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Amine Structure & Synthesis

In this paper, we have presented a theory that attempts to comprehend trauma-related structural dissociation of the personality. In this context, the term dissociation has been qualified in several ways. As a process, dissociation has been described as a failure to synthesize and personify terrifying experiences. In the acute phase, this failure manifests in psychoform and somatoform peritraumatic dissociative symptoms, and in the aftermath of trauma, in current dissociative symptoms. The theory holds that dissociative processes do not split the emotional system that constitutes the premorbid personality in random ways, but rather along metaphoric minute cracks that naturally exist between action systems and subsystems. These systems are conceptualized as evolutionary based action systems that serve major functions, predominantly survival of the individual in the face of major threat, survival of the species, and management of daily life. In this context we have proposed three levels of structural dissociation that mark a range of trauma-related disorders: simple PTSD; complex PTSD, DES and DDNOS; and DID. According to the theory, these various disorders can be situated on a continuum of complexity of structural dissociation of the personality. Within this perspective, DID is not a manifestation of suggestion and role-playing as some authors believe (Lilienfeld et al, 1999; Spanos, & Burgess, 1994), but an extreme on a dimension of trauma-related mental disorders (Draijer & Boon, 1999; Brown, Frischholz, & Scheflin, 1999). However, the theory also holds that secondary elaboration and shaping of previously evoked dissociative mental systems may occur, e.g., by a range of psychological, social, and cultural influences (Laria & Lewis-Fernández, 2001).

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Acute stress results in an increased release of norepinephrine in the hippocampus and other brain regions. Vietnam veterans with chronic PTSD experienced flashbacks when given an intravenous administration of yohimbine, an a2 antagonist that stimulates norepinephrine release (Southwick et al., 1993). A similar effect was provoked by intravenous administration of metachlorophenylpiperazine (m-CPP; Southwick et al., 1991). In psychological terms, these substances reactivated responses of the EP. Both animal and human studies have shown that high levels of norepinephrine release are associated with a decrease in metabolism in the cerebral cortex. Thus, following administration of yohimbine, PTSD patients had a tendency toward decreased brain metabolism in hippocampal, orbitofrontal, temporal, parietal, and prefrontal cortex areas, whereas healthy controls had a tendency toward increased metabolism in these regions (Bremner, Innis et al., 1997). This decrease could reflect the traumatized individualis lack of integrative mental activity. Indeed, norepinephrine affects memory encoding, storage, and retrieval in the hippocampus, a brain structure implicated in the synthesis of experiences and memory encoding. Another substance that is involved in the modulation of memory functions and the stress response is the neuropeptide corticotropin releasing factor (CRF). Bremner,Lichio et al. (1997) found an increase of CRF in PTSD patients, implying that memory function may be impaired in PTSD.

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The individual can probably integrate some action systems more readily than others. As Panksepp (1998) argues, multiple feedbacks within and across action systems promote synthesis of components of a system (e.g., perceptions, behaviors, sense of self) and integration across action systems. However, integrating action systems that involve quite different functions, and that are rather mutually exclusive, may be a far more demanding mental act than integrating components of a particular action system and integrating functionally related systems. According to this hypothesis, following traumatic stress, the integration of systems dedicated to normal life and survival of the species (ANP), and to survival of the individual in the face of that threat (EP), will fail more readily than integration across subsystems of these two complex systems, or components of these (sub)systems. From this point of view, structural dissociation between the ANP and the EP will be the basic type of integrative failure when trauma strikes. Indeed, primary structural dissociation characterizes the most simple trauma-related mental disorder known, i.e., simple PTSD.

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