However, we should be open to any other possible ways in which the pathology of DID can develop, as there might be many unknown factors which might contribute to it. My personal experiences with DID patients in Japan allowed me to consider childhood conditions and incidents other than sexual and physical abuse as possible causes for later development of DID.
In an academic article, I proposed one of these possibilities. “In Japanese society, the stress responsible for dissociative disorders appears less visible, embedded in a close relationship with others ("relational stress'), compared to more overt traumatic Stress such as childhood sexual and physical abuse”.(Okano,1993)
When I wrote this paper I was practicing psychiatry in the United States. It was (and it still is, I believe) a routine for clinicians to ask the patients about their history of childhood sexual abuse, and a great many of them had these histories.
When I came back to Japan in 2004 and began my practice, several DID patients that I met supported my view on the “relational stress”. All of them had seriously conflicted relationship with their mothers while fathers are typically absent at home.
While exploring my DID patiens’ personal histories, I realized that there is a common thread in their relationship with their mothers. Typically their mothers are overprotective and have a high expectation on their daughters (patients) while their daughters are very sensitive and receptive to their mothers’ expectation. Unlike in the United States history of sexual and physical abuse is not common in their childhood.
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