one ANP and one primitive EP.

This can occur as a full dissociation:
The ANP doesn’t remember a thing of the traumatizing experience (EP)

This can occur as a partial dissociation:
The ANP can remember parts of the traumatizing experience but it doesn’t feel like reality
or an own experience, the EP holds a part of the traumatizing experience.

(c) Nique, client at the Dutch TRTC trauma center Drenthe-Assen

I  explain by my own words the theory of the Structural Dissociation of the Personality such as given by:
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

Complex Trauma PTSDComplex Trauma Community ptsd vrij

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

DID and BPD in one? (Pag.1)

Part IDID 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