Held in mind, out of awareness. Perspectives on the continuum of dissociated experience, culminating in dissociative identity disorder in children

Abstract

With reference to research from the fields of neurophysiology and psychoanalytic theory, this paper gives an overview of the present understanding of how trauma is processed and the possible aetiology of multiple self-states. Clinical examples of a variety of self-states are given and thought about in terms of neuroception. Finally, some thoughts on clinical implications of treatment are offered.

Keywords:

• Dissociative identity disorder
• neuroception
• polyvagal theory
• self-state

Notes

1. Declarative memory refers to conscious memories, both those based on personal memories as well as learned knowledge. Procedural memory occurs largely out of conscious awareness and is created through numerous repetitions of complex activity (such as riding a bicycle) until all the neural systems involved can synchronise to produce the activity without needing conscious attention.

2. Efferent neurons conduct impulses away from the brain or spinal cord; they effect change on the receptor organ. Afferent neurons conduct impulses to the cortex and are affected by the environment.

3. A referral was made to investigate petit mal. The results were negative.