What personality disorders are caused by childhood trauma?

Dissociative Identity Disorder (Multiple Personality Disorder)

Dissociative identity disorder (previously known as multiple personality disorder) is thought to be a complex psychological condition that is likely caused by many factors, including severe trauma during early childhood (usually extreme, repetitive physical, sexual, or emotional abuse).

What Is Dissociative Identity Disorder?

Dissociative identity disorder is a severe form of dissociation, a mental process which produces a lack of connection in a person’s thoughts, memories, feelings, actions, or sense of identity. Dissociative identity disorder is thought to stem from a combination of factors that may include trauma experienced by the person with the disorder. The dissociative aspect is thought to be a coping mechanism — the person literally shuts off or dissociates themselves from a situation or experience that’s too violent, traumatic, or painful to assimilate with their conscious self.

Who Is At Risk for DID?

Research indicates that the cause of DID is likely a psychological response to interpersonal and environmental stresses, particularly during early childhood years when emotional neglect or abuse may interfere with personality development. As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances or traumas at a sensitive developmental stage of childhood (usually before age 6).

Dissociation may also happen when there has been persistent neglect or emotional abuse, even when there has been no overt physical or sexual abuse. Findings show that in families where parents are frightening and unpredictable, the children may become dissociative. Studies indicate DID affects about 1% of the population.

How to Recognize Dissociative Identity Disorder and Its Associated Mental Disorders

Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person’s behavior. With dissociative identity disorder, there’s also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness. With dissociative identity disorder, there are also highly distinct memory variations, which may fluctuate.

Although not everyone experiences DID the same way, for some the «alters» or different identities have their own age, sex, or race. Each has their own postures, gestures, and distinct way of talking. Sometimes the alters are imaginary people; sometimes they are animals. As each personality reveals itself and controls the individuals’ behavior and thoughts, it’s called «switching.» Switching can take seconds to minutes to days. Some seek treatment with hypnosis where the person’s different «alters» or identities may be very responsive to the therapist’s requests.

Other symptoms of dissociative identity disorder may include headache, amnesia, time loss, trances, and «out of body experiences.» Some people with dissociative disorders have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed). As an example, someone with dissociative identity disorder may find themselves doing things they wouldn’t normally do, such as speeding, reckless driving, or stealing money from their employer or friend, yet they feel they are being compelled to do it. Some describe this feeling as being a passenger in their body rather than the driver. In other words, they truly believe they have no choice.

There are several main ways in which the psychological processes of dissociative identity disorder change the way a person experiences living, including the following:

• Depersonalization. This is a sense of being detached from one’s body and is often referred to as an «out-of-body» experience.
• Derealization. This is the feeling that the world is not real or looking foggy or far away.
• Amnesia. This is the failure to recall significant personal information that is so extensive it cannot be blamed on ordinary forgetfulness. There can also be micro-amnesias where the discussion engaged in is not remembered, or the content of a meaningful conversation is forgotten from one second to the next.
• Identity confusion or identity alteration. Both of these involve a sense of confusion about who a person is. An example of identity confusion is when a person has trouble defining the things that interest them in life, or their political or religious or social viewpoints, or their sexual orientation, or their professional ambitions. In addition to these apparent alterations, the person may experience distortions in time, place, and situation.

It is now acknowledged that these dissociated states are not fully mature personalities, but rather they represent a disjointed sense of identity. With the amnesia typically associated with dissociative identity disorder, different identity states remember different aspects of autobiographical information. There is usually a «host» personality within the individual, who identifies with the person’s real name. Ironically, the host personality is usually unaware of the presence of other personalities.

How Is Dissociative Identity Disorder Diagnosed?

Making the diagnosis of dissociative identity disorder takes time. It’s estimated that individuals with dissociative disorders have spent seven years in the mental health system prior to accurate diagnosis. This is common, because the list of symptoms that cause a person with a dissociative disorder to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who have dissociative disorders also have coexisting diagnoses of borderline or other personality disorders, depression, and anxiety.

The DSM-5 provides the following criteria to diagnose dissociative identity disorder:

1. Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
2. Amnesia must occur, defined as gaps in the recall of everyday events, important personal information, and/or traumatic events.
3. The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
4. The disturbance is not part of normal cultural or religious practices.
5. The symptoms cannot be due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).

The distinct personalities may serve diverse roles in helping the individual cope with life’s dilemmas. For instance, there’s an average of two to four personalities present when the patient is initially diagnosed. Then there’s an average of 13 to 15 personalities that can become known over the course of treatment. Environmental triggers or life events cause a sudden shift from one alter or personality to another.

What Other Psychiatric Illnesses Might Occur With DID?

Along with the dissociation and multiple or split personalities, people with dissociative disorders may experience a number of other psychiatric problems, including symptoms:

• Depression
• Mood swings
• Suicidal tendencies
• Sleep disorders (insomnia, night terrors, and sleep walking)
• Anxiety, panic attacks, and phobias (flashbacks, reactions to stimuli or «triggers»)
• Alcohol and drug abuse
• Compulsions and rituals
• Psychotic-like symptoms (including auditory and visual hallucinations)
• Eating disorders

Are There Famous People With Dissociative Identity Disorder?

Famous people with dissociative identity disorder include comedienne Roseanne Barr, Adam Duritz, and retired NFL star Herschel Walker.

Walker wrote a book about his struggles with DID, along with his suicide attempts, explaining he had a feeling of disconnect from childhood to the professional leagues. To cope, he developed a tough personality that didn’t feel loneliness, one that was fearless and wanted to act out the anger he always suppressed. These «alters» could withstand the abuse he felt; other alters came to help him rise to national fame. Treatment helped Walker realize that these alternate personalities are part of dissociative identity disorder, which he was diagnosed with in adulthood.

What’s the Treatment Plan for Dissociative Identity Disorder?

There are currently no formal, evidence-based guldelines to treat DID. Many treatments are based on case reports or are even controversial.

While there’s also no «cure» for dissociative identity disorder, long-term treatment can be helpful, if the patient stays committed. Effective treatment includes:

• Psychotherapy: Also called talk therapy, the therapy is designed to work through whatever triggered and triggers the DID. The goal is to help “fuse” the separate personality traits into one consolidated personality that can control the triggers. This therapy often includes family members in the therapy.
• Hypnotherapy. Used in conjunction with psychotherapy, clinical hypnosis can be used to help access repressed memories, control some of the problematic behaviors which accompany DID as well as help integrate the personalities into one.
• Adjunctive therapy. Therapies such as art or movement therapy have been shown to help people connect with parts of their mind that they have shut off to cope with trauma.

There are no established medication treatments for dissociative identity disorder, making psychologically-based approaches the mainstay of therapy. Treatment of co-occurring disorders, such as depression or substance use disorders, is fundamental to overall improvement. Because the symptoms of dissociative disorders often occur with other disorders, such as anxiety and depression, medicines to treat those co-occurring problems, if present, are sometimes used in addition to psychotherapy.

Show Sources

National Alliance on Mental Illness: «Dissociative Identity Disorder.»

Mayo Clinic: «Dissociative disorders.»

Could Emotional Trauma Be the Cause of Personality Disorders

Personality disorders affect 9.1% of the American population, but the general public often has distorted ideas and harmful misconceptions about them.

When most people hear “personality disorder,” they think of narcissists, psychopaths, and “split personality disorder” (dissociative identity disorder).

In reality, there is a large range of variation between the expression, severity, and diversity of people who live with one of the 10 recognized personality disorders.

Before looking at the causes of a personality disorder, it is important to define a personality disorder.

Understanding the clinical perspective can drastically alter the way a person perceives themself or someone they care about.

What is a personality disorder?

Mental health professionals and doctors recognize 10 personality disorders:

• Antisocial personality disorder
• Avoidant personality disorder
• Borderline personality disorder
• Dependent personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder
• Obsessive-compulsive personality disorder
• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder

Each of these disorders has its own range of symptoms, which can range from mild to severe. What these disorders all have in common is the fact they impact four major aspects of a person’s life:

• How they think about themselves and other people
• The way they experience emotions and respond to others
• How they perceive and relate to others
• How they interpret, regulate, and control their own behaviors

A diagnosable personality disorder affects at least two of these areas in a person’s life. Looking closer, you will find that the exact experiences and symptoms vary by individual and disorder.

It is crucial for people to understand that people with the same personality disorder are still unique. They may share common symptoms, emotional responses, and behaviors, but their diagnosis does not define their entire identity.

An important part of improving mental health worldwide is understanding that even severe personality disorders do not make someone broken.

People can suffer immensely, but with the right treatment and a willingness to try, they can also heal.

Are personality disorders curable?

The answer to this question is difficult as symptoms may be managed, but a personality disorder could last a lifetime.

In reality, someone may always live with some symptoms linked to their disorder. However, they can learn to recognize these symptoms, manage them, and thrive.

There is always hope for someone who is willing to reach out and seek treatment.

Rather than see personality disorders as something a person needs to rid themself of, it’s better to accept them as a part of their lived experience.

Through a combination of medication and behavioral therapy, many people go on to recover from personality disorders and live wonderful, happy lives.

Currently, only 42.2% of people with a personality disorder receive treatment. This can range from hospitalization to routine psychotherapy.

Ultimately, reaching out is the best way for a person to receive the care and personalized treatment they both need and deserve.

The Role of Emotional Trauma in Personality Disorders

Researchers have found a strong connection between childhood trauma and personality disorders.

There are many long-term effects of childhood trauma, including a higher risk of developing a borderline personality disorder.

Emotional trauma affects people of all ages, but trauma sustained in childhood tends to have the biggest influence on the development of personality disorders.

In other words, it is unlikely someone will develop a personality disorder as a result of trauma in adulthood.

Instead, their symptoms may arise in their teens or 20s, but they likely stem from events that happened farther in the past.

Sexual abuse was found to have the highest impact on personality disorder development, but verbal abuse and neglect are also noteworthy factors.

Childhood emotional trauma can lead to significant emotional, cognitive, behavioral, and social challenges.

According to the National Child Traumatic Stress Network, children who grow up without a safe, secure, and stable environment go on to develop other means of coping with their lives.

In many cases, the adaptive behaviors a child develops go on to alter their thinking and emotional regulation. This can lay the framework for what later morphs into a personality disorder.

Trauma victims have a tendency to internalize their suffering. They take others’ actions as a reflection of their worth.

As a result, they tend to blame themselves for mistreatment. For some people, this can lead to withdrawal and extremely negative thinking.

Others may become highly self-conscious and go to great lengths to receive attention, approval, and validation.

In borderline personality disorder, people experience a deep-rooted fear of being abandoned, and their sense of identity is often turbulent.

They struggle to maintain healthy relationships because they find it extremely difficult to trust anyone.

This could result from feeling neglected as a child. Without forming a safe, secure attachment and having their identity affirmed, the child who felt ignored, abandoned, and unworthy of love may go on to develop symptoms of borderline personality disorder.

Children whose parents were extremely neglectful may not develop the ability to accurately experience, process, and interpret their emotions or emotions in others.

Their responding cold, distant, and emotionally detached nature goes on to reflect symptoms of schizoid personality disorder.

Does trauma increase a person’s risk for developing a personality disorder?

There is no definitive cause of personality disorders, but trauma does play a significant risk factor.

Research recently revealed that victims of childhood trauma are 13 times more likely to develop borderline personality disorder as adults.

When examining the role of trauma in personality disorders, it’s important to identify the effects of trauma on each individual.

Many people who suffer from Post-Traumatic Stress Disorder (PTSD) are often described as someone different from who they were before their disorder. However, they do not have a personality disorder.

What’s notable is that PTSD patients exhibit the expression of trauma in a way that may shed light on personality disorders as well.

In PTSD, adults who live through traumatic experiences often struggle with intrusive thoughts, high levels of anxiety, and difficulty controlling their emotional responses.

They may go on to hold beliefs about themselves or others shaped by their trauma. These trauma-based beliefs then go on to reinforce trauma-driven emotions, such as anxiety and anger.

In patients with personality disorders, the expression of trauma is less obvious. This can be due to the fact their trauma was more enduring, i.e. it happened over a period of time rather than a one-time event.

It can also reflect the time their trauma took place. Childhood trauma survivors often have to adapt in unhealthy ways to survive in an unsupportive environment.

If their parents or caregivers were neglectful, they may have had to “fill in the blank” with their own inflated ego, or they may have gone on to develop a deep need for others’ approval.

Over time, their unmet needs as children went on to become core beliefs about themselves and the world.

These beliefs then affect how they experience emotions, connect to others, and perceive their external environment.

For example, the attention-seeking behaviors neglected children exhibit can go on to become histrionic personality disorder if they are not addressed.

Additionally, studies show that narcissism can emerge as a coping mechanism for trauma and other negative early life experiences.

The behaviors common among personality disorders may have developed as a way to survive, but they only go on to hinder someone’s happiness, support, and connection in adulthood.

How do you treat a personality disorder?

Psychotherapy can be highly effective in treating personality disorders. In fact, behavioral therapy is the most effective form of treatment for personality disorders.

Contrary to popular belief, all disorders can respond to treatment. What matters most is the therapist’s experience, the type of therapy, and the patient’s willingness to participate in their treatment.

Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two of the most supported and evidence-based models for treating personality disorders.

However, personalized treatment plans that draw from different models may be most beneficial for someone living with a personality disorder.

Many people with personality disorders have struggled to ever feel validated, approved of, and genuinely heard and respected in their lives.

They deserve therapy that helps them move beyond unhelpful beliefs about themselves and others, so they can learn to relate to, experience, and enjoy life more fully.

Both outpatient and residential treatment programs can help someone with a personality disorder.

Choosing the right model for you might be best done with the help of your doctor or a psychologist.

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What personality disorders are caused by childhood trauma?

Borderline personality disorder is characterized by particular patterns of behavior, including instability of affect, interpersonal relationships, impulse control and self-image. This results in impairments in self-management and the achievement of goals, as well as deficits in social interactions.

Approximately 15-20 percent of clinical patients have BPD, 10 percent of outpatients, and 2 percent of the general population. Due to the high prevalence of the disorder and the sociocultural factors associated with it, many theories have been suggested to explain the possible causes of BPD.

Trauma in childhood can cause devastating psychological issues later in life. Interpersonal challenges and psychiatric disorders both can result from trauma. Major depression, panic disorder, substance abuse, post-traumatic stress disorder and eating disorders are all common outcomes associated with trauma during childhood.

Trauma can be caused by family violence, such as emotional or physical abuse, disease and the experience of war. Personality disorders such as borderline, avoidant, paranoid, antisocial and schizotypal may also be outcomes of trauma. Because of the severe consequences of childhood trauma, it is sometimes called “soul murder.”

Parental rejection or verbal assaults, devaluation and being ignored all impact a child’s identity. Parental maltreatment can also influence the development of a secure attachment. Attachment avoidance and attachment anxiety both may be the result of childhood maltreatment. Fearful attachment styles are characterized by a desire for intimacy combined with a fear of hurt and rejection. Someone with an unresolved or preoccupied attachment style may want an intimate relationship but has a tendency to view their partner as dependent.

Studies have demonstrated that people diagnosed with BPD have a high prevalence of childhood sexual abuse. In addition, childhood sexual abuse is associated with attachment avoidance. Some estimate a 75 percent rate of childhood sexual abuse in BPD patients. Furthermore, childhood sexual abuse was found to distinguish BPD patients from depressed, non-BPD adolescents.

Due to these factors, researchers believe that childhood sexual abuse may be an etiological factor for the development of borderline personality. In some studies, sexual abuse predicted BPD symptoms better than family environment, although instability in the family environment was a partial mediator.

Childhood sexual abuse is not the only form of maltreatment that has been linked with BPD. Physical abuse, emotional abuse and neglect are all associated with the development of the disorder. In some studies, the rates of maltreatment were as high as 90 percent in BPD patients.

Because severe dissociation is included in the diagnostic criteria for BPD, some researchers believe that it may also be related to the emotional neglect experienced by so many of those suffering with BPD. Dissociation is a state in which one becomes removed from reality. This may take the form of daydreaming, running on auto-pilot or a general disconnection from actions. One study found four risk factors for dissociation: inconsistent treatment by a caretaker, sexual abuse, witnessing sexual violence as a child and adult rape history.

Dissociation and BPD may both share the etiological factor of childhood trauma. This means that, for some, the disorder is a defense mechanism against the childhood trauma. Its purpose is to prevent dangerous information from entering consciousness. Researchers also posit that the degree of betrayal that is linked with the childhood trauma may influence subsequent memory encoding and accessibility.

Memory and dissociation in BPD are now topics of intense focus for researchers. One study required patients with the disorder to take the Autobiographical Memory Test. During this test, participants recall specific events in their lives when given negative, positive or neutral word prompts. Those with BPD remembered far more general events and had more non-responses than the control group. In addition, the BPD patients responded to negative cues with significantly more general memories. The researchers found a correlation between the amount of general memories and the severity of dissociation in the patients with borderline personality.

Additionally, those with BPD believe less in the benevolence of others and the world in general compared to patients with other personality disorders. More women than men report high-betrayal trauma, which may serve to explain why more women, approximately 75 percent, are diagnosed with BPD.

Some researchers note that this gender difference may also be related to power. Those in a less powerful position may view and respond to betrayal violations more intensely than those with more power in a situation. Others point to the “just world” construct, which is the belief that the world is just, and thus people are rewarded or punished based on their actions. Men, in particular European Americans and older Americans, tend to have higher just world beliefs than women, younger generations and African-Americans. This belief gives one a sense of invulnerability, which is altered after trauma. Gender aside, it is clear that betrayal traumas are strongly associated with BPD.

Because trauma is frequently associated with posttraumatic stress disorder (PTSD), this condition has been examined in relationship with BPD. Studies have demonstrated size reductions of the left amygdala and hippocampus that vary with the severity of PTSD. A recent study found both amygdala and hippocampus size reduction in patients with both BPD and PTSD. Interestingly, further research verified that a 12 percent hippocampus size reduction was present in those with BPD and PTSD, whereas an 11 percent reduction was found in those just with BPD.

Studies have found 10-20 percent hippocampus size reduction in individuals with BPD compared to control groups without the disorder. What this means is that trauma-exposed individuals with BPD, who do not have PTSD, still demonstrate size differences in this region of the brain. A 22 percent amygdala size reduction has been found in patients with BPD as well. Severity of traumatic exposure and severity of hippocampus size reduction have also been found to be related. What is evidenced by the current data is that BPD has a negative effect on the brains of those suffering with the disorder.