Structural Dissociation

Category:Psychiatric Terms
Category:Common Terms
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The Theory of Structural Dissociation or Structural Dissociation of the Personality is a proposed medical framework regarding the formation and functions of trauma-related dissociation. It is not a theory about plurality, and is not meant to be applied outside of the context of trauma-related dissociation. The model aims to provide a cohesive theory regarding various trauma-related disorders, such as PTSD, CPTSD, BPD, DDNOS, and DID, among others (See Tiers).
The Theory of Structural Dissociation was built upon the works of many previous authors and researchers, most notably Pierre Janet (1859-1947), a French philosopher, psychiatrist, and psychologist, who has been described as “one of the most seminal psychiatric clinicians and thinkers of the last two centuries”.Nemiah, J. C., Janet redivivus: The centenary of L’automatisme psychologique. American Journal of Psychiatry, 146, 1527-1529 The Theory of Structural Dissociation is comprehensively described in The Haunted Self, written by authors Ellert Nijenhuis, Onno van der Hart, and Kathy Steele, three leading researchers and clinicians working in the field of trauma and dissociation.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.
= Personality Systems & Structural Dissociation =
Structural dissociation is described by the authors of The Haunted Self as “a particular organization in which different psychobiological subsystems of the personality are unduly rigid and closed to each other. These features lead to a lack of coherence and coordination within the [trauma survivor’s] personality as a whole”. (p. viii)
The author’s use of the terms system and subsystem refer to personality systems and are based in an understanding of Janetian psychology of action, in which systems refer to “systems of ideas and functions that constitute personality”.Janet, Pierre (1907). The major symptoms of hysteria. London & New York: Macmillan. According to The Haunted Self, a personality system is “an assembly of related elements comprising a whole, such that each element is a part of that whole in some sense. … The personality as a system can be understood as being comprised of various psychobiological states or subsystems that function in a cohesive and coordinated manner.” (p. 2) It is notable that this definition of systems and subsystems is different from the plural community’s usage of these terms; within the context of the Theory of Structural Dissociation, everyone (plural or not) has a personality system and various subsystems comprising it. A personality system is not the same as plurality, but rather is an organization of different action subsystems (See Action Systems & Action Tendencies) which make up different aspects of personality.
Structural dissociation of the personality refers to a particular organization of the personality following trauma. According to the authors of The Haunted Self, “this organization is not arbitrary or coincidental, but in traumatization it likely follows rather well-defined, evolutionary metaphorical “fault lines” in the structure of the personality”. (p. 3)
= Action Systems & Action Tendencies =
Action systems are what make up personality systems. Two categories of action systems are described throughout The Haunted Self, one which involves systems which revolve around daily life and attractive stimuli (such as food, companionship, and caretaking) and one which involves systems which revolve around defense and avoiding aversive stimuli (such as various threats).
Action tendencies are different from the concept of actions. Whereas actions are carried out or executed, Pierre Janet notes that “action tendencies are not merely propensities to act in certain ways, but involve the complete cycle of action, including latency, readiness, initiation, execution, and completion.” Janet, Pierre (1934). La tension psychologique et ses oscillations [Psychological tension and its oscillations]. In G. Dumas (Ed.), Nouveau traité de psychologie [New Textbook of Psychology] (pp. 386-411). Paris: F. Alcan. Action tendencies are made up of a complex range of mental and behavioral actions. ( p. 3)
According to The Haunted Self, “Action systems help us to behave, think, feel, and perceive in particular ways; that is, engage in certain action tendencies that are meant to be beneficial to us. Thus, we may behave, think, feel, and perceive one way when we are hungry, and quite differently when we are curious about what has happened to a friend, or when we have a conflict at work.” (p. 4) Action tendencies may overlap across different action systems, however the goal of the action is different depending upon the overarching action system (ex. Running for play vs. running for escape).
Structural Dissociation of the Personality describes a division between action systems geared towards daily life and those geared towards defense due to trauma. As an example, Marilyn Van Derbur, former Miss America and a survivor of childhood sexual abuse, described her personality as being divided into a “day child” which was amnesic, detached, and focused on daily life, and a “night child” that endured the abuse and was focused on defense.Derbur, Marilyn Van M.,  2004, Miss America by Day
= Dissociative Parts of the Personality =
Divisions of the personality (ie. Structural Dissociation) are described as dissociative parts of the personality or dissociated parts of self. These dissociated parts are “self-conscious, have at least a rudimentary sense of self, and are generally more complex than a single psychobiological state”. (p. 4) The extent of separation of dissociative parts (described as emancipation and elaboration) is generally linked to the level of structural dissociation (See Tiers), but this may not always be the case (Such as a PTSD patient with a highly elaborated and emancipated EP).
Dissociative parts of the personality in the Theory of Structural Dissociation are categorized based on the work of British World War I psychologist and psychiatrist Charles Samuel Myers, who described a basic form of structural dissociation in World War I combat soldiers.Van der Hart, O., Van Dijke, A., Van Son, M., & Steele, K. (2000). Somatoform dissociation in traumatized World War I combat soldiers: A neglected clinical heritage. Journal of Trauma and Dissociation, 1(4), 33–66.Myers, C. S. (1940). Shell shock in France 1914–1918. Cambridge: Cambridge University Press.Myers, C. S. (1916b, September 9). Contributions to the study of shell shock. The Lancet, 461–467.Myers, C. S. (1916a, March 18). Contributions to the study of shell shock. The Lancet, 608–613.
This form of dissociation involves the co-existence of and alternation between an Apparently Normal [Part of the] Personality (ANP) and an Emotional [Part of the] Personality (EP), described in further depth below.
=== Apparently Normal [Parts of the] Personality (ANP) ===
ANPs are dissociative parts which are fixated in daily life action systems (such as socializing, food, sleep, exploration, and attachment). ANPs are often avoidant of traumatic memories and of trauma-holding EPs. (p. 5)
=== Emotional [Parts of the] Personality (EP) ===
EPs are dissociative parts which are fixated in defense action systems or subsystems (e.g., fight, flight, hypervigilance) that were activated at the time of traumatization. (p. 5) Emotions are not only experienced by EP; rather, Myers wanted to emphasize the vehement nature of EP’s trauma-related emotions in comparison to ANP.
=== Mixed Apparently Normal and Emotional Parts ===
Described in the Theory of Structural Dissociation is also the existence of “mixed parts”, typically seen in more complex forms of structural dissociation. Mixed parts are dissociative parts which are not clearly defined as either ANP or as EP. This is theorized to be more common in survivors whose trauma was a recurring part of daily life in such a way which prevented differentiation of ANP and EP, as well as survivors whose trauma was especially severe and started at a very young age. (p. 78), “Apparently Normal and Emotional Parts.” DID-R, did-research.org/origin/structural_dissociation/anp_ep.
= Tiers of Structural Dissociation =
Divisions of the personality can range from rather simple to extremely complex. To illustrate this, the Theory of Structural Dissociation organizes different levels of dissociative complexity into three categories: Primary, secondary, and tertiary structural dissociation.
It is important to note that while there are diagnoses attached to each tier, diagnosis may not always correlate to the level of structural dissociation. (p. 7) Further, the authors of The Haunted Self assert that these categories are prototypes and that “It is to be expected that the more complex structural dissociation becomes, the more there will be deviation from these prototypes. There can be infinite individual variations of the expressions of dissociation.” (p. 5-6)
=== Primary Structural Dissociation ===
Primary structural dissociation is described as involving the existence of a singular ANP and EP. In this level of structural dissociation, ANP is the “major shareholder” of the personality while EP tends to be rather limited in sense of self and autonomy.
Diagnoses listed under primary structural dissociation include simple types of Acute Stress Disorder, simple types of PTSD, simple types of DSM-IV Dissociative Disorder, and simple types of ICD-10 Dissociative Disorders of Movement and Sensation. (p. 8)
=== Secondary Structural Dissociation ===
Secondary structural dissociation is described as involving the existence of a singular ANP and multiple EPs. Secondary structural dissociation is theorized to occur when traumatization is increasingly overwhelming or prolonged, and involves further division of EP. This level of structural dissociation may relate to the failure of various kinds of defense strategies to integrate. EPs in secondary structural dissociation may be more elaborated and autonomous than seen in primary structural dissociation, but are often less so than EPs in tertiary structural dissociation. (p. 6)
Diagnoses listed under secondary structural dissociation include Complex PTSD, Disorders of Extreme Stress Not Otherwise Specified, Dissociative Disorder Not Otherwise Specified, Borderline Personality Disorder, and Complex ICD-10 Dissociative Disorders of Movement and Sensation. (p. 8)
=== Tertiary Structural Dissociation ===
Tertiary structural dissociation is described as involving the existence of both multiple ANPs and multiple EPs. Tertiary structural dissociation is theorized to occur when inescapable aspects of daily life become associated with trauma, or when ANP cannot function in daily life and becomes overwhelmed, leading to the development of new ANPs. Tertiary structural dissociation involves strong degrees of elaboration (e.g., names, ages, genders, preferences) and emancipation (separation and autonomy from other dissociative parts). (p. 6), 
The only diagnosis listed under this level of structural dissociation is Dissociative Identity Disorder. (p. 8)
= Personality Development and Age =
In the Theory of Structural Dissociation, young children are theorized to have various behavioral states to get their needs met. These states integrate into a cohesive personality during typical childhood development, however this process may be interrupted by trauma.
According to The Haunted Self, “Structural dissociation involves hindrance or breakdown of a natural progression toward integration of psychobiological systems of the personality that have been described as discrete behavioral states (Putnam, 1997). It involves a chronic integrative deficit largely due to a combination of the child’s immature integrative brain structures and functions (for reviews, cf., Glaser, 2000; Van der Kolk, 2003), and inadequate psychophysiological regulation by caregivers, such as insufficient soothing, calming, and modulation (Siegel, 1999).” (p. 7)
The Theory of Structural Dissociation also views the age at which traumatization occurs as a risk factor for more complex organizations of structural dissociation, with primary structural dissociation being associated with a relatively cohesive personality existing prior to traumatization. The Haunted Self describes tertiary dissociation as being “much more likely to develop in earlier childhood traumatization (prior to age 8)”. (p. 7, p.  84) Note that this is not an age cut-off, but rather an observed pattern.
== Related Terms ==
Apparently Normal Parts and Emotional Parts are an important concept within the Theory of Structural Dissociation. Integration and fusion are also frequently discussed by the authors both within The Haunted Self and in their other works when discussing recovery methods for structurally dissociated patients. 
Additionally, the idea of a core or original is sometimes seen as incongruous with Structural Dissociation as it proposes that there’s not a personality that splits, but a collection of parts that remain independent; however, this is untrue. Cores can and do exist within the framework of the theory, as explained here.
== Further Reading ==
* Trauma-related Structural Dissociation of the Personality: A summary of the full The Haunted Self book including excerpts. It is a very dense read but a good starting point.
* Problems With The Theory of Structural Dissociation: This article goes into more nuanced reasons as to where the theory struggles with other dissociative disorders.
* How Are New Alters Formed? An Explanation Of Structural Dissociation: Although made by a sysmed, this video offers a good overview of the theory using visual aids and in a more consumable way.
==References==
Category:Dissociation-Related Terms
Category:Disorder-Related Terms
Category:Not Plural Exclusive