In psychiatry, practitioners are often fixated on the DSM diagnostic classifications when working with patients – even as they often fail to consider trauma as an important precipitating and predisposing etiological factor.  This is not a surprise as trauma has been ignored as a major etiological factor for so many decades. So long as practitioners do not see such trauma as a problem worthy of emphasis in their index of suspicion, this ignorance will continue.

Treating patients with trauma, DID or otherwise, requires the therapist to understand the nature and depth of trauma, as well as both the short and long term consequences. Most of my DID patients and, from what else I have seen, for the DID community at large, had and have co-morbidities, including addictions, that often are the cause of the original misdiagnoses.

There are two physicians whose work is important for any therapist treating trauma patients to read and consider. The first is Colin Ross, a psychiatrist who has written many important books on DID based on his clinical work, research, and guiding other therapists in their DID and trauma work. In fact, his first major publication, Multiple Personality Disorder: Diagnosis, Clinical Features, and Treatment. New York: John Wiley & Sons, 1989, was one of the earliest and only texts that proved helpful to me in working with my MPD/DID patients at the time. The second doctor to mention is Gabor Maté, who has done the same kind of in-depth clinical trauma work focused on communities that have long been marginalized.

In The Trauma Model, Colin Ross sees trauma as the central issue that will confront and confound us for decades to come. For Gabor Maté, trauma, whether in early childhood or otherwise, is seen as the root cause of so many of the co-morbidities. His view, correctly, is that without treating the root cause, the prognosis is bleak.

Changing the view of an entire profession, takes insight, time and commitment. While there are both positive and negative views of each of the mentioned psychiatrists’ both in the psychiatric community and at large, their core insight of trauma as the driver of a multitude of symptoms and co-morbidities is, in my opinion and experience, correct.