Tertiary structural dissociation

Tertiary structural dissociation DEFAULT

The theory of structural dissociation

Here’s a post where I explain the theory of structural dissociation. All information is taken from The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization by Van der Hart, Nijenhuis and Steele (2006).

I am not a professional and am only repeating things I’ve read. The reason I’m making this post is because I (and others) refer to the theory of structural dissociation regularly, so having a clear post about it seemed like a good idea!

Before explaining the different ‘levels’ of structural dissociation, I’ll shortly explain the terms ANP and EP. ANP stands for Apparently Normal [Part of the] Personality, whereas EP stands for Emotional [Part of the] Personality.

Very broadly stated, ANP parts are focused on functioning in the daily life and distanced from anything trauma-related; in DID ANP’s can be completely unaware of any trauma. EP’s are more trauma-related; often ‘containing’ very intense, trauma-related emotions, memories, actions, beliefs et cetera.

However, it’s important to mention that the ANP/EP distinction is not black/white. Some EP’s can help out in daily life, ANP’s can still have emotions, stuff like that. Especially once there are multiple parts and more elaborated parts, the ANP/EP distinction becomes blurry. For instance, I wouldn’t be able to define for all of us whether they’re ANP or EP.

Okay. Back to the theory of structural dissociation. Two more important terms: elaboration and autonomy of parts. Please check out this infographic by @clever-and-unique-name​ on the elaboration of parts! Simply put, elaboration is about the degree to which a part has its own traits (e.g. name, internal appearance, skills, beliefs, …) and autonomy is about the degree to which a part feels they are their own self and the degree to which they can take executive control (aka ‘switch out’).

The theory of structural dissociation distinguishes between three ‘levels’ of structural dissociation:

  1. Primary structural dissociation. This is the most ‘simple and basic’ trauma-related division of the personality: a single ANP and a single EP. In this case, the EP is unelaborated and not very autonomous in daily life. Primary structural dissociation often occurs after a single traumatizing event.
  2. Secondary structural dissociation. When traumatizing events keep happening and keep being overwhelming, further division of the EP can happen while the ANP remains intact: in this situation someone will have one ANP and multiple EP’s. The EP’s can be more elaborated and autonomous than in primary structural dissociation, but are typically less elaborated and autonomous than in tertiary structural dissociation.
  3. Tertiary structural dissociation. The difference between this level and secondary structural dissociation is that in tertiary structural dissociation, the person has more than one ANP and multiple EP’s. This can happen when inescapable aspects of daily life have become associated with past trauma, or when the functioning of the existing ANP(’s) is so poor that normal life becomes too overwhelming - causing a new ANP to develop. In this level, it’s common for several ANP’s and EP’s to be more elaborated and autonomous than in secondary structural dissociation.

In severe cases of secondary and in all cases or tertiary dissociation, more than a single part may have a strong degree of elaboration (e.g. names, ages, genders, preferences) and emancipation (perceived separation and autonomy). This is not usually observed in primary structural dissociation, and neither in most cases of secondary structural dissociation.

According to the authors of The Haunted Self, the levels of structural dissociation and various diagnostic labels relate as follows (they categorize more diagnoses in the book, I’m only naming the ‘relevant’ ones right now):

  • PTSD = primary structural dissociation
  • Trauma-related BPD, CPTSD, OSDD = secondary structural dissociation
  • DID = tertiary structural dissociation

Please keep in mind this is a proposed relationship between structural dissociation levels and DSM diagnostic labels. Many survivors experience structural dissociation without the elaboration and emancipation of some dissociative parts found in DID. 

Based on this description of the theory it may seem easy to figure out ‘where you are at’, but personally I believe it’s not. That’s why I, for myself, hold onto the idea that dissociation is a spectrum. These categories help a lot, but there are no hard walls in between. Maybe someone with PTSD from a single traumatic event can have two EP’s. Maybe someone with CPTSD can have black-out amnesia but no elaborated parts. Maybe someone with OSDD can have more elaborated parts (that’s me).

A last important note is that, once you’re in a ‘higher’ level, you can also have the parts associated with lower levels. Simple example: someone with DID can also have very simple, one-dimensional, unelaborated EP’s.

I think that’s plenty information for now. Let me know if I made a mistake, missed something big, or if you have any questions.

- Sae

Posted on March 28, 2020with 411 notes
Sours: https://osddifficult.tumblr.com/post/613839561583378432/the-theory-of-structural-dissociation

DID Research

Primary Structural Dissociation

A graphic representing primary structural dissociation of the self. It shows a circle with a single ANP - which contains all daily life functions - partially overlapping with a single EP, which contains all trauma-related functions. These functions are listed out. Additionally, the image lists posttraumatic stress disorder and simple dissociative disorders as conditions that involve primary SD.

If an individual has a relatively safe and secure childhood, they will have the opportunity to fully integrate their personality, sense of self, and personal history. However, early development is not the only relevant factor in dissociation. A combination of genetics and trauma or extreme stress can cause an individual to dissociate later in life, leading to dissociative disorders such as depersonalization/derealization disorder or dissociative amnesia or to a trauma- and stress-related disorder, most notably posttraumatic stress disorder (PTSD). Early life trauma can lead to the same disorders when the individual is more resilient, when the trauma is not a betrayal-trauma, when the trauma is not repeated, or simply when the individual is not as genetically predisposed to dissociative responses. Regardless of when the dissociation of the personality occurs, primary structural dissociation is the problem.

According to the theory of structural dissociation, primary structural dissociation refers to the presence of one emotional part (EP) and one apparently normal part (ANP) within an individual. The ANP is the part responsible for daily life. The EP is dissociated from, or kept from integrating with, the ANP because it holds the traumatic experiences that could overwhelm the self and prevent the ANP from appropriately functioning in day to day life. That is to say, the fight, flight, freeze, and submission responses to trauma and the memories and internalized messages associated with them are dissociated, or not integrated, with the part of the personality that copes with normal life.

For those with PTSD, this allows the ANP to remain numb and avoidant towards traumatic materials except at times in which something triggers, or activates, the EP and brings it to the front of the mind in the form of dissociative flashbacks, hypervigilance, panic, irritability and recklessness, emotional outbursts, negative perceptions of the self and world, nightmares, or somatic symptoms. When the EP is activated alongside the ANP, the ANP experiences intrusions related to the traumatic materials contained by the EP.

When the EP in an individual with PTSD is so strongly activated that they gain complete conscious control at the expense of the ANP, they experience the traumatic experience in full as if it's occurring in the present. They are aware of nothing but the trauma. This effect is to some extent mitigated when EP and ANP are both aware at once, but the EP cannot remain grounded in the present to any meaningful extent on their own. All of their mental energy and resources are devoted towards futilely attempting to process the trauma that they experienced. When ANP have enough mental energy and resources of their own devoted to avoiding traumatic stimuli and preventing it from having an effect, this happens more rarely than when the ANP has been worn down or has fewer resources to spare. The ANP will likely have strongly negative reactions towards the EP even in the case of a full take-over by the EP of which the ANP is not consciously aware and cannot later recall.

It is not understood how structural dissociation encompasses simple dissociative disorders, but for this theory to be valid, it must in some way apply to all dissociative disorders (used here to mean all disorders in which dissociation is a primary characteristic whether it is the disorder's defining characteristic and classifier or not). It could be that for those with depersonalization/derealization disorder, the presence of an EP causes the ANP to experience a disconnect from aspects of themself or their internal processes or from their surroundings or the world around them. In this case, the EP causes negative and not positive symptoms (a loss of normal awareness and processing instead of a gain of trauma-related intrusions). This may represent a type of mental flight or a form of submission on the part of the EP. If the internal dissociation is caused by trauma, the EP might have internalized the disconnect between normal life and the trauma or have adapted the dissociation as a way to distance themselves from the trauma and so more easily allow the perpetrator to have their way without risking bodily harm to the individual.

For those with dissociative amnesia, the role of structural dissociation is far more easily explained. These individuals often develop symptoms of PTSD or actually develop PTSD when their amnesia for the traumatic event that triggered their dissociation ends. In this case, the ANP simply experiences a variable period of time without the interference of the EP that contains all conscious awareness of the trauma. Upon return of the EP, the individual experiences the same struggles as do individuals with PTSD.

It should be noted that some consider the presence of one ANP and one highly developed EP as a case of primary structural dissociation due to following a strict number based dichotomy. However, for the purposes of this website, individuals who have only one ANP and one EP but whose EP is experienced as a moderately differentiated entity or as a poorly differentiated entity for which the ANP is amnesiac (presenting as might a part for an individual with OSDD-1) are considered to have secondary structural dissociation. This is in order to avoid conflicting DSM-5 criteria for diagnoses. However, such presentations are rare. Even rarer is the individual who meets clinical criteria for DID yet has only two parts within their entire personality system. Again, such an individual is for the purpose of this website considered to have tertiary structural dissociation due to the complexity of the dissociative boundaries between the two parts.

Some facts from "The Haunted Self."

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.

Sours: https://did-research.org/origin/structural_dissociation/primary
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DID Research

Tertiary Structural Dissociation

A graphic representing tertiary structural dissociation of the self. It shows a circle with multiple ANP - each containing different daily life functions - partially overlapping with multiple EP, each containing different trauma-related functions. All functions are listed out. The ANP and several EP are not given more specific labels, and three EP are labeled "Attack," "Submit," and "Freeze." Dissociative identity disorder is listed as the disorder involving tertiary SD.

The causes of tertiary structural dissociation are very similar to the causes of secondary structural dissociation. That is, trauma that begins at a young age, lasts for a long time, is perpetrated by a family member or guardian, or involves more extreme disorganized attachment can result in either secondary or tertiary structural dissociation with tertiary structural dissociation resulting from more extreme or long-lasting trauma, in someone with less psychic defenses, or in someone who is more  naturally dissociative. Tertiary structural dissociation is theoretically equivalent to dissociative identity disorder (DID), though  in reality someone with other specified dissociative disorder-1 (OSDD-1) might fit the criteria while a few individuals with DID might not simply due to their number of parts.

Tertiary structural dissociation refers to the presence of multiple apparently normal parts (ANP) and multiple emotional parts (EP) within an individual.  The ANP of tertiary structural dissociation each handle different (though possibly overlapping) aspects of daily life. For example, one ANP might be the host and handle school, relationships, and work. Another ANP might be better at relationships and so assist the first in that regard either knowingly or unknowingly (some believe that ANP always lose time when they switch with each other and are not aware that they are not each other; for some with DID, this may be true) while another might help with a specific subject matter in school or aspect of work. Another ANP might handle the system's family of origin or help to take care of dependent children. Individuals with DID do not have a single ANP that accurately reflects who they would be as a fully integrated personality. Before individuals with DID are aware of their condition, their ANP are highly phobic of their EP, though some ANP might seek out less threatening EP once they understand what the EP are. Because alters can be highly developed and have strong dissociative barriers between them, ANP can often safely interact with certain EP without necessarily experiencing bleed through of traumatic memories, perceptions, or urges.

Strategies that ANP use to avoid the activation of EP can involve amnesia, anesthesia, or limiting the ANP's range of emotions or numbing their emotion intensity. These avoidant behaviors combined with frequent intrusions from EP can drain mental energy and allow for depression, anxiety, or chronic feelings of hopelessness, shame, guilt, or rage. Particularly desperate ANP might engage in self harm or use psychogenic substances in attempts to forcefully tether themselves to the present and prevent EP from intruding. It is likely that emotionally disconnected ANP will struggle to form meaningful relationships with others and will have a poor grasp of their own physical and emotional needs. However, most ANP have a need to appear high functioning and may find it easier to avoid all potentially triggering situations and actions, including those relating to attaching to and trusting others, and throw themselves into work or other non-reflective activities.

As in secondary structural dissociation, the EP of tertiary structural dissociation handle different aspects of the trauma and may contain different memories,  different learned responses, different internalized messages, different strong emotions, different attachment patterns, or different personal characteristics. The EP of tertiary structural dissociation are most like those found in OSDD-1. However, these EP are likely to be more complex and well developed than are those typically found in secondary structural dissociation, though some may remain fragmented traumatic containers. EP of those with DID may perceive themselves as belonging to a range of ages and are not always all small children who are frozen in time. EP may handle some aspects of daily life such as exploration, play, or socialization. Some may be very similar to ANP or even resent the implication that holding traumatic materials makes them somehow less developed, rational, or mature!

Individual EP may be focused more on defense through fight, flight, freezing, or submission, on specific emotions, or on specific types of attachment. It's common for EP to present in a stratified manner, with one or more EP presenting with their trauma as the previous EP and their trauma are processed and integrated. Multiple EP are often grouped according to the types of trauma that they experienced, with some EP even having experienced different aspects (sites, sounds, emotions) or being created to contain different defensive actions associated with the same trauma and traumatic memories. Some traumas might be associated with an experiencing part who registered the sensorimotor and affective elements of the trauma and with an observing part who witnessed the trauma from within or during an out-of-body experience. The observing part might present as emotionless and detached and is associated with the concept of an internal self helper.

Both EP and ANP can manifest through either passive influence or through full switches. Time loss and black outs may or may not always accompany full switches depending on the system's degree of co-consciousness. Systems with high degrees of co-consciousness are especially likely to deny each other or each others' memories, though denying each other also occurs for those who think to blame their black outs on a supposed medical condition, iatrogenic or sociocognitive influences, or a naturally poor memory, and denying each others' memories is common for all systems. On the other hand, both ANP and EP may be tempted to deny the body's current physical form or situation or may resent the system's job, spouse, children, or location.  ANP and EP may all be avoidant of each other or of internal groups that they do not identify with and may react to these unfavorable alters or groups with shame, blame, or hatred. However, internal friendships and alliances are also common, and some systems may even group based on perceived family units.

Alters may or may not be aware of each other or that they are part of a whole.  Alters may experience themselves as completely unique individuals and may view the other alters within their system as either completely separate individuals or experience them with a sense of "me but not me." They may intellectually own the system's shared history and current life and situations, but they may not feel that they have any control over each other and resent being made to feel as if they do. It is vital that systems take responsibility for all of their members, and most strive to do so, but  actions that are not harmful but simply preference based may be completely disowned but alters that are not involved. For example, if a vegetarian alter is told that because their host loves meat a part of them does as well, they may be angered or sickened at the perceived accusation that they are allowing part of themself to engage in actions that they do not approve of. While alters may acknowledge that they share a physical brain and body, they may insist that they are no less unique than clones of an individual would eventually become. That some alters are so independent, differentiated, and developed (sometimes referred to as emancipated and elaborated) does raise questions about what constitutes a person.

It is known that individuals with DID may form both additional EP and additional ANP in adulthood depending on their experiences and needs. While new real or perceived trauma is most likely to create new EP, new  ANP may result to give birth or take care of children, to handle new work responsibilities, or to replace previous hosts who have grown too worn to continue to manage daily life. New parts are created when new action systems, strong emotions, memories, or perceptions cannot be integrated into the whole of the individual or into any existing part. It must be remembered that no part can contain anything that is not available to the individual; to use a clear and extreme example, a part cannot be created to be a medical doctor if the system does not have medical training! On a more realistic level, a part cannot be created that can automatically heal the system or handle all of the system's current problems if the coping skills and desires to do so are not already present within the system.

Some facts from "The Haunted Self."

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.

Sours: https://did-research.org/origin/structural_dissociation/tertiary
Dissociative Identity Disorder - Structural Dissociation


Structural dissociation tertiary


Structural Dissociation, D.I.D., Relational Dissociation Disorder (Codep/NPD reframed) #VGCommunity


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