In the course of studying Dissociative Identity Disorder (DID), researchers have come to the conclusion that trauma plays an important role in the onset of dissociation. However, as trauma can be acquired at any point in life, it is important to identify at which exact period in a person’s life trauma does contribute to DID. In the review of several studies, it was found that Dissociative Identity Disorder spurs from adverse childhood experiences (Sar, 2011; Stein et. al., 2012; Powers et. al., 2014); in particular, children who were traumatized due to maltreatment are more likely to experience emotional dysregulation which can eventually lead to trauma-related psychopathology such as DID (Burns et. al., 2010; McLaughlin et. al., 2011). Maltreatment, in this case, can occur in several manners: sexual abuse, physical abuse, emotional abuse, and neglect (Sar, 2011). Experiencing any form of such can contribute to a child’s trauma development.
Age exposure and the frequency of the trauma
In support of this, a study by Stein et. al (2012) concluded that age of exposure to trauma and the frequency of the trauma are also critical in promoting dissociative symptoms. This would mean that the type of maltreatment done to the child is insignificant as they all provide the same dissociative effects, depending on the age of the child and the frequency of maltreatment. Following this analysis, it could be said that the younger the child and the more exposed he/ she is to maltreatment, the greater is the chance of developing Dissociative Identity Disorder.
The process of this development can be explained in Burnand’s (2013) study on the brain hemispheres. His findings suggest that children go through six key problems initiated by the environment, responsibly dealt with by the brain’s left and right hemispheres. Failure to pass all problems will prompt the brain to activate its backup in order to prevent recklessness. The brain activities are guided by visual images, also called schemas, which, if treated as entities, become a person’s independent identity. In order to understand this finding in relation to previous studies, maltreatment should be seen as one of the unresolved problem effects driven by the environment, prompting the brain to develop schemas an eventually, identities as response to childhood stressors. This leads researchers and therapists to account significant childhood experiences as they may be the primary cause of the psychological condition.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has given way to the inclusion of a dissociative subtype under Post-Traumatic Stress Disorder, a condition that primarily requires previous continuous exposure to trauma. The emergence of this new step brought about new studies on biological markers and validators for the relationship of DID and PTSD. In the study of Lanius et. al. (2012), it was concluded that people suffering from dissociative states in relation with PTSD produced excessive corticolimbic inhibitions, thereby resulting in overmodulated emotional response patterns. This result is in-line with the overmodulated responses also associated with childhood trauma.
Being a multifactorial disorder, DID, in relation to PTSD, does not stop at trauma and neurobiological bases. It was also empirically proven that psychosocial factors also play a role in the development of the disorder. For instance, stress was deliberately found to have a significant contribution to Dissociative Identity Disorder. Consistent with previous research, a study of military personnel concluded that majority experienced self-initiated dissociative states under stress (Morgan and Taylor, 2013), implying that dissociation may arise as a treatment for stress. Furthermore, inefficiency in stress management was also found to be prominent among individuals with PTSD and DID (Precin, 2010). As other negative organizational implications are brought about by stress, another psychosocial factor may come into play.
Emotions also influence the relationship between DID and trauma
Emotions also influence the relationship between DID and trauma. An affective condition called motional dysregulation was found to be a significant contributor to DID development even after trauma exposure (Powers et. al., 2015). In this light, it can be concluded that patients with DID-PTSD do not have the consistent capability to regulate emotional responses especially during experiential reminders of traumatic incidents. This result is supported by Zerach et. al.’s (2013) longitudinal study on ex-prisoners of war. Their findings suggest that traumatic events (in the study’s case—captivity), leads to loss of emotional control and post-traumatic intrusion symptoms which are associated with persistent dissociations.
Despite the growing number of studies dedicated to understanding Dissociative Identity Disorder, many questions are yet to be answered; however, it is acceptable to conclude that DID develops as an effect of trauma, especially those that occurred during childhood. In this paper, it is essential to emphasize that all factors related to DID and PTSD development occur as responses to trauma. Therefore, it is only fitting that evaluations, treatments, and interventions of DID, especially when comorbid with PTSD, use a therapeutic approach that can treat even trauma, the baseline problem.
References
Burnand, G. (2013). A right hemisphere safety backup at work: Hypotheses for deep hypnosis, post-traumatic stress disorder, and dissociation identity disorder. Medical Hypotheses, 81, 383-388.
Lanius et. al. (2012). The Dissociative Subtype of Posttraumatic Stress Disorder: Rationale, Clinical and Neurobiological Evidence, and Implications. Depression and Anxiety, 29, 701-708.
Morgan, C. A. III. & Taylor, M. K. (2013). Spontaneous and Deliberate Dissociative States in Military Personnel: Are Such States Helpful? Journal of Traumatic Stress, 26, 492-497.
Powers et. al. (2014). PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample. Journal of Psychiatric Research, 61, 174-179.
Precin, P. (2010). Return to work: A case of PTSD, dissociative identity disorder, and satanic ritual abuse. New York: New York Institute of Technology.
Sar, V. (2011). Epidemiology of Dissociative Symptoms. Epidemiology Research International, 2011.
Stein et. al. (2012). Dissociation in Posttraumatic Stress Disorder: Evidence from the World Mental Health Surveys. Biological Psychiatry, 73, 302-312.
Zerach et. al. (2013). The Relations Between Posttraumatic Stress Disorder and Persistent Dissociation Among Ex-Prisoners of War: A Longitudinal Study. Psychological Trauma: Theory, Research, Practice, and Policy, 6(2), 99-108.
