Dissociative Identity Disorder and Trauma: Coping and Healing

Have you ever driven home lost in thought, unaware of what you experienced during your drive? Not even sure if all the lights you passed were green? People often chalk that up as dissociation, which is true. It can feel a little freaky or odd, but it’s been normalized as something that happens to everyone. Someone living with dissociative identity disorder (DID) experiences a much different reality—severe dissociation, gaps in their memory, and new identities that develop.

Trauma can cause DID. Many experts have explored this connection, including Athena Phillips, who we spoke to in our recent podcast episode. You can listen to that here. 

What Is Dissociative Identity Disorder (DID)?

Dissociative identity disorder, once known as multiple personality disorder, describes someone with two or more separate, independent identities¹ or ‘alters.’ People can have dozens of alters with their own habits, memories, and even genders. DID is one of several dissociative disorders¹ marked by derealization, memory loss, distorted self-identity, and disruptions in consciousness. 

Each identity has their own view of the world and makes their own decisions². Someone with DID may know about all their alters or just a few, especially ones that come out more often. Patients typically experience memory loss when various identities take over—alters aren’t usually aware of what the others are doing, and memory loss occurs as a result. For example, if an alter brings home a new vase, someone with DID may not recognize it later or know where it came from.

Each alter has their own first-person experience and forms memories based on what they see, feel, and think. Other alters and the true self aren’t usually able to retrieve these memories², though many clinicians propose they could if they didn’t strongly believe they can’t. Believing they can access an alter’s memories could allow the true self or other alters to retrieve them.

Causes of DID

DID most often occurs as a response to trauma¹, typically physical, sexual, or emotional abuse in childhood. The post-traumatic model of DID² proposes that “​​dissociative identities are the primary results of early trauma and the relational, cognitive, emotional, and neurobiological consequences of it.” Children may unconsciously resort to dissociation and numerous personalities to both avoid and cope with traumatic memories.

Each alter develops as a disconnected, separate, autonomous subset of the self. Picture islands separated by deep waters instead of one town. The true self may travel to different islands depending on what their situation demands and memories that arise, often memories of severe trauma. Once the true self goes to an island, it becomes their whole reality and remains closed off from the other islands.

Clinicians and researchers have found trauma to be the leading and primarily identifiable cause of DID², though some genetic dispositions, social influences, and personality traits could contribute to dissociation and someone’s inability to cope with stress. Someone who’s more likely to experience dissociation and struggle to deal with stress could be more likely to develop DID.

Diagnosing DID

Most people with DID don’t get an accurate diagnosis until later in life¹ because DID has similar symptoms to other personality disorders, including amnesia, dissociation, and losing consciousness. Particularly, borderline personality disorder (BDP) shares similar symptoms, and like DID, patients often present as suicidal and engaging in self-harm. BPD patients also struggle with emotional regulation and dissociation. To meet diagnostic criteria for DID, experts say patients must present with these 4 factors¹:

1. The ability to dissociate
2. Intense, overwhelming traumatic experiences 
3. Alters with unique personalities, names, and memories
4. Homelife instability

Children may cope with unstable homes and overwhelming trauma by self-soothing through dissociation and developing alters. Someone with DID also has altered brain structures³, usually the hippocampus and amygdala, which can affect memory and overall functioning. Looking at the brain can help doctors accurately diagnose DID and rule out other diagnoses. Observing patients also clues doctors into the personality shifts related to DID, as a few key physical signs often occur:

• Eyes rolling
• Fading into a trance-like state
• Blinking or twitching eyes
• Sudden posture changes

History of DID

Until 1994, DID was known as multiple personality disorder and not well understood³ or sympathized by the medical community. Its strong connection to trauma has recently become better known and understood, helping patients get the diagnosis and help they need.

Before it was recognized as a mental health condition, DID was thought to be the work of demonic possession¹. Cultures outside North America were more likely to attribute symptoms to possession, while schizophrenia or psychosis incorrectly explained many symptoms in other cultures. Internal voices from other alters were explained as schizophrenia, which can have similarities.

How Trauma Can Lead to Dissociative Identity Disorder

Children or adults who experience more trauma and stress than they’re capable of dealing with can develop DID as a coping mechanism¹. Their experience goes beyond what their mind can process and articulate, leading to dissociation as a way to escape and alternate identities to process a fractured sense of self. 

Certain alters may be more capable of dealing with the traumas experienced and come out when situations mimic the original trauma, or memories of the trauma arise. For example, a tough male alter may take over when a female with a history of assault feels uncomfortable around certain men. He comes out to protect her and deal with a situation she cannot. 

Dissociation as a Predictor of DID

Intense trauma can cause dissociation¹, as seen in some cases of post-traumatic stress disorder. An out-of-body experience during an assault can be the brain’s effort at protection. Children who suffer repeated abuse or instability in their homes may regularly dissociate to protect themselves. Alters can eventually present during dissociation and take over general consciousness, leading to amnesia. 

Small Social Cues Can Trigger Shifts in Identity

Social cues can prompt small behavioral changes, triggering an alter to take over² in someone with DID. As an example, picture a formal event. This requires professionalism and different social etiquette. Someone without DID could adapt to the situation by speaking more formally, standing straighter, and carrying themselves differently. But someone with DID may unknowingly shift to an alter identity that’s more poised and professional. Their true self may not remember the event or what they talked about if the alter takes over.