The abused and the abuser(s): attachment relationship in dissociative identity disorder

Sachs Simpson, Adah (2014) The abused and the abuser(s): attachment relationship in dissociative identity disorder. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

This thesis aims to draw a unified picture of the relationship between Dissociative Identity Disorder (DID) (APA, DSM-5, 2013), the affected person’s attachment pattern, and specific characteristics of their trauma history. In particular, the analysis of these three elements focuses on cases where a person is persistently involved in a life of ongoing abuse, despite years of DID-specific psychotherapy. Based on attachment, forensic and psychoanalytic perspectives and on my extensive clinical work, I propose several new classifications to help identify and explain such cases, and ultimately improve their treatment. The first is further classification of the Disorganized Attachment (DA) category of attachment theory, to include two new sub-types: Concrete Infanticidal Attachment (IAc), which develops when a child needs to engage an attachment figure who only responds while the child is being severely abused, and Symbolic Infanticidal Attachment (IAs), which develops in response to severe but not abusive relational trauma, such as neglect. The second proposes a differentiation between two presentations of DID, Active and Stable. The first describes people who continue to be involved in a life of abuse even in adulthood, and their DID is thus constantly reinforced and recreated. The second pertains to people who bear the scars of childhood relational trauma but are safe at present and can focus on recovery from their traumatic past. Finally, I propose the Cyclical Model, which describes the relationship between severe childhood abuse, IAc and active DID as a self-perpetuating cycle. The term cyclicity is used to describe a repetitive, change-resisting quality of people with active DID. Cyclicity is attributed to their extreme levels of anxiety and terror. I argue that this quality, while ‘quiet’ and hard to detect, forms a major obstacle to recovery. Following these ideas, additional theoretical and clinical considerations are suggested as expansion to the Phase-Oriented Approach for the treatment of DID (ISSTD 2011). Key words: active DID, stable DID, attachment theory, childhood abuse, cyclicity, infanticidal attachment, relational trauma, phase-oriented treatment approach.