Page 19 - PIECES OF THE PUZZLE Eline Vissia

maltreatment during developmental years often co-occur and may be the precipitant of psychiatric treatment (Putnam 1997, Brand et al. 2012, Gentile, Dillon & Gillig 2013) and the neurobiological sequelae of early stress and maltreatment may play a significant role in the emergence of psychiatric disorders during development (Teicher et al. 2003). DID has been associated with prolonged, severe and early childhood trauma (Chu et al. 1999, Boon, Draijer 1993b, Putnam et al. 1986) and the vast majority of DID patients report severe forms of abuse.
Clinical and neurobiological studies show that childhood traumatic experiences typically affect the mental functions most heavily dependent on the development and functioning of large associative networks, such as the state of consciousness and self-consciousness, or from the integration of different brain areas, such as emotional control and autobiographic memory (Chu 2010, Lanius, Vermetten & Pain 2010, Teicher et al. 2010, Tononi, Koch 2008, Farina, Liotti 2013).
Dissociation
Many divergent experiences have been described as dissociative, ranging from normal failures in attention to the breakdown of memory processes as seen in dissociative disorders. There is no consensus on the meaning of the term dissociation and the term is, in psychopathology, essentially used to define three different yet related concepts (Farina, Liotti 2013): 1) a diagnostic category, Dissociative Disorders (DD) of the ICD-10 and DSM-5; 2) a group of symptoms, dissociative in nature such as amnesia or derealization; 3) some pathogenic processes caused by traumatic experiences interfering with the integration of mental functions. Both retrospective and prospective studies and clinical observation suggest that dissociation is the central pathogenic mechanism rather than a peripheral feature of trauma related disorders (Sar 2011). Dissociative symptoms can disrupt every area of psychological functioning and are usually divided into two types (Spiegel et al. 2013): first there are unbidden intrusions into awareness and behavior, with accompanying deficits in continuity of subjective experience, labeled “positive” dissociative symptoms, and second, there is an inability to access information or to control mental functions, called “negative” dissociative symptoms (Spiegel et al. 2013).
GENERAL INTRODUCTION
17