The Model of Structural Dissociation

About sixteen years ago, when my therapist at the time suggested there were younger parts of my personality exiled in my psychological Siberia, I was scared. To me, that meant I was “crazy”. Although I rejected the idea of mental illness as solely a genetic-based disorder, nevertheless I was an empiricist. The idea of younger parts seemed as ludicrous as the thought of a homunculus directing the workings of my brain. Younger parts of my personality? Did that mean I was like Sybil from the movie? I knew my past. I knew a lot of things had happened that I tried not to remember. Yet how my therapist got from point A — a women with a history of childhood abuse and neglect — to point B — a women with residual younger parts holding memories of unresolved trauma — threatened what I held true about myself and the nature of personhood.

I didn’t have the classic symptoms of Dissociative Identity Disorder — amnesia, losing time, alternate personalities. However, I did feel detached from my body when highly stressed, and sometimes strong emotions seemed to overtake me. If I had been honest with myself or understood what my dreams were trying to show me, I would have acknowledged that I felt threatened by the sense of some part of me breaking through my defenses, which eventually did happen as flashbacks of sexual abuse.

I would have been more accepting of working with parts of my personality had I known the idea of a singular, rational self was a modern invention, odd by the standards of human history. Yet I had strived for the Western ideal, which I naively adopted when I went to university. After a truancy problem in high school severe enough for my principal to threaten to expel me (notice the lack of logic in that strategy), I finally felt I had escaped my past. I believed that if I became smart and lived a knowledge-driven life, I could leave all the painful emotions and memories behind. Lacking in this plan was wisdom. I hadn’t yet understood how life worked, and that everything I ran from would eventually catch up with me.

I didn’t have Dissociative Identity Disorder, although I have had clients who did. They are some of the most creative, intelligent, and compassionate people I have ever met. Like many clinicians, I don’t perceive the spectrum of Dissociative Disorders as pathologies, but rather adaptations to inhumane conditions. The problem isn’t having unintegrated parts of the personality. Rather, it’s the pain of unresolved trauma and the confusion of acting, feeling, and thinking from multiple perspectives without understanding why or having conscious control over parts of one’s own personality.

Today, there is more acknowledgment of people having multiple parts of their personality, or even distinctly different personalities. The deliberate construction of multiple identities via social media, along with the very public contradictions (and seeming hypocrisies) of both media idols and villains, is returning the idea of multiplicity to the norm. However, the sense of being fragmented as a result of trauma is not the same as consciously manipulating one’s image, or persona. With trauma, multiplicity is not a choice. The shifts in personality that happen are often driven by strong, unconscious emotions.

Of note, wholeness doesn’t necessarily mean an end to parts of the personality, but rather the absence of fragmentation. You can have parts and be whole. In fact, many psychological theorists believe this is the nature of humankind, and we’ll look at two theorists’ ideas in a few weeks — Jung’s analytical psychology and James Hillman’s imaginal psychology.  For me, after years of working with my younger parts, developing healthy defenses, and eventually accepting my past, they have pretty much become silent, replaced with my attention to the life I am living now.

According to the model of structural dissociation, a sense of a separate self or selves, distinct from a core sense of self, is possible because of how the brain is divided into two hemispheres and separated by the corpus callosum, which can inhibit communication between the hemispheres. As mentioned in a prior post, this bicameral organization of the brain is the reason for structural dissociation. The left hemisphere, which is associated with consciousness, can function without awareness of traumatic memories ‘held’ in the right hemisphere – until something triggers a memory and defenses get activated. At that point, the left hemisphere no longer functions unimpeded by traumatic memories, and neither can we. We are once again mired in the emotions and defenses associated with the original trauma(s), which interfere with daily tasks, goals, and obligations, as well as happiness and positive self-regard.

Many theories of trauma emphasize the role emotional regulation plays in posttraumatic stress. In contrast, according to Onno van der Hart, Ellert R. S. Nijenhuis, and Kathy Steele, the creators of the model of structural dissociation, “the essence of trauma is structural dissociation of the personality.”1 Regardless if sexual abuse happened when you were a child, an adolescent, or an adult, some degree of structural dissociation is considered a natural part of coping with sexual abuse.

In response to trauma the personality dissociates into at least two parts: an Apparently Normal Part (ANP) of the personality that is associated with the left hemisphere and attends to daily functioning; and an Emotional Part (EP) of the personality identified with the right hemisphere that includes unconscious memories of the trauma as well as the survival responses activated during the trauma (such as fight or flight) that could not be acted upon.

Following trauma, these truncated defense responses can haunt us as much as memories of the abuse. According to Pierre Janet, whose work informs many of the ideas found in the model of structural dissociation, “The patients who are affected by traumatic memories have not been able to perform any of the actions characteristic of the stage of triumph2 ….” This “stage of triumph” is the completion, or discharge, of the defense activated at the time of the trauma yet could not be used to protect oneself. (Sensorimotor Psychotherapy and Somatic Experiencing are particularly good for working with truncated defenses.)

By emphasizing the truncated survival defenses associated with EPs, the model of structural dissociation gets at the core of why trauma haunts us. Bessel van der Kolk observed, “For human beings the best predictor of something becoming traumatic seems to be a situation in which they no longer can imagine a way out; when fighting or fleeing no longer is an option and they feel overpowered and helpless.”3 EPs hold the unfinished business of self-defense. They interfere with efficiently and effectively adapting to present conditions. In effect, EPs drain energy from leading the lives we desire to live in the present moment by keeping us tethered to the unfinished business of the past.

Yet EPs are not necessarily bad. They are not broken parts of ourselves that we need to annihilate in order to get on with our lives. EPs also have strength, courage, creativity, and insight. Although they carry our wounds, they are often talented and interesting parts of ourselves. Much as Jungian analyst Jean Knox wrote:

“Defenses are not only avoidance mechanisms, but also active constructions in the form of narratives, created in imagination and fantasy to support a positive sense of identity and personal worth when these are threatened by cruelty, hostility or indifference….”4

The model of structural dissociation identifies degrees to which fragmentation occurs according to primary, secondary, and tertiary dissociation.5 These distinctions correspond to the extent, and ways, in which the personality fragments in response to trauma. Primary dissociation occurs in response to a single incident trauma and is associated with Posttraumatic Stress Disorder. At least one ANP and one EP emerge in response to the trauma, with the traits of the EP determined by the memories, emotions, and the defense action tendency activated at the time of the trauma.

Secondary dissociation is a reaction to chronic traumatic conditions. It is associated with complex PTSD, a diagnosis given when trauma is ongoing and there is a sense of being physically or emotionally captive and unable to escape harm. These are the conditions that are common to ongoing child sexual and/or physical abuse, long-term domestic violence, and forced sex work. Secondary dissociation may also be associated with Borderline Personality Disorder, which is correlated with histories of childhood abuse, including emotional abuse and neglect; Bipolar Disorder and shifting affective states; as well as Dissociative Disorder Not Otherwise Specified that includes people who relied extensively on dissociative defenses to survive chronic abuse yet never developed distinctly different identities, amnesia, or depersonalization.

Like primary dissociation, secondary dissociation involves an ANP that relies on the left hemisphere’s capacity for executive functioning to make plans, meet goals, and generally take care of daily tasks. Yet in secondary dissociation there are more EPs, each organized around a defense action tendency. For example, there can be a Fight EP, Flight EP, Freeze EP, Submit EP, and an Attachment Cry EP. All of these EPs may be present, or just a few. Each of these Emotional Parts of the personality emerges in response to a defense being activated, although there wasn’t the possibility of escaping the trauma. Instead, survival required developing beliefs, behaviors, feelings, and fantasies that supported surviving in ongoing inhumane conditions.6

The Fight EP tends to act like a protector. It exhibits anger when threatened, although anger can be turned inward and lead to self-destructive behavior, including suicidality. The Fight EP also tends to be devaluing and impulsive.

The Flight EP tries to create distance from what is perceived as threatening. Since the Flight EP emerged with the action tendency to escape a trauma that could not be acted upon, it tends to escape in the mind. This includes using addictions to evade uncomfortable emotions, body sensations, and situations. With the Flight EP, there are often feelings of ambivalence and difficulty committing to goals.

The Freeze EP is associated with feeling terror. When the Freeze EP is activated, there can be panic attacks or agoraphobia. The Freeze EP also tends to be wary of unfamiliar people and situations and is frightened of being witnessed by others.

The Submit EP is the emotional part that brings up feelings of shame. It includes behaviors such as being passive as a strategy for feeling safe, or being a ‘good girl’ and care-taking as ways to create feelings of safety. Depression and self-loathing are also associated with the Submit EP.

The Attachment Cry EP is often experienced as the needy part of the personality. This is the part that tends to act childlike in efforts to get care from others. The Attachment Cry EP, since it couldn’t just cry out for help, instead adapts by expressing feelings of helplessness, or using charm as an attempt to receive care.

There can also be a Sexual EP that arises when sexuality is used to protect from harm, barter for basic needs, or avoid traumatic memories and emotions.7

Tertiary dissociation is present with severe Dissociative Disorder Not Otherwise Specified and Dissociative Identity Disorder. For both these conditions, more parts of the personality have been necessary for survival. Along with having a Fight EP, Flight EP, Freeze EP, Submit EP, Attach EP, and Sexual EP, the ANP also divides according to functions, and can include a Worker ANP, a Caretaker ANP, and a Social ANP.

It’s not unusual for women with histories of chronic childhood sexual abuse to have a repertoire of behaviors, beliefs, and emotions that dominate when they are at home, and a completely different repertoire while at work or in social situations. Similar to having multiple EPs, having multiple ANPs can lead to exhaustion from efforts to create a fluid and meaningful life.

Having multiple ANPs can feel confusing when a woman is high functioning in her job (where she has no associations with trauma), yet has difficulties maintaining her household (where feelings of overwhelm have been the norm). In contrast, some women may only feel safe and capable in their homes where they know they won’t be triggered. Other women may be submissive in their intimate relationship, yet are competent and assertive in social or work dynamics (or vice versa).

The model of structural dissociation was developed for clinicians to use with clients rather than as a self-help approach. In the companion workbook Coping With Trauma-Related Dissociation, the authors write, “We strongly recommend that you use this manual only in the course of individual therapy or in a structured skills-training group run by trained clinicians.”8 Janina Fisher, who recently published Healing the Fragmented Selves of Trauma Survivors, a book on the clinical treatment of structural dissociation, recognizes the importance of integrative work outside of therapy, although she also emphasizes the significance of having a therapist.

Because EPs get activated outside of conscious awareness, it helps to have someone who can  identify how and when the EP was likely triggered and introduce methods that can support integration, and ultimately recovery. A therapist also helps with mentalizing inner parts, fostering inner communication, and encouraging compassion among parts. Until they are well into recovery, most sexual abuse survivors aren’t particularly good at loving themselves. It helps to have someone point out the good in you.

Working with the model of structural dissociation may seem relatively straightforward, and it is (despite the potential for numerous EPs and ANPs). The difficulty isn’t the method as much as the natural avoidance of remembering trauma. Deciding to upend the inner structures of dissociation is scary and can be destabilizing. Especially if self-harm, addictions, or suicidality are possible responses to feeling overwhelmed, therapeutic support is vital for working with the different parts of yourself.

From my own experiences, I know it’s difficult to think about the ways you’ve contorted your defenses and personality to survive something you should never have experienced. Be gentle on yourself, and try not to judge. You have become who you needed to be in order to survive. Love all of yourself, even the parts you don’t like, for this is the core of recovery.

Over the next several weeks, we’ll look at some ways the model of structural dissociation is used to reduce internal conflicts and self-destructive behaviors. Until then, something to ponder: Play is one of the best things we can do for ourselves. According to esteemed psychoanalyst D. W. Winnicott, “it is play that is the universal, and that belongs to health.” What one truly playful activity can you commit to this week? Something you loved to do as a child, like drawing, playing a board game, swimming, or making a playlist of your favorite songs? Something you’ve discovered as an adult, like taking photographs, hiking, baking, or going dancing? Invest an hour or two in play this week, and do something simply for the joy it brings you.

 

See you next week,

Laura

 

References

1 Hart, Onno van der, Nijenhuis, Ellert R. S., & Steele, Kathy. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. New York: WW Norton & Company, p. vi.

2 Quoted in Ogden, Pat, Minton, Kekuni, & Pain, Clare. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: W. W. Norton & Co., p. 247.

3 Kolk, Bessel van der. (2006). “Forward”. In K. M. Pat Ogden, Clare Pain (Ed.), Trauma and the body. New York: W. W. Norton & Company, p. xxi.

4 Knox, Jean. (2003). Archetype, attachment, analysis: Jungian psychology and the emergent mind. New York, New York: Brunner-Routledge, p. 130.

5 Hart, Nijenhuis, & Steele, 2006.

6 The following material on EPs comes from the training I received from the Sensorimotor Psychotherapy Institutes and Ogden, Pat. (2007). Training for the treatment of attachment, development, and trauma manual. Boulder, CO: Sensorimotor Psychotherapy Institute.

7 Hart, Nijenhuis, Steele, p. 34.

8 Boon, Suzette, Steele, Kathy, & Hart, Onno van der. (2011). Coping with trauma-related dissociation: Skills training for patients and therapists. New York: W. W. Norton & Co, p. xxi.

 

© 2018 Laura K Kerr, PhD. All rights reserved (applies to writing and photography).