Genesis of a dissociative child: how ‘I’ can become ‘us’ and back again*

Abstract

ABSTRACTThis paper traces the aetiology of a dissociative identity disorder in a 15-year-old young woman who attended weekly psychoanalytic psychotherapy at a UK Child and Adolescent Mental Health Service (CAMHS) clinic following the discovery of the potentially dangerous ‘second life’ of an alternative personality of which she was largely unaware. The internal impacts of parental dysfunction, sexual trauma and geographical dislocation are examined through the lenses of attachment theory and neuroscience to illustrate how her dissociative disorder was forged in the crucible of a series of unfortunate circumstances and events. Established theories are interwoven into the account, including Putnam’s non-linear shifts between infantile behavioural states, Liotti’s delineation of the tension between opposing inborn motivational systems and Stern’s highlighting of unformulated experience. The material is also viewed from the psychoanalytic perspectives of Fairbairn’s concept of the moral defence, Rosenfeld’s description of the pathological organisation and Michael Sinason’s technique of addressing the destructive internal cohabitee. Details of the internal dynamics between self states and the particular resolution found by this young person are described together with a brief exploration of additional therapeutic approaches with dissociative children: invitational inclusionism, reframing, narrative psychoeducation.