Page 20 - PIECES OF THE PUZZLE Eline Vissia

CHAPTER 1
Clinicians and researchers seem to agree that dissociation is the loss of the ability of the mind to integrate some of its higher functions (Dutra et al. 2009, Waller, Putnam & Carlson 1996, Farina, Liotti 2013). Dissociation can be broadly defined as a structured separation of mental processes that are normally integrated (Spiegel, Cardena 1991), such as memory, consciousness and identity (Liotti 2004). Dissociation in DID appears to serve as an automatic defense mechanism which reduces the impact of highly aversive or traumatic events (Van IJzendoorn, Schuengel 1996). Boon and Draijer (1993a) note that the assumption of a dissociative continuum, ranging from ‘normal’ forms of dissociation2 to pathological dissociation such as found in DID (Hilgard 1977, Ludwig 1983, Bernstein, Putnam 1986, Putnam 1989), is in contrast with Janet’s original ideas (Janet 1907) in which dissociative states are regarded as discrete pathological states and dissociation is defined as a lack of integration among two or more different “systems of ideas and functions that constitute personality” (p332) (Nijenhuis, Van der Hart 2011). The term dissociation was used by Janet to indicate a disorder of the integrative capacity leading to a mental fragmentation over several levels: from a deficit in the field of consciousness to an impairment of the unity of the subject’s personality (Van der Hart, Nijenhuis & Steele 2006). The disconnection of the normally overlapping and integrated functional levels of the mental functions is induced by the violent emotions caused by traumatic experiences (Van der Hart, Dorahy 2006). The development of a structured clinical interview for diagnosing dissociative disorders, which examines the quality and seriousness of five dissociative symptom classes (SCID-D) (Steinberg 1993) has contributed to the phenomenological knowledge of the various forms of dissociation.
In line with Cardena (1994) and Allen (2001), Brown (2006) and Holmes (2005) proposed a different classification of dissociative phenomena. They proposed two distinct forms of dissociation, namely detachment and compartmentalization. Detachment consists of depersonalization, derealization, and related phenomena, like out of-body experiences. These experiences are typically triggered by overwhelming emotions caused by life- threatening experiences (Lanius et al. 2010). Compartmentalization, in contrast, encompasses dissociative amnesia, somatoform dissociation, surfacing of traumatic memories and distorted emotional and identity unity control (alternation of multiple personalities) (Nijenhuis, Van der Hart 2011, Holmes
2 Such as daydreaming or losing oneself in a good book
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