Causes and development

Before anyone has a diagnosis

How does trauma become DID? Researchers haven't found one path that can be traced from a childhood event to a diagnosis years later. The starting point is a child whose memory, emotions, bodily experience, and sense of self are still developing. Repeated trauma can interfere with how those experiences come together.¹

The ISSTD guidelines describe one vulnerability as the inability of many traumatized children to develop a unified sense of self¹. The important word here is develop: the question is not only what happened, but what was still taking shape when it happened.

There's also the question of when. During early childhood, autobiographical memory, emotional regulation, attachment, and a coherent sense of self are still developing.¹² Repeated overwhelming experiences can interrupt those processes, leaving memories, emotions, and ways of responding harder to hold together.¹

Trauma is not just an event

Nijenhuis calls trauma an injury that implies recurrent re-enactment³ rather than the event that preceded it. For him, the same event can have very different effects depending on a person's development, body, and surroundings. Sensations, emotions, actions, or ways of seeing oneself may keep returning when the experience has not been fully placed in the past.

When adults tell a childhood history, it often comes out as a list: this happened, then this happened. A child lives the whole situation around those events. How old were they? Could they get away? Did anyone notice and help afterward? Did the danger come from the same person they depended on for food, comfort, and safety? These details help explain why two children can go through something similar and respond differently.¹²

Young children cannot simply leave. If a caregiver is both frightening and necessary, the relationship continues because the child needs it to. Developmental models suggest that dissociation may help the child manage experiences they cannot escape or bring together into one continuous story.¹²

What happens afterward also matters. A caregiver may notice, respond, and help the child settle, which changes what the child has to carry alone. A review of developmental pathways points to disruptions of the parent-infant dialogue⁴ and caregiver unavailability as possible contributors to later dissociation.⁴

Dutra's study began in infancy

The study by Dutra and colleagues stands out because the researchers had followed participants since infancy. They observed early caregiving instead of relying only on what adults remembered years later. Among the 56 people who remained in the study at age 19, the quality of early care predicted dissociative symptoms even after childhood trauma was taken into account.⁵

A separate study by Heather Dye surveyed 748 college students. Those who reported emotional abuse scored higher on depression, anxiety, stress, and neuroticism than the comparison groups in that sample.⁶ DID was outside the study, but the result is one reason emotional abuse should not be treated as a harmless footnote beside physical or sexual violence.

Why one child and not another?

Even siblings do not have exactly the same childhood. They may be different ages when something happens, be treated differently, or find support in different places. Temperament and timing can matter as well.²⁷

Repeated trauma and disrupted attachment appear across developmental accounts. Some researchers emphasize dissociative capacity or temperament; others look more closely at emotional neglect, caregiver availability, biology, culture, and the child's wider environment.¹²⁷ They do not all give those factors equal weight.

Most studies start after the person is already seeking help. Following children from early life into adulthood takes years, so there are still parts of the proposed pathway researchers haven't directly observed.²

What we know now is that DID is linked to serious adversity early in life, not any specific severity or degree of trauma.² There is no single event a person must report or severity score they have to meet, despite how much denial may want us to meet such standards.

Footnotes7

Footnotes

1. International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187. pp. 121-122. Developmental account of DID and interacting contributing factors. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

2. Sar, V., Dorahy, M. J., & Kruger, C. (2017). Revisiting the etiological aspects of dissociative identity disorder: A biopsychosocial perspective. Psychology Research and Behavior Management, 10, 137-146. Abstract and conclusion. Multifactorial account of DID development and the limits of single-cause explanations. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

3. Nijenhuis, E. R. S. (2015). The trinity of trauma: Ignorance, fragility, and control, Volumes I and II. Vandenhoeck & Ruprecht. Volume I, pp. 214-215; Volume II, pp. 545-546. Nijenhuis distinguishes adverse events from trauma as injury and describes that injury as involving recurrent re-enactment. ↩

4. Leeds, A. M. (2010, April 5). Developmental pathways to dissociation. Sonoma Psychotherapy Training Institute. Prospective longitudinal studies and developmental implications. Clinical review of attachment, caregiver availability, and early-care research in developmental pathways to dissociation. ↩ ↩²

5. Dutra, L., Bureau, J.-F., Holmes, B., Lyubchik, A., & Lyons-Ruth, K. (2009). Quality of early care and childhood trauma: A prospective study of developmental pathways to dissociation. Journal of Nervous and Mental Disease, 197(6), 383-390. pp. 386-390; results, discussion, and limitations. Prospective associations among observed early caregiving, measured childhood trauma, and dissociative symptoms at age 19. ↩

6. Dye, H. L. (2020). Is emotional abuse as harmful as physical and/or sexual abuse? Journal of Child & Adolescent Trauma, 13(4), 399-407. Abstract; sample and results. Online survey of 748 college students. Reported emotional abuse was associated with higher depression, anxiety, stress, and neuroticism scores; DID was not studied. ↩

7. Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardena, E., Frewen, P. A., Carlson, E. B., & Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin, 138(3), 550-588. Abstract and review of trauma-model evidence. Review evaluating competing explanations for the association between trauma and dissociative symptoms, including limits of the available evidence. ↩ ↩²