sensation. Gradually over the course of treatment, she was eventually able to remain in the memory of the sensation long enough during a therapy session to explore it without abreacting (i.e., becoming dysregulated), and she was able to reconnect this experience as an adult to sexual abuse she had experienced as a child. Fragmentation Fragmentation is present when an individual refers to “parts” of themselves and relates to them as if they are separate, rather than a unified whole, but is still aware of their existence. Fragmented individuals may describe feeling a loss of control or a sense of going through the motions of life, and they are aware of and can sense childlike or young parts of themselves. Such individuals are aware that they sometimes respond to situations from the point of view of these childlike parts, rather than from their present ages or life stages. Each fragmented part may access a different age or emotional state. Fragmented individuals frequently dislike some of these parts of themselves and wish to be separate from them. For example, Rebecca, age 26, periodically says, “I hate my child self. She’s so dumb.” The difference between this form of dissociation and dissociative identity disorder is a matter of degree and whether the person is conscious of these splits in their sense of self. This type of fragmentation is sometimes categorized as dissociative disorder not otherwise specified (American Psychiatric Association [APA], 2013). Dissociative Identity Disorder Dissociative identity disorder (DID) is at the far end of the dissociative spectrum and was formerly referred to as multiple personality disorder (APA, 2013). In this state, the fragmentation is complete and there are completely separate parts of the self that are not aware of each other’s existence. Each self part has a different function or a different job to do and may have originally emerged at different times in childhood to hold and compartmentalize different traumatic events, different perpetrators, or different intolerable feeling states. DID typically develops in individuals who, during very early childhood, have experienced extreme and chronic abuse, usually including elements of sexual, physical, and emotional abuse. Profound isolation from others at the time of the traumatic events also contributes to the development of this disorder (Steele et al., 2016; van der Kolk, 2014). Neurobiological evidence also supports a close relationship between PTSD and DID (Reinders & Veltman, 2021). Complete dissociation becomes the individual’s defensive coping mechanism under conditions of such extreme stress, instead of the alternative, which might be a complete psychotic break. Complete dissociation represents the system’s attempt to keep a part of itself healthy and functioning by developing other parts to hold the various emotions, memories, and responses to the trauma. These Model for Integration: The BASK Model To heal fragmentation and dissociation, the individual needs to be able to process a whole and complete memory with all of its component parts. To do so, the memory must be fully integrated within the body–mind system. The BASK model of memory dimensions (Braun, 1988) is used as the foundation of many treatments for dissociation and is a helpful tool to explain what is necessary for a fully integrated memory or activity. BASK is an acronym. B : Behavior A : Affect S : Sensation K : Knowledge
parts are referred to as “alters,” and an abuse survivor may have developed anywhere from a few to a very large number of alters to hold various emotions or memories. For example, one part may hold and be aware of feeling anger, another part may hold the sadness, and yet another part may hold a specific memory separate from the rest of the system. It is common for some of the parts to be child parts and, if accessed, they can state their age, gender, and role in the system. In contrast to the category of fragmentation, these parts are not aware of each other until the individual is under safe and specialized treatment conditions. Treatment of DID is a highly specialized subset within trauma treatment. The Dissociative Disorders Interview Schedule (Ross et al., 1989) or the Dissociative Experiences Scale (Bernstein & Putnam, 1986) can measure a full range of dissociative symptomatology. Treating individuals with this diagnosis requires specialized training. Clinical Clues in the Detection of Dissociative Identity Disorder. None of the following signs are sufficient in and of themselves for a diagnosis of DID; however, an increasing number of these symptoms should raise the clinician’s level of concern and prompt a more thorough evaluation and referral to a specialized provider. The signs are (Schiller, 2008): ● Multiple previous psychiatric or psychological diagnoses ● A diverse symptom picture that does not correspond to more usual syndromes ● A history of severe childhood trauma; note that a significant lack of recall may be as important as what is recalled ● Periods of lost time (“I don’t know where I was on Sunday; I have no memory of that day”) or lack of memory about a span of years during childhood (“I can’t remember anything between ages 4 and 12”); note that no or little memory for events before age 4 is developmentally normative ● Behaviors the client cannot explain (“I know that I don’t like jellybeans and can’t imagine how 10 packages ended up in my cupboard”) ● Flashbacks, nightmares, sleepwalking, or auditory hallucinations ● The use of multiple nicknames and other peculiar references to self ● Unusual somatic symptoms not explained from a medical perspective that may vary or spontaneously come and go ● Extreme mood swings ● Changes in handwriting ● Observations during therapy sessions that include sudden changes in the person’s facial expression unexplained by content or significantly different styles of clothing from one meeting to the next, such that the clinician feels they are dealing with a different person In other words, the client must have conscious access to the behaviors or actions of anyone involved in the incident, including themselves, as well as access to their own affect or emotions, to sensations or body feelings, and to knowledge of what happened for the memory to be considered complete. If all of these features are present, available to conscious recollection, and related appropriately to the source event, then a memory can be considered fully integrated.
EliteLearning.com/Psychology
Book Code: PYCA2725
Page 88
Powered by FlippingBook