Abstract
Discrete Behavioral States Theory (DBST) is a transtheoretical, translational theory of human consciousness. DBST elucidates human experience across myriad normal and pathological domains. DBST is essential for understanding human development, mind/brain/body relationships, and psychopathology. Phylogenetically, studies of organisms from bacteria to primates have shown multiple discrete behavioral states (DBS). Human sleep and some sleep disorders can be understood in terms of different hierarchical DBS– sometimes called isomorphs - from DNA states through brain-wide changes ultimately leading to shifts in consciousness from waking DBS into the multiple DBS that make up sleep. Studies of different brain states (e.g., default mode, salience networks) are related to specific behavioral states. Studies of infant states show that DBS are critically important in human development; the shared states of infants and caregivers are basic to normal developmental attunement and attachment processes. DBST can unify understanding of many aspects of normal and pathological human functioning (e.g., emotional states; daydreaming; eating; toileting; artistic states; work states; private states; group states (e.g., at a concert); peak experiences, etc). Transdiagnostically, many psychiatric disorders can be conceptualized as “state-change” disorders (e.g., mood disorders, anxiety disorders, substance use disorders) as well as problematic behaviors such as self-destructive, suicidal, and high-risk behaviors. The transdiagnostic model of state-change disorders is helpful in unifying concepts of psychopathology through understanding of state-switching/shifting (e.g., from depression to mania), as well as potentially understanding the switch/shift processes themselves. DBST synthesizes theoretical and clinical conceptualization of psychological trauma, dissociation, and trauma-and-stressor related (TSRD) and dissociative disorders (DD) as paradigmatic state-change disorders. DBST subsumes all theories of dissociation (e.g., structural dissociation theory; hypnotic theory) as these are fundamentally state-based theories.

The presenter will review the basics of DBST. He will discuss DBST in human development, as well as developmental pathology (e.g., type-D attachment). He will review how DBST can inform conceptualization and treatment of TSRD and DD. He will discuss that DBST underlies a developmentally informed model of DID as a posttraumatic developmental disorder where extreme, malevolent, unpredictable early-life traumatic states and attachment pathology interfere with development of a unified sense of self across states and contexts. DID is best conceptualized as a disorder of self-integration, and the presenter will share a common-sense way of understanding concepts of self, identity, and personality, where “self-state” is the most developmentally and clinically appropriate way to conceptualize DID subjective self-divisions. Data from psychological assessment studies show that DID has a unique personality organization, based both on a posttraumatic adaptation to extreme, unpredictable malevolence from caregivers, as well as preservation of important psychological resiliencies that predict responsiveness to the tri-stage/phase model of trauma treatment. These include psychological complexity; a belief in attachment; the capacity for good reality testing and non-distorted cognitions; and a hyper -developed capacity for self-observation, and others. The presenter will discuss a unified adaptation-based conceptualization of DID self-states. The connotations of our received terminology (“helper”, “host”, “malevolent”, “persecutory”) blinds us to the dynamically adaptive functions of DID self-states. The presenter will suggest alternative conceptualizations.

This presentation was originally presented as part of the 2024 ISSTD Annual Conference in March 2024.

Potential to distress: yes