Trauma FAQ

  • Trauma refers to the emotional and physiological impact of experiences that overwhelm a person’s ability to cope, integrate, or feel safe. What makes an experience traumatic is not only what happened, but how it was experienced—particularly whether it disrupted a person’s sense of safety, agency, or trust in the world.

    Some experiences are widely recognized as potentially traumatic because they involve threat, violation, or profound loss. These commonly include experiences such as:

    • Physical abuse

    • Sexual abuse

    • Emotional abuse

    • Physical neglect

    • Emotional neglect

    • Growing up with a caregiver struggling with mental illness

    • Exposure to substance misuse in the household

    • Domestic violence or witnessing harm to a caregiver

    • Parental separation or divorce

    • Incarceration of a close family member

    These experiences often occur in childhood, when the nervous system and sense of self are still forming, but trauma can happen at any point in life.

    More broadly, trauma can arise from any situation that is sudden, unpredictable, or deeply destabilizing—especially when it involves threat to life, bodily integrity, psychological safety, or relational security. Events such as serious accidents, medical emergencies, physical or sexual assault, military combat, natural disasters, or the unexpected loss of a loved one are common examples. What unites these experiences is not their category, but their impact: a sense that something fundamental has been broken, and that safety can no longer be assumed.

    Importantly, trauma does not require a single dramatic event. Ongoing experiences—such as chronic criticism, emotional unavailability, repeated ruptures in care, or persistent exposure to stress without adequate support—can also have a profound and lasting effect. When experiences accumulate without sufficient protection, repair, or meaning-making, they can shape how a person relates to themselves, others, and the world.

    How trauma affects someone varies widely. Two people may live through similar circumstances and emerge with very different outcomes. Factors such as prior experiences, attachment history, belief systems, cultural context, nervous system sensitivity, available support, and the ability to process what happened all influence whether and how trauma-related symptoms develop.

    At its core, trauma is less about the event itself and more about what happens inside a person when their capacity to cope is exceeded—especially when they must face overwhelming experiences alone. Healing, therefore, is not about comparing experiences or measuring severity, but about restoring safety, integration, and a renewed sense of agency and connection.

  • Acute trauma reflects intense distress in the immediate aftermath of a one-time event and the reaction is of short duration. Common examples include a car crash, physical or sexual assault, or the sudden death of a loved one. EMDR is particularly helpful for acute trauma.

    Chronic trauma can arise from harmful events that are repeated or prolonged. It can develop in response to persistent bullying, emotional or physical neglect, abuse (emotional, physical, or sexual), and domestic violence.

    Complex trauma can arise from experiencing repeated or multiple traumatic events from which there is no possibility of escape. The sense of being trapped is a feature of the experience. These traumas are often experienced relationships.

    Like other types of trauma, it can undermine a sense of safety in the world and beget hypervigilance, constant (and exhausting!) monitoring of the environment for the possibility of threat.

    Insidious trauma refers to the daily incidents of marginalization, objectification, dehumanization, intimidation, et cetera that are experienced by members of groups targeted by racism, heterosexism, ageism, ableism, sexism, and other forms of oppression, and groups impacted by poverty.

    Secondary or vicarious trauma arises from exposure to other people’s suffering and can strike those in professions that are called on to respond to injury and mayhem, notably physicians, first responders, and law enforcement. Over time, such individuals are at risk for compassion fatigue, whereby they avoid investing emotionally in other people in an attempt to protect themselves from experiencing distress.

  • Dissociative disorders or Dissociative adaptation are adaptive conditions that involve experiencing a loss of connection between thoughts, memories, feelings, surroundings, behavior and identity. They involve disruptions or breakdowns of memory, awareness, identity, or perception. These adaptive conditions are associated with Complex Trauma and include escape from reality. Managing everyday life can feel harder.

    In the context of severe chronic abuse, the reliance on disassociation is adaptive, as it succeeds in reducing unbearable distress, and warding off the threat of extreme psychological overwhelm that is further damaging to the person’s sense of self and well-being.

  • Research tends to show that dissociation stems from a combination of environmental and biological factors. The likelihood that a tendency to dissociate is inherited genetically is estimated to be zero (Simeon et al., 2001).

    Most commonly, repetitive childhood physical and/or sexual abuse and other forms of trauma are associated with the development of dissociative disorders (e.g., Putnam, 1985). In the context of chronic, severe childhood trauma, dissociation can be considered adaptive because it reduces the overwhelming distress created by trauma. However, if dissociation continues to be used in adulthood, when the original danger no longer exists, it can be maladaptive. The dissociative adult may automatically disconnect from situations that are perceived as dangerous or threatening, without taking time to determine whether there is any real danger. This leaves the person “spaced out” in many situations in ordinary life, and unable to protect themselves in conditions of real danger.

    Dissociation may also occur when there has been severe neglect or emotional abuse, even when there has been no overt physical or sexual abuse (Anderson & Alexander, 1996; West, Adam, Spreng, & Rose, 2001). Children may also become dissociative in families in which the parents are frightening, unpredictable, are dissociative themselves, or make highly contradictory communications (Blizard, 2001; Liotti, 1992, 1999a, b).

    The development of dissociative disorders in adulthood appears to be related to the intensity of dissociation during the actual traumatic event(s); severe dissociation during the traumatic experience increases the likelihood of generalization of such mechanisms following the event(s). The experience of ongoing trauma in childhood significantly increases the likelihood of developing dissociative disorders in adulthood (International Society for the Study of Dissociation, 2002; Kisiel & Lyons, 2001; Martinez-Taboas & Guillermo, 2000; Nash, Hulsey, Sexton, Harralson & Lambert, 1993; Siegel, 2003; Simeon et al., 2001; Simeon, Guralnik, & Schmeidler, 2001; Spiegel & Cardeña, 1991).

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  • Amnesia refers to the inability to recall important personal information that is so extensive that it is not due to ordinary forgetfulness. Most of the amnesias typical of dissociative disorders are not of the classic fugue variety, where people travel long distances, and suddenly become alert, disoriented as to where they are and how they got there.

    Rather, the amnesias are often an important event that is forgotten, such as abuse, a troubling incident, or a block of time, from minutes to years. More typically, there are micro-amnesias where the discussion engaged in is not remembered, or the content of a conversation is forgotten from one moment to the next. Some people report that these kinds of experiences often leave them scrambling to figure out what was being discussed. Meanwhile, they try not to let the person with whom they are talking realize they haven’t a clue as to what was just said (Maldonado et al., 2002; Steinberg et al., 1993; Steinberg, 1995)

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  • There are four main categories of dissociative disorders as defined in the DSM-5. The four dissociative disorders are: Dissociative Amnesia, Dissociative Fugue, Dissociative Identity Disorder, and Depersonalization Disorder (American Psychiatric Association, 2000; Frey, 2001; Spiegel & Cardeña, 1991).

    DISSOCIATIVE AMNESIA is characterized by an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness. The amnesia must be too extensive to be characterized as typical forgetfulness and cannot be due to an organic disorder or DID (American Psychiatric Association, 2000; Frey, 2001; Maldonado et al., 2002; Spiegel & Cardeña, 1991; Steinberg et al., 1993).

    DISSOCIATIVE FUGUE is characterized by a sudden, unexpected travel away from home or one’s customary place of work, accompanied by an inability to recall one’s past and confusion about personal identity or the assumption of a new identity. Individual’s suffering from Dissociative Fugue appear “normal” to others. They are generally unaware of their memory loss/amnesia (American Psychiatric Association, 2000; Frey, 2001; Maldonado et al., 2002; Spiegel & Cardeña, 1991; Steinberg et al., 1993).

    DEPERSONALIZATION DISORDER is characterized by a persistent or recurrent feeling of being detached from one’s own mental processes or body. Individuals suffering from Depersonalization Disorder relate feeling as if they are watching their lives from outside of their bodies, similar to watching a movie (American Psychiatric Association, 2000; Frey, 2001; Guralnik, Schmeidler, & Simeon, 2000; Maldonado et al., 2002; Simeon et al., 2001; Spiegel & Cardeña, 1991). Individuals with Depersonalization Disorder often report problems with concentration, memory and perception (Guralnik et al., 2001). The depersonalization must occur independently of DID, substance abuse disorders and Schizophrenia (Steinberg et al., 1993).

    DISSOCIATIVE IDENTITY DISORDER (previously known as Multiple Personality Disorder) is the most severe and chronic manifestation of dissociation, characterized by the presence of two or more distinct identities or personality states that recurrently take control of the individual’s behavior, accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. It is now recognized that these dissociated states are not fully-formed personalities, but rather represent a fragmented sense of identity. The amnesia typically associated with Dissociative Identity Disorder is asymmetrical, with different identity states remembering different aspects of autobiographical information. There is usually a host personality who identifies with the client’s real name. Typically, the host personality is not aware of the presence of other alters (American Psychiatric Association, 2000; Fine, 1999; Frey, 2001; Kluft, 1999; Kluft, Steinberg & Spitzer, 1988; Maldonado et al., 2002; Spiegel & Cardeña, 1991; Steinberg et al., 1993). The different personalities may serve distinct roles in coping with problem areas. An average of 2 to 4 personalities/alters are present at diagnosis, with an average of 13 to 15 personalities emerging over the course of treatment (Coons, Bowman & Milstein, 1988; Maldonado et al., 2002). Environmental events usually trigger a sudden shifting from one personality to another (Maldonado et al., 2002).

    DISSOCIATIVE DISORDER NOT OTHERWISE SPECIFIED (DDNOS): DDNOS includes dissociative presentations that do not meet the full criteria for any other dissociative disorder (American Psychiatric Association, 2000; Steinberg et al., 1993). In clinical practice, this appears to be the most commonly presented dissociative disorder, and may often be better characterized by Major Dissociative Disorder with partially dissociated self states (Dell, 2001).

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  • Identity confusion is a sense of confusion about who a person is. An example of identity confusion is when a person sometimes feels a thrill while engaged in an activity (e.g., reckless driving, drug use) which at other times would be repugnant. Identity alteration is the sense of being markedly different from another part of oneself. This can be unnerving to clinicians. A person may shift into an alternate personality, become confused, and demand of the clinician, “Who the dickens are you, and what am I doing here?” In addition to these observable changes, the person may experience distortions in time, place, and situation. For example, in the course of an initial discovery of the experience of identity alteration, a person might incorrectly believe they were five years old, in their childhood home and not the therapist’s office, and expecting a deceased person whom they fear to appear at any moment (e.g., Fine, 1999; Maldonado et al., 2002; Spiegel & Cardeña, 1991; Steinberg, 1995).

    More frequently, subtler forms of identity alteration can be observed when a person uses different voice tones, range of language, or facial expressions. These may be associated with a change in the patient’s world view. For example, during a discussion about fear, a client may initially feel young, vulnerable, and frightened, followed by a sudden shift to feeling hostile and callous. The person may express confusion about their feelings and perceptions, or may have difficulty remembering what they have just said, even though they do not claim to be a different person or have a different name. The patient may be able to confirm the experience of identity alteration, but often the part of the self that presents for therapy is not aware of the existence of dissociated self-states. If identity alteration is suspected, it may be confirmed by observation of amnesia for behavior and distinct changes in affect, speech patterns, demeanor and body language, and relationship to the therapist. The therapist can gently help the patient become aware of these changes (e.g., Fine, 1999; Maldonado et al., 2002; Spiegel & Cardeña, 1991; Steinberg, 1995).

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  • When a person is asking whether or not they have DID, that is a question that is worthy of consultation. Some people are relieved to find that there is a diagnosis and an understandable model for their experiences. Some dissociative experiences may provoke considerable anxiety and bafflement, and it is important to be able to find an organizing concept that makes these experiences understandable.

    The bottom line in all this is that it is our strong recommendation that this question (How do I know if I have DID?) be asked in the context of an ongoing psychotherapy. If you are in a psychotherapy, ask your therapist what they think. Ask them if they have enough experience with DID to feel comfortable in making the diagnosis. If they dont, ask them to get a consultation for you and for them.

    There are a number of diagnostic tests, such as the Structured Clinical Interview for Dissociative Disorders (SCID-D), the Multidimensional Inventory of Dissociation (MID), and the Dissociative Disorders Interview Scale (DDIS), that are available and can be administered by a trained clinician.

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