Welcome! The purpose of this carrd is to provide information and academic sources on why DID is a real, trauma-based disorder.Last Updated: 11/28/22

DID IS TRAUMA-BASED

First off, what is trauma?Trauma is a psychological wound. van der Kolk (1995) describes a traumatic event as a stressful experience that overwhelms a person's ability to cope. Everyone has a different threshold for what is traumatic to them, although the ISSTD (2020) states that some experiences are so stressful that most people would find them traumatic.According to van der Hart, et al. (2006), how someone is affected by an event is subjective. Two people could go through the same exact event and only one of them might end up traumatized.Mind (2020) says that "what's traumatic is personal. Other people can't know how you feel about your own experiences or if they were traumatic for you. You might have similar experiences to someone else, but be affected differently."More info:
- What is trauma?
- Posttraumatic stress versus PTSD
- Overview of trauma & complex trauma

How about dissociation?Dissociation is a mental process where you disconnect from yourself or your surroundings.Dissociation is often described as a spectrum from mild to severe. On one side are non-disordered experiences like highway hypnosis and daydreaming, while on the other side are more severe experiences like depersonalization and maladaptive daydreaming. According to Dr. Brand (2022), everyone will experience mild, healthy dissociation at times.More severe dissociation, often called trauma-based dissociation, is believed to be a survival mechanism against highly stressful or overwhelming experiences. Repeated or long-lasting trauma can result in chronic dissociation. This is why dissociative disorders are almost always connected to repeated or long-term trauma, especially childhood abuse or neglect.More info:
- What is dissociation?
- FAQs about dissociation
- History of trauma & dissociation

What is DID and why is it trauma-based?
Dissociative identity disorder is widely accepted as a trauma-based and developmental disorder. It is currently classified as a dissociative disorder within the DSM-5 and ICD-11. The DSM-5 describes DID as being "associated with overwhelming experiences, traumatic events, and/or abuse occurring in childhood" (DSM-5, 2013). It's characterized by divisions in the personality, gaps in everyday memory, distress or impairment, and other dissociative symptoms such as depersonalization, derealization, or trance (DSM-5, 2013).The idea that DID is a legitimate trauma-based disorder is supported by a wealth of empirical research and evidence, a few of which you will find below. DID is associated with unique biomarkers and neural activation patterns in the brain, which are similar to but distinct from PTSD (Blihar, et al., 2020). Neuroscience has placed DID on a continuum with PTSD (Lebois, et al., 2022).Furthermore, there are no studies in clinical populations which support the idea of non-trauma DID (Loewenstein, 2018). Multiple studies have shown that people without DID, regardless of fantasy-proneness, cannot create genuine DID or be therapeutically suggested into doing so (Reinders et al, 2012; Reinders & Willemsen, 2014; Reinders et al, 2016). In an evaluation of over 1,500 studies, Dalenberg et al. (2012) concluded that "there is strong empirical support for the hypothesis that trauma causes [severe] dissociation" and little support for the contrary. More info:
- What causes DID? - Carolyn Spring
- What causes DID? - DID Research
- Podcast interview with an expert on dissociation & trauma
- Podcast interview with the past president of the ISSTD

ACADEMIC SOURCES

╰┈➤ Dissociative identity disorder: An empirical overview
This is an overview of empirical data on DID. It concludes that the cause of DID lays in "a complex combination of developmental and cultural factors" including childhood trauma.╰┈➤ A Grounded Theory of Dissociative Identity Disorder
An easy to understand chapter detailing the most modern research on dissociation and dissociative disorders, provided with a theory which grounds DID in the mind, body, and brain.╰┈➤ Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective
This overview of the empirical data on DID concludes that “DID develops when a child is exposed to chaos, coercion, and overt severe physical and/or sexual abuse or, alternatively, to ‘apparently normal’ dissociative families often with subtle neglect, disorganized attachment to caregivers, and misattuned communication styles.”It also concludes that presentations of DID (which might be diagnosed as OSDD-1 or P-DID) can develop from covert childhood trauma, such as dysfunctional family relationships or subtle emotional neglect. (Learn more about emotional neglect here.)╰┈➤ Dissociation debates: everything you know is wrong
Addresses many of the misconceptions about dissociation and DID. Almost no clinical data and research supports the idea that DID is non-trauma.╰┈➤ Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder
Professionals from Harvard College empirically examine 6 myths about DID, including the misconception that it is non-trauma.╰┈➤ Dissociative identity disorder.
Written by the researchers who helped update the DSM-5. They describe DID as “a complex posttraumatic developmental disorder that usually begins before the age of 5–6."╰┈➤ Dissociative Symptoms and Trauma Exposure
The relationship between trauma and dissociation is not as straightforward as we think. There’s multiple factors alongside trauma that can make someone more vulnerable to dissociating. One of the predictors is poor affect regulation. (Learn more about affect regulation here.)╰┈➤ Lifetime axis I and II comorbidity and childhood trauma history in dissociative identity disorder
A sample of 135 people diagnosed with DID. Comorbid disorders and childhood trauma are measured. The results of this study show that DID is correlated with trauma.- 90% reported physical abuse.
- 92.3% reported sexual abuse.
- 96.2% reported physical and/or sexual abuse.
- 76.2% reported 4+ types of sexual abuse.
- 97.2% were currently experiencing a major depressive episode.
- 79.2% were currently experiencing PTSD.╰┈➤ Modeling the connection between self-reported trauma and dissociation in a student sample
A sample of 109 random college students. Their dissociation, childhood trauma, and fantasy-proneness are measured. The results of this study show that dissociation is correlated with trauma.╰┈➤ Prevalence of Dissociative Disorders in Psychiatric Outpatients
A sample of 231 outpatients (predominantly non-white and impoverished). The prevalence of people with dissociative disorders here was actually higher than the prevalence found in inpatient, which the researchers suggest may be due to how a high prevalence of traumatic experiences is commonly reported in impoverished areas. The results of this study show that dissociation is correlated with trauma.╰┈➤ Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients
A sample of 160 inpatients. Their dissociation & childhood trauma are measured. The results of this study show that dissociation is correlated with trauma and dysfunctional/disorganized parent-child relationship.╰┈➤ Disorganized/disoriented attachment in the etiology of the dissociative disorders.
A study showing that dissociative people are more likely to have disorganized/insecure attachment with at least one parental figure than people with other psychiatric conditions.╰┈➤ Disorganized Attachment, Development of Dissociated Self States, and a Relational Approach to Treatment
A breakdown of how disorganized attachment forms a basis for the development of dissociated self states which are seen in BPD and dissociative disorders. Research shows that disorganized attachment predicts dissociation.╰┈➤ Predicting a dissociative disorder from type of childhood maltreatment and abuser-abused relational tie
A study that shows dissociative disorders can be predicted. Childhood emotional neglect from parents or siblings was found to be the biggest predictor of a dissociative disorder. (Learn more about emotional neglect here.)╰┈➤ “I Am Not I”: The Neuroscience of Dissociative Identity Disorder
A summary of history of DID neuroscience & why it took so long for scientists to want to study the brains of people with DID. This is because Sigmund Freud popularized the idea that DID is not caused by trauma. Neuroscience into DID has shown that DID has biomarkers and is related to PTSD.╰┈➤ A systematic review of the neuroanatomy of dissociative identity disorder
A systematic review of all existing neuroanatomical data on DID (at the time of the review).╰┈➤ Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: A PET study and neurobiological model
Neuroanatomical evidence that DID and PTSD are related.╰┈➤ Abnormal hippocampal morphology in dissociative identity disorder and post‐traumatic stress disorder correlates with childhood trauma and dissociative symptoms
A study comparing people with PTSD & people with PTSD-DID, vs controls. Smaller hippocampal volumes and contractions of hippocampal surface is shown to be related to severity of childhood adversity and dissociative symptoms. The people with PTSD-DID had smaller volumes compared to the people with just PTSD. These results "are in line with the clinical observation that DID is related to chronic childhood abuse and neglect."╰┈➤ The traumatized brain: gray and white matter morphology in dissociative identity disorder and Posttraumatic Stress Disorder
Multiple neuroscientific studies on DID. The results support that DID is caused by trauma. "Numerous studies and empirical data including cross-cultural epidemiological studies indicate a trauma-related etiology for DID."╰┈➤ Aiding the diagnosis of dissociative identity disorder: pattern recognition study of brain biomarkers
An algorithm is able to spot the difference between healthy brains and brains with DID with up to 73% accuracy.╰┈➤ Biomarkers of Pathological Dissociation: A Systematic Review╰┈➤ Neurodevelopmental origins of abnormal cortical morphology in dissociative identity disorder╰┈➤ Dissociative identity state-dependent working memory in dissociative identity disorder: a controlled functional magnetic resonance imaging study╰┈➤ Evaluation of the evidence for the trauma and fantasy models of dissociation.
An examination of data on trauma and non-trauma causes of pathological dissociation. The conclusion is that research supports trauma being the cause of dissociation, and does not support otherwise.╰┈➤ Fact or Factitious? A Psychobiological Study of Authentic and Simulated Dissociative Identity States
When people with DID switch between alters, certain neural activation patterns can be seen. This neuroscientific study compares the neural activation patterns between people with genuine DID and people without DID who are simulating alters. The DID simulators are split into two groups based on fantasy proneness. They also passed multiple tests to make sure that they were simulating DID as accurately as possible. The results of the study show that both high & low fantasy-prone people without DID do not show the same brain activity that is characteristic of switching between DID alters.╰┈➤ The Psychobiology of Authentic and Simulated Dissociative Personality States: The Full Monty
Follow up and new data from the previous neuroscientific study. Results from the new tests provide even more support for trauma-based DID and even less support for non-trauma DID.╰┈➤ Is it Trauma- or Fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls
A study done measuring the fantasy proneness and trauma symptoms of four groups: a control group, people with PTSD, people with DID, and people simulating DID. The data finds that the DID group had the most severe presentation of trauma symptoms, and were not any more fantasy prone or suggestible than the other groups. Their conclusion provides great evidence that DID is traumagenic.╰┈➤ DID is trauma based: further evidence supporting the trauma model of DID
A massive analysis of 1,500 studies on both trauma and non-trauma causes of pathological dissociation. The conclusion is that research supports trauma being the cause of dissociation, and does not support otherwise.╰┈➤ Dissociative Identity Disorder and Fantasy Proneness: A Positron Emission Tomography Study of Authentic and Enacted Dissociative Identity States
Another neuroscientific study that takes both high and low fantasy-prone people without DID and attempts to induce alters in them through motivation and suggestion. The results show that the simulators did not show the same neural activation patterns seen in DID alters.

DEBUNKING NON-TRAUMA DID

First off, where does the non-trauma theory originate?
This theory largely originates from Sigmund Freud. Freud could not believe that childhood trauma/abuse was so prevalent, and asserted that DID symptoms were the result of repressed sexual fantasies instead of genuine trauma (Lebois, 2022). For many decades, Freud's non-trauma approach to DID was favored by both society and clinicians. However, after an insurgence in PTSD after the Vietnam War, the clinical field began to take trauma disorders and dissociation more seriously.Non-trauma supporters insisted that DID was the result of false memories of trauma, rather than real memories. In 1992, a man privately accused of sexually abusing his daughter would come up with the term "false memory syndrome" and create the False Memory Syndrome Foundation (FMSF). The FMSF would largely focus on discrediting DID as a legitimate trauma-based disorder, postulating that it was created through suggestibility, social contagion, or therapeutic malpractice. The FMSF would spread internationally, popularizing FMS and Freud's ideas of non-trauma DID, causing massive damage to trauma and memory research and treatment (ISSTD, 2020). In 2019, the FMSF was finally dissolved.Amongst all of this, people who identified with some DID symptoms did not experience it as a disorder and instead proposed that it was a healthy, non-traumagenic phenomenon (Plural Deep Dive, nd). This is what eventually evolved into what people online now call "endogenic plurality." Endogenic plurality is not DID and should not be conflated with it (Endogenic Hub, nd).More info:
- History of DID neuroscience
- History of trauma & dissociation
- History & ethical considerations of plurality & DID
- The rise and fall of FMSF
- Survivors celebrate the end of FMSF
- Controversy regarding the validity of DID
- History of the plurality community & system discourse
- Information about endogenic plurality

ACADEMIC SOURCES

╰┈➤ Dissociation debates: everything you know is wrong
Addresses many of the misconceptions about dissociation and DID. Almost no clinical data and research supports the idea that DID is non-trauma.╰┈➤ Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder
Professionals from Harvard College empirically examine 6 myths about DID, including the misconception that it is non-trauma.╰┈➤ Evaluation of the evidence for the trauma and fantasy models of dissociation.
A massive analysis of 1,500 studies on both trauma and non-trauma causes of pathological dissociation. The conclusion is that research supports trauma being the cause of dissociation, and does not support otherwise.╰┈➤ Fact or Factitious? A Psychobiological Study of Authentic and Simulated Dissociative Identity States
When people with DID switch between alters, certain neural activation patterns can be seen. This neuroscientific study compares the neural activation patterns between people with genuine DID and people without DID who are simulating alters. The DID simulators are split into two groups based on fantasy proneness. They also passed multiple tests to make sure that they were simulating DID as accurately as possible. The results of the study show that both high & low fantasy-prone people without DID do not show the same brain activity that is characteristic of switching between DID alters.╰┈➤ The Psychobiology of Authentic and Simulated Dissociative Personality States: The Full Monty
Follow up and new data from the previous neuroscientific study. Results from the new tests provide even more support for trauma-based DID and even less support for non-trauma DID.╰┈➤ Is it Trauma- or Fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls
A study done measuring the fantasy proneness and trauma symptoms of four groups: a control group, people with PTSD, people with DID, and people simulating DID. The data finds that the DID group had the most severe presentation of trauma symptoms, and were not any more fantasy prone or suggestible than the other groups. Their conclusion provides great evidence that DID is traumagenic.╰┈➤ DID is trauma based: further evidence supporting the trauma model of DID
Regarding the study above this one, this is a response to some criticism they received from non-trauma DID supporters. With further data and analysis, the researchers once again conclude that DID is traumagenic.╰┈➤ The Weakness of the Sociocognitive Model of Dissociative Identity Disorder
A response to non-trauma DID theorists who suggest that DID is induced by therapy, media, or culture.╰┈➤ Dissociative Identity Disorder and Fantasy Proneness: A Positron Emission Tomography Study of Authentic and Enacted Dissociative Identity States
Another neuroscientific study that takes both high and low fantasy-prone people without DID and attempts to induce alters in them through motivation and suggestion. The results show that the simulators did not show the same neural activation patterns seen in DID alters.╰┈➤ The online community: DID and plurality
An examination of the online plurality community. Endogenic plurality does not suggest that DID is non-trauma.

ADDRESSING MISCONCEPTIONS

Why might someone claim to have non-trauma DID?
╰┈➤ People who claim this are usually misinformed. It's difficult to find reliable information on the Internet, and many people are vulnerable to being misled by the things they see online. Someone with genuine DID might claim they have non-trauma DID because they do not remember any adverse childhood experiences or do not believe the experiences they went through "counts" as trauma. Click here to learn more about trauma. Some people may also claim they have non-trauma DID because they do not currently have PTSD. This is due to a misunderstanding about trauma. Having trauma does not mean you have PTSD. Only about 20% of trauma survivors develop PTSD (Sidran Institute, nd). PTSD is usually a short-term disorder, where about half of adults will fully recover within 3 months (DSM-5, 2013). On the other hand, DID is a long-term, trauma-based disorder that may or may not involve symptoms of PTSD (DSM-5, 2013).What should I do if someone claims to have non-trauma DID?
╰┈➤ Please do NOT attack them or call them fake. If they are a stranger, you don't know anything about their mental health issues. Please ignore them. If it's someone you care about, try to be understanding. If you feel it's right, you might want to gently show them accurate information about DID just in case they've been misinformed. If they are not already receiving professional help, encourage them to seek help if they are struggling with their mental health. Click here for resources.DID is a 'dissociative' disorder in diagnostic manuals, not a trauma-based disorder!
╰┈➤ 'Trauma-based' is not a diagnostic classification. I call DID trauma-based in reference to how the disorder is conceptualized & treated, not what chapter title it got stuck under in the DSM-5. Disorders are grouped together into different chapters in the diagnostic manuals based off of their core feature. DID's core feature is dissociation, which is why it is grouped together with other disorders that share this. Please don't get too caught up in how diagnostic manuals divide up disorders. According to the DSM-5 (2013), "the classification of disorders (the way in which disorders are grouped, which provides a high-level organization for the manual) has not generally been thought of as scientifically significant, despite the fact that judgments had to be made when disorders were initially divided into chapters. . ."How is DID trauma-based if trauma isn't in the diagnostic criteria?
╰┈➤ The only diagnostic manual with criterion is the DSM-5, which is primarily used in America. Criterion do not reflect what causes the disorder, but rather what the core symptoms are. It's a good thing that trauma is not included in DID's criteria because the core symptoms of DID involve forgetting and disconnecting from trauma. Despite this, the DSM-5 (2013) still acknowledges that the development of DID "is associated with overwhelming experiences, traumatic events, and/or abuse occurring in childhood."The DSM says 'associated' not always!
╰┈➤ The DSM also says that mental disorders are "usually associated" with distress or impairment. Are you going to make the reach that mental disorders aren't disorders anymore?

But this other out-of-context part of the DSM says...
╰┈➤ The DSM-5 is for professionals who have an extensive education and training in understanding, diagnosing, and treating mental disorders. It's not your Mental Disorders 101 textbook.How can DID be trauma-based if it can manifest at any age?
╰┈➤ While DID is connected to childhood trauma, the symptoms of the disorder usually do not become fully apparent until adulthood (Spring, 2012). Since dissociation is a survival mechanism, the person might not be negatively impacted by their symptoms until later in life, when the original danger no longer exists (ISSTD, nd). Another reason why DID may not become fully apparent until adulthood is because dissociative parts are not as developed or distinct in children with DID (Reuben, nd). Please also remember that a core symptom of DID is forgetting everyday events and trauma (DSM-5, 2013).Can non-trauma factors play a role in causing DID?
╰┈➤ Yes. Being trauma-based does not mean trauma is the only thing that caused the DID. Alongside adverse experiences, non-trauma factors (such as culture, genetics, etc.) actually play a very complex role in DID's development and presentation (Şar, et al., 2017). It's just that these factors alone are not known to cause DID.Does "endogenic plurality" count as non-trauma DID?
╰┈➤ No. Endogenic plurals are people who experience themselves as being more than one person in a spiritual or psychological sense. The vast majority of them do not view this experience as a mental disorder (Endogenic Hub, nd).Is it possible for an endogenic plural to get diagnosed with DID?
╰┈➤ Theoretically, yes. Very, very rarely, a genuine endogenic plural might fit the criteria and even get diagnosed with DID. A documented example of this involves a practitioner of non-pathological spirit possession who technically fit the DID criteria despite not having it. This was because the DSM-5 fails to acknowledge the complexities of endogenic plurality (Delmonte et al., 2016). So, while it may happen very rarily, such cases are probably best seen as an outlier or a misdiagnosis due to the lack of awareness and research on plurality. Endogenic plurals can still have mental health issues and struggles with their plurality. However, professionals who are aware of plurality believe that endogenic plurals are excluded from the DID diagnosis (Delmonte et al., 2016; Christensen, 2022).