Article 4a: Dissociation, trauma, and borderline personality disorder (Krause-Utz, 2022)

Question 1

Dissociation

Answer 1

Discontinuity or disruption of usually integrated function, such as consciousness, attention, memory, perception and identity. Can lead to:
- Depersonalisation: subjective detachment from the own person.
- Derealisation: subjective detachment from the environment.
- Memory disruptions: can range from specific memories to dissociative amnesia.
- Analgesia: altered pain perception.
- Loss of voluntary motor control

Question 2

2 views on aetiology of dissociation

Answer 2

1. Trauma models: psychological trauma is a crucial risk factor in the development of dissociation. Dissociation may serve as an (evolutionary-based) defence mechanism to cope with unbearable, overwhelming experiences.
2. Socio-cognitive models: cognitive predispositions combined with social factors and sleep disturbances may contribute to the way individuals, who are prone to dissociation, perceive stressful events.

Question 3

Negative consequences of dissociation

Answer 3

• Can hinder integration of emotions, thoughts and sensations.
• Compartmentalisation: salient characteristics of a stressful event may be stored as fragmented memories.
• Flashbacks
• Interfering with emotional learning
• Interfering with acquisition of new information in stressful contexts (like in exposure therapy)

Question 4

Etiology of dissociation and childhood maltreatment

Answer 4

Early onset of abuse and longer duration of abuse predict more severe dissociation.

Question 5

Potential neurobiological mechanisms of dissociation

Answer 5

Findings are mixed, but hint towards increased activity in frontal regions and temporal eras during a dissociative state.

Question 6

Dissociation in BPD

Answer 6

BPD symptoms are closely linked to dissociation symptoms and often overlap in clusters like:
- Emotion dysregulation
- Disturbed identity
- Relational problems

Question 7

Emotion dysregulation (in dissociation and in BPD)

Answer 7

The tendency to experience intense overwhelming emotions. Dissociation may increase difficulties in identifying emotions, maladaptive emotion regulation strategies, and less bodily and emotional awareness.

Question 8

Disturbed identity (in dissociation and in BPD)

Answer 8

Rapid changes in self-image, perceiving their identity as incoherent, inconsistent, vague or fragmented. Chronic feelings of emptiness. Shows overlap with dissociative symptoms and can be hard to distinguish.

Question 9

Relationship problems (in dissociation and in BPD)

Answer 9

Mistrust, rejection hypersensitivy, strong ambivalence between need for closeness and need for autonomy. Dissociation contributes to sexual revictimisation after child sexual abuse.