The theory of structural dissociation proposes that dissociation isn't necessarily caused by abuse, although that is definitely one way it can happen. It suggests that dissociation, including DID, is caused by the inability of the child to integrate the various aspects of the personality due to a lack of integrative experiences, from a range of denial of emotions or a parent disallowing expression of emotion, to severe abuse without restorative experiences.

This theory proposes that people do not 'create' alters as such, but that all young children experience different emotional states of self, and in a nurturing environment children learn to integrate these states into one cohesive sense of identity. In a punishing, denying or abusive environment children are unable to integrate these emotional states, and they continue to develop independently of one another.