Child Abuse in the Etiology of Dissociative Disorders

Abstract

A growing body of literature, both case reports and surveys, links dissociative symptoms and disorders to childhood experiences of severe abuse. Several surveys (Bliss, 1980, 1984; Braun & Sachs, 1985; Kluft, 1984a; Putnam, Gurof, Silberman, Barbar, & Post, 1986) report that 97% of patients with multiple personality disorder (MPD; also known as dissociative identity disorder, or DID, since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSMIV; American Psychiatric Association, 1994]) report some history of abuse during childhood. Since the early 1980s, the hypothesis that this high frequency of prior abuse is somehow intrinsically related to the development of dissociative symptoms has become central to theory and research in the field. The present chapter analyzes in detail this proposed etiologic association between childhood abuse and MPD. We review case histories and case surveys in which adults and children describe sadistically assaultive and soul-murdering childhood environments and the depersonalization phenomena and fantasy absorption that took place during moments when this environment became overwhelming. We examine the problem of corroborating histories of child abuse, which remains a major objection to the hypothesis. We also review similarities between dissociative disorder patients and other child abuse survivors. Similarities in family characteristics, victim symptoms, and community response indicate that dissociative disorder patients may represent some of the more severely abused and severely symptomatic of a continuum of survivors of child abuse (Braun, 1990). Both abuse and dissociation were denied by professionals in the first half of the twentieth century, probably as part of the same historical process (Goodwin, 1985b). Comprehensive biopsychosocial understanding of these disorders requires integration of the child abuse hypothesis with data about genetics, physiology, psychology, comorbidity, and natural history, including treatment responses in patients who dissociate.