Van der Hart, O., Nijenhuis, E., & Steele, K. (2006) | References

What This Research Found

Van der Hart, Nijenhuis, and Steele's The Haunted Self presents the most comprehensive theoretical framework for understanding how chronic trauma fragments the human personality. Building on Pierre Janet's 19th-century work and integrating contemporary neuroscience, the book has fundamentally shaped how clinicians understand and treat complex trauma and dissociative disorders.

The core concept: structural dissociation of the personality. The authors propose that chronic traumatisation results in a division of the personality into dissociative parts. This isn't metaphor or loose clinical language—it describes a fundamental disruption in the integrative functions of the mind. Normally, the personality integrates experiences, emotions, sensations, and behaviours into a coherent whole. When trauma overwhelms this integrative capacity, the personality divides into parts that remain insufficiently integrated, each carrying different aspects of experience and functioning somewhat autonomously.

Apparently Normal Parts (ANPs) and Emotional Parts (EPs). The theory identifies two primary types of dissociative parts. Apparently Normal Parts are focused on daily functioning—managing work, relationships, and ordinary life. ANPs tend to avoid trauma-related stimuli and may have limited access to traumatic memories; their goal is to carry on with life despite what happened. Emotional Parts, in contrast, remain fixated on traumatic experiences. EPs hold the traumatic memories, the intense emotions, and the defensive responses (fight, flight, freeze, submit) that were active during trauma. When triggered, EPs intrude into consciousness, producing flashbacks, emotional flooding, and trauma-related behaviours that can seem to "take over" the person.

Three levels of structural dissociation. The severity of fragmentation determines the clinical picture:

Primary structural dissociation involves one ANP and one EP. This is typical of simple PTSD after a single traumatic event. The person generally functions normally (ANP) but is intruded upon by traumatic re-experiencing (EP).
Secondary structural dissociation involves one ANP and multiple EPs. This characterises Complex PTSD and borderline personality disorder. Different EPs may carry different traumatic memories or be organised around different defensive responses (a fight part, a flight part, a freeze part, a part that seeks attachment to the abuser).
Tertiary structural dissociation involves multiple ANPs and multiple EPs. This is the structural basis of Dissociative Identity Disorder (DID). Different ANPs handle different aspects of daily life (a work self, a parenting self), and the person experiences significant identity confusion and amnesia.

Phase-oriented treatment. Perhaps the book's most clinically significant contribution is its treatment model, which has become the standard of care for complex trauma and dissociative disorders:

Phase 1: Stabilisation and symptom reduction. Before any trauma processing, survivors must develop safety, stability, and regulatory capacity. This includes establishing external safety, building a therapeutic alliance, developing affect regulation skills, addressing self-destructive behaviours, and beginning to work with dissociative parts. This phase may take months or years.
Phase 2: Treatment of traumatic memories. Only after adequate stabilisation can trauma processing proceed. Using approaches like EMDR, cognitive processing, or imaginal exposure, traumatic memories are processed so they can be integrated rather than remaining frozen and intrusive. This phase must proceed at a pace all parts can tolerate—rushing retraumatises.
Phase 3: Integration and rehabilitation. After trauma processing, work turns to integrating dissociative parts, building a coherent sense of identity and personal history, addressing the life impact of trauma (relationships, career, meaning), and consolidating gains. This phase is about building a life beyond trauma.

The evolutionary basis of action systems. The authors ground their theory in evolutionary psychology. They identify several "action systems" that serve survival: systems for daily living (exploration, play, energy regulation, attachment, caregiving, sociality) and systems for defence (fight, flight, freeze, submission, attachment cry). Trauma produces structural dissociation when defensive action systems become chronically activated and fail to integrate with daily life systems. ANPs are dominated by daily life action systems; EPs are dominated by defensive action systems. Healing involves integrating these action systems into a unified personality capable of adaptive responding.

How This Research Is Used in the Book

This foundational work on structural dissociation appears in Narcissus and the Child to explain why recovery from narcissistic abuse requires addressing not just traumatic memories but the fundamental fragmentation that chronic abuse creates. In Chapter 19: Protecting Yourself, the book addresses dissociation as both a survival mechanism and a challenge in recovery:

"Dissociation, common in C-PTSD from narcissistic abuse, served as protective mechanism during trauma but becomes problematic in recovery. Survivors might feel disconnected from their bodies, emotions, or surroundings. They might lose time, feel like they're watching themselves from outside, or feel fundamentally unreal. This dissociation protected against overwhelming abuse but now prevents full engagement with life. Healing requires gradually reconnecting with dissociated parts while maintaining safety."

This citation supports the book's nuanced understanding of dissociation: it was never dysfunction, but survival. The child of a narcissistic parent faced an impossible situation—the person who should provide safety was also the source of danger. The attachment system and the defence system were simultaneously activated, with no resolution possible. Dissociation allowed the child to continue functioning, to maintain necessary attachment to the caregiver, while protecting the most vulnerable parts of the psyche from ongoing harm.

The book uses this framework to help survivors understand that their dissociative symptoms—the spacing out, the emotional numbness, the sense of unreality, the gaps in memory—are not signs of weakness or "craziness." They are evidence of a psyche that did what was necessary to survive. Recovery involves honouring that survival while gradually building the capacity to integrate what was once too overwhelming to hold.

The phase-oriented treatment model informs the book's realistic portrayal of healing: stabilisation must come first, trauma processing second, integration last. This sequence cannot be rushed. Survivors who pressure themselves to "get over it" faster, or who encounter treatment approaches that jump to trauma processing before establishing safety, often find themselves retraumatised—not because they failed, but because the treatment failed to respect the architecture of structural dissociation.

Why This Matters for Survivors

If you experienced narcissistic abuse, especially in childhood, the structural dissociation framework validates experiences that may have made you feel fundamentally broken or "crazy."

Your fragmentation was survival, not weakness. When a child depends on a caregiver who is also abusive, integrating that reality is impossible. You cannot simultaneously process "this person is dangerous" and "this person is my only source of survival and love." The mind solved this impossible equation by not integrating it—by developing parts that hold different aspects of the experience. The part that attached to your parent to survive and the part that knew your parent was dangerous couldn't exist in the same consciousness. Structural dissociation was the only solution. You didn't fragment because you were weak; you fragmented because no human psyche could integrate what you faced.

The experience of being "two people" makes neurobiological sense. The ANP that gets you through work, maintains friendships, and presents as "fine" isn't fake—it's a real part of you that developed to handle daily life. The EP that breaks down in private, that gets triggered by tones of voice or facial expressions, that carries the pain and fear—this is also really you. Structural dissociation explains why you can be both: functional and devastated, coping and overwhelmed, moved on and trapped in the past. You're not lying about your recovery or faking your competence. Different parts of you hold different truths. Both are real.

Understanding your parts reduces shame and self-attack. Many survivors experience brutal inner critics that attack them for their symptoms. "Why can't you just get over it?" "What's wrong with you?" "Other people cope better." The structural dissociation framework reframes these symptoms: the hypervigilance is an EP still on guard; the emotional numbness is an EP in protective freeze; the flashback is an EP intruding with unprocessed memory; the shame spiral is an EP carrying the abuser's message. When you can say "a part of me is activated right now" rather than "I'm a mess," you create space between your Self and your symptoms. That space is where healing happens.

Recovery requires working with parts, not against them. You cannot heal by suppressing, overriding, or hating your dissociative parts. They hold survival wisdom and traumatic material that must be processed. The part that still seeks approval from your abuser developed because attachment was survival—the trauma bond is partly a parts phenomenon; fighting it creates internal war. The part that dissociates developed because feeling was unbearable; attacking it intensifies the dissociation. Recovery involves developing curiosity about your parts, understanding their protective functions with self-compassion, and gradually helping them update to present reality. The part that protected you at age six doesn't know you're an adult now with resources and choices the child lacked. Healing involves delivering that message—gently, repeatedly, through experience.

The phase-oriented model explains why healing takes time. You cannot rush through stabilisation to "get to the real work." Phase 1 is the real work—building the regulatory capacity, the internal resources, the therapeutic alliance that make trauma processing possible. If you've tried therapy and it didn't help—or made things worse—it may have skipped stabilisation. The structural dissociation framework validates that healing from chronic developmental trauma takes years, not months. This isn't failure; it's the reality of addressing fragmentation that developed over years in a system designed to maintain it.

Clinical Implications

For psychiatrists, psychologists, and trauma-informed healthcare providers, the structural dissociation model has direct implications for assessment and treatment of survivors of narcissistic abuse and other chronic interpersonal trauma.

Assessment must include dissociative symptoms and part phenomena. Standard PTSD measures may miss the structural fragmentation central to complex trauma presentations. Clinicians should assess for identity confusion ("Do you feel like different people at different times?"), amnesia ("Are there gaps in your memory for childhood or recent events?"), depersonalisation ("Do you feel detached from yourself, like you're watching yourself from outside?"), derealisation ("Does the world sometimes seem unreal?"), and switching ("Do you experience sudden shifts in mood, behaviour, or sense of self that feel involuntary?"). The Dissociative Experiences Scale (DES) and the Somatoform Dissociation Questionnaire (SDQ-20) provide standardised assessment. History-taking should explore chronic childhood adversity, particularly abuse by attachment figures.

Phase-oriented treatment is essential, not optional. Attempting trauma processing before establishing stabilisation risks retraumatisation, therapeutic rupture, and symptom exacerbation. Phase 1 must establish safety (internal and external), build affect regulation capacity, address self-destructive behaviours, and begin working with dissociative parts. Only when the system has sufficient stability can Phase 2 trauma processing proceed safely. For survivors of chronic developmental trauma, Phase 1 may take one to three years. This has implications for treatment planning and managed care negotiations—brief, protocol-driven treatments designed for single-incident PTSD are inappropriate for structural dissociation.

Work with parts, not around them. Effective treatment engages all parts of the personality, not just the ANP who attends appointments. Recognise that treatment resistance often reflects protective EPs—parts that fear what will happen if defences are dropped, parts that don't trust the therapist, parts that believe change is dangerous. Rather than confronting resistance, get curious about it: "I notice something in you seems hesitant. I wonder if there's a part that has concerns about this process?" Teach patients to notice when parts are activated and to communicate with them rather than being overwhelmed by them. Internal communication between parts often must develop before integration can proceed.

Expect the therapeutic relationship to carry special weight. For patients whose trauma occurred in primary attachment relationships, the therapeutic relationship is not merely the context for treatment—it is a central mechanism of change. The therapist becomes a figure through whom the patient can experience consistent, boundaried, non-abusive relating. Attachment dynamics will pervade treatment: fear of the therapist's abandonment, testing behaviours, difficulty with therapeutic frame (vacations, endings), and both idealisation and devaluation. Parts may have different relationships with the therapist—some trusting, others deeply suspicious. The therapist must maintain consistent presence across these shifting relational dynamics.

Consider how pharmacotherapy interacts with structural dissociation. Psychiatric consultation may be valuable for managing acute symptom distress during stabilisation. Medications that reduce hyperarousal may help hypervigilant EPs calm enough for therapeutic work. Mood stabilisers may widen the window of tolerance. Sleep medications may address the sleep disturbance common in complex trauma. However, medications that numb or sedate may interfere with the internal awareness necessary for parts work. Benzodiazepines in particular may reinforce dissociative defences rather than address them. Pharmacotherapy should support the therapeutic work, not substitute for it.

Prepare for long-term treatment. Structural dissociation that developed over years of chronic trauma does not resolve quickly. Evidence-based treatment for DID and severe structural dissociation typically requires five to seven years; Complex PTSD presentations may require two to five years. Clinicians should be transparent about this timeline while offering hope that meaningful improvement occurs throughout treatment, not only at the end. Each phase produces benefits: Phase 1 reduces chaos and crisis; Phase 2 resolves intrusive symptoms; Phase 3 builds a life beyond trauma.

Broader Implications

The structural dissociation framework illuminates patterns far beyond individual therapy, revealing how trauma's fragmenting effects ripple through families, organisations, and society.

The Intergenerational Transmission of Dissociation

Narcissistic parents typically have their own unintegrated parts—wounded child parts, defensive parts, grandiose parts that developed to protect against unbearable vulnerability. When a parent's parts interact with a child, the child develops complementary parts in response. The parent's rageful part triggers the child's fearful freeze part. The parent's needy part elicits the child's caretaking part. The parent's idealising-then-devaluing pattern shapes the child into parts that alternatively seek approval and anticipate rejection. Intergenerational trauma transmits not just through explicit abuse but through this parts-to-parts interaction. Breaking cycles requires healing structural dissociation in every generation touched by trauma.

Relationship Patterns in Adulthood

Adults with structural dissociation often recreate familiar dynamics in intimate relationships because different parts are drawn to different partners—or different aspects of the same partner. A part that still seeks the unavailable parent's approval may be attracted to emotionally unavailable partners. A part organised around the defence of "attach to the abuser" may experience healthy relationships as boring or wrong. A part that learned love means suffering may unconsciously arrange for suffering. Recognising these as parts-based patterns rather than unchangeable fate opens possibilities: when all parts can participate in partner selection and relationship decisions, different choices become possible.

Workplace and Organisational Dynamics

Professional settings frequently trigger dissociative responses in trauma survivors. The critical supervisor activates parts that expect parental criticism. Performance pressure activates parts organised around proving worth to win conditional approval. Workplace conflict activates fight-flight-freeze responses disproportionate to the actual threat. Trauma-informed organisations can design management practices that reduce unnecessary triggering: clear expectations, private feedback, predictable processes, and understanding that some employees' stress responses reflect trauma history, not poor work ethic.

Institutional Care and Policy

The phase-oriented treatment model has implications for how systems serve trauma survivors. Psychiatric hospitals, substance abuse programmes, and correctional facilities often encounter individuals with significant structural dissociation—and often retraumatise them. Restraints may activate fight parts; seclusion may activate parts conditioned to isolation as punishment; unpredictable environments may chronically trigger hypervigilant parts. Trauma-informed systems recognise that stabilisation must precede confrontation, that behaviour often reflects parts activation rather than wilful defiance, and that safety—physical and psychological—is prerequisite to any other intervention.

Legal and Policy Considerations

The structural dissociation framework has implications for legal proceedings involving trauma survivors. Dissociative amnesia may affect a witness's ability to recall events reliably. Parts that carry traumatic memories may provide different accounts than parts that were dissociated during events. Courtroom settings may trigger dissociative responses, impairing testimony. Legal professionals working with trauma survivors benefit from understanding that memory gaps, inconsistencies, and emotional flooding during testimony may reflect structural dissociation rather than deception. Expert testimony on dissociation can educate courts about these dynamics.

Public Health Framework

Viewing structural dissociation through a public health lens reveals that childhood trauma produces population-level mental health burden. The adverse childhood experiences (ACEs) research shows that childhood adversity predicts adult physical and mental illness; structural dissociation explains one mechanism by which early trauma produces lasting effects. Prevention—protecting children from abuse during the developmental periods when structural dissociation is most likely to form—may be among the highest-return public health investments. Early intervention for children showing dissociative symptoms can prevent consolidation into chronic structural patterns.

Limitations and Considerations

The structural dissociation model, while clinically influential, has important limitations that warrant acknowledgment.

The evidence base is primarily clinical and theoretical. While the model integrates extensive clinical observation with theoretical scholarship, randomised controlled trials comparing structural dissociation-informed treatment to other complex trauma treatments are limited. The treatment recommendations derive from clinical consensus and case series rather than the controlled comparisons that would establish definitive efficacy. Clinicians should be transparent about the state of the evidence while remaining open to approaches supported by clinical experience and theoretical coherence.

The relationship to neurobiological research continues to evolve. While the authors incorporate neuroscience, understanding of dissociation's neural substrates continues to develop. Neuroimaging studies of dissociation show promising findings (altered default mode network connectivity, prefrontal-limbic dysregulation), but a complete neuroscience of structural dissociation remains incomplete. The model's constructs—ANP, EP, action systems—await full neurobiological validation.

Individual variation in dissociative presentation is substantial. Not all chronic trauma survivors develop prominent structural dissociation, and those who do vary in severity and manifestation. The three-level model provides useful categories, but individuals don't always fit neatly. Some patients relate strongly to the parts framework; others don't. Clinicians should offer the model as one lens rather than impose it on patients who don't find it useful.

Cultural considerations require attention. The structural dissociation model emerged from Western clinical and theoretical traditions. How dissociation manifests, is understood, and is healed varies across cultures. Possession states, spirit encounters, and other culturally-specific phenomena may represent structural dissociation expressed through different cultural frameworks. Clinicians must adapt the model to patients' cultural contexts rather than assuming universal applicability.

Historical Context

The Haunted Self appeared in 2006, synthesising ideas that the authors had been developing individually and collaboratively over decades. The book represented a deliberate return to ideas that had been sidelined in psychology's history.

Pierre Janet, working in France in the late 19th century, developed sophisticated theories of dissociation as the core mechanism underlying trauma-related disorders. Janet understood that trauma overwhelms the mind's integrative capacity, producing a division of consciousness. His clinical descriptions of traumatised patients remain remarkably relevant. However, Janet was eclipsed by Freud, whose repression-based theories dominated 20th-century psychiatry. Dissociation was largely forgotten until the 1980s rediscovery of Multiple Personality Disorder (now DID) and the development of PTSD as a diagnosis.

Van der Hart spent decades studying Janet's original work, publishing extensively on the history of psychiatry and trauma. Nijenhuis developed the concept of somatoform dissociation—how trauma manifests in the body—and created assessment instruments. Steele brought extensive clinical experience treating dissociative disorders. Their collaboration integrated historical scholarship, theoretical development, and clinical application.

The book built on earlier publications by the authors, including Nijenhuis's work on somatoform dissociation and van der Hart's Janet scholarship. By 2006, evidence-based treatments for PTSD had proliferated, but clinicians treating complex trauma and dissociative disorders lacked adequate theoretical framework. The Haunted Self filled that gap.

The theory has been elaborated in subsequent publications, including Steele's Treating Trauma-Related Dissociation (2016) and Janina Fisher's Healing the Fragmented Selves of Trauma Survivors (2017), which translated structural dissociation concepts into accessible clinical practice. The phase-oriented treatment model has been adopted by treatment guidelines from the International Society for Traumatic Stress Studies and the International Society for the Study of Trauma and Dissociation.

The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization

APA Citation