The paradox of "detachment disorders": binding-disruptions of dissociative process.

ABSTRACT

This case is discussed in the contexts of affect theory, attachment theory, and dissociative experience. Dissociative adaptations to living that become entrenched resistances during psychotherapeutic inquiry give way to a scrupulous attention to the characteristics of dissociative experiencing. Somatosensory free association and appreciation of experiential aspects of depersonalization, derealization, and dissociative amnesia open new areas of negotiation between patient and therapist. Paradigms from infant attachment and adult attachment research parsimoniously explicate psychodynamic formulations. "Conflicted interest" and "conflicted disinterest" are proposed to flesh out appreciation of the child's inner experience during Type A and Type C attachment experiences. The Type D attachment style is consistent with a dissociative phenotype. The concept of "isolated subjectivity" can help explain the extent to which individuals both know and don't know about their experience, in the same moment, and without conscious conflict or anxiety.