More than one voice
Understanding the causes and risk factors for Dissociative Identity Disorder
Relatively rare but still a viable diagnosis, Dissociative Identity Disorder has been estimated to affect about 1.5 per cent of the global population. It is also often highly misunderstood. In this blog, we attempt to understand it in depth. And what better way to do that than by a study?
Dissociative Identity Disorder — A Case Study
Sarah is a 32-year-old graphic designer. She reports finding evidence of activities she can’t remember participating in. A consultation with the therapist reveals several identity states with different emotional, posture, and speech patterns. In one state, Sarah is highly functional, while in another, her behavior changes to being childlike with heightened fear responses. Interpersonal stress is her primary trigger for changing from one state to another. Her past reveals prolonged physical and emotional abuse before age six, with no protective caregiver to take care of her. She has no diagnosis of substance abuse, psychotic behaviors, or any other neurological illness.
Sarah suffers from Dissociative Identity Disorder, a mental health condition where the mind segregates life experiences into separate parts as a coping mechanism for dealing with severe trauma that a person has encountered in early childhood. These parts are called identity states, and are recognizable by different feelings, memories, or ways of behaving. The patient may have no memory of what happens when another part is in control. DID is not about pretending in order to draw attention to oneself. It is a survival response of a traumatized person to overwhelming experiences, where dissociation helps the person function when life feels unsafe.
The Many Faces of the Mind
An individual with DID goes through a process of identity fragmentation. Everyone has different parts such as an “angry” self, an inner critic, or a child who feels abandoned after a breakup. In DID, the separation and distinction between these parts is greater.. The mind separates into two or more distinct identity states referred to as “alters” or “multiple personalities” in psychiatric terminology. Each identity state manifests as a separate personality which holds different memories. Potentially, identity states can have their own name, age, gender, behaviors, and unique ways of perceiving the world. One state may appear as the direct result of a trigger and dominate the other states. .
In order to merit a DID diagnosis, a person’s alters must hold memories which are not accessible to the primary personality. In other words, the person has periods of amnesia during which an alter was functioning. This multiplicity is the mind’s way of coping with trauma, carried forward from early life. People with DID have experienced so much trauma that a full awareness of it would prevent them from functioning. Alters hold the trauma memories so that the main personality can attend school, work, and generally be successful in life. Furthermore, some alters may be unaware of traumatic experiences which enables them to experience joy and take in love from parents who vacillate between abusive and loving.
For some people, another key component of DID is Depersonalization. This is also common in other dissociative disorders, such as Depersonalization Disorder or Other Specified Dissociative Disorder. Depersonalization is an experience in which the client reports the feeling of being detached from themselves, manifested in states like feeling unreal, numb, or detached from emotions, bodily sensations, or actions.
People experiencing depersonalization may say things like:
- “I feel like I’m watching myself from the outside.”
- “My body doesn’t feel like it belongs to me.”
- “My emotions feel muted or distant.”
- “I know this is me, but it doesn’t feel like me.”
A key feature of depersonalization is insight. The person perceives the experience as strange or uncomfortable, but they realize that it is a mental state rather than a literal separation from reality. This distinguishes depersonalization from psychosis.
Depersonalization is the patient’s response to stress, anxiety, panic attacks, or trauma. It can also appear during periods of exhaustion, illness, or emotional overload. For some people, it is brief and passes on its own. For others, it can become persistent or recurrent.
Depersonalization vs. Derealization
Depersonalization is different from Derealization. As the name suggests, depersonalization is a state in which the person feels detached from themselves. In contrast, in Derealization, the person feels detached from reality — the external world, which seems flat, unchanging, and independent of human consciousness. It may appear to be dreamlike, or even unreal. Depersonalization and Derealization have a common ground in that both are ways in which the brain defends itself against overwhelming emotional input.
Is Depersonalization Dangerous?
Depersonalization per se is not dangerous. However, it can cause significant distress. People often feel they are “going crazy” or losing control, which can worsen their symptoms. In reality, depersonalization is a common and reversible response to stress as opposed to psychosis, which can be incurable and irreversible.
Treatment comprises anxiety management, stress reduction, and focuses on addressing underlying trauma. Grounding techniques, therapy, and medication, used in combination, can help reduce symptoms.
Also Read: High-Functioning Anxiety: Signs, Causes & How Therapy Helps
Causes and Risk Factors for Dissociative Identity Disorder
A widely accepted cause of Dissociative Identity Disorder is severe, repeated trauma during early childhood, as reported by most clients, whose documented history reveals chronic abuse or neglect before the age of six. Physical, sexual, emotional abuse, or extreme neglect are all contributing factors for DID.
Abuse can have a debilitating impact on a child when his or her sense of identity is still forming. A child, especially aged less than six years, does not have the psychological mechanisms to process intense fear, pain, or betrayal, especially when the trauma comes from caregivers who are supposed to provide safety. Unable to absorb the shock of betrayal, the child adopts dissociation as a survival strategy. By mentally separating from the traumatic experience, the child can continue to function in daily life.
Over time, this coping mechanism can become deeply entrenched in the psyche, breaking it into different identity states, which handle different roles or emotions, such as fear, anger, or compliance. This division is automatic in the brain’s quest for adaptivity to ongoing threat.
Repeated & Inescapable Trauma
Not all trauma causes DID. One key risk factor is repetition. A single traumatic event, while harmful, is less likely to result in DID than ongoing trauma that the child cannot escape. Situations in which the child is trapped in regular or unpredictable abuse cause the maximum damage.
The lack of external support is another major cause. Without the presence of a safe adult to turn to, children use an internal coping mechanism like dissociation as the only recourse for survival. Further, when the abuse goes unacknowledged, children learn that their experiences cannot be disclosed openly, which reinforces the separation.
Attachment Disruption & Betrayal
When the emotional bonds with the caregiver are disrupted, such as in cases where caregivers are abusive, neglectful, or emotionally unavailable, the child experiences a deep sense of betrayal and confusion that results in the fragmentation of the mind. The brain disconnects experiences into separate compartments to preserve some sense of connection while storing unbearable emotions in a separate compartment. This helps explain why DID often involves two or more identity states — one holding traumatic memories while the other supervises everyday functioning.
Developmental Vulnerability
Disassociation has a strong connection with childhood, when a child’s brain is both flexible and vulnerable, and the child does not see himself/herself as a single, unified identity. Because of this, dissociation can shape the structure of identity itself. That changes with the maturity of the brain. That’s why traumatized adults are more likely to develop Post Traumatic Stress Disorder rather than DID.
Related Article: Teletherapy vs In-Person: Which Is Right for You?
Environmental & Social Risk Factors
Certain environments are conducive to the development of DID: households where kids experience or witness domestic abuse, drug addiction, serious mental illness in caregivers, or extreme instability. Poverty and social isolation also hinder access to protection or intervention, thus becoming risk factors for the condition.
Cultural factors may impact how the child expresses their condition, but do not cause DID on their own. Psychiatrists attribute DID to one sole driver — early childhood trauma combined with a lack of safety and support.
Misconceptions
It is important to note that DID is not caused by fantasy, attention-seeking, daily stress, or mild adversity. It is rather a condition induced by severe and sustained trauma that is revealed through identifiable patterns in memory, behavior, and brain functioning.
If you’re looking for DID Therapy in Upper East Side, New York City, Laura Pearl uses a combination of talk therapy, grounding techniques, Gestalt parts work, and EMDR to treat DID.
