Page 21 - PIECES OF THE PUZZLE Eline Vissia

et al. 2005, Nijenhuis et al. 1998a) and stem from the compartmentalization of normally integrated functions. Compartmentalization symptoms are typically a consequence of traumatic development and seem to modify the very structure of the personality (Lanius et al. 2010, Chu 2010, Classen et al. 2006), whereas detachment symptoms are experienced by everybody in extreme situations.
Putnam (1997) proposed a trauma-related developmental pathway to complex dissociative disorders such as DID via repetitive evocation of “discrete behavioral states” in the traumatized infant or young child (Van der Hart, Nijenhuis 2009). These states are precursors to a normally cohesive personality. Recurrent traumatization of the child compromises developmental psychobiological processes and involves a lack of integration among behavioral states and, eventually, dissociative parts of the personality (Putnam 1997).
Psychodynamic views regard dissociation as a psychological defense that emerges when an individual lacks the capacity, skills, motivation, or social support to integrate extremely stressful events or resolve intrapsychic conflict (Howell 2005, Kluft 1985). Recent psychodynamic views on dissociative disorders have integrated object relations, ego and self- psychology, intersubjectivity, and affect and attachment theories to further the understanding and treatment of these complex disorders (Howell 2005, Kluft, Foote 1999).
Attachment
Attachment theory is a psychological model that attempts to describe the dynamics of long-term interpersonal relationships between individuals and is often integrated with a psychodynamic perspective. This theory relates DID to highly disturbed attachment patterns between caretakers and their children (Lyons-Ruth et al. 2006, Barach 1991). This pattern involves the caretaker’s extreme emotional unavailability and unduly frightened and frightening behaviors toward the child, resulting in a disorganized attachment style (Van der Hart, Nijenhuis 2009). Fear without solution, caused by the interaction with a seriously neglectful, maltreating, dissociated or simply frightened parent, prevents children from coherently organize their normal attachment behaviors (Main, Hesse 1990, Farina, Liotti 2013). Results of a prospective
GENERAL INTRODUCTION
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