Affect Dysregulation and Disorders of the Self (Norton Series on Interpersonal Neurobiology) by Allan N. Schore

Author:Allan N. Schore
Language: eng
Format: epub
Publisher: W. W. Norton & Company
Published: 2013-11-04T05:00:00+00:00

DISSOCIATION AND BODY-MIND PSYCHOPATHOLOGY

Dissociation is a common symptom of a spectrum of severe psychopathologies, from reactive attachment disorder of infants (Hinshaw-Fuselier et al., 1999), to dissociative identity disorders (Putnam, 1989), psychotic experiences (Allen & Coyne, 1995), borderline personality disorders (Golynkina & Ryle, 1999), and posttraumatic stress disorders of adults (van der Kolk, McFarlane, & Weisaeth, 1996). The DSM-IV lists five dissociative disorders: dissociative amnesia, dissociative fugue, depersonaliztion disorder, dissociative identity disorder, and dissociative disorder not otherwise identified (American Psychiatric Association, 1994).

Because dissociation appears in the earliest life stage, a developmental psy-chopathology perspective is being utilized to understand its etiology (Putnam, 1997), and disorganization of attachment is now proposed as a model system to understand dissociative psychopathology (Liotti, 1992, 1999). However, these models are purely psychological, and do not refer to the neurobiological mechanisms that underlie the phenomena. An integration of neuroscience and clinical data can offer such a model.

It is important to emphasize that in traumatic abuse the individual dissociates not only from the external world, from processing external stimuli associated with terror, but also from the internal world, that is, painful stimuli originating within the body. It is sometimes difficult to keep in mind the fact that the body of an abused infant is physically assaulted, and therefore in pain. Darwin, in the work that began the scientific study of emotion, asserted that “Pain, if severe, soon induces extreme depression or prostration but it is first a stimulant and excites to action . . . Fear again is the most depressing of all emotions, and it soon induces utter helpless prostration” (1872/1965, p. 31). Krystal (1998), in a classic text on trauma, also described the state switch from sympathetic hyperaroused-terror into parasympathetic hypoaroused conservation-withdrawal hopelessness and helplessness:

The switch from anxiety to the catatonoid response is the subjective evaluation of the impending danger as one that cannot be avoided or modified. With the perception of fatal helplessness in the face of destructive danger, one surrenders to it. (pp. 114–115)

Using interdisciplinary data, Krystal further explained how the catatonoid reaction is the affective response to unavoidable danger, a pattern of surrender, and equates it with the “freeze” response and state of cataleptic immobility: “in the state of surrender and catatonoid reaction, all pain is stilled and a soothing numbness ensues” (1988, p. 117). As previously described, this numbness is due to a sudden massive elevation of endogenous opioids in stress-induced catalepsy or immobility (Fanselow, 1986). A clinical description of the traumatized child state is offered by Nijenhuis and colleagues (1988):

[I]ndividuals tend to hide in dark places, freeze there, and prefer to physically disappear when they feel threatened. Adopting a fetal position, they seem to be unresponsive to external stimuli. (p. 251)

Bodily stiffening frequently accompanies these incidents, and the passive defense of dissociation increases with the severity of abuse.

The long-term effect of infantile psychic trauma is the arrest of affect development and the process of desomatization (Krystal, 1997). The ultimate end-point of experiencing catastrophic states of relational-induced trauma in early life is a

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