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see also
Structural Dissociation (allpartswelcome.blogspot.com)
What are Dissociative Parts and How or When to Introduce “Parts” Language? – ESTD
http://traumadissociation.com/alters
Age Regression in Dissociative Identity Disorder | HealthyPlace
The difference between Ego States and dissociative parts - dis-sos
"Pathological dissociation, the experience of detachment from or discontinuity in one’s internal experience, sense of self, or surroundings [1], is a common experience in the aftermath of trauma [2, 3]. However, symptoms of trauma-related pathological dissociation and dissociative disorders remain at best under-appreciated and, at worst, frequently go undiagnosed or misdiagnosed [4, 5]. Clinical misunderstanding about dissociation (For brevity, we use the term dissociation to refer to trauma-related pathological dissociation throughout the manuscript. It does not include non-pathological forms of dissociation.) is historically longstanding and rooted largely in an individual and societal reluctance to acknowledge the prevalence of childhood abuse and domestic violence and its impact, in particular, on women [4, 6]. The cost of this stigmatization and misunderstanding is high: it has prevented people from accessing appropriate and effective treatment, prolonged suffering, and stunted research on dissociation, the dissociative subtype of posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID) [4, 6, 7].
More psychological and biological research in this area could serve as a lifebuoy—helping to destigmatize and understand these conditions, and how best to treat them. Psychological research embracing trauma-related pathological dissociation has determined that it encompasses a range of experiences or “subtypes” [8]. Subtypes like depersonalization and derealization are frequent experiences in both the dissociative subtype of PTSD and DID [1]. Depersonalization and derealization involve feelings of detachment or disconnection from one’s sense of self, body and environment [1]. Individuals report feeling like their body or surroundings are unreal or like they are in a movie.
Dissociation also includes experiences of self-alteration common in DID in which people lose a sense of agency and ownership over their thoughts, emotions, actions and body [9]. With this loss of agency and ownership, people then experience some thoughts, emotions etc. as partially-dissociated intrusions [9]. Individuals report feeling like they are hearing voices or that their thoughts, emotions, and actions emerge without their control and ‘intrude’ on their conscious experience. Importantly, these intrusions are characterized as partially-dissociated rather than psychotic because the person retains fully intact reality-testing though subjectively feels “as if” the experiences do not belong to them [9]. Both depersonalization, derealization, and experiences of self-alteration can help people cope in the face of inescapable threat and trauma [10]. However, they can also impede one’s ability to function and can interfere with new emotional learning [11]. This adds urgency to our need to better understand mechanisms of dissociation so we can enhance interventions that will ameliorate these symptoms. Brain-based measures of dissociation can provide scientific evidence for the validity of these experiences and can link the clinical phenomenology with biological mechanisms. While foundational studies have begun to characterize the neurobiology of dissociation [12–14], the field lacks a synthesized model across the range of dissociative experiences that could place it in context with other common psychiatric conditions. This gap in our knowledge about experiences that disproportionately impact women [15–17] contributes to gender-related health disparities and must be addressed to help eliminate this inequity.
The Triple Network model of psychopathology may provide a synthesized neurobiological model for pathological dissociation. This model offers an integrative framework based in systems neuroscience for understanding cognitive and affective dysfunction across psychiatric conditions [18]. The basic model implicates altered intrinsic organization and interactions between three large-scale brain networks across disorders: the right-lateralized central executive network (rCEN), the medial temporal subnetwork of the default network (tDN), and the cingulo-opercular subnetwork of the SN (cSN; Fig. S1). These three networks serve complementary functions. The rCEN, a lateral frontoparietal network, is strongly implicated in cognitive processes such as reasoning, attention, inhibition, and memory [19, 20]. The rCEN is distinct from left CEN, which is primarily involved in language processing [19, 20]. Conversely, tDN, a medial frontoparietal network [21], is involved in autobiographical memory, recollection of events in one’s past (i.e., episodic memory retrieval) and simulating future events [22–25]. Lastly, cSN, a midcingulo-insular network [21], is involved in interoception, especially the experience of emotion derived from information about the internal milieu [26]. These subnetworks are easily identified using group independent component analysis and are highly reproducible [19, 20, 27]. Altered organization and interaction between CEN, DN, and SN are consistently reported across psychiatric disorders [18]. Central to these alterations is improper assignment of relevance or salience to either internal or external stimuli [18]. Inappropriate salience detection, failing to assign relevance to something important or assigning relevance to something unnecessarily, can create a cascade effect where the CEN and DN do not engage or disengage appropriately. Depending on the subtype of pathological dissociation (e.g., depersonalization/derealization, partially-dissociated intrusions etc.), these symptoms could involve inappropriate salience detection in either direction, and concomitant alterations in executive functioning and selfgenerated thought. Neuroimaging work to date implicates altered connectivity of regions in all three networks [12, 14, 28]. These studies typically focus on dissociative symptoms of depersonalization and derealization—with both seed-based and group independent component analysis functional connectivity findings in the dissociative subtype of PTSD highlighting altered connectivity of regions located in the SN, DN, and CEN (e.g., amygdala, insula, prefrontal and parietal cortex [12, 29, 30]). One study from our team found that hyperconnectivity of regions in CEN and DN was associated with a measure of pathological dissociation that combined scores of depersonalization, derealization, and partially-dissociated intrusions in a PTSD, PTSD dissociative subtype, and DID sample [31]. Relatedly, there is also foundational work implicating altered activity in these networks in PTSD [12] and DID [13, 32–37]. Taken together, these findings cover a range of dissociation subtypes; however, they do not directly compare different subtypes. The unique contributions of different dissociation subtypes to altered connectivity in the three core networks of the Triple Network model are unknown. Parsing heterogeneity in dissociation could add significant impact to our understanding of differences in both illness and treatment trajectories across individuals – and represents the critical next step in advancing personalized medicine for dissociative symptoms. To address this gap, we assessed the connectivity of rCEN, tDN, and cSN as related to different subtypes of pathological dissociation: the dimensional symptoms of depersonalization/ derealization and partially-dissociated intrusions, and the diagnostic category of DID. Notably, we used a novel method for assessing both overlapping and unique contributions of different dissociation types [38]. Given prior work both in dissociation and the Triple Network model of psychopathology, we hypothesized all three networks would be implicated in dissociation and unique patterns of connectivity would emerge for each dissociative subtype.
Triple Network Model of Pathological Dissociation. The Triple Network Model of Pathological Dissociation depicts biomarkers (brain regions) with functional connectivity to our core networks (right central executive, medial temporal default network, and cinguloopercular salience network) that is associated with the full variance of each pathological dissociation variable (dissociative identity disorder diagnosis, depersonalization/derealization, and partially-dissociated intrusions). Green regions indicate the network of interest (right central executive, medial temporal default network, or cingulo-opercular salience network). Yellow indicates areas with increased connectivity between that region and the network of interest that is associated with pathological dissociation. Blue indicates regions with decreased connectivity between that region and the network of interest that is associated with pathological dissociation. The radial bar graph depicts the number of markers linked with pathological dissociation in each network associated with increased or decreased connectivity either within or outside the network of interest. Images made with MRIcroGL (https://www.nitrc.org/plugins/mwiki/index.php/mricron:MainPage). rCEN right central executive network, cSN cingulo-opercular salience network, tDN medial temporal default network.
We found that partially-dissociated intrusions were linked to rCEN hyperconnectivity concentrated in lateral prefrontal cortex. This network is often active during cognitively challenging working memory, problem solving, and decision-making tasks [18]. This implies that greater partially-dissociated intrusions are related to heightened communication within CEN. This hyperconnectivity may also reduce the flexibility of the network to engage with other networks. Second, partially-dissociated intrusions were associated with increased connectivity between DN regions (middle temporal gyrus) and rCEN. DN is often suppressed while CEN is engaged [18]. However, here we see some synchronization of these two networks. Intriguingly, this matches the subjective experience of partially-dissociated intrusions as “recurrent, jarring, involuntary intrusions into executive functioning and sense of self” [43]. In contrast, rCEN had decreased connectivity with tDN regions: the dorsal posterior cingulate cortex (dPCC) and precuneus, which may reflect decreased communication between these networks. These regions are involved in self-generated thought [23]
In particular, the dPCC may serve to regulate global brain dynamics—helping to balance internally vs. externally focused attention and the breadth of attentional focus (i.e., narrow vs. broad; [53]). Furthermore, recent theories speculate dPCC may facilitate fast shifts between different mental states [53]. The unique contributions of a DID diagnosis to altered connectivity were concentrated in the rCEN. Specifically, DID diagnosis was associated with a complex pattern of both increased and decreased connectivity between rCEN and regions distributed across tDN, cSN, and other networks. The dominant finding was one of rCEN hyperconnectivity with regions in tDN. DN is often suppressed while CEN is engaged [18], but in DID we instead saw some synchronization of these networks. A pattern of decreased CEN connectivity with regions in cSN also emerged in DID. SN may facilitate shifts between CEN and DN [26]. Decreased communication between rCEN and cSN could impact the appropriate engagement or disengagement of CEN and DN [18]. Overall, these findings support a plausible mechanism underlying executive functioning difficulties and differences in DID. For example, individuals with DID report experiences of amnesia, partially-dissociated intrusions, or working memory difficulties [9, 54]. Interestingly, there have also been some reports of preserved or even enhanced executive functioning for individuals with dissociative disorders or high levels of dissociation in which they out-perform control participants on executive functioning, working memory and spatial memory tasks that are not emotionally-provocative [49, 55, 56]. It may be that some of the altered rCEN connectivity we identified could facilitate this enhanced executive functioning in certain contexts. Future work involving tasks that elicit CEN activity are needed to sort out when and how these alterations may facilitate enhanced vs. diminished executive functioning."
