What causes dissociative identity disorder?
Whilst it is not certain what causes dissociative identity disorder (DID), many people believe that it is a response to repeated childhood trauma. The trauma affects how the child's mind develops, causing DID symptoms in adulthood.
What is trauma?
Trauma occurs when an overwhelming event leaves a person feeling helpless. The event can be physical, sexual or emotional in nature. The traumatic feelings are too great for the mind to take in and to process. What the mind cannot process is relived time after time as if happening all over again. It is possible for any person to experience trauma; there is no personality type which is immune to it; no race or gender. If a person is overwhelmed by an experience and feels helpless, trauma occurs.
Trauma can manifest in many ways: flashbacks, nightmares, avoidance of people, places and situations, fearfulness and panic. It can cause relationship difficulties, self-harm, depression and even suicide. It can also trigger dissociation.
Dissociation is a strategy used by the mind to cope with trauma. It is an altered way of thinking and feeling. It creates a psychological distance from the overwhelming feelings. Dissociation can be experienced in many ways, some of which are normal, everyday experiences. Others accompany more significant, psychological trauma. Examples of dissociation are:
- Depersonalisation - feeling as if you are not yourself.
- Derealisation - feeling as if your surroundings are unreal.
- Losing time.
- Blanking out.
- A sense of time going more slowly - for example, when feeling afraid.
What role do trauma and dissociation have in dissociative identity disorder?
Not everyone who experiences trauma and dissociation goes on to develop dissociative identity disorder (DID). People who experience DID have often had early lives where they have felt unsafe and frightened by the people who were meant to keep them safe. They have experienced repeated trauma throughout their childhood.
This may have been at the hands of a caregiver, or it may have involved the caregiver because he/she did not prevent the traumas from occurring. Faced with repeated traumas, the child's mind uses dissociation to cope. Dissociations during childhood, when a young person's mind is still developing, can affect how the personality forms. Instead of one complete personality, during times of dissociation, fragments of identity are created.
These identity fragments remain separate and dissociated - cut off from the rest of the person's mind. They can resurface at times of distress. Whilst DID stems from childhood trauma, its symptoms show themselves in adulthood, often long after the traumas have stopped. The DID mind continues to cope with stress by using its dissociated identities. What was a brilliant survival strategy for the child, causes problems for the adult who is no longer in danger.
Anyone can experience trauma and dissociation, so DID can be thought of as a developmental response, rather than a 'mental illness'. It could happen to anyone who has survived repeated childhood trauma.
Not everyone thinks that DID is a result of trauma. Because some people with DID are easily hypnotised, some professionals have wondered whether DID might be induced in susceptible people by hypnosis and suggestion. This might also be at the hands of inexperienced therapists, or by therapists who are actively looking for signs of DID. Rather than it being a response to trauma, some people think that the identity fragments are embellished at the suggestion of the professional trying to diagnose and treat them. This is known as the 'iatrogenic model'. DID symptoms are also influenced by the person's environments, by media and by culture. This effect on symptoms is called the 'sociocognitive model'. People continue to debate the cause of DID.
DID used to be known as 'multiple personality disorder'. It has been renamed because the personalities in DID are fragments of one, unintegrated personality. They are not multiple, fully formed personalities residing within one mind.
Further reading and references
International Society for the Study of Trauma and Dissociation (2011); Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, Journal of Trauma & Dissociation, 12:2, 115-187
Brand BL, Sar V, Stavropoulos P, et al; Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harv Rev Psychiatry. 2016 Jul-Aug24(4):257-70. doi: 10.1097/HRP.0000000000000100.
Reinders AA, Willemsen AT, Vos HP, et al; Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS One. 20127(6):e39279. doi: 10.1371/journal.pone.0039279. Epub 2012 Jun 29.
Brand, B. L., Myrick, A. C et al. A Survey of Practices and RecommendedTreatment Interventions Among Expert Therapists Treating Patients With Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified. Psychological Trauma:Theory, Research, Practice, and Policy. Advance online publication. doi: 10.1037/a0026487 (2011)
Cronin E, Brand BL, Mattanah JF; The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders. Eur J Psychotraumatol. 2014 Mar 65. doi: 10.3402/ejpt.v5.22676. eCollection 2014.
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