Due to the client losing both her parents during infancy in a tragic car accident, the client’s disorder can be viewed as a disorder of attachment. The client’s history shows deficits in three of the five Pathogenic Care Realms: settings where there is persistent disregard for the child’s emotional needs, settings in which there are repeated changes in primary caregivers, and settings in which child is raised with limited opportunities for stable attachments (American Psychiatric Association, 2013). The strict, cold religious school where the client spent the majority of her childhood offered little support for the client’s emotional needs. The client did not bond with any teacher at the school and had no particular primary caregiver after the death …show more content…
The client experienced a detachment from her family, not just losing her parents to death, but also being separated from her twin brother.
According to Bowlby, the client’s difficulties in maintaining boundaries, periods of abrupt withdrawal, and subsequent movement through a period of anxious attachment, exemplify steps towards internalization of a protected base of attachment (1988). A toddler looks to the mother as a secure base to return to when frightened. By contrast, the client’s secure base was tragically removed, thus leaving her in a state of despair, waiting for her mother to return. When her mother does not, the client begins to detach. The closest adult figures to a secure base the client has are the teachers at her school. When they turned on the client, exclaiming her as blasphemous, the client dissociates to cope with the overwhelming distress, creating an alternate identity. According to the International Association for the Treatment of Trauma and Disassociation, “the development of DID requires the presence of