Trauma, Dissociation (Structural Dissociation of the Personality), and EMDR
A traumatizing event is a situation that overwhelms one’s sense of vulnerability and control. These are situations where a person experiences tremendous fear, horror, and powerlessness in the face of a perceived threat. Trauma may occur not only from direct threat, but also from witnessing horrible events.
According to the Adaptive Information Processing Model (Shapiro, 1995, 2001) such experiences can be so emotionally and physiologically arousing that they become dysfunctionally stored in state specific form, unable to process. These memories live in “trauma time” and when there is a reminder (either internal or external), the images, thoughts, emotions, sensations, mental and behavioral actions that were experienced at the time of the trauma, may be re-experienced. Hence, current problems are the result of past dysfunctionally stored memories.
Eye Movement Desensitization and Reprocessing (EMDR) is an eight phase therapeutic approach, which research has shown to be effective for treatment of traumatic memories (Shapiro, 1995, 2001). However, EMDR is also effective in treating any disturbing memory, and consequently is helpful for a wide variety of problems. Guided by the Adaptive Information Processing Model, EMDR can be used to treat present day problems by processing the a) underlying past memories, b) the present situations that continue to trigger symptoms, and c) laying down a positive future template for adaptive behavior.
Complex trauma results when there is severe and prolonged abuse and/or neglect, especially in childhood. While rooted in memories of traumatizing events that are dysfunctionally stored, the resulting clinical picture can be more comprehensively understood and phenomenologically elaborated by The Theory of Structural Dissociation of the Personality (TSDP). In this framework, the traumatizing events create a division of personality in terms of dissociative parts of the personality. Personality is defined as the dynamic organization within the individual of those biopsychosocial systems (called “action systems”) that determine his or her characteristic mental and behavioral actions. There are two major categories of action systems, those that have to do with everyday living (e.g. exploration, social engagement, care-taking, play, energy regulation and sexuality/reproduction) and those that have to do with defense of the individual when under threat (e.g. fight, flight, freeze, submission), As a result of the trauma, the person’s personality is unduly but not completely divided among two or more of such dissociative parts each having its own, at least rudimentary, first-person perspective. The basic splitting is between the two major action systems, resulting in what is called the Emotional Part of the Personality (EP), which holds (using AIP language) the dysfunctionally stored information and the Apparently Normal Part of the Personality (ANP), focused on carrying on daily life (Van der Hart et al., 2006). The EP is basically fixated in traumatic memories and defensive systems operating during the traumatic event. The ANP is focused on daily life functions, and because the traumatic memories are too intense and overwhelming, is fixated in avoidance. Hence, the ANP is not able to stay present (e.g. within the “window of tolerance”) when an EP is activated.
TSDP proposes three groups ranging from very simple to extreme division of the personality:
Primary Structural Dissociation: Involves one major part of the personality mainly focused on daily life (i.e., the ANP), and the other (i.e., the EP) mainly fixated in defense and re-enactment of traumatic memories. This type of dissociation is often seen in simple PTSD.
- Secondary structural dissociation: Involving one ANP and more than one EP. Thisis common when traumatization is more repetitive, severe, and prolonged, especially during childhood. This level of dissociation likely characterizes patients with Complex PTSD, trauma-related borderline personality disorder (BPD), and DDNOS, Subtype 1.
- Tertiary structural dissociation: More than one ANP exist, in addition to multiple EPs. This level refers to patients with DID. In the context of chronic interpersonal neglect, maltreatment and abuse that started in childhood, many dissociative parts, and each in his or her own way, struggle with attachment problems.
Because the person (e.g. ANP) is not able tolerate the emotional intensity of the traumatic memories (held by the EP), a Phase Oriented treatment approach is needed when treating complex trauma. A phase oriented approach consists of (1) stabilization, symptom-reduction, and skills training; (2) treatment of traumatic memories; and (3) (re)integration of the personality. A variety of treatment methodologies are utilized in the treatment of complex trauma (including EMDR). However, specialty training in trauma and dissociation is essential for effective treatment.