Personality Disorder as Dissociation

Personality disorders are characterized by pervasive, inflexible, and maladaptive patterns of thought, feeling, and behavior that deviate significantly from cultural expectations. This analysis focuses on dissociative disorders that underlie all personality disorders like Borderline Personality Disorder (BPD), highlighting their core features: profound instability in self-image, interpersonal relationships, and emotional dysregulation.  

The deep roots of personality disorders, are often found in severe, chronic, and inescapable trauma, especially during early childhood. This type of trauma is consistently identified as the primary underlying cause for dissociative disorders and profoundly impacts personality development. Statistics reveal that up to 99% of individuals who develop dissociative disorders have a recognized personal history of recurring, overpowering, and often life-threatening traumas, typically occurring before the age of six. Dissociation emerges as an adaptive defense mechanism in response to overwhelming pain or fear, allowing the child to mentally detach and compartmentalize the traumatic experience to survive or thrive.  

The “fragmented self” commonly observed in personality disorders is not merely a symptom but a direct structural consequence of untreated dissociation, where the mind literally separates to cope with unbearable internal conflict and external threat until healing can happen. Severe trauma leads to a “disintegration of the self-structure,” resulting in a “fragmentation of the ego-identity” and a profound sense that one’s self-coherence and self-continuity have been invaded and systematically broken down. However, as with great experiences, come great healings.

This manifests in symptoms such as identity confusion and identity alteration, where individuals struggle to define themselves or experience a shifting sense of who they are. This division can be pronounced, with the presence of distinct “alters” or personality states, but how one labels who become important to how stigmatization occurs; ultimately in preventing care. The concept of “division of the personality” is considered distinct to dissociative conditions; until O’Brien (2023a) reminded the field of medicine and psychology that drug use (prescription or otherwise) is traumatic to the unconscious body (particularly without unconscious informed consent), that one can become addicted to trauma, and that addiction is transdiagnostic and dissociative, then a full scope of pathology is not know; thus the law rand society remains immature. This perspective suggests that the characteristics of a “personality disorder” are not simply a collection of maladaptive traits but rather deeply ingrained survival strategies where parts of the self are walled off or developed separately to manage the overwhelming impact of trauma. As denial and dissociation are addictive, when these dissociated parts are not integrated through effective treatment, they continue to operate independently, leading to the chronic instability and dysregulation that define these disorders. But what defines them even more is that they remain unhealed because the system of care does not have their definitions accurately defined.

Untreated dissociation perpetuates and shapes the symptomatic presentation of personality disorders in several critical ways:

• Identity Disturbance: Dissociation directly contributes to a “markedly unstable self-image” or “sense of self,” making it difficult for individuals to define themselves, their values, or their goals, often leading to contradictory beliefs. In the extreme case of DID, this manifests as distinct “alters” or personality states that control behavior at different times. As time and space are essential to knowing who is who is ones psyche, those who do not know, do not know.
• Emotional Dysregulation: Dissociation, particularly secondary dissociation (depersonalization and derealization), is associated with excessive corticolimbic inhibition, reduced amygdala activity, and hypoarousal. While this can lead to emotional numbing, it can paradoxically also contribute to heightened emotional reactivity and an inability to manage intense emotions effectively.  
• Relationship Difficulties: Insecure attachment patterns, which are highly prevalent in trauma survivors, are deeply intertwined with dissociation and significantly impact interpersonal relationships. Individuals may struggle to form stable connections, often striving to control relationships or testing the reliability of others.  
• Self-Harm and Suicidality: Dissociation is strongly linked to self-harm and suicidal behaviors in BPD, frequently serving as a desperate attempt to reduce overwhelming distress or to terminate acute dissociative states.  
• Memory Gaps: Amnesia, ranging from significant gaps in memory to micro-amnesias (forgetting parts of a conversation), is a hallmark feature of DID and can occur in other dissociative states, leading to confusion and distress in daily functioning.  
• “Psychotic-like” Symptoms: Dissociative experiences can overlap with psychotic symptoms, such as hallucinations (particularly auditory hallucinations, which may include child voices) and ideas of reference, especially during periods of intense stress.  

The persistence of dissociative symptoms, particularly trait dissociation, is a significant predictor of poorer long-term treatment outcomes for personality disorders, underscoring that addressing dissociation is not merely an adjunct but a core requirement for lasting change. Research indicates that higher levels of trait dissociation are consistently associated with greater psychopathology. While initial symptom reduction may occur during intensive therapies like Dialectical Behavioral Therapy (DBT) or EMDR, trait dissociation has been shown to predict reduced long-term benefits, even after controlling for baseline symptom burden. Furthermore, pathological dissociation is linked to poor functional outcomes, higher treatment dropout rates, inhibited emotional learning, and a diminished response to treatment. This demonstrates that even if immediate symptom relief is achieved, untreated dissociation acts as a fundamental barrier to sustained recovery, making its targeted treatment a critical focus for effective intervention and improved prognosis. However, as readers will find by studying WHI programming and material, there are enough cause for alarm with how the systems treat and label people/citizens with these diagnoses (if they exist) because they do not understand. From our lived experience at WHI, we have remind people that transdiagnostic phenomena are conditional and dependent on healing to survive.

Key Table: Dissociative Symptoms in Personality Disorders (BPD & DID)

Dissociative Symptom	Manifestation in BPD	Manifestation in DID
Identity Confusion/Alteration	Markedly unstable self-image, contradictory beliefs, difficulty defining self	Two or more distinct identities (“alters”), each with unique traits, controlling behavior; feeling possessed
Amnesia/Memory Gaps	Difficulty remembering personal information, gaps in memory, forgetting skills	Inability to recall key personal information, daily events, traumatic events; micro-amnesias
Depersonalization	Feeling detached from self, emotions, body; watching self from afar; feeling robotic	“Out-of-body” experiences, feeling detached from body
Derealization	Feeling world is distorted, unreal, foggy, dreamlike; objects changing	World feels unreal or foggy
Emotional Numbing/Dysregulation	Difficulty managing emotions, emotional instability, dampened affective arousal	Detachment from emotions
“Psychotic-like” Symptoms	Hallucinations, body-image distortions, ideas of reference during stress	Internal voices, transient psychotic symptoms

The blurred boundary between BPD and dissociative disorders necessitates a flexible, trauma-informed approach to diagnosis and treatment. Psychotherapies that specifically address trauma and dissociation are often effective, typically implemented in a phased approach focusing on safety, trauma processing, and integration. Furthermore, fostering the development of social support networks and adaptive coping mechanisms is crucial to counteract the isolation and maladaptive strategies frequently. As psychedelics offer more than what psychology has previously know, there is more promise with trauma resolution and healing then there is with not.

For more on our work and cause, consider following or signing up for newsletter or our work at woundedhealersinstitute.org or donating to our cause: HERE.

References

O’Brien, A. (2023a). Addiction as Trauma-Related Dissociation: A Phenomenological Investigation of the Addictive State. International University of Graduate Studies. (Dissertation). Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/

O’Brien, A. (2023b). Memory Reconsolidation in Psychedelics Therapy. In Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/

O’Brien, A. (2023c). Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2024a). Healer and Healing: The re-education of the healer and healing professions as an advocation. Re-educational and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2024e). Path of the Wounded Healers for Thrivers: Perfectionism, Altruism, and Ambition Addictions; Re-education and training manual for Abusers, Activists, Batterers, Bullies, Enablers, Killers, Narcissists, Offenders, Parents, Perpetrators, and Warriors. Re-Education and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025). American Made Addiction Recovery: a healer’s journey through professional recovery. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

*This is for informational and educational purposes only. For medical advice or diagnosis, consult a professional.