Background

Betrayal, Trauma, Dissociation: Roots of Cluster B Personality Disorders (Compilation)

Uploaded 3/7/2023, approx. 2 hour 11 minute read

Okay, modeling interlude over, we can move on to betrayal trauma.

The basic assumption of betrayal trauma is that trauma is independent of the reaction to trauma.

Betrayal trauma was coined and described by Jennifer Frey, F-R-E-Y-D.

I hope I'm pronouncing her name correctly, Jennifer Frey, maybe.

She introduced the terms betrayal trauma and betrayal trauma theory.

Long ago, in 1991, she made a presentation at the Langley- Porter Psychiatric Institute. It is absolutely to the discredit of the profession that betrayal trauma theory is not much more dominant and possibly the dominant theory of trauma.

It definitely guides me in my studies.

So Frey made this presentation, it was titled Memory RepressionDissociative Statesand Other Cognitive Control Processes involved in Adult Sequelity of Childhood Trauma. And it was August 1991.

And I want to quote from this talk that she gave.

She said, "I propose that the core issue is betrayal, a betrayal of trust that produces conflict between external reality and a necessary system of social dependence.

Of course, a particular event may be simultaneously a betrayal trauma and life-threatening. Rape is such an event.

Perhaps most childhood traumas are such events.

Betrayal trauma theory, she says, involved the psychic pain involved in detecting betrayal, as in detecting a cheater, is an evolved, adaptive motivator for changing social alliances.

In general, it is not to our survival or reproductive advantage to go back for further interaction to those who have betrayed us.

However, if the person who has betrayed us is someone we need to continue interacting with despite the betrayal, then it is not to our advantage to respond to the betrayal in the normal way.

What she's saying is we must distinguish two situations.

If we depend on the person, if we can't go no contact, if we have to continue to be in touch with someone because we need him, then we deny the trauma. We deny the betrayal because it's not to our advantage to confront him.

We may lose him.

Sofor example, a child with mother, a child betrayed by an abusive, distant, dead, emotionally unavailable, selfish, narcissistic, instrumentalizing, parentifying, objectifying mother. Such a child cannot confront that mother. He cannot get rid of that mother. He cannot go no contact with that mother. He cannot even think bad things about love because he needs mother for survival.

And that's a perfect example of denying the trauma, denying the betrayal trauma.

And then if you are not dependent on the person, you can just say goodbye. You can just walk away, but many people don't have this option.

Insteadshe says, if we are dependent on the person, if we can't go no contact, if we can't just walk away.

Instead we essentially need to ignore the betrayal.

If the betrayed person is a child and the betrayer is a parent, it is especially essential that the child does not stop behaving in such a way that it will inspire attachment.

For the child to withdraw from a caregiver he is dependent on would further threaten the child's life, both physically and mentally.

Thus, the trauma of child abuse by the very nature of it requires that information about the abuse be blocked from mental mechanisms that control attachment and attachment behavior.

One does not need to posit any particular avoidance of psychic pain per se here.

Insteadwhat is of functional significance is the control of social behavior.

Brilliant.

Brilliant on multiple levels.

First of all, she contextualized trauma within the realm of social interactions.

Even Freud himself hinted to this when he said that the superego has relational mechanisms, mechanisms related to other people.

And of course, in object relations theory, this already blossomed and flourished into a fullfledged tenet and foundational concept.

But what she did, she recast trauma as a social interaction.

And her second major contribution is to say that we cannot always acknowledge the trauma, the betrayal and confront our tormentor and our abuser.

Because our circumstances, what we need to do in order to survive is to deny the trauma, to block the trauma, so as to allow us to continue the attachment and the interaction with the abuser.

And so there's this concept of betrayal blindness.

Betrayal blindness is the unawareness, not knowing.

You remember from one of my previous videos, the unthoughtknown, unthoughtknown, bad came up with this concept.

So betrayal blindness is the unawareness, the not knowing, the forgetting exhibited by people when they're betrayed.

It's in a way, one of the ways betrayal blindness comes into being is dissociation.

And so again, Freud introduced the concept of betrayal blindness in 1996 and expanded on it in 1999. And then together with Birn, in 2013, they developed betrayal trauma theory, which I'm going to discuss in a few minutes and incorporated it in there.

Now such blindness, we see itfor examplein adultery.

Very often the spouse or the intimate partner, they have all the proof, all the evidence, everything they need to realize that they're being cheated on.

And it's very, very traumatic.

And yet they suppress, they repress, they deny, they dissociate, they forget, they ignore, they lie to themselves, they reframe, they confabulatejust not to confront the trauma.

Same in the workplace where you can't afford to lose your job.

And same in society, victims, perpetrators, witnesses, they all display betrayal blindness in order to preserve relationships or institutions or social systems because they depend on these.

There was a very important and interesting essay by Eileen Zülbrigen.

Why do they have these names?

I think they ended up in psychology because they have these names.

It's very traumatizing.

Zülbrigen, whatever.

So she wrote an essay, betrayal trauma in the 2004 election. And she used the theory to give a demonstration of something called institutional betrayal.

Institutional betrayal is when the wrongdoing, the abuse, is perpetrated by an institution and it's perpetrated on individuals that depend on the institution.

So failure to prevent a catastrophe like a pandemic, a response that supports wrongdoing, suppression of rights, abuse, infringement, encroachment, coercion, rings a bell in today's circumstances or, for example, in sexual assault where the system actually pathologizes and retraumatizes, re-victimizes the rape victim, not the rapist.

So these are all institutional forms of institutional betrayal.

And again, institutional betrayal is a part of betrayal trauma theory.

And I refer you to Platt, Barton and Freid, 2009, Smith and Freid, 2011, several papers.

Medrano, Martin and Freid, 2011.

And the core book is blind to betrayal. Highly recommended.

Freid and Birell, 2013.


I want to quote a sentence from Freid.

He wrote in 2008, "Betrayal trauma occurs when the people or institutions on which a person depends for survival significantly violate that person's trust or well-being.

Childhood, physical, emotional or sexual abuse perpetrated by a caregiver are examples of betrayal trauma."

And then we come to betrayal trauma theory.

And the earliest paper that had dealt with this, the best of my knowledge, is a paper by Syverts, Schuller and Freid from 2002.

And there they wrote that betrayal trauma theory is a theory that predicts that the degree to which a negative event represents a betrayal by a trusted, needed other will influence the way in which that event is processed and remembered.

Now, that sounds simple.

But it's absolutely one of the most revolutionary approaches to trauma and to the consequences and sequelae of trauma.

I will read it again, more slowly this time. Pay attention.

Betrayal trauma theory is a theory that predicts that the degree to which a negative event represents a betrayal by a trusted, needed other, that degree will influence the way in which that event is processed and remembered.

The more you depend on someone, the more you need someone financially for survival to raise the kids together, whatever.

You could be rendered homeless. You could be rendered destitute. You could lose your children. You could use your job.

The more dependent you are on someone, the less you will perceive that that person is abusing you, tormenting you, taunting you, violating your boundaries.

And throughout the 1990s and in a seminal article published in 1994 and in the book in 1996, Freight, together with others like the Prince, Gleaves, expounded on that.

And so she gradually refined the concept of betrayal trauma.

And she said it is trauma perpetrated by someone with whom the victim is close to and reliant upon for support and survival.

And so betrayal trauma theory, the first appearance of this phrase was in 1994 by, of course, Jennifer Fray.

It's situations when people or institutions in which you rely, you're relying for protection, you trust for resources and survival.

These people violate your trust, well-being, break your boundaries, and sometimes statistically and egregiously, betrayal is the core and precedent of many, many mental health manifestations.

For example, when you use betrayal theory, you have perfect explanation for dissociation, you know, because dissociation is intended to preserve the relationship with a caregiver when you can't go no contact.

And the child dependent on the caregiver for support will have a higher need to dissociate traumatic experience from conscious awareness.

In other words, you can begin to regard the false self that the child creates as a form of dissociation. It's like a repository. It's like the child says, okay, I'm exposed to abuse, I'm exposed to trauma by, for example, mother, but I can't be conscious of it.

Because if I become conscious of the abuse and the trauma, if I develop negative emotions, if I get hurt, then I won't be able to attach to money. I won't be able to bond with money, and I won't be able to receive from money what I need in order to survive.

That's a dangerous path.

So exactly as Melanie Klein suggested, the child splits.

But in a pathological dysfunctional family environment where the mother is a dead mother, the child doesn't split the mother into good and bad because there's no good. There's only bad.

So the child cannot split the mother.

Instead, the child splits himself.

Healthynormal children split money into bad mother, good mother, bad breast, good breast. That's Melanie Klein.

Even when they develop, when they grow between the ages of six months and two years, their mommy sometimes is good, sometimes it's frustrating, sometimes it's there, sometimes it's absent.

So the child learns to separate these aspects into a good mother and a bad mother.

And later on, by the way, the child annexes, appropriates the bad aspects so that he can idealize other.

But it's always clear that there is a unitary child and a kind of disjointed mother.

The need to split mother is critical in development.

The child who later develops into a larcissist made a wrong turn.

Instead of splitting the bad and good aspects of mother, he splits his own.

His personality fractures and fragments in a dissociative process and that gives rise to the false self.

He cannot split mother into good and bad because there's no good in mother.

So he splits himself.

Betrayal trauma theory also integrates evolutionary processes, mental moduli, social cognitions, developmental needs and even ethics.

Because there's a violation of trust, it's highly unethical.

There's a question of foundations of moralitywe know and it's common and accepted and orthodox thinking that empathy underlies morality.

It's not possible to be a moral being or an ethical being without empathy.

So in such situations, ethics, the development of morality is challenged.

All people from a very alleged age react to injustice.

We have two years old reacting to injustice in numerous studies.

So we realize when there's a violation of the social contract, we realize when our trust is betrayed, we realize when our boundaries are breached, they are cheat detectors.

And so in the context of abusive relationships, you want to escape.

It's your first urge, your reflex, is to run away, you know, flight, fight, etc.

You touch a hot plate, you withdraw your end, withdraw avoidance.

The flight response is fundamental.

Second most fundamental is the fight response.

Then there is the freeze responseand finally the form response.

In abuse and trauma, initially in healthy situations, it's flight.

But what do you do if escape is not a viable option?

If your cheater detecting mechanism leads you to want to avoid and want to escape and want to flee from a person upon whom your survival depends.

You can go away, you will die.

So what you do, you suppress your cheater detecting mechanism for the higher goal of survival.

It's psychogenic amnesia. It's designed to perpetuate attachment by blocking painful experiences.

And we have this in romantic betrayal.

Early literature, pre-freed, everyone was talking about betrayal of an unspoken agreement, like betrayal of trust. There was an unspoken agreement and it was breached.

And this is the source of the pain.

But betrayal trauma theory suggests that all these behaviors like domestic violence, cheating and so on, they involve a betrayal of trust.

But when the victim has no viable exit strategy or option, when the victim remains or returns to the abuser, does not report the abuse, under reports the severity of the abuse, experiences shame and anxiety, which are also mechanisms, mental mechanisms intended to downplay what's happening or to repress, to deny what's happening.

All this is an attachment injury and it's a component that is critical in betrayal trauma theory.

It's not only a betrayal of trust, like in the classic literature, it's a betrayal of trust in a time of need and dependence.

This combination is what destroys, erodes and corrodes the victim.

That the victim had been betrayed at its most vulnerable moment, at her most vulnerable moment.

She depended, she depended on her abuser. She believed her abuser. She relegated functions to her abuser, sometimes ego functions, internal functions and then the betrayal.

Betrayal alone is bad, but betrayal with trust, betrayal with need, betrayal with survival, betrayalthat's horrible.

And in the context of intimate partner violence, vulnerability, fear, relationship expectations, shame, low self-esteem, communication issues, these are all outcomes of the exposure to betrayal trauma and there are barriers not only to escape, but also barriers to forming new relationships.


You see, ironically, if you cheat, if you cheat on an abusive partner, it's a sign of health, it's a sign of partial health, let's be precise, because at least you are taking care of yourself, at least you're trying to solve your wounds, you're trying to self-administer some medication. It's a dysfunctional solution. There are much better solutions.

No contact is the best solution. Gray rock, second best solution.

But cheating is a solution that indicates partial health.

What is not healthy is to deny, to minimize, to under-report, to reframe, to lie to yourself about the abuse, the trauma and the torture that you're experiencing.


I want to introduce here another concept and it's a concept of a submissive world.

In 1992, Janusz Bollmarian, he identified three assumptions.

One, the world is benevolent.

Two, the world is meaningful.

Three, the world is worthwhile, is worthy.

These threehighly optimistic, I call them malignantly optimistic, assumptions put togethercreate what he called the "assumptive world".

The "assumptive world" is the core belief system.

Individuals perceive the world as essentially good, secure and fair.

And these assumptions are shattered by distorted social behavior, antisocial behavior, even a-social behavior.

When social behavior becomes anomic, sick, pathologized, then this worldview is at risk, it's threatened.

Maybe the world is not benevolent. Maybe it's not meaningful.

And maybe it's not worthwhile and so on, commit suicide.

In the context of betrayal trauma theory, when caregivers or intimate partners include relationships, when they violate you, they destroy your "assumptive world" and they impair your ability to reconstitute the "assumptive world".

Because if you're burned once badly, it's difficult after that to be naive, pathologically naive, malignantly optimistic. It's difficult after that to trust, really, to trust again.

And so they damage you for life.

Watch my previous video about self-stalking.

They damage you for life and they contribute to avoidance not only of the trauma experience, which is betraying yourself, but avoidance of future possibilities to remedy the damage.

And this is a part of post-traumatic stress disorder, or complex post-traumatic stress disorder.

An individual who may experience little or not conscious awareness of their trauma still develop, PTSD or CPTSD.

It shows you that consciousness, awareness are not everything.

If the trauma does not have conscious knowledge, the effects of the abuse still manifest, physically via somatization or psychological symptoms, such as dissociation.

Watch my video presentation to the conference about signs of narcissistic abuse.

Many found that dissociation can be a predictor of developing PTSD after trauma. So dissociation precedes actually trauma.

It's not true that people who have PTSD or CPTSD are conscious. That's one of the reasons that I keep railing against the over-diagnosing and self-attribution of CPTSD.

Every victim in his dog has CPTSD. That's not true.

PTSD and CPTSD are very often preceded by a denial of the abuse, denial of what had happened, repression, forgetting, dissociation. That's why the body is reacting and the mind is rebelling against this lie, this confabulation.

The body is telling you, "Hey, wake up! You've been traumatized!" And your mind is telling you, "Listen, I'm in trouble. I've been badly damaged. Stop invalidating me. Stop denying what had happened. Face up to it."

Dissociative identity disorder is at the end of this spectrum, because some trauma victims deploy a protective response, such as dissociation or repression, to block awareness of the trauma to the end, to the extreme.

For example, in childhood sexual abuse, some interpersonal injuries, they create dissociative reaction that is so bad that it leads to dissociative identity disorder, previously called multiple personality disorder. And it's connected intimately with overwhelming trauma, or with a very, very long exposure to complex trauma.

This trauma can create identity diffusion or identity disruption or disturbance. Your very identity is challenged by the trauma of the abuse, partly because you are denying them.

It's like you are internalizing energy, bad energy.

Freud used this metaphor. He said that unconscious content has energy, and this energy is like a volcano, like tectonic energy along fault lines, and this energy finally flares up, erupts, and fractures you.

And this is multiple personality, dissociative identity.

And in borderline, borderlines are on the verge of this. They are like on the edge. That's why they are called borderlines. They are on the border between neurosis and psychosis. They are so disregulated. And they lack narcissistic defenses. For example, they do have access to their negative and positive emotions, and they have empathy.

So borderlines don't have defenses. And whenever they experience hurt and humiliation and rejection, or even anticipate it, they fracture. They are at high risk of a psychotic episode or suicide. Ten percent of people diagnosed with borderline personality disorder end up committing suicide, and about 30 to 40 percent self-mutilate and self-harm.

So distinct personalities sometimes are the only solution.

Remember the splitting that I told you before? That's multiple personality.

When the child is faced with overwhelming, inexorable, uncontrollable abuse and trauma, the child fractures, breaks apart, splits in the fullest sense of the word.

The false self is another personality. The true self is another personality.

What is this, if not multiple personality?

The narcissist has dissociative identity disorder. It's a private case. He has two personalities with distinct perception, cognition, sense of self, agency. They are so disparate, the true self and the false self.

The person with such a condition experiences gaps in the record of everyday events or traumatic events.

Same with the narcissist.

Narcissists try to bridge these gaps by confabulating, and so they are perceived to be liars. Few narcissists lie, actually. They don't need to. Their whole life is a lie.

The false self is false. It's all a fantasy. It's all a confabulation. There's not a shred of truth in any of it.

The least of all in what the narcissist knows about himself and the continuity of his life.

The narcissist is discontinuous. And of course, narcissist is trying, like everyone else, trying to somehow self-soothe and self-medicate with alcohol, with drugs, with women, with something, with work, work-all, addictive behaviors.


Interpersonal trauma, such as betrayal trauma, is intimately connected to addictive behaviors, especially substance abuse.

So childhood, physical and sexual abuse increases the risk for substance abuse. And betrayal trauma also shifts the locus of control from internal to external.

Once you're traumatized and abused, and especially if you can't, you're not allowed to have a voice, especially if you're terrified to verbalize, to actualize, to manifest your pain and your hurt, especially if you suppress the rants at the beginning of each video, especially then, you would tend to feel that you are no longer in control of your life.

The control of your life, your inner life, and your life generally, your biography, has shifted from the inside to the outside, starting with your abuser.

Your abuser is in control. He's at the driver's seat.

Intermittent reinforcement, he decides what day is good, what day is bad. Sometimes what moment is good, what moment is bad.

So handing over the control to alcohol or to drugs is a natural extension.

When you talk to alcoholics, they tell you, "The drink made me do it. The drug made me do it." They refer to the drink or the drug like a kind of abuser.

It's a way to cope with post-traumatic negative affect traits such as avoidance, tension reduction, self- medication.


And when we come to personality disorders, and most particularly to borderline personality disorder, there are numerous studies that show that it has links to early maltreatment and attachment difficulties in early childhood.

The maltreatment is emotional, physical, verbal, or very frequently sexual abuse, but by caregivers, by people in whom the child plays trust to perpetuate and maintain its survival.

Betrayal trauma theory incorporates attachment disruptions, attachment dysfunctions, and damage from caregiver.

It's part of the definition. And it is the only marriage I'm aware of between attachment theory and abuse theory. It includes dissociation as a diagnostic criterion of borderline personality disorder.

Some people say that betrayal trauma theory explains the dissociation that borderline experience, because dissociation is a defense mechanism against childhood trauma.

High betrayal traumas have been implicated in the development of traits indicative of borderline personality disorder.

And it goes further and further. It's very deep.

Betrayal trauma theory is very deep. It explains hyper reflection in the schizophrenia spectrum and other psychotic disorders. It explains hallucinations. So they tend to suggest that childhood abuse is intimately linked to hallucinations.

When you reduce betrayal trauma via talk therapy, hallucinations disappear. There's no need for medication.

It's an amazing theory, which I really advise you to go more deeply into.

There seem to be intergenerational effects. Individual levels of dissociation are correlated with betrayal trauma experienced by the individual, but also with the betrayal trauma experienced by the mother of the individual.

So it seems that the mother is ending her betrayal trauma. The child becomes the repository of her betrayal trauma.

Her pain, her hurt, she offloads it to the child.

It's perhaps that mothers with betrayal trauma or dissociative symptoms, maybe they have more difficulty in creating a safe environment for the children. Maybe they are predisposed to becoming dead mothers. They can become a safe base.

So let's summarize this part of the video.

Betrayal trauma says that there is a social utility in remaining unaware of trauma when the perpetrator is a caregiver. And it's based on the study of social contracts.

It explains why and how humans are excellent at detecting betrayal and that under some circumstances, detecting betrayal may be counterproductive to survival.

And there are cases where the victim is dependent on the caregiver. And so survival may require that she remains unaware of the betrayal or even denies it.

And so there are examples of childhood sexual abuse and childhood psychological abuse to substantiate this.

The traditional assumption in trauma research has been that fear is the core of the response to trauma.

Freid changed that. And it is not to the merit or the credit of my profession that the revolution that she had introduced did not go further.

Freid, as early as 20 years ago in 2001, noted that traumatic events differ in degree of fear of betrayal, depending on the context and characteristics of the event.

Research suggests that the distinction between fear and betrayal is very important to the post-traumatic outcomes.

The prince in the same year, 2001, found that self-reported betrayal predicted PTSD and dissociative symptoms much more than self-reported fear.

So it seems that the critical element is not a fear, it's the violation of trust, it's a betrayal.

And there are numerous other studies that have confirmed this, that betrayal is the psychologically toxic substance that creates dissociation that leads to post-traumatic conditions, including PTSD.

I'm referring to Kelly, to Weathers, to Mason, to Bruno as late as 2012.

And I also encourage you to go online and have a look at Freid's two-dimensional model for traumatic events. It places everything neatly everywhere.


Now a few frequently asked questions.

One, is it necessary for the victim to be conscious of the betrayal in order to call it "betrayal trauma"? The answer is no.

I will quote from the Prince and Freud, it's an article they published in 2002.

"The role of betrayal in betrayal trauma theory was initially considered an implicit but central aspect of some situations.

If a child is being mistreated by a caregiver, he or she is dependent upon, this is by definition betrayal, whether the child recognizes the betrayal explicitly or not.

Indeed, the memory impairment and gaps in awareness that betrayal trauma theory predicted were assumed to serve in part to ward off conscious awareness of mistreatment in order to promote the dependent child's survival goals.

While conscious appraisals of betrayal may be inhibited at the time of trauma, and for as long as the trauma victim is dependent upon the perpetrator, eventually the trauma survivor may become conscious of strong feelings of betrayal.

Of course, we still have to study in depth the emotional perception of betrayal, how betrayal is experienced, the distress, the subjective experience of distress, and what's the connection to recovery, how does it prognosticate recovery?

And Brown and Fries started to do this work in 2008, but it's far from complete.


Next question, "Is gender a factor? Do men or women experience betrayal traumamore often?"

It seems that men experience non-betrayal traumas more than women. Women experience betrayal traumas more than men.

This goes well with other discoveries that women attach more deeply and differently, that are more empathic and so on.

I am not sure how valid this is nowadays.

The number of narcissistic women today equals the number of narcissistic men, and many women have begun to develop psychopathic features, psychopathic behaviors and traits. Many women, especially and also post traumatized women, women who had gone through CPTSD, are indistinguishable from borderlines.

And so I don't know how valid this is here, but Goldberg and Fries, in a series of articles in 2004-2006, said that men experience betrayal trauma less, and the impacts of betrayal trauma on men and women, according to the Prince, are also different.

Men have impact is less significant with women.

These gender differences probably have to do with socialization, some factors of socialization, even acculturation.

Because gender roles, as you recall from my previous videos, gender roles are learned. They are not real. They are not embedded in biology.

99% of gender roles are learned. It's mediated and communicated via socialization agents, like mother and later father.

So we learn these roles. And we can, by the way, unlearn these roles.

Or the learning process can be disrupted and then we end up being gender undifferentiated. Very confused about how to be a man, how to be a woman, how to be a middle ground.

So it seems that socialization factors also affect how one experiences betrayal and trauma.


And so now there's a question about how is betrayal trauma related to the Stockholm Syndrome.

And I want to quote from a website dedicated to Fries' work.

"Fries' Syndrome, named for a 1973 bank hostage situation in Sweden, refers to what seems at first a paradoxical reaction to being held hostage.

This reaction involves positive feelings towards the captors, the kidnappers, the hostage takers.

Fries' Syndrome is a term applied to the special case of those feelings developing after a hostage takeover, as when an individual or group is kidnapped and held for ransom.

From a theoretical perspective, Stockholm Syndrome reaction may possibly be understood as a special kind of betrayal trauma.

The unusual aspect of Stockholm Syndrome, compared with most betrayal trauma situations, is that the strong emotional attachment occurs after the abduction and without the pre-existing context of an enduring caretaker or trusting relationship.

It is usually considered that for Stockholm Syndrome to occur, the captors, the hostage takers, must show a certain amount of kindness or at least a lack of cruelty towards the hostages.

From a betrayal trauma perspective, the most important elements of predicting Stockholm Syndrome would not be kindness per se, but rather caretaking behavior on the part of the captors and an implicit or explicit belief on the part of the victims that survival depends upon the hostage takers.

And so the victims would have to experience the captors, the hostage takers, as a source of caretaking and as necessary for survival in order to develop the emotional attachment necessary to create a betrayal trauma.

Once the captors are experienced as necessary caretakers, a process much like that in infancy could occur, such that the victims have a good reason for attaching to the hostage takers and thus eliciting caretaking behaviours.

At that point, a certain amount of reality distortion might be beneficial to the victims, such that seeing the captors in a positive light might support an adaptive response to the victim's predicament.

This theoretical possibility leads to an empirical prediction that remains to be tested.

Anecdotal support for the premise that features of dependence and survival are at the heart of the development of Stockholm Syndrome can be found in an FBI online article about the Stockholm Syndrome, and I'm quoting from that article by the FBI.

In cases where Stockholm Syndrome has occurred, the captive is in a situation where the captor has stripped nearly all forms of independence and gained control of the victim's life as well as basic needs for survival.

Some experts say that the hostage regresses to perhaps a state of infancy.

The captive must cry for food, remain silent and exist in an extreme state of dependence, like a baby.

In contrast, the perpetrator serves as a mother figure, protecting her child from a threatening outside world, including law enforcement's deadly weapons.

The victim then begins struggle for survival, both relying on and identifying with the captor.

I also refer you to an article by Fabrique Romano, Vecchi and Van Hasselt, a 2007 articlewhich elaborates upon it a lot.

It is important to note, and continuing from the website, it is important to note that Stockholm Syndrome is rare, whereas betrayal trauma events and reactions are unfortunately fairly common.

Nonetheless, Stockholm Syndrome might prove to be a useful, extreme boundary condition for investigation of betrayal trauma theory, while at the same time betrayal trauma theory might provide useful insight into behaviour of hostages that is otherwise considered paradoxical.

I would add to this that trauma bonding is the middle case.

Like in the extreme, when you are really taken by kidnappers with guns, you might develop Stockholm Syndrome.

But when you are kept hostage because you are dependent on an abuser, an egregious abuser, even just a verbal abuser, physical abuser, psychological abuser, sexual abuser, when you are dependent, when you can't walk away, when you can't go into contact for a variety of reasons, there is a middle ground and that is trauma bonding.

It also incorporates betrayal trauma, because in trauma bonding you are denying the negative aspects of abuse, torment, torture, teasing, withholding, ignoring, humiliating, rejectingand degrading you. You are denying all this. And you are denying all this so that you are able to continue to attach and bond with the source of everything that you need or the things that you need.

So that's a middle ground situation.

Next question, are demands for silence a factor in not knowing about betrayal?

So there are implicit motivations for not knowing. We describe them.

A person is dependent on the abuser, so he denies the abuse.

But the victim may have other reasons for not knowing, for silencing, for repressing, for denying.

For example, the perpetrator might demand silence, might isolate the victim from his social safety net or family or friends, might establish a rule that dirty laundry is made only in-house. You never air the dirty laundry. A rule of silence.

And others may collaborate and collude in that because of discomfort and embarrassment. Family, society, demands for silence, and I refer you to work by Veluis in 1999, demands for silence may lead to a complete failure to even discuss an experience, to even mention it.

You know, it's uncomfortable, it's shameful, it's disgraceful, I don't want to embarrass anyone, I don't want to discomfort anyone. So I'm not going to talk about this.

Experiences that have never been shared by anyone else may have a different internal structure than shared experiences.

Shareability and social support are critical in healing, curing, reframing, and transforming traumatic experiences towards closure.


I want to link betrayal trauma to a few other disciplines and modalities.

Let's start with attachment theory.

John Bowlby, the father, grandfather, great-grandfather attachment theory in the objects relations school, John Bowlby in 1969 identified a link between attachment processes and dissociative psychopathology.

See, he preceded Waggler by quite a while, so he said that some attachment processes may lead to dissociation.

He referred to internal representations as internal working models. I call them internal objects.

Actually, the current usage is internal objects. So internal working models, where one can discern which internal content is dominant, which internal content requires attention, and which can be segregated into unconscious awareness.

It's like a male sorting facility before the age of Trump, where the male is sorted to be taken care of, express male, you know, surface male, and to the garbage male, like male in balance.

And once the attachment system is activated, the internal working model is identified as a guide to the formation of attachment behavior and to the appraisal of attachment emotionsin the self.

And in others, there's a theory of mind. What makes other things tick? Are they attached to me? Are they showing signs of attachment?

Bauwelbe emphasizes that traumatizing experiences, especially with one's caregiver, these are likely to result in negative impacts on a child's attachment security, stress, coping strategies, and even sense of self.

Securely organized internal working model, the evidence indicates the secure attachment is associated with positive appraisal of one's own attachment emotions and expectations that a child requests will be experienced as significant and legitimate by a caregiver.

Compare this to an insecurely attached or insecurely organized internal working model, avoidant, resistant. This is associated with a negative appraisal of attachment emotions, with the expectation that one's request for attention and attachment will be rebuffed, will be received as a nuisance or an intrusion by the caregiver, emotionally unavailable mother, dead mother.


And then there's a disorganized internal working model. It's very common in borderline and even in narcissism. This is linked to unresolved traumas and losses experienced by the caregiver and the effect they had on the subsequent attachment style of the offspring.

Maine and Hessen, in 1990, they theorized within betrayal trauma theory, disorganized attachment develops when the caregiver is both a source of the child's solution and a source of the child's fear.

What do you do when the same person is supposed to provide you with safety and security and daring and exploratory grandiosity and love, the same person?

And that very person is the source of your nightmares, the waking nightmare, the surrealistic dreamscape. What do you do in such case?

You approach, avoid, what?

And this form of attachment leads to altered consciousness. And this altered consciousness is what we call dissociation. It's a disruption of conscious memory, identity, perception of one's immediate environment.

Freight herself and her colleagues in 2007, she identified knowledge isolation, the extent to which information is hidden from awareness. Volsus, unknown, is a private case.

Dissociation during time of extreme stress or trauma, we have conclusively demonstrated using functional magnetic resonance imaging that when you dissociate in extreme stress or trauma, people have been exposed, for example, to most horrifying real life videos and photos. And we saw how the brain, the neural mechanisms, the brain changes, the functioning changes.

And there's evidence that childhood trauma is an ecological factor, is a cause of dissociation and has massive impacts on several areas of the brain, prefrontal cortex, hippocampus, amygdala.

So the level of betrayal trauma experience, low, moderate law, they influence the degree of dissociation.

When you have low betrayal trauma, it sometimes doesn't create dissociation. But low betrayal trauma doesn't include strong elements of violations of trust.

It seems again that the trust is the critical problem.

And we have empirical evidence that exposure to high betrayal trauma, where there's a massive violation of trust, is linked to increased level of dissociation, impaired memory of trauma related words as compared to low dissociation.

Trauma, stress-orrelated disorders, dissociation, and personality disorders founded on dissociation, which emanate from dissociation, like borderline, like narcissism, all of them are connected to betrayal trauma.

Dissociation during trauma affects individuals and causes them to compartmentalize the traumatic experience from conscious awareness. Dissociation is an adaptive process. It's aimed to maintain self-preservation, self-protection against psychological pain.


And if we look at the development of psychopathology and tie it into attachment theory, this dissociation is the core feature. It's the core feature in most, I would say, psychiatric disorders.

Dissociation can occur even to the point where there's alternative personality state or self-state, as we have in borderline personality disorder and dissociative identity disorder.

And so models of attachment-based dissociative disorders, trauma-related disorders, they all involve betrayal trauma.

And post-traumatic stress disorder, diagnostic groups, personality disorders, trauma and stress-related disorders, dissociative disorder, even schizophrenia and psychotic disorders, even substance abuse disorders, addiction, all of them, are unified in the mechanism, in the transmission vector.

Trauma abuse dissociation, onwards to the pathology.


Now, there's something called betrayal trauma inventory, BTI, and it assesses betrayal trauma in patients. It measures all kinds of physical, emotional, sexual abuse, childhood, in adulthood, all kinds of traumas.

And it's essentially behavioral. It deals with behaviors.

Like, did someone hold your head underwater or try to drown you before you were at the age of 16? I'm not kidding. It's one of the questions.

And so you see how many yeses there are. You calculate the age, the relationship, the severity of the injuries, memory of the events. And it takes about 45 minutes and coupled with or founded upon the abuse and perpetration inventory, A.P.I., you get a pretty clear picture of any trauma or traumatic landscape before the age of 16.

The brief betrayal trauma survey is adopted from the BTI. It includes only 11 items for traumatic experiences, such as sexual, physical, emotional abuse. And it includes, there's a question if the person was someone close to them on an interpersonal level. And it looks at events prior to the age of 18.

Then there is the institutional betrayal questionnaire, IBQ, created by Smith and Frayed in 2011. It's even shorter. It has a 10 item questionnaire. It assesses institutional betrayal in the context of sexual assault on college campus, for example, similar, and identifies the level of involvement of the institution in the unwanted experience and in the associated experiences, for example, normalizing totally pathological conditions or creating environments which facilitate abuse and breach of rights, covering up incidents and failed policies.

This is all, I am sure, very, very relevant during this pandemic.


And finally, let's talk about what can be done. Treatment for betrayal trauma is very new and no one is quite sure what to do.

There's not enough evidence based treatment.

And betrayal trauma is a very wide concept that applies to numerous pathologies, which no one is quite sure how much they have in common.

So there's an article by Jennifer Gomez in 2016 suggested relational cultural therapy, relational cultural therapy, may be the best treatment for betrayal trauma.

It's a therapy which was established by Jean Miller. It's a feminist therapy, honestly, so I don't advise men to take it.

And the therapist focuses on relational disconnections that the client experiences.

So there's not the therapy doesn't deal with symptoms. It deals with disruptions in relationships. It works through the contextualizing the betrayal trauma, separating the self decision making from the trauma.

And it's an interesting approach because it introduces the social and cultural aspect. And it implies that what we experience the symptoms are actually merely the way we experience disruptions in meaningful relationships.

Again, we are coming to Sapolsky's and others point of view.

The self is the intersection of relationships. Take away on the relationships. There's nothing left. Even in pathological narcissism, there's a hive mind. Even there, even the false self is the intersection of the gaze of multiple others. It is this intersection that gives rise to a human being in the full sense of the word.

When it's disrupted, you get a narcissist, you get a psychopath. But even then, they're not. They're not islands. The narcissist cannot survive without narcissistic supply, which happens to come from other people.

The psychopath cannot achieve goals, goal oriented, cannot achieve his goals, act on his impulses, be defined. He doesn't want to define and don't want to take from.

We are social creatures, zoned political. Thank you, Plato. Thank you, Auistotelis.

And if any of you succeeds to solve the riddle of why I had chosen to attribute this sentence to Eugene O'Neill and not to its originator, Jean-Paul Sartre, please let me know. I'll be delighted.

One of you came close by me. Don't let anyone traumatize you by betraying your trust.

Watch my video about who to trust and when to trust. It's a good introduction.

OK, enough with jokes. Let's get to the business of teaching you students.

And as is my habit or my new habit in my recent videos, I start by referring you to literature.

So I suggest that you read everything you can by Dorahe, D-O-R-A-H-Y, Van der Hart, H-A-R-T, Nijen Hois, Don't Ask, Caffi Steele, Butler, Crabtree, Brown, and go into some historical writings by Jeanette Brown and also read everything you can by Van de Kolk.

Those of you who've heard of some of these gentlemen realize that today's topic is trauma and the dissociation that trauma induces.

This is a topic that underlies the most modern thinking, most up-to-date bleeding edge thinking on a variety of mental health disordersamong them narcissistic personality disorder and borderline personality disorder.

But today what I want to do, I want to explore one approach to dissociation, which is first becoming a dominant approach.

In 1893, that's a bit before I was born, there were two gentlemen, Breuer and Freud.

And of course, having said gentlemen, it's clear that they were Jewish.

So these two gentlemen came up with an article, wrote an article, published an article, and they suggested that individuals with trauma memories go through numbing, detachment, amnesia, and avoidance of triggers and memories.

And they said the very same people who try to avoid triggers the best they can in a variety of ways, they are triggered the most.

Trauma was the main topic of study.

I would even say the cornerstone of early psychoanalysis pre-Young when Young was still a disciple and affording and admiring student of Freud.

It was much later that Freud recanted and he realized that he was the victim of high society, rich women with nothing better to do.

He was a form of entertainment. They came to him and they told him stories about how they had been abused by their fathers, usually.

And he bought it hook, line, and sinker and constructed a whole theory based on their stories and false memories, memories that they came up with in order to gratify and please Freud.

Freud went to the extent of saying that he now disbelieves most of the trauma stories that he had heard from his patients, because had they been true, then he himself must have been sexually abused by his own father.

But that's a vignette, vignette.


So let's continue.

The personality is not a monolithic slab of stone. It's not the proverbial rock.

In other words, it's not an entity, exactly like the living body. The living body is a colony, a colony of trillions of cells.

And in each one of our cells, there are very, very ancient and primitive organisms which had survived inside ourselves. These organisms have nothing to do with us. They don't share genetic material with us.

Metacondria, for example.

So we are like a giant zoo. Our bodies are like giant zoos with trillions of cells, organisms, the gut flora, for example, billions of bacteria or viruses.

I mean, we canwe carry this gigantic zoo with us wherever we go.

The personality and the mind are the same. It's a zoo. It's an amalgamation of very ancient voices, of constructs, of defenses.

So different structures comprise the personality experience.

Personality is therefore a process, a process. It's an experience. It's not a thing.

And some personalities experience too little. Some personalities experience too much.

This distinction is very, very important.

Some people are prone to interface with the world and with other people, much more than other people.

So this important, although apparently trivial insight, underlies the theory of structural dissociation.


Before we go any further, structural dissociation is one of well over 50 trauma-related theories and trauma-related therapies, which I had incorporated into Cold Therapy.

Cold Therapy, to remind you, is the treatment modality that I had invented, that I had created, for people diagnosed with narcissistic personality disorder or for people with major depression.

And I suggested to reconceive of narcissism, to reconceive of narcissistic personality disorder, as essentially a post-traumatic condition.

And therefore requiring trauma therapies.

Structural dissociation was an important theoretical foundation of cold therapy.

So together with other approaches to trauma and other approaches to re-traumatization, I put these together and also with child psychology and came up with cold therapy.


So what is this theory? What does it say? What does it teach us?

Well, dissociation can be conceived as one of two things.

Either it's a deficit, it's a malfunction, it's a glitch in the software.

It's when we can't take very painful, very threatening, very harrowing experiences and the thoughts we had during these experiences and the emotions we had felt during these experiences.

We can't cope with them and we can't integrate them. We can't make them a part of our self.

So we kind of hive them off. We kind of push them out, push them away.

These memories, the cognitions that go with them, the thoughts, the emotions that we had felt, we place them in a container.

And therefore there is an integrative deficit, dysfunctional, dysfunctional integration.

There's another way to look at it, and that's the older way, the way of Freud and others.

The dissociation is actually a defense. It's when the child usually is faced with extreme abuse, extreme trauma.

He has very few active defenses. The defenses he has are very primitive, like splitting, and their work only so far.

Splitting, for example, is very threatening because if you split, mother, an abusive mother, you split her in two. There's a bad mother and a good mother. The bad mother is there. She's very frightening.

So even the defense mechanisms, the primitive defense mechanisms, infantile defense mechanisms of the child, they are not very defensive. They bring the horror of the situation to the front.

So the children are defenseless. Dissociation is one defense. It's simply not remembering, forgetting, or not being there, or thinking of the whole thing is not real. Derealization, depersonalization, amnesia, in reverse order.

And so structural dissociation claims, the theory claims, that dissociation is an integrative deficit, not so much a defense. And that dissociation has two types of symptoms, psychopharm symptoms and somatoform symptoms. We'll come to it in a few minutes.


What is integration? What is this integration that the theories is analyzing and dissecting so much?

The structural dissociation theory.

What is integration?

Integration, first of all, is an adaptive behavior. It's a behavior that helps you to survive, to cope, to function, to propagate yourself.

So it is also an adaptive behavior on the level of the species, not only on the level of the individual. And it depends on two processes.

The first one is synthesis.

Synthesis is when we associate, when we put together, when we combine in a reasonable, coherent, cohesive, rational form, combine all the components of experiences and all the functions into meaningful, coherent metal structures. And these metal structures are created on the fly.

As we have an experience, we immediately create a mental structure to cope with this experience. This mental structure contains the memories, the thoughts, cognitions, emotions, and the functions associated, the behaviors associated with all this. And this is the mental structure that we create with each and every experience. This is called episodic mental structure.

And mental structures that amalgamate, aggregate, find common denominators across multiple experiences, across time. So these are the synthesis processes.

And then there's another process, realization.

Remember, we are talking about integration. Integration depends on synthesis, creating mental structures to cope with episodic experiences and with experiences across time, that is, synthesis.

And the second process is called realization.

Realization is when we analyze and when we assimilate experiences, but we do it in two ways, personification and presentification.

Personification is when we own the experience, when we analyze the experience, and then we digest it, we assimilate it, we own it, we say, it is my experience.

This experience, to a large extent, defines who is I, who is me, it is my self. It's a little similar to the concept of constellation in Jung, although there are important differences.

But constellation is a form of personification.

And then presentification. Presentification is when during the process of realization, during the process of living through the experience, during the process of experiencing, we bring the past and the future into the present moment and we integrate over.

It all makes sense. The moment makes sense precisely because it's a natural flowing extension of the past and it leads inexorably and seamlessly to a future which is also connected to the past in ways which are comprehensible and acceptable and reasonable and not nightmarish.

So presentification is the equivalent of mindfulness and it involves reflexivity. It involves the ability to regard the moment as the most important. It's the most important because it explicates, it gives meaning to, it organizes and it explains perfectly everything that led to it, the past and everything that will come. Forward, will come henceforth, the future.

In other words, the present is the interpretative tool and organizing principle of our lives. And this presentification and personalification, the feeling of self, they together combine realization and you have synthesis and synthesis and realization, of course, lead of course to integration.

Because if you feel that your experience is yours and that is connected to your past and to your future, you're integrated, you are put together, your parts make sense, you make sense.

Depersonalization, for example, when you don't feel that you are you, when you feel whatever is happening is happening to someone else, when you even stand outside observing yourself, observing things that are happening to that thing, that entity which looks like you. Depersonalization, being on autopilot, things are happening to me but it's not really me. I'm removed from the scene. I'm detached mentally.

Well, depersonalization is a failure in personification because it creates semantic memory but not episodic memory. It creates language memory. You can describe what had happened, of course. You were there. You were an observer. You were a spectator. You were documenting the events, at least in your memory, in your hippocampus, in your longterm memory.

And yet, you didn't experience what was happening. It was not episodic. This is not an episode that had happened to you. It's only semantics, only language.

And I have a whole video dedicated to this. It's a lecture I prepared for my students in one of my universities, Southern Federal University in West Omerdon in Russia. It's a video lecture that deals with connection between types of memoryand identityand how disruptions in memory create disruptions in identity, identity disturbanceor identity diffusion.

So depersonalization is an example of personification failure.

Trauma generally reduces our ability to integrate.

And this depends crucially on who we are.

Some people are very, very, very sensitive to trauma. They have pre-morbid personalities, as we call them.

To start with, they have low integrative capacity, either because psychobiologically, they don't have the tools or the properly developed instrument. So it has something to do with genetics or biology, or because they've been exposed in early childhood to traumatic experiences, or because they are highly sensitive people.

So it is a tiny fraction of a population which have highly overdeveloped empathy.

No, no, no, not empathism. Empathism are grandiose terms of what I suspect to be covert narcissists. I'm talking about really, really hyperempathic people, people who have high, who have an abnormal form of empathy.

So they would have, they would be traumatized all the time. And the trauma reduces their integrative capacity and leads to recurrent dissociation.

But we must distinguish dissociation from dissociative process. Dissociative process is any time we fail to integrate. Any time you fail to integrate.

And this happens a lot in normal day-to-day dissociation. For example, when you listen to my lectures, my boring lectures, your mind wanders. Or you fall almost asleep. Or you begin to zone out, cut me off, tune out, which proves that you are very healthy. It's the only way to listen to my lectures.

But that is a normal dissociative process. So we should distinguish this from traumainduced dissociation.

Before I go into the theory itself and what it saysand what lessons we can learn from the theory when it comes to cluster B personality disorders, which I personally think are post-traumatic states, post-traumatic conditions. I think all the so-called dramatic or erratic personality disorders and some others, like for example, schizotypal, paranoid, etc. I think many personality disorders are actually post-traumatic conditions and should be totally reconceived in terms of posttrauma. So this theory is very useful in an attempt to understand the wider context of what today we call, in my view, erroneously, personality disorders. These are not personality disorders. These are disorders of integration. These are disorders of synthesis, of personification, of presentification. These are procedural disorders. These are disorders of process, not disorders of substance.

But that's another debate.


Before we go to the theory itself and what it says about dissociation, I have to mention what the skeptics are saying.

The skeptics are saying that trauma is a phantasys. Dissociation does exist, but it produces phantasys of trauma.

The person is asking herself, "Why am I forgetting things? Why am I dissociating? Ah, probably I was traumatized."

And then, "When was I traumatized?" "Well, let me think, did my father ever touch me inappropriately? Let me think real hard. Let me imagine this.

Wow, I think he did."

This is called false memory.

So dissociation produces false memories and phantasys of trauma, and that is true. It's been documented many times, multiple times.

Therapists who are not skilled and not adept and, frankly, narcissistic, have personality problems of their own. These kind of therapies, they tend to induce false memories and phantasys of trauma because they force their patients to please them, to gratify them, and the patient is terrified to lose the therapist.

So we tell the therapist anything, and then the patient convinces herself that it actually had happened, a process known as confabulation.

So the skeptics say most of the so-called traumas are actually phantasys of traumas, false memories and so on. They say that dissociative disorders are artifactual conditions, artifacts, not really, and they are produced by yatrogenesis.

I mean, the doctor, the therapist creates them in the patient, or even by social- cultural factors.

In some societies, some cultures, when things change, there's a place for redefining some behaviors as trauma.

For example, I grew up in a society where it was perfectly acceptable to beat up children. Children were beaten physically, regularly.

And in that society, the physical behavior, the physical communication mode of the parent was actually proof of love.

But of course, as the contexts change, it's now perceived as physical abuse, and even, I would say, traumatic physical abuse.

Trauma is heavily culture-dependent, period-dependent, society-dependent.

But I must say, having presented the skeptics point of view, I wholeheartedly, fervently, fervidly, vehemently, and believe me, I know many other words, disagree.

Because the preponderance and abundance of clinical data and research do not support this view.

There is clear, clear, linear relationship and proportional correlation and causation between childhood abuse and trauma, as they are defined even social- culturally.

When there are culture or society incongruent, so everywhere in the world, incest is considered abuse.

There are things which are universally considered abusive, regardless of the culture or society of the period.

So when we trace back childhood memories of this kind of abuse, we end up having dissociation and many, many of what today we call personality disorders, such as borderline personality disorders.

So without further ado, and to cut a long story even longer, let's delve into the issue of dissociation.


The preeminent scholar of dissociation, Freud and Breuer, was Janet.

In 1907, which is when the last dinosaurs still walked the earth and played with me as a kid, in 1907, Janet wrote that dissociation is when there are two or more systems of ideas and functions that constitute personality.

In other words, Janet actually was describing what later in the 60s and 70s used to be called multiple personality disorder.

When you had, when the personality fragmented, broke down into two discernible selves, full-fledged almost, which could easily be described as a separate personality.

That was Janet.

It's a very restrictive view of dissociation, and today we don't hold this view any longer, at least not exclusively.

In other words, we don't think that dissociation is only when you have multiple personality.

And he said that dissociation is the result of inability to integrate owing to physical illness, exhaustion, stressors, stressful situations, and young age.

And that it leads to pathological alterations in consciousness, to greater emotivity, to reactive behaviors and beliefs.

Notice the phrase greater emotivity.

This is what today we call emotional dysregulation, and it's one of the two hallmarks, together with dysfunctional attachment, one of the two hallmarks of borderline personality disorder.

Janet, decades, many decades before the diagnosis of borderline personality disorder was even imagined, Janet actually was describing borderline personality disorder.

Pathological alterations in consciousness, greater emotivity, reactive behaviors, reactive beliefs, unstable beliefs.

What today we call identity disturbance. It's one of the diagnostic criteria of borderline personality disorder.

Not long afterwards, there was a guy called Mitchell in 1922. He suggested that maybe these were not really full-fledged personalities, like Janet said, but they were not far.

And here's what he wrote.

He said, when there is dissociation, it leads to fragmentation, to breakdown of the personality.

But each of these psychobiological systems that results from the dissociation has its own unique combination of perception, cognition, effect, and behavior. Each has its own sense of self, no matter how rudimentary.

Fast forward a few decades, and the American Psychiatric Association in the year 2000, when the Diagnostic and Statistical Manual Edition 4, the previous edition, was published, the APA said the dissociation is a breakdown or disruption in usually integrated function.

All these gentlemen and some ladies keep mentioning the word integration.

It seems that this is the crucial, immutable, invariable foundational problem.

Deficient, dysfunctional, disrupted breakdown in integrative processes, in integration. We'll come to it a bit later.

Structural dissociation is a theory of dissociation, but it should be distinguished. We'll deal with it in a minute. We'll dedicate a big part of this video to diving into structural dissociation.


But before I go there, I would like to provide you with some tools to make nuances and finer distinctions than structural dissociation does, although it's a very fine theory.

So, first of all, there is the issue of dissociative self-states, or dissociative personality states, as the DSM used to call it.

We do have situations where we see emerging something that is not a personality in any sense of the word, in any functional, dimensional, categorical sense of the word, definitional sense of the word. It's not a personality, but it is a different self. So I would call it pseudo- personality.

When the borderline, for example, faces rejection, humiliation, abandonment, neglect, being ignored, stress, severe depression, or when she is under the influence of substances, drinks to excess, does drugs, the borderline switches, moves to another self-state, which is essentially psychopathy. She becomes a secondary psychophile. We'll deal with it a bit later.

But these are distinct self-states. Anyone who has ever been with a borderline, treated a borderline, spent time with a borderline, has witnessed this switching. No one can deny it.

And structural dissociation has difficulty accommodating this switch. They have something called intrusion, which we'll come to a bit later.

But it's not the same. Intrusion is like a negotiated process. A dance macabre, a kind of filling each other out between structures of personalities. It's like a bargaining thing.

It's like, I withdraw your approach, your approach, like approach, avoidance, repetition, compulsion. It's very, very ballet-like. That's not what happens in borderline switching. Absolutely not. It's much closer to what you see in people with dissociative identity disorder, multiple personalities.

Where you see one person disappears and another person appears. Many before there are smiles and compassion and love and empathy. And the minute after this cold-hearted, stone-faced, goal-oriented, machine, dysempathic, aggressive, vindictive, so on, as this problem of self-states, which is not fully accounted for in structural dissociation, they did develop something called tertiary structural dissociation, which we'll come to a bit later.

But I don't consider this a satisfactory solution.


Second problem with structural dissociation is that it doesn't cope well, doesn't describe well, dissociative phenomena and non-dissociative self-states or personality states.

You see, there are situations where people switch between self-states and personality states and they remember everything.

In other words, there's no dissociation. There's just a switching between states which are solved.

Structural dissociation says that's nonsense.

They call it reification. That doesn't exist.

I have the surprise for all these eminent psychologists. If something exists and you deny it, shockingly, it continues to exist.

So denying it is not a good strategy. It's there. There are non-dissociated switching. There is non-dissociated switching between non-dissociated self-states or personality states.

And someone needs to give an answer or to incorporate it. If one wants a total theory dissociation, one needs to deal with this.

And a bit later, I will come to a new diagnosis in the Diagnostic and Statistical Manual 5, atypical DID states, atypical states of dissociative identity disorder, multiple personalities.

Like every theory in psychology, there's a metaphysical layer to structural dissociation.

The theory suggests that each one of us is born with a psycho-biological series of mechanisms or subsystems. They're inborn, they're self-organizing, they're self-stabilizing, and they're homeostatic. They're like operating systems, like Windows or Android. So they're like operating systems, but they are emotional operating systems. And we're all born with them. And they're there. And we make use of them to cope with experiences and so on. And these are called action systems.

So there are two types of action systems. Remember, these are psycho-biological entities, something that every person in the world has, according to the theory.

I regard this as metaphysics. I mean, it's total speculation. Maybe it's right, maybe it's wrong. I don't think it's possible to falsify it. It's not amenable to the scientific method, in my view.

So it's not science. It's pseudoscience.

But if it makes their day, not against it, you know?

Anyhow, since this is what they're saying, I have to share it with you.

They said that there are action systems. There are two types.

The first type of action system, it's an operating system. The first type of action system, it guides daily living, daily life. And it has a dimension which has to do with the survival of the species.

So this is the system that drives us to have children. Total failure, in my case. Probably I don't have it.

This is the system that drives us to have sex. No comment here.

So this is the system that drives us to behave, to act in daily lifeself-efficaciously, so as to guarantee favorable outcomes, so as to allow us to propagate our genes within the gene pool of the species.

In other words, to guarantee the survival of the species.

Then there is a second action system. So this will be an evolutionary action system.

There's a second action system, and that is what is known as the four Fs. The fight, flight, freeze and fall.

This is a physical defense action system, and it's reactive exclusively to threat. Whenever there's a perceived threat, this action system springs into action.

Now, if you put these two together, if you put the daily life action system and the physical defense under threat action system, put the two of them together, together they operate in social circumstances, where we socialize, or where we work or act within social systems.

Because they constitute, when you put them together, they constitute a social defense against abandonment and rejection.

So it would stand to reason that in people with borderline personality disorder, both these systems, or maybe when these systems work together, they go haywire.

Because what happens in borderline personality disorder, when there is a perceived risk of abandonment or rejection, or when there is actual abandonment or rejection, the individual depersonalizes and acts out, becomes reckless, self-destructive, self-defeating.

In other words, the individual begins to become suicidal, begins to destroy himself and everyone around him.

So, in borderline, the confluence, the combination of these two action systems, which usually operate in social circumstances and interpersonal relationships, this confluence has a glitch. It goes haywire.

And the borderline, when these two systems collude, combine, cooperate to work within society, and they go bad, they go haywire, the borderline goes haywire, becomes self-destructive and other destructive.

The loser's empathy, for example, becomes reckless, becomes defiant, becomes impulsive, aggressive, even violent.

So, this is the first function of the combination of these two action systems.


And there is, when you put the two of them together, what you also get is what is called the integral receptive defense.

The integral receptive defense is the defenses we have against mental content, voiceless memories, mental content, that is very, very upsetting, very egodystonic, paralyzing even.

Now, we all have this defense, introjective, receptive defense.

But in dissociative and personally disordered people, in my view narcissistic personality disorder, the integral receptive defense again goes haywire. It protects against mental content.

Yes. But it protects too effectively, too efficiently, so as to slice the mental content off, to cut it off, to give no access.

And that is why, for example, the narcissist cannot access his emotions.

This is a very, the internal receptive defense is like all the infantile defense mechanisms put together.

Primitive defenses like splitting, combined with some sophisticated defenses like passive aggression. And together they are the internal receptive defense.

Again, in normal people, it's very useful. In dissociative and personally disordered people, it creates dysfunction because you have no access to big parts of your memory.

So you have to confabulate all of your identity. So you have no identity. There's identity diffusion and disturbance. All of you have no access to your emotions. So you're emotionally disregulated, like the borderline, or emotionally dead, like the narcissist and psychopath.

The internal receptive defense can go too far, like everything else. The source of this theory, I mean, this theory is very old, actually.

The founding father of the theory is an army doctor, British army doctor. His name was Charles Samuel Lyons. And in 1940, he found himself treating acutely traumatized war veterans, already from Dunkirk and, you know, other battle theaters, combat theaters in Europe. So he was treating badly, injured, badly traumatized war veterans.

And he came up with the idea of action systems and so on. He suggested that when someone is traumatized, his personality actually breaks in two.

One part is he called the A&P, the apparently normal part.

So he said, when you're traumatized, you break. And there's a part that is called apparently normal.

And there's another part, EP, and that's the emotional part.

This is a reaction to trauma. It doesn't happen in daily life, only when you're exposed to trauma.

Myers called the A&P and the EP, the apparently normal part and the emotional part. He called them personalities.

But today we realize these are not personalities, so we call them parts.


Action system number one, the action system that is in charge of daily life, is connected to the AP, to the apparently normal part.

Action system number two, the action system that has to do with physical defense on the thread, is connected to the emotional part, to the EP.

Now, let's delve a bit deeper into these two structures that materialize suddenly out of thin air in reaction to trauma.

What is the EP? The emotional part. The emotional part contains vivid trauma recall.

In other words, you've been exposed to trauma. The trauma could be pinpointed, can be a single event, a car accident, a plane crash. You've been at war, so your body being blown apart. A divorce event, a pinpointed divorce, a cheating, being cheated on, the death of a loved one. All these create post-traumatic stress disorder.

And so the EP, the emotional part, contains a vivid recollection of all this, but not in the sense that you sit back and say, "Wow, I remember the car crash. It was really terrible."

No. But you experience the car crash again. And if this is really extreme, you can't tell reality apart from your flashback. You are in the flashback. You feel that you are in the car againhaving the accident. You're absolutely oblivious to your environment. Your wife talks to you, you don't listen, which is a normal thing.

Okay, forget that. Your dog barks. Your television explodes. Nothing. You're in the car. You're having the accident all over again. You're in the plane, you're crashing.

Or you recall the exact minute that the Twin Towers collapsed, or the very second where you have learned that your wife is cheated on you. These are all traumas.

And flashbacks are stored in a container. And this container is the EP, the emotional part.

The emotional part contains not only the memory, but all the emotions that went with the memory. And these are known as vehement negative emotions. Vented negative emotionality includes fear, horror, helplessness, anger, guilt, shame, anticipatory anxiety.

So all these are stored with a vivid flashback of the traumatic event.

And either you experience these emotions, or you are so afraid to experience them that you develop the exact opposite. Lishlessness, non-responsiveness and submissiveness. Submissiveness in the sense that you become a zombie. You become a robot. You react in slow motion.

And if you are pushed beyond this, you begin to derealize and depersonalize. You feel that you are not in reality. What's happening is not real. And you feel that it's not you, but it's happening to someone else who looks like you very much. And you're just mildly amused, spectator.

And so all these are the residents, the denizens of the emotional part.


The flashbacks, responses.

And they usually affect the body. Not the body, but they perceive your body.

So they bring about body dysmorphia. You begin to perceive your body wrongly, or parts of your body wrongly.

And they create a separate sense of self. This is extreme event-related pinpointed trauma.

What we have discovered later, much later in the early 90s, through the agency of Judith Herrmann, is that repeated exposure to such events creates a much more complex ep, complex emotional part. We'll talk about it a bit later.

And this is, of course, complex trauma or CPTSD, complex post-traumatic stress.

Now there's a big disagreement between some of the proponents of this theory and Herrmann's own. And again, we'll touch upon it a bit later.

But there is a general agreement that there are two types of traumatic dissociative reaction to an eventlike trauma and to prolonged anticipatory, long-term, repetitive, predictable trauma.

Now, the emotional part had been described by numerous scholars, and each one gave his own favorite name to the emotional part.

Loafer called the emotional part the "war self." Wong called it the "survivor mode."

Tober, who conducted amazing studies of Holocaust survivors, so Tober called it the "child part" of the Holocaust survivor compound personality.

Glolinkina and Ryle called it the "zombie part" in trauma-related borderline personality disorder.

Claf and Putnam called it the "alternative personalities" in DID, the "sociative identity disorder," or used to be called "multiple personalities."

And Bruin called it "identities associated with situationally accessible trauma-related memories."

No one has ever accused Bruin of being catchy. And all these include abuser rage, victim rage, and passivity.

Rage of the abuser is internalized, actually. And there is a rage of the victim for having been victimized, but the clash between the two creates passivity.

This is the EP, the emotional part.

What about the apparently normal part, the A.N.P.?

The main role of the A.N.P. is to cut off the EP.

The main job of the A.N.P. is to make sure the EP never gets access to consciousness, never interrupts any truths of the conscious functioning, conscious memory, conscious identity, conscious everything of the person.

So the A.N.P. represses traumatic memories.

This structure avoids triggers, and it avoids triggering the trauma, avoids flashbacks, avoids remembering the trauma, avoids re-traumatizing, avoids re-experiencing the trauma, avoids going there, you know?

The A.N.P. tries its best to dissociate the trauma, and the emotions attendant on the trauma, in short, the EP.

So the A.N.P. does this using a variety of mechanisms and techniques and strategies and tools.

Amnesia, of course, is the most dominant dissociative amnesia. But there are many others.

For example, sensory anesthesia, restricted emotions, numbness, depersonalization, many.

Again, the A.N.P. had been previously described and renamed by many others. Loafer called it the adaptive surge.

Wong called it the normal personality functioning mode.

Tober, who studied Holocaust survivors, called it the adult part of the Holocaust survivor compound personality.

Golinkina called it the coping part in borderline. It's been called the host personality or the moderator personality in the A.N.P.

And Bruin, remember the guy who can never say anything in less than 46 words? Bruin called it identities associated with verbally accessible memories of general autobiographical experience and of some elements of traumatic events.

And yes, I'm kidding you're not.

Now, there is a war. It's a conflict zonein the traumatized person's mind. There's an ongoing war, belligerence and conflict with many, many attendant dissolances between the A.N.P. whose job is to suppress the A.P. and the A.P. whose job is insurgency, insurrection and acts of terrorism.

The A.P. is like the colonies and the A.N.P. is like the colonial power. Keep it away from the media. Don't let anyone at home know what we're doing here. Concentration camps, killing women and children. It's not for the delicate conscious of people at home, back home.

So there's the A.N.P. and the A.P. and they're fighting all the time. And the A.P. interferes with the A.N.P. intrudes, obstructs, undermines, attacks, tries to like intrusion detection system, tries to find the vulnerabilities, the access points.

You know, installs malware behind the front lines, sends spies. The A.P. is in constant war with the A.N.P. because it is a container for trauma- related memories and overwhelming and disorganized emotions.


No. And aside, many so-called and self-styled empaths, actually, what they describe is not empathy at all. It's this defenselessness, this lack of skin, this being overwhelmed by disorganized emotions and emotional fragments related to trauma.

Trauma is like a hand grenade, you know. It splinters everything. It fragments everything. It's a mess. It's very easy to confuse this emotional dysregulation with empathy.

But it's not.

Empathy actually never goes with emotional dysregulation. Emotional dysregulation leads to the exact opposite of empathy, this empathy.

But that's for another video.

So the A.P. is this hand grenade. It contains these broken memories, damaged goods, total chaos and disorganization. And it wants to intrude on the A.N.P. because it's repressed and suppressed and has this pent-up energy.

Freud said that when you repress something, when you repress a memory, you repress the memory and the energy of the memory. And this energy works in the unconscious until it erupts.

Now, in psychoanalysis, we manage the eruption. The eruption is managed and structured and controlled. And this is called abreaction.

But in classic traumatized person who is not attending therapy, in daily life, there is this battle going onand the A.P. has a lot of energy. It's like an improvised explosive device. It's like a nuclear bomb, to be more precise. It has a lot of energy and it threatens the precarious balance that the A.N.P. had succeeded to create.

Now, the A.N.P. itself is a pathological structure. It is sick and weak. It's a lost ditch defense against recalling the horrors of the trauma.

And so this battle, if the A.P. wins, if the A.P. disrupts the A.N.P., the emotional part, if it comes to the surface, if there is uncontrolled abreaction, if it reaches consciousness, it's the end.

It leads to absolute demolition of impulse control, impulsive behaviors, defiance, recklessness, anywhere from insecurity to drug abuse, maladaptive reactance. Reactance is an element of psychopathy. So it leads to a switching. If it's in a borderline, for example, it switches the borderline to a psychopath. If it's in a psychopath, it switches the psychopath to malignant narcissist. If it happens to a narcissist, it switches the narcissist to a borderline.

This is the switching mechanism. The victory, the triumph of the A.P. over the A.N.P. leads immediately via collapse and mortification to switching between the three states, overt, collapsedand covert.

And each of these three states is the exact equivalent, the parallel of what today we call personality disorders. The collapsed state of the psychopath, the covert state of the psychopath is actually grandiose borderline or narcissist. The covert state of the narcissist is very, very close to borderline. You're beginning to see that these are simply mirror images.

If you look from the left, you see borderline. But if you look from the right, you see a collapsed state of a narcissist. If you look from the right, you see a psychopath. But if you look from the left, you see a collapsed state of a borderline. That's a psychopath, secondary psychopath.

So it gives rise to a unifying theory where actually we say, okay, if trauma management fails, whenever trauma management fails via collapse and mortification, there is switching between alternative parts.

Switching between alternative parts. And each of these parts is actually what today we call erroneously a personality disorder.

So again, when the borderline collapses, she switches to a part, to an A.P., to a part, or to another A.N.P. which is a secondary psychopath, which is today what we call secondary psychopath.

This is a proliferation of entities because what we are doing, we are like the three blind, wise men who were brought to inspect an elephant. One of them hugged his leg, one of them touched his trunk, one of them touched his tail.

And of course they had three totally different descriptions of the animal because they were blind.

But it was the same elephant. And there's only a single elephant.

Dissociation and trauma related.

Structure, in this senseI agree with him.

Structure and within this structure, depending on the results of the war between the A.N.P. and the E.P., we have collapsed states and we have covert states. The collapse is brought on by this war and part of this war or another name for this war is mortification.

Now this is a mortification.

And so when the war, one day, E.P., when the trauma, when the traumatic element wins the war, there is switching from overt to collapse, from collapse to covert. And each of these states is what today we call personality disorder.

The A.N.P., of course, is conditioned to be afraid of the E.P. E.P. is a serious threat to the survival of the individual and more broadly in evolutionary terms, survival of the species.

So the A.N.P. is very afraid of the very fearful of the E.P., of the emotional part. And it reacts to the emotional part's attempts to intrude. It reacts to the attacks by the emotional part.

Emotional part is like a virus, I mean computer virus. Or actually like a real virus as well. It tries to infiltrate the system and then replicate.

So the A.N.P.'s job is to prevent this from happening. And it uses everything, every tool and weapon in its arsenal to prevent the E.P. from taking over.

It alters consciousness. It lowers consciousness or even goes unconscious. It encourages behaviors which lower consciousness, for example, substance abuse, alcohol abuse, addictions, compulsions, self-mutilation.

Self-mutilation in such situations is in order to silence the inner voice of the E.P., to silence the memory of the trauma.

And the A.N.P. is so terrified of the E.P. and its recurrent incursions, its recurrent insurgency, its terrorist attacks. So the A.N.P. is so terrified of this, it develops phobias, multiple phobias.

It's very much like the response of the United States after 9/11. We react to phobias, we react with phobias to such intrusions.

So the A.N.P. develops phobias.

Anyhow, it's a weakened pathological structure. It's a splinter of the original personality which was fragmented and fractured by the explosion of the original trauma.

So it's weak to start with. It becomes paranoid. It begins to develop a persecutory ideation and per secretary internalized, per secretary objects.

So it creates phobias. It begins to be afraid of thinking, of emoting. So it develops obsessive-compassive internalized rituals.

Don't think about this word. Don't think about this word. Or externalized obsessive-compassive rituals. Wash your hands. Ten times a minute.

So afraid of mental action. It begins to be afraid of the dissociative parts. It begins to deny and repress and suppress and fight and battle.

Not only the trauma, the original trauma, but anything remotely that has remotely to do with it.

So it develops aversion to triggers. It becomes terrified of attachment and intimacy, of losing attachment. So attachment loss, phobia of attachment loss.

Because attachment and intimacy can present a panoply, a plethora, a compendium of triggers.

When you're in a relationship and it's intimate, your chances to be triggered are much higher.

So the AP teaches the trauma victim to avoid attachment, avoid intimacy, avoid loss, avoid normal life, avoid any change.

And there is a pernicious, very sick process called evaluative conditioning.

Evaluative conditioning is when we associate neutral stimuli, totally irrelevant stimuli.

Like, "Good morning" or "Would you like coffee?" or "Looking at this glass" or "I don't know, a displant." Totally neutral stimuli.

Associating neutral stimuli with negative or positive outcomesand with negative or positive feelings. This is called evaluative conditioning.

Why is it bad? Why is it pernicious? Why is it totally destructive and self-defeating?

Because neutral stimuli are neutral. If you evaluate them improperly, you're likely to react improperly. If you evaluate them negatively, you're likely to be re-traumatized, suffer, be in pain, be in fear, withdraw from life. If you evaluate neutral stimuli positively, you're likely to end up with very bad people in reckless situations and be sexually assaulted.

So it's bad to misinterpret the value sign of a stimulus. A stimulus is neutral, should be neutral, not motivated to action.

So when a neutral stimulus was previously connected, previously associated with a negative stimulus, the neutral stimulus acquires negative overtones.

And when a neutral stimulus has been associated with a positive stimulus in the past, it acquires positive overtones.

And this is evaluative conditioning. It's total distortion. Total distortion of the world.

And so evaluative conditioning is used by the ANP in the battle against the E.P.

The ANP says, "Let's avoid all negative outcomes. Let's avoid all negative feelings. And let's avoid all the stimuli that had ever been associated, however remotely, tangentially and indirectly, with negativity."

So this process is called constriction. Constriction of life. Constriction of the world.

Your life becomes narrower and narrower and narrower and narrower, focused until it's a single point on the screen and gone.

An individual can have one ANP and one E.P. and this is called primary dissociation, primary structural dissociation.

An individual can have one ANP and two or more E.P.s, emotional parts. There will be secondary structural dissociation.

An individual can have multiple ANP and multiple E.P.s and there will be a tertiary structural dissociation.

And this is actually DID, dissociative identity. Both ANP and E.P., according to the theory, have a redeemantary sense of self.

There is an "I" behind each one of them. The E.P., if it could talk, it would say, "I feel bad. I feel afraid. I feel angry. I feel ashamed. I feel guilty.

And the ANP, if it could talk, would have said, you know, "I am terrified of the E.P. I must suppress this memory. I cannot go through this again. If I go through this again, I will disintegrate and die, etc."

Both of them have a narrative voicewhich is very close to Jung's constellated self or to Freud's, perhaps, ego, maybe ego plus super- ego, because there is an element of inner critic there. And both of them have exclusive access to some memories.

In other words, the E.P. has access to memories that the ANP doesn't have access to.

Because the ANP doesn't want the access. The ANP doesn't want to be seen dead with these memories. It doesn't want to remember them. It doesn't want to restore them. It doesn't want to classify them. It doesn't want to work with them. It doesn't want to use them. It wants to forget them.

So there are memories that only the E.P. accesses because the ANP gave up on them.

And of course, the other way, there are memories that the ANP is usingbut would not be conducive to maintaining the fresh memory of the trauma, the flashbacks.

So the E.P. is avoiding these memories.

Again, I refer you to my lecture about identity and memory on this channel. It's a lecture that I give to my students.

So dissociative parts vary in many, many ways in the degree of intrusion, in the avoidance of trauma-related cues, in affect regulation, in psychological defenses, in capacity for insight, in response to stimuli, body movements, behaviors, cognitive schemes, attention, attachment styles, sense of self, self- destructiveness.

Promiscuity, suicidality, flexibility and adaptability in daily life, structural division, autonomy, number of substructures, subjective experience, overt manifestations, dissociative symptoms. All these, so you can't just say, "E.P. is this, ANP is this." It so crucially depends on the personal history of the individual, on the exact type of the trauma, on previous reactions to trauma, on coping mechanisms, etc.

Consider, for example, dissociative symptoms. There are negative symptoms and positive symptoms. Negative symptoms have to do with loss, loss of something.

So you have an easier, numbness, impaired thinking, loss of skills, loss of needs, wishes, fantasies, loss of motor functions, loss of motor skills, loss of sensation. All these are losses.

Some people have these, some people are there.

You have positive dissociative symptoms when mental content or functions of one part intrude on another part.

So this is very, very close to effect, to psychotic disorder, to schizophrenia.

As these people, for example, hear voices, the war is so big that the E.P. uses everything to intrude and to break through the deficits, like the siege, the famous sieges of the Middle Ages, where you had to break through the fortress, fortress walls, you know, with catapults and whatever you had.

So the E.P. is using voices, using psychosis to break through the ANP. Non-volitional behaviors, ticks, pains with no reason. You have psychopharm and somatoform dissociative symptoms. Somatoform dissociative symptoms is what Freud used to call convergent symptoms.

And so we should narrate a bit.

Dissociative symptom is a dissociative symptom only if there's a clear evidence that it comes from some dissociative part of the personality. And also if the symptom is found in one or some parts of the personality, but never in all of them.

So if you have a promiscuous woman, and in what, she is always promiscuous. Even when she switches as a borderline, for example, she switches between clearly dissociative parts, she switches from borderline to secondary psychopath or to narcissists, from overt to covert and from covert to collapsed.

I mean, with all these switches, in all these situations, she's promiscuous.

So that promiscuity is not a dissociative symptom.

But if she becomes promiscuous only when she switches from borderline to psychopath, or only when she switches from overt to covert, that would strongly indicate that it's a dissociative symptom.

A and P and E P are not totally divorced, of course. They're in the same skull, using the same brain for those of you who have brains.

They share a lack of full realization of the trauma, of course.

What A and P knows, E P doesn't know. What E P doesn't know, A and P doesn't want to know.

And so there's a kind of Chinese war between firewalls. They don't talk too often, meaningfully at least. They're like very old married couples.

So they don't realize the trauma fully. If they were put together, integrated, fused, you would have a clear full fledged processing of the trauma, which is what we do in therapy.

But as it is, the trauma is segregated. Both of them have obstructive, adaptive deficits. Both of them are not very adaptive. They don't help the person much.

Too much energy is going into separating, segregating, avoiding, fighting, numbing, you know.

So they're not very adaptive. And they both lead to significant dissociative symptoms.

Structural dissociation is a permanent pathological state. It requires treatment to fuse the parts. And it requires social support and restorative experiences after the trauma.

As we discovered that having a social safety network, just a little affection and comfort, having some restorative experiences, good experiences after trauma, they buffer.

They even reverse post-traumatic effectseven better than therapy. And in therapy, we commit usually three mistakes.

And these mistakes give the emotional part, the upper hand. We actually re-traumatize the patient. We cause damage.

One, we reify the parts. We tend to treat each part that appears after the switching as though we're talking to another person.

We don't really communicate across the parts, but we communicate with each part separately, thereby encouraging the emergence of multiple personality disorder.

That's why many skeptics say that multiple personality disorder is a heterogenic thing. It's induced by the therapist.


The second mistake is that we put undue emphasis on differences between dissociative partsrather than on the commonalities.

The third mistake is that we put a premature focus on traumatic memories.

But in cold therapy, these mistakes are the strong points. These mistakes are the main techniques.

We want to break the narcissist. We want the narcissist to re-experience this trauma in the form of a flashback. We want the narcissist to go through that horrible, harrowing, torturous, destructive, terrifying period in his life and to go through it really, not semantically, but episodically, to experience the episode, to live through it.

The only hope for destroying, for getting rid of the false self.

So these mistakes in classic therapy of classic trauma victimslike women with borderline, in treating narcissists via cold therapy, I took these mistakes and I made them the foundation stones of cold therapy.

When the ANP is full functioning and dominant, PTSD is delayed, of course. It's the main job of the ANP to keep PTSD at bay. And dissociative symptoms are late.

But there's a price. ANP consumes a lot of energy and prohibits, prescribes, it's prescriptive. It prevents, it inhibits certain behaviors.

So functioning is reduced. When the ANP is successful, functioning is reduced. And even people who delay the PTSD by having a successful ANP, they are much less functional than people who don't have PTSD at all.


I have many disagreements with the theory, but one of them is that I believe the ANP fluctuates. I believe there are periods of high functioning ANP and periods of low functioning ANP and these would tend to explain the collapse.

I think when the ANP wanes, when it wanes, there's a collapse. And when it walks, there's restoration of the overt phase. And when it wanes, the collapse leads to a covert state.

So the ANP goes down, there is a collapse via modification, there is a covert state, and then the overt state.

Even the theory itself, structural dissociation, they recognize that in some situation there is what they call submission.

Submission, vanishing, it's actually the freeze, fall and flight parts. Freeze, fall and flight coupled with submission, coupled with vanishing.

What do we have? Covert state.

Even structural dissociation describes actually the covert state, but just doesn't call it covert.

When the ANP is less than successful, when it has low energy, or low consciousness, or low self-efficacy, when the ANP is not working that well and the EPs is intruding on the turf, invading, in that stage this leads to covert behaviors.

And we'll explain, for example, why passive aggression comes to the fore as a defense. This is associated with EPs.

Collapse and Motification are traumatic, and they evoke past childhood traumas. The child has been told that he's bad and worthy.

And the collapse and the modification force regression into that phase, where the word, the word, the logos, the word of the godlike creatures, mom and dad, they're godlike creatures, they're infallible, they're omnipotent. They are seven meters, seven meters high, tall. I mean, these creatures are telling you that you're bad, unworthy, failure. You take it. You absolutely believe it. And it's very, very traumatic, because it's terrifying. Maybe if you're bad and unworthy, they will dump you in the nearest garbage bin. You know, maybe they'll get rid of you. Maybe they'll not feed you. Maybe they'll kill you. Maybe they will bring another child to take you place. It's a terrifying statement. And so the collapse and modification force the narcissist or the borderline or the even the psychopath, the Israeli force them back, regress them to that part of their childhood, where they were mortally, mortally terrified for their own survival.

Now, CPT is the complex trauma, borderline personality disorder, and a now defunct category called disorders of extreme stress not otherwise specified. All of them were considered a part of secondary structural dissociation.

I would like to focus for a few minutes on a new diagnosis in the latest edition of the DSM, DSM five published in 2013 and it's called other specified dissociative disorder subtype one. And it's a, it'sthis is the epitome of the secondary structural dissociation OSDD one is very similar to D ID and and so it's not 100% secondary.

But as opposed to the idea, there's noone easier.

So the person switches between personalities, which are not personal switches between partsswitches between traumatic parts, you know, but remembers everything. The parts are not fully differentiated. So, and so the both the A and P and the EP. Remember everything, this access to memory is amazing, because theoretically, OSDD one should have only one and multiple EP, but this is sometimes not the case, you could have an EP or series of EPs in with always did you want.

And, but of course these EPs will be not as as developed as in as in full fledged D ID, but still you know quite a few of them and very powerfulvery well developed and so on and they were, there will be traumatic containers and.

The nature of the interaction between the A and P and the, and the EP parts will resemble uncannily. The way these parts interact in borderline personality disorder, and in complex trauma in CPT isin CP is the differentiation is incomplete.

These authorsalternative personalities are not fully developed. They don't have a full fledged idea of self or self would not totally separated the sense, they don't recognize each other, they don't share the same memory pool in all in OSDD. One.

They do. So, always did he one is like BPD or CPT is the austere.

The EPs of OSDD one handle some aspects of daily lifefor example, you can have a piece that are very playful like children, or they are very curious, explore the world, grandiose even.

And indeed, most of these EPs, self described as children.

And they, when they're in a safe environment, or when they are triggered.

Sometimes they switch, and you can see the child appears. And sometimes they don't switch. It's something called passive influence, they kind of flow. There's a gradual incremental change.

They sometimes have arguments, these parts, they deny each other or they deny each other's memories or they deny the form of the body that they're occupying.

And the A&P itself is infected with emotional lability, dysregulation, and shame and blame and hatred and it's a big mess, you know, it's a big mess and always did he seems to me.

The kind of primordial state, primordial dissociative statethat once more developed becomes borderline personality disorder and CP is these symptoms sound almost to the letter like the symptoms of borderline personality disorder.


The two foundational characteristics of borderline personality disorder, insecure attachment and emotional dysregulation exist in CP and in BPT and in the next edition of the ICD, edition 11, the international classification of diseases.

CP is going to be a recognized diagnosis, and it's going to include as diagnostic criteria, insecure attachment and emotional dysregulation, which raises the question, why the proliferation of entities, why do we need CPT-SD or complex trauma and BPT if they share 90% of all the diagnostic characteristics.

CPT-SD if CPT-SD is founded on insecure attachment and emotional dysregulation, then it's not only a trauma reaction. It's what we would call today a personality disorder.

But of course we can reverse the argument. Maybe a personality disorder is a trauma reaction. Maybe we're getting it backwards.

We say, wait a minute, CPT-SD sounds like a personality disorder. Maybe it's not a trauma reaction.

But wait a minute, maybe it's the opposite.

Borderline sounds like CPT-SD, so maybe it's not a personality disorder. Maybe it's a trauma reaction.

In both cases, there are traumas of childhood, subtle, severe, nuanced, real, ambient.

There's no borderline personality disorder without some kind of trauma.

The trauma doesn't have to be overt. It doesn't have to be physical meeting or incest, sexual abuse.

Trauma can be ambient, can be parental expectations, can be conditional love, can be what we call lack of parental attunement.

The famous pediatrician turned psychologist, Winnicott, he called it being dropped by the mind of the mother. He said, the mother should be good enough. And if she's not good enough, if she drops the child in the mind, that's trauma.

Judith Hermann, Dr. MacLean, Gallup and a zillion other scholars argue repeatedly that CPT-SD is misdiagnosed as borderline personality disorder. And that borderline personality disorder should be abolished as a separate diagnostic and clinical entity.

I go even further. All personality disorders should be abolished. There should be a single personality disorder. And it should be moved in the DSM to the post-traumatic conditions section. It should be a form of CPT-SD.

CPT-SD, dissociative CPT-SD, I mean, when CPT-SD is coupled with dissociation, it leads to what today we call personality disorders.

personality disorders are the dissociative states of trauma.

As Hermann says, the data on this point are beyond contention. 50 to 60 percent of psychiatric inpatients and 40 to 60 percent of outpatients report childhood histories of physical or sexual abuse or both in borderline and in CPT-SD.

What happens with narcissistic personality disorder, borderline personality disorder, there is childhood trauma in one way or another. There are 100 ways to abuse a child. Many of them are not overt. And these subtle, ambient, underground ways are even worse, more pernicious.

So there is abuse, there is trauma, and some people with pre-mobil personalities react to this trauma by dissociating. They create an ANP and EP, whatever model you want to use, I don't care. They dissociate. Dissociation, by definition, is a fragmentation and fracturing of personality.

Presto, you have narcissistic personality disorder, two personalities. You have borderline personality disorder, effectively multiple personalities are switching. You have the psychopath, secondary, primary. You have overt state, covert states, collapsed states.

This all fits perfectly. All we have to do is stop being obstinate, look at the data and accept that at the root cause of all this is trauma and dissociation separately and sometimes co-jointly.

Thank you.

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How To Recognize Collapsed/Covert Personality Disorders

Professor Sam Vaknin discusses the concept of Occam's Razor in science and proposes that all personality disorders are a single clinical entity. He delves into the covert states of various personality disorders, such as covert narcissism, covert histrionic, and covert borderline, and their characteristics and behaviors. He also touches on the collapsed states and the transition between different states in each overlay. Additionally, he mentions the collapsed histrionic and the covert antisocial personality disorder.


How Trauma Destroys Your Sense of Self (PTSD Literature Review)

Neuroscience studies support the idea that narcissistic and borderline personality disorders are post-traumatic conditions due to disruptions in the formation of the self. Trauma, especially in early childhood, leads to dissociation, depersonalization, and derealization, affecting the sense of self. The default mode network in the brain is implicated in these disruptions. PTSD and CPTSD are reactions to single or repeated traumatic events, with EMDR and cognitive behavior therapy as recommended treatments. Medication options for PTSD include paroxetine, sertraline, and alpha 2 receptor antagonists, while benzodiazepines and certain other drugs are not recommended.


Post-Traumatic Stress Disorder (PTSD) in Victims and Survivors of Abuse

Post-traumatic stress disorder (PTSD) is typically associated with the aftermath of physical and sexual abuse in both children and adults. However, PTSD can also develop in the wake of verbal and emotional abuse, providing it is acute and prolonged, and in the aftermath of drawn-out traumatic situations such as a nasty divorce. The diagnostic and statistical manual criteria for diagnosing PTSD are far too restrictive, and hopefully, the text will be adopted to reflect this. PTSD can take a long time to appear and lasts more than one month, usually much longer.


Flashbacks in C/PTSD: “Emotional" vs. Real (See DESCRIPTION 1st! University Lecture)

Professor Sam Vaknin discusses the construct of emotional flashbacks in complex post-traumatic stress disorder (CPTSD) and its validity. He proposes a nuanced classification of PTSD, which includes overuse of dissociation, defensive compartmentalization of trauma, hijacked neurobiology with hallucinations, and numbing. Flashbacks are a key symptom of PTSD, involving the re-experiencing of traumatic events in the present. They are a way of coping with trauma and suspending the distinction between internal and external objects, and are a fundamental tool that we are born with. Flashbacks are intimately connected to trauma and dissociation, and involve reliving experiences.


4 Paths of Trauma Release and Reactance (International Summit on Depression, Anxiety and Stress Management)

Professor Sam Vaknin discusses the connection between trauma, including external shocks such as the pandemic, and reactants, or disproportional reactions to daily triggers. He reconceives personality disorders as post-traumatic conditions, with all personality disorders in cluster B starting as trauma and abuse in early childhood. Trauma imprinting is the core of post-traumatic stress disorder and complex trauma, and triggers are places, people, smells, sounds, circumstances, dates, and objects that are reminiscent of the same classes of stressors involved in the original trauma. The pandemic has touched upon every dimension of existence, making it difficult to recover from, and there is a risk of a secondary pandemic of mental health, with millions of people developing personality disorders.


EPCACE: Between PTSD and CPTSD (Trauma in Adulthood, Late Onset)

Professor Sam Vaknin discusses the diagnosis of Enduring Personality Change After Catastrophe Experience (EPCACE) and its differentiation from Complex Post-Traumatic Stress Disorder (CPTSD). He argues that EPCACE should not be subsumed under CPTSD, as the reactions to the diagnostic issues are not the same. He suggests that EPCACE should be reconceived with a set of diagnostic criteria that incorporate symptoms such as somatization, self-harm, and sexual dysfunction. He also believes that diagnoses such as masochistic personality disorder, sadistic personality disorder, and negativistic, passive-aggressive personality disorder should not have been eliminated.


Intimate Partners Who Were Sexually Abused in Childhood

Julian Ford discusses the unique dissociative symptoms of sexual violation in complex post-traumatic stress disorder. He describes the conflict between the need for touch and intimacy and the intense disgust or terror experienced by individuals with a history of childhood sexual abuse. Victims of childhood sexual abuse often dread intimacy, sexualize love, and struggle with setting boundaries in adulthood. They may employ defense mechanisms such as self-objectification, dissociation, and self-punitive choices in intimate relationships. These experiences can lead to a complex and challenging dynamic for intimate partners of childhood sexual abuse survivors.


Borderline Mislabels Her Emotions (as do Narcissist, Psychopath)

Professor Sam Vaknin discusses the emotional and cognitive deficits in individuals with Cluster B personality disorders, such as narcissists, borderlines, psychopaths, histrionics, and codependents. These individuals have deformed, mutated forms of empathy, and their emotional regulation is not healthy. They do not have the basic tools to understand and label emotions in themselves and others, and instead, they use cognitive emotion, analyzing their emotions rather than experiencing them wholeheartedly. Coping strategies in all these personality disorders involve self-soothing, which is dysfunctional. Many of them switch from self-soothing to repetition compulsions.


Abuse Victim's Body: Effects of Abuse and Its Aftermath

Abuse and torture have long-lasting and frequently irreversible effects on the victim's body, including panic attacks, hypervigilance, sleep disturbances, flashbacks, intrusive memories, and suicidal ideation. Victims experience psychosomatic or real bodily symptoms, some of them induced by the secretion of stress hormones, such as cortisol. Victims are affected by abuse in a variety of ways, including PTSD, which can develop in the wake of verbal and emotional abuse, in the aftermath of drawn-out traumatic situations such as domestic divorce.

Transcripts Copyright © Sam Vaknin 2010-2023, under license to William DeGraaf
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