Page 18 - PIECES OF THE PUZZLE Eline Vissia

CHAPTER 1
not receive optimal care, which is incredibly costly to the mental health care system (Coons 1998, Brand et al. 2012, Insel, Cuthbert 2015). Findings from (fundamental) research need to be better translated to clinical applications. This project has emerged from a neuroscientific interest with a translational aim and was set up in close collaboration with experts in the clinical field.
Trauma, dissociation and attachment
Trauma
In psychopathology trauma is regarded an unbearable and inescapable life- threatening experience in the face of which a person is powerless (Herman 1992, Farina, Liotti 2013, Van der Kolk 1996, Krystal 1988). It has been postulated that traumatic experiences overwhelm a person’s defense ability and take over the usual fight or flight defensive responses (Schore 2009). The activation of an archaic defense system causes a disconnection between the various functional levels of the mind, prevents the integration of the traumatic event in psychological life and causes the discontinuity and fragmentation of consciousness and memory (Schore 2009, Nijenhuis et al. 1998b, Putnam 1997).
Trauma can be seen as a psychological “wound” evolved in relation to a variety of associated psychological, biological, social, and other environmental factors (Nijenhuis, Van der Hart 2011). Psychobiological factors include limitations of the exposed individual’s integrative capacity as revealed in dissociative reactions, affect dysregulation, and persistent avoidance of traumatic memories. Several studies show that traumatic pathogenetic processes cause detached states and neurobiological damage, impair a person’s integrative capacity and cause the fragmentation of behavioral strategies, mental activities, autobiographic and procedural memories, as well as the sense of self (Schore 2009, Farina, Liotti 2013).
Early maltreatment has enduring negative effects on brain development (Teicher et al. 2002, Teicher et al. 2003, Teicher, Tomoda & Andersen 2006). Because children have limited coping and self-regulatory capability in early stages of development they are easily overwhelmed (Putnam 1997) and abuse during this time disrupts self-regulation of emotion as well as early organization of self-perception (Putnam 1997). Emotional dysregulation and
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