The influence of Pierre Janet’s Views in the Field of Psychotraumatology
Onno VAN DER HART
Reprinted from : VAN DER HART, O. (2006). The influence of Pierre Janet’s Views in the Field
of Psychotraumatology. Janetian Studies, Actes des conf. du 27 mai 2006, No Spécial 01, pp. 54-63.
Worldwide, the influence on Pierre Janet’s pioneering work
is probably most recognized and visible in the field of psychotraumatology, in
particular among scientists and clinicians who are interested in the
relationship between trauma and dissociation. However, with his approximately
20,000 printed pages, Janet has so much more to offer to modern psychology and
psychiatry, such as his dynamic psychology and his psychology of action. The Institut Pierre Janet, in particular its
President, Isabelle Saillot, is doing wonderful work in bringing these largely
unknown domains of knowledge to the foreground. Likewise, Serge Nicolas, one of
the founding members of the Institut
is wonderfully active in republishing Janet’s works in a series of inexpensive
books through his publishing house, L’Harmattan. At the General Meeting of the Institut today, various speakers will
testify to the wide range of subjects related to Janet which are of current
interest. They come from
In this brief report, I discuss a few trends and developments that took place in 2005 up to the present which relate to Janetian psychotraumatology research and clinical practice.
Janet as the Pioneer on Trauma-Related Dissociation
In an important book, The Dissociative Mind, published in 2005, the American psychoanalyst and traumatologist Elizabeth F. Howell, PhD, wrote: “Janet (1859-1947) is the primary theorist on whose shoulders we stand when it comes to dissociation” (p. 50). Furthermore, she stated, “Most of our theories of PTSD confirm with, if they are not actually based on, Janet’s ideas” (p. 12). Thus, Howell dedicates 14 pages to Janet’s views on trauma and dissociation (pp. 50-64), and one of her conclusions is:
Janet’s work is now in the process of major excavation and revivification. In the final analysis, Janet’s theory of trauma and dissociation may be much more applicable that Freud’s theory of repression. (p. 64)
The recognition of Janet’s clinical observations and theoretical notions about trauma and dissociation indeed have received wide recognition, especially among those clinicians and researchers dealing with survivors of chronic traumatization. This recognition is symbolized, for instance, by the International Society for the Study of Dissociation (ISSD), which presents the annual Pierre Janet Writing Award to an individual for the best clinical, theoretical or research paper in the field of dissociative disorders. Furthermore, at ISSD’s annual meeting, one of the highlights is the Pierre Janet Memorial Lecture. This year’s annual meeting will include a workshop on Pierre Janet.
Pierre Janet Translation Project
While work of Janet is currently being translated into Russian and Japanese, perhaps the single most important development related to the—future—impact of Janet’s work in the field of psychotraumatology is the translation project initiated by the International Society for the Study of Dissociation in collaboration with the Institut Pierre Janet. The first work chosen to be translated is L’automatisme psychologique: Essai de psychologie expérimentale sur les formes inférieures de l’activité humaine (AP) (1889). The translator is Paula Ann Monahan, who, during this meeting, will report in more detail about the project. Already for years many non-French reading professionals have expressed great interest in such a translation. In fact, previously there have been several aborted attempts to translate AP. Given the support from ISSD, which includes a Task Force and a Scientific Advisory Board, chances are high that a complete English translation will be available some day. I predict that this will be a major breakthrough internationally. After all, a former Editor of the American Journal of Psychiatry, John C. Nemiah, MD, wrote in a 1989 Editorial:
The recent festivities celebrating the bicentennial of the French Revolution have overshadowed the remembrance of another occurrence in French history that, from a scientific point of view at least, is perhaps of equal magnitude—the publication in 1889 of Pierre Janet’s L’automatisme psychologique. (p. 1527)
The 2005 Meeting of the Pierre Janet Gesellschaft
On 3 and 4 May, 2005, the first international Pierre
Janet Symposium organized by the Berlin-based Pierre Janet Gesellschaft e.V.
(Society), founded in 2001, took place in
Janet’s Views and the Theory of Structural Dissociation of the Personality
Pierre Janet’s views on trauma-related dissociation, such as expressed in AP (1889), Les névroses et idées fixes (1898), L’état mental des hystériques, sec. ed. (1911), and Les médications psychologiques (1919/25), as well as his psychology of action (e.g., Janet, 1926, 1928, 1938), are most important in the development of the theory of structural dissociation of the personality that Kathy Steele, Ellert Nijenhuis and I developed in recent years. In 2005 we published a long article on phase-oriented treatment of patients with complex trauma-related disorders based on this theory (Steele, Van der Hart, & Nijenhuis, 2005), and in September 2006 our book, The haunted self: Structural dissociation and the treatment of chronic traumatization will appear (Van der Hart, Nijenhuis, & Steele, 2006).
Briefly, this theory takes as its point of departure Janet’s (1907) definition of hysteria, which, in our view, pertains to a wide range of trauma-related disorders, including posttraumatic stress disorder (PTSD):
Hysteria is a form of mental depression characterized by the retraction of the field of personal consciousness and a tendency to the dissociation and emancipation of the systems and functions that constitute personality. (p. 332)
Given the fact that Janet emphasizes the dissociative nature of hysteria, we believe that the term refers to the dissociative disorders in a generic sense, thus not only the DSM-IV dissociative disorders but also PTSD, trauma-related borderline personality disorder, and many of the DSM-IV somatoform disorders. According to the theory of structural dissociation, traumatization consists of an essential dividedness of the personality between one or more parts that primarily engage in functions of daily life and reproduction (i.e., survival of the species), and one or more parts that are fixated on traumatic memories and that engage in animal-defence like reactions when exposed to real or perceived threat (i.e., survival of the individual). The different parts of the personality exert different functions, driven by evolutionary derived action systems such as attachment, exploration, play, and defense, and manifest in particular mental and behavioral action tendencies.
Inspired by Pierre Janet’s psychologie de la conduite, the psychology of action sheds light on the breakdown of integrative capacity during traumatization, which implies the development of structural dissociation. It describes the trauma survivors’ mental and behavioral actions that maintain this structural dissociation and highlights the specific actions that they need to execute in order to increase their integrative capacity, resolve the dissociation, and become more adaptive in meeting daily life challenges. Thus, both theoretical approaches and the phase-oriented treatment model1 based on these theories provide the basis for effective treatment. Among other things, they describe each treatment phase in terms of overcoming specific phobias. Phase 1, stabilization and symptom reduction, is geared toward overcoming phobias of mental contents (i.e., a range of internal conditioned stimuli), dissociative parts of the personality, and attachment and attachment loss with the therapist. Phase 2, treatment of traumatic memories, is directed toward overcoming the phobia of traumatic memories, and phobias related to insecure attachment to the perpetrator(s). In Phase 3, integration and rehabilitation, treatment is focused on overcoming phobias of normal life, healthy risk-taking and change, and intimacy. In clinical practice, especially with regard to complex traumatization, these phases are flexible and recursive, involving a periodic need to return to previous phases.
Although in our most recent work we also attempted to integrate elements of Janet’s psychology of action, it needs to be emphasized that we have probably only scratched the surface. Janet’s works contains so much richness, that we, and hopefully many colleagues with us, will further explore these sources and integrate them with modern developments in clinical practice, theory and research.
Janet’s Views and Sensorimotor Psychotherapy
A milestone in the trauma field is the forthcoming
publication of the book, Trauma and the
body: A sensorimotor approach to psychotherapy, co-authored by Pat Ogden, Kekuni
Minton, and Clair Pain (2006), from the
Part I explores the theoretical foundation and rationale for sensorimotor psychotherapy interventions, drawing on the century-old insights of Pierre Janet as well as the work of contemporary experts in the areas of trauma treatment, neuroscience, attachment, affect regulation, dissociation, and the body. (p. xxvi)
In Part II of their book,
Misunderstandings about Janet’s Position on Dissociation
The ongoing interest in Janet’s views on dissociation is colored by a number of misunderstandings that are being repeated throughout the years.
The first misunderstanding is illustrated, for instance, in another positive Editoral in the American Journal of Psychiatry. More than two decades after Nemiah wrote his Editorial, David Spiegel, MD, also referred to AP when he mentioned Janet’s “dissociationist model of psychopathology” (Spiegel, 2006):
Two papers in this issue of
the Journal provide important new
findings regarding the prevalence and neurobiology of dissociative disorders.
This form of psychopathology has been a stepchild in American psychiatry for
centuries, included uncomfortably at best in the family of mental disorders.
Pierre Janet’s dissociationist model of psychopathology ([Janet, 1889]) was
influential in Europe but was eclipsed in the
Spiegel’s statement is a recognition of the importance of Janet’s “dissociationist model of psychopathology.” Spiegel is right that in AP Janet used the term désagrégation (as it is spelled correctly), or rather désagrégation psychologique. However, he was mistaken, like Perry and Laurence (1984) before him, that “dissociation” is a poor translation.2 Both before (e.g., Janet, 1887) and after (e.g., Janet, 1904/11) the publication of AP, Janet used this term (e.g., Janet, 1887, 1904), thereby following a French tradition that perhaps originated with Moreau de Tours (1845), who used both terms interchangeably (Van der Hart & Horst, 1989).
Thus, a second, frequently made, misunderstanding pertains to the error, dominant in the work of the philosopher Ian Hacking (1995), that it was Janet who first coined the term dissociation.
A third misunderstanding is the idea that Janet in later years disavowed his dissociation theory. This misunderstanding also originated with the writings of Hacking (1995, 1998) and is subsequently adopted by clinicians and scientists with a bias against the DSM-IV dissociative disorders, in particular dissociative identity disorder (DID; formerly multiple personality disorder) (e.g., Barry-Walsh, 2005; McNally, 2003). Both in earlier and more recent work we have refuted this claim (Dorahy & Van der Hart, 2006; Van der Hart, 1996, 2005). Even in a book published one year before his death, Janet indicated his life-long positive interest in dissociation (Janet, 1946):
[t]hese divisions of the personality offer us a good example of dissociations which can be formed in the mind when the laboriously constructed syntheses are destroyed. The unity, the identity, and personal initiative are not primitive characteristics of psychological life. They are incomplete results acquired with difficulty after long work, and they remain very fragile. All constructions built by the work of thought belong to the same genre: Scientific ideas, beliefs, memories, languages can be dissociated in the same way, and the end [product] of illnesses of the mind is the dissociation of tendencies as one observes in the most profound insanities. (p. 160)
This text reads, in the original, as follows:
Ces divisions de la personnalité nous offrent un bon example des dissociations qui peuvent se former dans l’ésprit quand les synthèses édifiées laboreusement se détruisent. L’unité, l’identité, l’initiative personelle ne soit pas des propriétés primitives de la vie psychologique, ce sont des résultats acquis difficilement et incomplètement après un long travail et restent très fragiles. Toutes es constructions édifiées par le travail de la pensée sont du même genre, les idées scientifiques, les croyances, les souvenirs, les langages peuvent se dissocier de la même manière et le terme des maladies de l’esprit est la dissociation des tendences que l’on observe dans les démences les plus profondes. (p. 160)
A fourth misunderstanding, again originating from Hacking, is that Janet was dismissive of multiple personality by equating it with bipolar disorder. Janet, however, stated that multiple personality, or rather double personality, is the hysterical (i.e., dissociative) variant, which is both a suble and highly significant difference (see for more detailed discussions of this issue: Dorahy & Van der Hart, 2006; Van der Hart, 1996, 2005).
A fifth, and most important misunderstanding abounds in the field of trauma and dissociation at large. While Janet (1907) clearly distinguished between retraction of the field of consciousness and dissociation in his definition of hysteria (see above), most students of dissociation have overlooked this difference and have regarded retraction of the field of consciousness, as well as other alterations in consciousness, as forms of dissociation (e.g., Bernstein & Putnam, 1986). Subsequently, these alterations in consciousness have been labeled normal dissociation, and phenomena more exclusively related to dissociation as an undue division of the personality as pathological dissociation (Waller, Putnam, & Carlson, 1996). In various publications we have argued that such views seriously confound the concept of dissociation and our understanding of dissociation, and hamper adequate research in this area. We have proposed that the solution is to revisit Janet’s views on dissociation and regard alterations in consciousness and dissociation as different but related phenomena (Steele, Dorahy, Van der Hart, & Nijenhuis, in press; Van der Hart, Nijenhuis, & Steele, 2004, 2006).
A sixth misunderstanding, also common in the field of trauma and dissociation, is that dissociative symptoms (such as amnesia) are only psychoform in nature, i.e., solely refer to mental functions. As referred to above, dissociative symptoms also pertain to bodily functions, hence are somatoform in nature. Janet’s extensive observations as well as those of many of his contemporaries make this abundantly clear (e.g., Janet, 1889, 1911). Examples include dissociative anesthesia, paralysis, contracture, pseudo-epileptic seizures: symptoms which have been wrongly labeled as conversion symptoms. There is increasing understanding in the field that this error needs to be corrected (Kihlstrom, 1992; Nemiah, 1991; Nijenhuis, 1999; Van der Hart et al., 2004, 2006). The ICD-10 (WHO, 1992) has already made this correction by renaming conversion disorder as dissociative disorders of movement and sensation.
Lacunae in the Trauma Field regarding Janet’s Views on Trauma and Dissociation
Although Janet’s influence in the trauma field, as mentioned above, especially among clinicians and researchers dealing with survivors of chronic childhood traumatization, it needs to be emphasized that there are large domains within the trauma field where this is not the case. PTSD seems to be the trauma-related disorder about which is most frequently written, but it is only a minority of authors that refer to its dissociative nature, let alone to Janet’s work. This is most noticeable in the major contributions of cognitive-behavioral therapy (CBT). For instance, in the 472 pages book, Cognitive-Behavioral Therapies for Trauma (sec. ed.), edited by Follette and Ruzek (2006), there are only three places where dissociation—mostly as a mental avoidance strategy only—is mentioned. However, there is still hope: The first, historical chapter contains an acknowledgment of Janet’s pioneering work (Monson & Friedman, 2006):
… Pierre Janet was also instrumental in bringing a psychological approach to posttraumatic reactions, and his writings include some precursor elements of CBT. Indeed, cognitive-behavioral theories of traumatic reactions find their roots in Janet’s writings about the categorization and integration of memories. He contended that people develop meaning schemas based on past experiences that prepare them to cope with subsequent challenges. When people experience “vehement emotions” in response to frightening experiences, their minds are not capable of integrating the events with existing cognitive schemes. When the memories cannot be integrated into personal awareness, something akin to dissociation occurs. Janet also introduced the notion of patients experiencing a “phobia of memory” that prevents the integration of traumatic events. The memory traces linger as long as they are not translated into a personal narrative. In his conception of trauma, synthesis and integration are the goals of treatment, which was in contrast to the psychoanalytic goals of catharsis and abreaction prevalent at the time (Janet, 1907). (pp. 3-4)
Although not completely correctly referenced, these statements should inspire CBT clinicians to study the original sources.3
John Briere, one of authorities in the CBT who do focus on dissociation, does not mentioned Janet even once in his new book, Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (Briere & Scott, 2006).
One of the saddest and astonishing states of affairs
is that Janet’s works on trauma and dissociation still remain extremely
undervalued in the French-speaking world of psychotraumatologists, including
his home country,
However, there are signs that this sad state of
affairs is slowly but unmistakenly changing. For instance, apart from Crocq’s (2003)
article, the May 2005 issue of the Revue
Francophone du Stress and du Trauma contains two articles in which some of
Janet’s important ideas at least are recognized (Andreoli & Damsa, 2005;
Graux & De Soir, 2005). I predict that future issues of the Revue will show an increase in number of
references to Janet. Another example is that recently an increasing number of
workshops are being held in
Finally, the Institut Pierre Janet, dynamic and still young, will play a major role in the further dissemination of Janet’s contributions—incidently, not only in the field of trauma and dissociation. The same goes for the republications of Janet’s books and other works, which will allow those who are becoming more interested to dig up unexpected treasures.
1 Current phase-oriented treatment of complex trauma-related disorders also harks back to Janet’s pioneering publications on treatment (Janet, 1898b, 1919/25; cf., Van der Hart, Brown, & Van der Kolk, 1989a,b).
2 Perry and Laurence (1984, p. 10) mentioned that in AP, “Janet proposed a theory of désagrégation (often translated into English incorrectly as dissociation).” Since then, many North American scholars, e.g., Kihlstrom, Tataryn, and Hoyt (1993), have repeated this error.
3 A fine study on obsession and depression integrating Janet’s original views and treatment principles and modern CBT has already been published in German [Hoffmann, 1998]; an English translation would be very welcome. The general affinity of cognitive behavioral approaches with the Janetian conception of psychotherapy is discussed in a German article (Heim & Bühler, 2003).
Andreoli, A., & Damsa, C. (2005). Stress, dissociation ou traumatis psychique? Incidence des travaux francophones dans le débat international. Revue Francophone du Stress et du Trauma, 5, 65-77.
Barry-Walsh, J. (2005).
Dissociative identity disorder (Letter). Australian and
Bernstein,E.M., & Putnam, F.W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727-735.
Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. Thousand Oaks, CA: Sage.
Bühler, K. E., & Heim, G. (2005). Die Konzeption des “Unterbewussten” und des psychischen Automatismus bei Pierre Janet. In M. B. Buchholz & G. Gödde (Eds.), Macht und Dnamik des Unbewussetn: Auseinanderstzungen in Philosophie, Medizin und Psychoanalyse (pp. 296-320). Gießen: Psychosozial Verlag.
Crocq, L. (1999). Les traumatismes psychiques the guerre. Paris: Editions Odile Jacob.
Crocq, L. (2003). L’approache cathartique. Revue Francophone du Stress et du Trauma, 3, 15-24.
Crocq, L., & De Verbizier, J. (1989). Le traumatisme psychologique dans l’oeuvre de Pierre Janet. Annales Médico-Psychologiques, 147, 983-987.
Dorahy, M., & Van der Hart, O. (2006, in press). Fable or fact?: Did Janet really come repudiate his dissociation theory? Journal of Trauma and Dissociation, 7(2).
Eckhardt-Henn, A., & Hoffmann, S. O. (Eds.) (2004), Dissoziative Bewusstseinsstörungen: Theorie, Symptomatik, Therapie. Stuttgart: Schattauer.
Fiedler, P. (Ed.) (2006a). Trauma, Dissoziation, Persönlichkeit: Pierre Janets Beiträge zur modernen Psychiatrie, Psychologie und Psychotherapie. Lengerich, Germany: Pabst Science Publishers.
Fiedler, p. (2006b). Ein Blick
zurück in die Zukunft: Pierre Janet überholt Sigmund Frued. In P. Fiedler
(Ed.), Trauma, Dissoziation,
Persönlichkeit: Pierre Janets Beiträge zur modernen Psychiatrie, Psychologie
und Psychotherapie (pp. 35-56).
Follette, V. M., & Ruzek, J. I. (2006). Cognitive-Behavioral therapies for trauma, sec. ed.. New York: Guilford.
Graux, C., & De Soir, R. (2005). Visites à domicile au décours d’une inondation: Des psychologiues “hors murs” à pratique “hors normes”? Revue Francophone du Stress et du Trauma, 5, 109-115.
Heim, G., & Bühler, K. E. (2003). Pierre Janet: Ein Fall für die moderne Verhaltenstherapie? Verhaltenstherapie und Verhaltensmedizin, 24, 205-224.
Heim, G., & Bühler, K. E. (in press). Psychological trauma and fixed ideas in Pierre Janet's conception of dissociative disorders. American Journal of Psychotherapy, 60.
Hoffmann, N. (1998). Zwänge und Depressionen: Pierre Janet und
Howell, E. F. (2005). The dissociative mind.
Huber, M. (2003). Trauma und die Folgen. Paderborn: Junferman.
Janet, P. (1887). L’anesthésie systématisée et la dissociation des phénomènes psychologiques. Revue Philosophique, 23, 449-472.
Janet, P. (1889). L’automatisme psychologique: Essai de psychologie expérimentale sur les formes inférieures de l’activité humaine. Paris: Félix Alcan.
Janet, P. (1898a). Névroses et idées fixes, Vol. 1. Paris: Félix Alcan.
Janet, P. (1898b). Le traitement psychologique de l’hystérie. In A. Robin (Ed.), Traité de thérapeutique appliquée. Paris: Rueff. Also in P. Janet, L'état mental des hystériques, sec. ed. (pp. 619-688). Paris: Felix Alcan. (Reprint: Laffitte Reprints, Marseille, 1983.)
Janet, P. (1904). L'amnésie et la dissociation des
souvenirs par l'émotion. Journal de
Psychologie, 1, 417-453. Also in
P. Janet, L'état mental des hystériques
Janet, P. (1907). The major symptoms of hysteria.
Janet, P. (1911). L'état mental des hystériques (pp. 506-544). Paris: Félix Alcan. (Reprint: Laffitte Reprints, Marseilles, 1983.)
Janet, P. (1919). Ls
Janet, P., with the
collaboration of H. Piéron and C. Lalo (1946). Manuel du baccalauréat, seconde partie, Philosophie: Questions complémentaires,
Kihlstrom, J. F. (1992). Dissociation and conversion
disorders. In D. J. Stein & J. E. Young (Eds.), Cognitive science and
clinical disorders (pp. 247-270).
Kihlstrom, J. F., Tataryn,
D. J., & Hoyt,
Maercker, A., & Rosner, R.
(Eds.) (2006). Psychotherapie der
McNally, R. (2003). Remembering trauma.
Monson, C. M., & Friedman, M. J. (2006). Back to the future of understanding trauma: Implications for cognitive-behavioral therapies. In V. M. Follette & J. I. Ruzek (Eds.), Cognitive-behavioral therapies for trauma, 2nd ed. (pp. 1-13). New York: Guilford.
Moreau de Tours, J.
J. (1845). Du hachisch et de l’aliénation
mentale :Études psychologiques.
Nemiah, J. C. (1989). Editorial: The centenary of L’automatisme psychologique. American Journal of Psychiatry, 146, 1527-1529.
Nemiah, J. C. (1991).
Dissociation, conversion, and somatization. In A. Tasman & S. M. Goldfinger
(Eds.), American Psychiatric Press review
of psychiatry, Vol. 10 (pp. 248-260).
Nijenhuis, E. R. S. (1999). Somatoform dissociation: Phenomena, measurement, and theoretical issues.
Perry, C., & Laurence,
J.-P. (1984). Mental processing outside of awareness: The contributions of
Freud and Janet. In K. S. Bowers & D. Meichenbaum (Eds.), The unconscious reconsidered (pp. 9-48).
Reddemann, L., Hofmann, A., & Gast, U. (Eds.) (2004). Psychotherapie der dissoziativen Störungen. Stuttgart: Georg Thieme Verlag.
Spiegel, D. (2006). Recognizing traumatic dissociation. American Journal of Psychiatry, 163, 567-568.
Steele, K., Dorahy, M., Van
der Hart, O., & Nijenhuis, E. R. S. (in press). Dissociation versus
alterations in consciousness: Related but different concepts. In P. Dell &
J. O'Neil (Eds.), Dissociation and the
dissociative disorders: DSM-V and beyond.
Steele, K., Van der Hart, O., & Nijenhuis, E. R. S. (2005). Phase-oriented treatment of structural dissociation in complex traumatization: Overcoming trauma-related phobias. Journal of Trauma and Dissociation, 6(3), 11-53.
Van der Hart, O. (2005). I. Hacking on Pierre Janet: Observations. With a 2005 postscript. Janetian Studies, 2; Web URL: http://pierre-janet.com/JSArticles/ovdh05A.doc.
Van der Hart, O., Brown, P., & Van der Kolk, B. A. (1989a). Le traitement psychologique du stress post-traumatique de Pierre Janet. Annales Médico-Psychologiques, 147, 976-980. Also in: L'Automatisme psychologique de Pierre Janet: 100 ans après. Réunion conjointe (22 mai 1989) entre la Société Medico-Psychologique et la Société Pierre Janet (pp. 976-980). Paris: Masson, 1990.
Van der Hart, O., Brown, P., & Van der Kolk, B. A. (1989b). Pierre Janet’s treatment of post-traumatic stress. Journal of Traumatic Stress, 2, 379-396.
Van der Hart, O., & Horst, R. (1998). The dissociation theory of Pierre Janet. Journal of Traumatic Stress, 2, 397-412.
Van der Hart, O., Nijenhuis, E.
R. S., & Steele, K. (2004). Trauma-related
dissociation: Conceptual clarity lost and found. Australian and
Van der Hart, O., Nijenhuis,
E. R. S., & Steele, K. (2006). The haunted self: Structural dissociation
and the treatment of chronic traumatization.
Waller, N. G., Putnam, F. W., & Carlson, E. B. (1996). Types of dissociation and dissociative types: A taxonomic analysis of dissociative experiences. Psychological Methods, 1, 300-321.
World Health Organization
(1992). ICD-10. The ICD-10 classification of mental and behavioural
disorders. Clinical descriptions and diagnostic guidelines.