Clarifying the Etiology of the Dissociative Disorders

Abstract

Dissociative identity disorder patients have two important features: (1) high hypnotizability, and (2) a history of trauma. The trauma model of the dissociative disorders acknowledges only one of these features – trauma. That is probably why the overall weighted correlation between trauma and dissociation is surprisingly weak: 0.32. A correlation of this size indicates that trauma cannot be the sole determinant – or even the primary determinant – of dissociation. The thesis of this chapter is that, in the absence of high hypnotizability, no amount of trauma can generate a dissociative disorder. There are two kinds of dissociation-like phenomena: (1) breakdown phenomena (i.e., depersonalization, derealization) that are caused by temporary disruptions of one’s normal biological-perceptual-neurocognitive frame of reference; and (2) high-hypnotizability-enabled, dissociative defenses against pain and misery. Breakdown phenomena cannot make a dissociative disorder. Only highly hypnotizable individuals have the ability to block pain, block memory, ‘go away,’ ‘go up to the ceiling and watch the little girl down there,’ make alters, switch, and so on. These phenomena are ‘hypnotic’ feats, not breakdown phenomena. Trauma models – including the theory of structural dissociation – need to incorporate high hypnotizability into their account of the etiology of the dissociative disorders.