Elizabeth F. Howell

“Secondary structural dissociation involves one ANP and more than one EP. Examples of secondary structural dissociation are complex PTSD, complex forms of acute stress disorder, complex dissociative amnesia, complex somatoform disorders, some forms of trauma-relayed personality disorders, such as borderline personality disorder, and dissociative disorder not otherwise specified (DDNOS).. Secondary structural dissociation is characterized by divideness of two or more defensive subsystems. For example, there may be different EPs that are devoted to flight, fight or freeze, total submission, and so on. (Van der Hart et al., 2004). Gail, a patient of mine, does not have a personality disorder, but describes herself as a "changed person." She survived a horrific car accident that killed several others, and in which she was the driver. Someone not knowing her history might see her as a relatively normal, somewhat anxious and stiff person (ANP). It would not occur to this observer that only a year before, Gail had been a different person: fun-loving, spontaneous, flexible, and untroubled by frightening nightmares and constant anxiety. Fortunately, Gail has been willing to pay attention to her EPs; she has been able to put the process of integration in motion; and she has been able to heal. p134”

“Dissociation, in a general sense, refers to a rigid separation of parts of experiences, including somatic experiences, consciousness, affects, perception, identity, and memory. When there is a structural dissociation, each of the dissociated self-states has at least a rudimentary sense of "I" (Van der Hart et al., 2004). In my view, all of the environmentally based "psychopathology" or problems in living can be seen through this lens.”

“Stern observes that unformulated experience is not only a source of defense, but also a source of creativity. We must allow the unformulated to organize itself.”

“Chronic trauma (according to the meaning I propose) that occurs early in life has profound effects on personality development and can lead to the development of dissociative identity disorder (DID), other dissociative disorders, personality disorders, psychotic thinking, and a host of symptoms such as anxiety, depression, eating disorders, and substance abuse. In my view, DID is simply an extreme version of the dissociative structure of the psyche that characterizes us all.”