I’ve talked about the diagnostic criteria for dissociative identity disorder (DID), identity disruption and amnesia. What causes DID? How is it related to trauma? These are the topics I’d like to tackle next. If you are questioning whether DID is true for you or are in the early phases of your treatment process this may be information you do not have access to and maybe you are not ready for it. It is okay if you decide that this post is not for you (of course that applies to all my posts)! Your system may help you manage when you are ready for more information.
The dissociative disorders in general frequently occur in the aftermath of trauma. Many theorists agree that DID develops in response to severe trauma in early childhood, most typically extreme, repeated physical, sexual, and/or emotional abuse. In their Guidelines for Treating Dissociative Identity Disorder in Adults the International Society for the Study of Trauma and Dissociation provides an overview of theories that are developmental, trauma-related, and acknowledge the importance of the relational environment before and after trauma:
In short, these developmental models posit that DID does not arise from a previously mature, unified mind or “core personality” that becomes shattered or fractured. Rather, DID results from a failure of normal developmental integration caused by overwhelming experiences and disturbed caregiver–child interactions (including neglect and the failure to respond) during critical early developmental periods. This, in turn, leads some traumatized children to develop relatively discrete, personified behavioral states that ultimately evolve into the DID alternate identities.
One theory stresses that trauma interferes with normal developmental tasks. The traumatized child is not able to develop a unified sense of self, especially when the trauma begins before age five. These developmental theorists also address the relational and attachment context in which abuse occurs. DID develops throughout the course of childhood and beyond, and may involve elaboration on the number of parts, their complexity, and their sense of separateness. DID is not thought to occur in response to traumatic events in adulthood, unless the person had already experienced childhood trauma and resulting identity fragmentation (For more information about these theories see Loewenstein & Putnam, 2004, and Putnam, 1997).
Another model says the following four factors must be present for DID to develop:
- the capacity for dissociation
- experiences that overwhelm the child’s nondissociative coping capacity
- secondary structuring of DID alternate identities with individualized characteristics such as names, ages, genders
- a lack of soothing and restorative experiences, which renders the child isolated or abandoned and needing to find his or her own ways of moderating distress (for more information see R. P. Kluft, 1984).
Criteria 4 is related to the relational and attachment context discussed above. When a child does not have caretakers who provide protection and soothing, the child must turn inward in order to survive.
A third theory, structural dissociation, is based on the work of Pierre Janet. It says that we all create our personality and that this requires integrating all our experiences, even very aversive ones. When this is not possible (due to exposure to severe, acute traumatic events), the personality is divided into two parts: one part that attempts to avoid all reminders of the traumatic event (called the ANP for “apparently normal part”) and another that is re-experiencing and attempting to defend against the trauma (called the EP for “emotional part”). There may be more than one part of the self functioning as APs and EPs.
An interesting area of study involves looking at early attachment styles and the development of DID. There is considerable research about infant attachment that points clearly to a pattern of attachment called Type D attachment (or insecure, disorganized) as predicting adult dissociation. Attachment in general and as it relates to dissociation is too big a topic to fully address here. Look for an upcoming post about this!
Understanding DID as a response to and creative strategy for surviving trauma is crucial to healing. Having DID does not mean you are “crazy”. It is not your fault, or the fault of any part of you. Accepting and honoring that all of you together have overcome a great deal already may help pave the way for working together now to create the life you want going forward.