Making Sense of Structural Dissociation
By Sarah Vassileff M.A., LCPC, EMDR Trained Complex Trauma Psychotherapist, Clinical Supervisor
September 15, 2025
Understanding and Healing Structural Dissociation.
INTRODUCTION TO TRAUMA STRUCTURAL DISSOCIATION
What is structural dissociation (SD), you may ask? Why is it so frequently used as a term in the trauma world, for clinicians and trauma survivors, alike? I want to be clear about what it is and what it isn’t.
Let’s start by describing what it is not. SD is not everyday dissociation. It is not a state of leaving the body or going into our minds the way that most of us may when experiencing a sense of fatigue, discombobulation, or a feeling of “off-ness,” when feeling stressed, overworked, or perhaps feeling intense anxiety or disconnection, or experiencing trauma-induced flashbacks. All folks with SD have experienced extensive trauma, but not all that have experienced extensive trauma will develop SD; rather, it starts as a learned protective defense that occurs for some in attempts to escape chronic and inescapable physical, sexual, and emotional abuse/neglect. Chronic physical and/or sexual trauma or pervasive emotional neglect in early childhood must be present for structural dissociation to develop.
SO WHAT IS TRAUMA STRUCTURAL DISSOCIATION AND HOW DOES IT HAPPEN?
The Theory of SD suggests that neither of us are born with an integrated personality. In fact, we are all born with loosely connected ego states (i.e., multitudes of Self). These ego states will only integrate if our attachment needs are met between the ages 0-3. Infants operate off a loose collection of ego states that handle different needs. Over time, as we experience the consistent meeting of our needs, these ego states will integrate into one cohesive personality. Severe early childhood trauma can disrupt this process.
Hence, at a young age (0-3), different ego states are left unable to merge with one another due to conflicting needs, traumatic memories, repetitive learned action paths, and responses to trauma. For those of us that are integrated, this may present as an insecure or disorganized attachment with others due to having endured inconsistent parenting / caregiving. One cannot develop a coherent sense of Self when the primary caregivers of the child are inconsistent, loving one moment and abusive/neglectful the next, preventing healthy attachment within and with others from occurring, resulting in internal disorganization.
This can also happen if one parent is loving while the other is neglectful. However, for most of us, this internal disorganized structure of attachment is not the same as structural dissociation. The difference being that in SD, there are distinct ego states that are not integrated into one’s personality. Most of us may have internal disorganization but will have one coherent personality. In SD, there is a distinct presence of self-states that hold traumatic memory or take on a function/role to prevent the accessibility of traumatic memory. These processes are not integrated into one’s personality and rather, there is a splitting into multiple disconnected states (or sometimes personalities). In the presence of chronic, severe childhood trauma between the ages of 0-3, multiple ego states of the Self might remain unintegrated to serve as storage for related traumatic material or in the service of survival (van der Hart, Ellert R.S., Nijenhuis, & Steele, 2006).
IMPLICATIONS AND HEALING TRAUMA DISSOCIATION
What does this mean if you are a multiple? Well, it may mean that there is a lot of confusion internally, and perhaps a lot of self-denial, and dare I say a great deal of feeling misunderstood by mental health professionals and society alike. Depending on the levels of dissociation, there will also be amnesia, a sense of losing time and not remembering. Amnesia is a common aspect of SD, as memory is locked away for protective purposes. Dissociative amnesia occurs when ego states switch, sometimes and often, involuntarily. It is at this time that folks will feel like they are missing chunks of time depending on how structurally dissociated one is. This amnesia can occur when one is driving, when they are relocating from place-to-place, in benign moments, or when they are under stress, and certainly, in response to attempted recall of trauma. Sometimes folks that are structurally dissociated will have arrived at a place and not know how they got there or what they are doing there (this is called a dissociative fugue).
Another common experience for those that are structurally dissociated is a lack of sleep. Sometimes even involuntarily, sleep will be deterred for long periods of time to avoid the reoccurrence of former traumas. This is sometimes an involuntary process because of the influence of ego states that are trying to keep you safe.
Similarly, one may find items in their space that they do not remember acquiring or purchasing, notes containing different handwriting, or a sense of pervasive and elusive internal conflict. This may sound like bickering internal voices or may be more nuanced and indistinguishable.
So ... what should healing look like?
It is for you to decide. The goal is not necessarily to merge into a continuous Self if you do not want. The goal is to create more internal harmony and help to orient yourself to the presence of safety and truth that can exist in the present, differentiating the past from the present and helping ego states differentiate between then and now.
What I have learned through working with folks that are structurally dissociated is that, fusion (the merging of ego states into one personality) is not necessary; rather, integrating in a way that feels comfortable and desirable for you is most important (e.g., managing of amnesia, sharing of internal resources, sharing of memories, sharing an understanding of the Self). Usually, through awareness of the multiplicity and sharing of internal resources, amnesia dissipates, because as such, more cohesion occurs within one’s being. Usually as healing occurs, integration does too. But you are the only one that can decide how much integration you want to work toward.
Do you experience some of what I mentioned above? If so, please keep reading.
HOW THERAPY CAN HELP WITH MANAGING STRUCTURAL DISSOCIATION
Recognize the presence of your system
Learn to work with and communicate effectively with ego states
Manage dissociative processes
Process and integrate traumatic memory
Restore self-trust and internal safety
Increase self-efficacy
Kindly,
HELPFUL LINKS
National Suicide Prevention Lifeline - Call or text 988
Crisis Text Line - text HOME to 741741
If you are experiencing a mental health crisis, always seek professional help immediately. Please call 911 or the suicide prevention lifeline at 988 or go to your nearest emergency room for immediate care.
DISCLAIMER
The content of these webpages and blogs and information provided is for general informational and educational purposes only and is not intended as a substitute for professional medical or mental health advice, diagnosis, or treatment. Always seek the advice of your qualified health provider with any questions you may have regarding a medical or mental health condition. Seek professional help immediately if you are experiencing a mental health crisis or any other medical condition.