Cause of Dissociative Identity Disorder - Etiology
The bulk of clinical literature on dissociative identity disorder (DID) cites early, and constant childhood emotional, sexual and physical abuse and lack of attachment as the cause of severe cognitive deficits that prevent intense emotions from being processed. Individuals diagnosed with dissociative identity disorder consistently report severe child abuse during early to mid-childhood. They also report more historical psychological trauma than those diagnosed with any other mental illness. Awareness, memory and feelings of a harmful action or event, caused by a caregiver, is pushed into subconscious and dissociation becomes a coping mechanism for an abused child.
The hurtful memories and feelings are later experienced as a separate entity, and if this happens multiple times, multiple alters are created. What may be expressed as PTSD in adults, may become dissociative identity disorder when found in children, possibly due to their greater use of imagination as a form of coping or due to developmental changes and a more coherent sense of self past the age of six. This way, experience of extreme trauma may result in different, though also complex dissociative symptoms and identity disturbances.
A specific relationship of childhood abuse, disorganized attachment and lack of social support are thought to be a necessary component of dissociative identity disorder, along with rigid parenting styles, rigid genetic predisposition and an inversion of the parent-child relationship. Other suggested explanations include insufficient childhood nurturing combined with the innate ability of children in general to dissociate memories or experiences from consciousness. A high percentage of people with dissociative identity disorder report child abuse.
Discrete behavior states to alters[edit]
Putnum, in 1977 described discrete behavioral states (DBS), (these are beginnings of states) and their integration. He understood that the personality is not one unit, but instead begins as discrete behavioral and mental "states" (again these are not full states) that are the puzzle pieces that make up human behavior and consciousness. If this natural process is impeded by childhood abuse, then the process of integration will be disrupted, and the self states will stay bound to original context. [1]:141
Kluft describes discrete behavioral "states" as: A disaggregate self state (i.e., personality) is the mental address of a relatively stable and enduring particular pattern of selective mobilization of mental contents and functions, which may be behaviorally enacted with noteworthy role-taking and role-playing dimensions and sensitive to intrapsychic, interpersonal, and environmental stimuli. It is organized in and associated with a relatively stable ... pattern of neuropsychophysiologic activation, and has crucial psychodynamic contents. It functions both as a recipient, processor, and storage center for perceptions, experiences, and the processing of such in connection with past events and thoughts, and/or present and anticipated ones as well. It has a sense of its own identity and ideation, and a capacity for initiating thought processes and action. [2]:132
Developmental model / betrayal trauma theory[edit]
Briefly, many experts propose a developmental model and hypothesize that alternate identities result from the inability of many traumatized children to develop a unified sense of self that is maintained across various behavioral states, particularly if the traumatic exposure first occurs in very early childhood. These difficulties often occur in the context of relational or attachment disruption that may precede and set the stage for abuse and the development of dissociative coping (Barach, 1991; Liotti, 1992, 1999). Freyd’s betrayal trauma theory posits that disturbed caregiver–child attachments and parenting further disrupt the child’s ability to integrate experiences (Freyd, 1996; Freyd, DePrince, & Zurbriggen, 2001). Fragmentation and encapsulation of traumatic experiences may serve to protect relationships with important (though inadequate or abusive) caregivers and allow for more normal maturation in other developmental areas, such as intellectual,interpersonal, and artistic endeavors. In this way, early life dissociation may serve as a type of developmental resiliency factor despite the severe psychiatric disturbances that characterize dissociative identity disorder patients (Brand, Armstrong, Loewenstein, & McNary, 2009). Severe and prolonged traumatic experiences can lead to the development of discrete, personified behavioral states (i.e., rudimentary alternate identities) in the child, which has the effect of encapsulating intolerable traumatic memories, affects, sensations, beliefs, or behaviors and mitigating their effects on the child’s overall development. Secondary structuring of these discrete behavioral states occurs over time through a variety of developmental and symbolic mechanisms, resulting in the characteristics of the specific alternate identities. The identities may develop in number, complexity, and sense of separateness as the child proceeds through latency, adolescence, and adulthood (R. P. Kluft, 1984; Putnam, 1997). Dissociative identity disorder develops during the course of childhood. [2]:122
Four factor model[edit]
Another etiological model posits that the development of dissociative identity disorder requires the presence of four factors: (a) the capacity for dissociation; (b) experiences that overwhelm the child’s nondissociative coping capacity; (c) secondary structuring of dissociative identity disorder alternate identities with individualized characteristics such as names, ages, genders; and (d) 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 (R. P. Kluft, 1984). The secondary structuring of the alternate identities may differ widely from patient to patient. Factors that may foster the development of highly elaborate systems of identities are multiple traumas, multiple perpetrators, significant narcissistic investment in the nature and attributes of the alternate identities, high levels of creativity and intelligence, and extreme withdrawal into fantasy, among others. Accordingly, therapists who are experienced in the treatment of dissociative identity disorder typically pay relatively limited attention to the overt style and presentation of the different alternate identities. Instead, they focus on the cognitive, affective, and psychodynamic characteristics embodied by each identity while simultaneously attending to identities collectively as a system of representation, symbolization, and meaning. [2]:122-123
Structural dissociation[edit]
"The theory of “structural dissociation of the personality,” another etiological model, is based on the ideas of Janet and attempts to create a unified theory of dissociation that includes dissociative identity disorder (Van der Hart et al., 2006). This theory suggests that dissociation results from a basic failure to integrate systems of ideas and functions of the personality. Following exposure to potentially traumatizing events, the personality as a whole system can become divided into an “apparently normal part of the personality” dedicated to daily functioning and an “emotional part of the personality” dedicated to defense. Defense in this context is related to psychobiological functions of survival in response to life threat, such as fight/flight, not to the psychodynamic notion of defense. It is hypothesized that chronic traumatization and/or neglect can lead to secondary structural dissociation and the emergence of additional emotional parts of the personality." [2]:123
References[edit]
- ^ Howell, E.F. (2011). . . New York: Routledge
- ^ a b c d International Society for the Study of Trauma and Dissociation. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, volume 12, issue 2, 28 February 2011, page 115–187. (doi:10.1080/152947)
