It is caused by extreme severe repetitive trauma during early childhood. Physical/sexual/emotional abuse. I guess that is what forces folks into living alternate realities. Is it curable or does one just have to manage it/live with it? I wonder if the erratic quixotic dramatic reactions of some are due to such early childhood trauma? A distinct break from reality. Because they find it intolerable and cannot live with what they find there. So they create illusions to make life bearable. Can folks suffer this without being aware of it? Are there degrees that go from mild to severe? Ever meet anyone who was a very pleasant cheerful person at times and the exact opposite at other times. Flipflopping constantly between the two extremes?