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Four Factor Theory

Trigger warning! This article mentions childhood trauma.

The four factor theory of etiology was created by dr. Kluft as an explanation for origins of dissociative identity disorder (back then known as multiple personality disorder). In our opinion it's the most useful and universal amongst existing models of etiology of traumagenic plurality. Apart from that, four factor theory may be at least partially compatible with many other models, since it focuses mainly on circumstancecs that lead to the emergence of the disorder, not psychological mechanisms underlying the proccess.

Dissociative identity disorder is almost always caused by chronic trauma in early childhood. But trauma cannot be the only factor, since many people with such experiences do not end up with this disorder. Dr. Kluft's theory proposes four factors that are neccessary for its development: natural dissociative tendencies, traumatic experiences, circumstances that influence the type of dissociative response and lack of sufficient support in proccessing emotions[1].

First of all, the child must have an ability to use dissociative mechanisms that for some people are not achieveable even in traumatic circumstances. Studies show that non-pathological dissociation is genetic to a great extent[2]. Genes that may be connected to dissociative symptoms were also found[3]. It's possible that apart from heritability there are also other factors that shape a neurological base favouring dissociation or strenghtening its intensity, for example deficiencies of some vitamins[4].

Next, the child with dissociative tendencies must experience circumstances that overwhelm their capacity to cope in ways other than dissociation. Most common types of trauma that cause dissociative identity disorder are sexual and physical abuse[5]. Other types are for example psychological abuse, death of a loved one, war and severe ilness. Apart from that there may be present physical or psychological factors that make this specific event more traumatic than it would be for another person[1].

You could say that the third factor is actually a lot of potential factors grouped into one category. According to the theory they influence the form that dissociative defense mechanism assumes (e.g. identity alteration, dissociative amnesia, depersonalization). Here may play a role innate tendencies for a specific kind of dissociation and high hypnotisability, since self-hypnosis may play a role in creating many plural experiences (e.g. convincing onself that one is a mythical creature insensitive to trauma for so long that it becomes a subjective reality). Among other internal factors that lead to complex dissociative disorders dr. Kluft gives examples of ease of introjection, internalising and identifying with other person and having imaginary friends. And in external factors he includes for example motivation for role-playing, contradictory expectations from caregivers and influences from media[1].

The last factor is lack of sufficient support from loved ones in proccessing the difficult experience, such as comforting, taking care of physical injuries and taking precautions, so such event never happens again. According to the theory, in children who did get such support dissociation is supposed to be only temporary, not last into adulthood[1]. Percentage of people with dissociative identity disorder who experienced abuse from their parents is really high[5], and this factor may explain why. The child will usually seek support in their parents and they may rarely expect it from them when they are responsible for the trauma. Studies only partially support the hypothesis of the fourth factor. Lack of familial and social support enhances the probability of dissociative identity disorder and other dissociative mechanisms[6][7], but it is not necessary for their emergence[8]. In spite of this imperfection the four factor theory of etiology is a very helpful tool in understanding causes of dissociative identity disorder in most people who suffer from it.

References

  1. ↑ a b c Treatment of Multiple Personality Disorder: A Study of 33 Cases, dr. Richard P. Kluft and John Donne, the Psychiatric Clinics of North America, 1984
  2. ↑ A genetic analysis of individual differences in dissociative behaviors in childhood and adolescence, Kathryn A. Becker-Bleas et al., Journal of Child Psychology and Psychiatry, 2004
  3. ↑ The Molecular Genetics of Dissociative Symptomatology: A Transdiagnostic Literature Review, Ravi Philip Rajkumar, genes, 2022
  4. ↑ Study of Relationship between Dissociative Disorders and Vitamin-C Status in Rural Subjects of Western Uttar Pradesh, Sanchit Tiwari, International Journal of Science and Research, 2022
  5. ↑ a b Abuse Histories in 102 Cases of Multiple Personality Disorder, dr. Collin A. Ross et al., The Canadian Journal of Psychiatry, 1991
  6. ↑ Familial and Social Support as Protective Factors Against the Development of Dissociative Identity Disorder, dr. Susan Korol, Journal of Trauma & Dissociation, 2008
  7. ↑ Association between negatively perceived parenting attitudes and dissociation: a cross-sectional study on the general population in Japan, Baihui Wang and Toshihide Kuroki, Frontiers in Psychology, 2023
  8. ↑ Traumatic childhood events, perceived availability of emotional support, and the development of dissociative tendencies, H. J. Irwin, Child Abuse and Neglect, 1996


    9. Created: 12.08.2025
    Translated: 20.12.2025