Papers by Onno van der Hart
European journal of psychotraumatology, 2011
Affect regulation is often compromised as a result of early life interpersonal traumatization and... more Affect regulation is often compromised as a result of early life interpersonal traumatization and disruption in caregiving relationships like in situations where the caretaker is emotionally, sexually or physically abusing the child. Prior studies suggest a clear relationship between early childhood attachment-related psychological trauma and affect dysregulation. We evaluated the relationship of retrospectively recalled childhood traumatization by primary caretaker(s) (TPC) and affect dysregulation in 472 adult psychiatric patients diagnosed with borderline personality disorder (BPD), somatoform disorder (SoD), both BPD and SoD, or disorders other than BPD or SoD, using the Bermond-Vorst Alexithymia Questionnaire, the self-report version of the Structured Interview for Disorders of Extreme Stress, the Self-rating Inventory for Posttraumatic Stress Disorder (SRIP) and the Traumatic Experiences Checklist. Almost two-thirds of participants reported having experienced childhood TPC, ra...
Activitas Nervosa Superior, 2010
Many traumatized individuals alternate between re-experiencing their trauma and being detached fr... more Many traumatized individuals alternate between re-experiencing their trauma and being detached from, or even relatively unaware of the trauma and its effects. At first sight one may be inclined to conceptualize detachment from trauma and reexperiencing of trauma as mental states. However, on closer scrutiny it becomes apparent that in both cases a range or cluster of states rather than a singular state is involved. For example, being detached from trauma does not itself exclude being joyful, ashamed, sexually aroused, or curious at times, and re-experiencing trauma can encompass states such as fleeing, freezing, and being in pain or being analgesic. In this paper we relate detachment from trauma and reexperiencing trauma to emotional operating systems and functional systems , briefly addressed as action systems. Action systems control a range of functions, but some are more complex than others. Reexperiencing trauma will be associated with the inborn and evolutionary derived defensive system that is evoked by severe threat, in particular threat to the integrity of the body. As a complex system, it encompasses various subsystems, such as flight, freeze, and fight. Detachment from trauma, in our view, is associated with several action systems (Panksepp, 1998), i.e., the ones that control functions in daily life (e.g., exploration of the environment, energy control), and the ones that are dedicated to survival of the species (e.g., reproduction, attachment to and care for offspring). In this context we will maintain that severe threat may provoke a structural dissociation of the premorbid personality ( . In its primary form this dissociation is between the defensive system on one hand, and the systems that involve managing daily life and survival of the species on the other hand. To summarize the essence of the theory of structural dissociation of the personality, we argue (1) that traumatic experiences, especially when they occur early in life and involve severe threat to the integrity of the body, may activate psychobiological action systems that have been developed by evolution, and (2) that due to extreme stress levels and classical as well as evaluative conditioning to traumatic memories these systems may remain unintegrated to varying degrees.
Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD), Jan 20, 2016
This article presents the history of a 21-year-old female college student with total denial of pr... more This article presents the history of a 21-year-old female college student with total denial of pregnancy who experienced an acute dissociative reaction during the spontaneous delivery at home without medical assistance where the newborn died immediately. Psychiatric examination, self-report questionnaires, legal documents, and witness reports have been reviewed in evaluation of the case. Evidence pointed to total denial of pregnancy, i.e. until delivery. The diagnoses of an acute dissociative reaction to stress (remitted) and a subsequent PTSD were established in a follow-up examination conducted 7 months after the delivery. Notwithstanding the inherently dissociative nature of total denial of pregnancy, no other evidence has been found about pre-existing psychopathology. For causing the newborn's death, the patient faced charges for "aggravated murder," which were later on reduced into "involuntary manslaughter". Given the physical incapacity to perform volu...
Interest in multiple personality disorder (MPD) as well as sexual child abuse is rapidly growing ... more Interest in multiple personality disorder (MPD) as well as sexual child abuse is rapidly growing in the Netherlands, perhaps more so than in otherEuropean countries. Clinical, theoretical, and research developments in these respects are outlined, and it is mentioned that patients stating that they have been victims of satanic cult abuse are also encountered in the Netherlands. The need fin-more international cooperation is expressed.
European Journal of Psychological Assessment, 2006
Objective: This review tests Ribot's classic twofold categorization of generalized amnesia (GA) i... more Objective: This review tests Ribot's classic twofold categorization of generalized amnesia (GA) into Type I, total loss of episodic memory, and Type II, additional more or less extensive loss of semantic and/or procedural memory. It also explores his law of regression, according to which, cast in modern terms, recovery of lost procedural and semantic memories precedes recovery of episodic memory, as well as reported aetiological factors. Method: Clinically and formally assessed cases of GA, published since 1845, were surveyed and further analyzed. Results: Over and above authentic episodic memory loss, cases differed widely in the extent of impairment of semantic and procedural memory. Recovery of semantic and procedural memory often preceded recovery of episodic memory. This particularly applied to authenticated trauma memories. To an extent, lost memories affected current functioning, and in some cases were associated with alternating dissociative personalities. Severe memory distortions upon memory recovery were not reported. Most cases were trauma or stress related, while in some cases the aetiology remained unknown. Conclusions: Contrary to the view expressed in DSM-IV, which states that dissociative amnesia pertains to an inability to recall personal information, GA may also involve loss and recovery of semantic and procedural memories. Since the loss of various memory types in GA is dimensional rather than categorical, Ribot's typological distinction does not hold. Some of the reviewed cases suggest a trauma-related aetiology. Generalized amnesia of varying degrees of severity can involve delayed retrieval of trauma memories, as well as the loss and delayed retrieval of the premorbid personality.
Journal of Family Psychotherapy, 1988
Http Dx Doi Org 10 1080 00029157 1983 10404125, Sep 22, 2011
This discussion reinterprets a sixteenth-century case of possession and exorcism as Dissociative ... more This discussion reinterprets a sixteenth-century case of possession and exorcism as Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder (MPD). This is perhaps the earliest historical case in which DID can be diagnosed retrospectively with confidence. Jeanne Fery, a 25-year-old Dominican Nun, wrote her own account of her exorcism which took place in Mons, France in 1584 and 1585. Her exorcists produced an even more detailed account describing both identity fragmentation and a past history of childhood trauma. Also well described in both accounts are major criteria and associated features of DID as described in present day diagnostic manuals (American Psychiatric Association, 1987.) The 109-page description of her treatment course was republished in French in the nineteenth century by Bourneville (1886), a colleague of Janet, who also diagnosed Jeanne's disorder as "doubling of the personality," (the term then in use for DID). This article is the first English-language presentation of these documents.
Objectives: Interest in the work of Pierre Janet is presently undergoing a scholarly revival and,... more Objectives: Interest in the work of Pierre Janet is presently undergoing a scholarly revival and, in the process, his contribution to dynamic psychiatry is increasingly being recognised. This article compares and contrasts Pierre Janet's early studies on hysteria and the neuroses with those of Freud. Method: The study surveys original works by Janet and Freud and contemporary scholarly exegeses. It particularly focuses on ideation and memory, consciousness and dissociation, psychological trauma, the self, therapeutic influence, and treatment by integration versus abreaction. Results: Grounds are presented for either preferring Janet's notions to Freud's, or for integrating them. Conclusion: It is concluded that a number of Janet's contributions to psychopathology and psychotherapy, particularly in the field of dissociative disorders, deserve further exploration and application.
Http Dx Doi Org 10 1080 00207148808409329, Jan 31, 2008
... CASE HISTORY Judith (not her real name), a 32-year-old married woman, was grief-stricken when... more ... CASE HISTORY Judith (not her real name), a 32-year-old married woman, was grief-stricken when she called the author. Her father had died suddenly and had been buried ... [Strategies in hypnotherapy.] Deventer: van Loghum Slate-rus, 1987. Pp. 210-219. ...
The Israel Journal of Psychiatry and Related Sciences, Feb 1, 1987
Therapeutic leave-taking rituals are a short-term strategic form of mourning therapy. These ritua... more Therapeutic leave-taking rituals are a short-term strategic form of mourning therapy. These rituals consist of three phases: a) preparatory-in which the therapist explains how performing a ritual might help in taking leave of the deceased; b) reorganization-in which the client carries out certain tasks, such as writing daily entries in a 'continuous letter' to the deceased; and c) finalization-which is divided into a leave-taking ceremony, a cleansing rite, and a reunion ritual which symbolically expresses the client's most important relationships in his or her new stage of life. This directive approach is especially relevant in treating clients with a conflicted grief syndrome.
TO THE EDITOR: What's in a name? Dr. Nakdimen concurs that dissociative identity disorder is unde... more TO THE EDITOR: What's in a name? Dr. Nakdimen concurs that dissociative identity disorder is underdiagnosed, but criticizes the current DSM-IV-TR nosology for removing multiplicity of identity from the name and for not including hiddenness among the diagnostic criteria, which is more like the DSM-III criteria. Undoubtedly, there are multiple ways of naming and describing the identity disturbance of such individuals, some emphasizing fragmentation, others the proliferation of partial competing identities. The diagnostic criteria themselves make it clear that the problem is the presence of "more than one identity or personality state." The current title emphasizes the failure of integration rather than multiplicity of identities, which has the advantage of indicating that the "personalities" are not really personalities but rather fragments of identity indicative of a damaged personality. It is true that hiddenness is not explicitly mentioned in the diagnostic criteria, but that is also characteristic of many psychiatric symptoms, such as delusions in schizophrenia, which are sometimes jealously guarded and only mentioned in response to specific inquiry. Clearly, the exact title of the disorder will again be explored, and hopefully more attention will be paid to the diagnosis and treatment of dissociative disorders. They have been with us for a long time. A rose is a rose is a rose.
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Papers by Onno van der Hart