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Over splitsen, splijten en dissociëren

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Tijdschrift voor Psychotherapie

Abstract

Splitsen als afweerstrategie is een centraal kenmerk van de borderline–persoonlijkheidsstoornis. Voor de dissociatieve stoornis is dissociëren een centraal kenmerk. Tussen deze beide afweervormen wordt in vele psychoanalytische theorieën geen onderscheid gemaakt, terwijl klinisch sprake is van een grote overlap in symptomatologie en verschijningsvorm tussen beide typen stoornissen. In dit artikel wordt betoogd, dat splitsen een algemeen afweermechanisme is, dat zich niet beperkt tot de zogenaamde vroege stoornissen en dat dezelfde dynamiek vertoont als dissociëren. Bij de borderline–persoonlijkheidsstoornis is sprake van een onvermogen tot integratie van verschillende zelf– en objectbeelden op grond van cognitieve en affectieve instabiliteit. Hierbij maakt het niet uit hoe deze zijn ontstaan. Bij zowel dissociatieve stoornissen als de borderline–persoonlijkheidsstoornissen wordt de relatie met vroeg–kinderlijk seksueel misbruik en mishandeling steeds beter geboekstaafd.

Voor de behandeling is echter van belang dat er een duidelijk onderscheid gemaakt wordt tussen borderline–persoonlijkheidsstoornissen en dissociatieve stoornissen. De behandeling van borderline–persoonlijkheidsstoornissen vereist een andere aanpak dan die van dissociatieve stoornissen. Op grond van literatuuronderzoek wordt geconcludeerd, dat het splitsen van objecten bij patiënten met een borderline–persoonlijkheidsstoornissen op een primitievere psychische organisatie terug te voeren lijkt dan dissociatie.

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    N. J. Nicolai

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Splitting and dissociation

Splitting as defense is considered a central marker of borderline personality disorder. Dissociation is a central defense in dissociative disorders. In many theories a distinction is made between the two forms of defense. Dissociation is seen as referring to memory, consciousness and identity; splitting as referring to affects, object and self representations. However, considerable overlap exists in symptomatology and phenomenology of borderline and dissociative disorders. For both disorders a distinct correlation with childhood sexual and physical abuse has been found. For psychotherapeutic management it is, however, important to distinguish between the more primitive personality organisation of the borderline personality and the personality organisation of dissociative disorders. After reviewing the relevant literature, the author concludes that dissociation and splitting are the same defense mechanisms and are both central defense mechanisms in normalcy, neurosis and trauma. It does refer to identity, memory and consciousness, but also to affect, self and object representations. The splitting of borderline pathology is, however, not only division, but refers more to a lack of synthesis or integration, due to cognitive and affective distortions by disturbances in attachment experiences.

Mw.drs. N.J. Nicolai is psychiater–psychotherapeut, werkzaam bij de RIAGG Rijnmond Noord–West te Vlaardingen en in eigen praktijk te Rotterdam.

Correspondentieadres: Rotterdamse Rijweg 190, 3042 AV Rotterdam.

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Nicolai, N.J. Over splitsen, splijten en dissociëren. PSIE 23, 46–58 (1997). https://doi.org/10.1007/BF03061825

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