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This article describes treatment results in 33 patients with multiple personality disorder with respect to the major identifying characteristic of the condition: the presence of separate personalities within a single individual. The author discusses responsiveness to treatment, apparent and stable fusion, follow-up, and reassessment.
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The case of a 30-year-old woman with five distinct personalities is presented. The patient was treated, using a system of structured video taped sodium amobarbital interviews, in which areas to be explored were developed in psychotherapy. Tapes were played for the patient after each session. The taped material was used as the basis for psychotherapeutic investigation. The patient evidenced many of the features previously reported in cases of multiple personality, specifically: being the product of an unwanted pregnancy in a repressively rigid family; emotional distancing by one parent; strong sibling rivalry with an adopted sib; family history of mental illness; a traumatic first sexual experience (rape); a marriage to a maladjusted individual in an attempt to escape the parental home; a high internalized standard of performance and an inability to display anger or negative feelings toward the parents. In the course of treatment, the patient's personalties fused and she was able to accept each component as part of herself. No further fragmentation has occurred during the year following discharge. The therapy technique minimized dependency, and the possiblity of addiction to amobarbital interviews permitted more active patient therapy involvement, and set clear-cut goals and expectations for improvement before further amobarbital interviews could be conducted.
This is the third report of a patient with dissociated personality followed for 38 years. There has been a gradual integration of the dissociated states. The most remarkable aspect of the clinical course has been the patient's excellent work record in contrast to a severe restriction in her social life. The original diagnosis of hysteria was changed to schizophrenia. Evidence is presented to show that the diagnosis of schizophrenia was incorrect. The authors believe that dissociated states occur more frequently than diagnosed, and that the syndrome should be given independent diagnostic status.
1. Multiple Personality Disorder (MPD) is more common than one may think. There are many people with undiagnosed MPD. 2. As a caring, effective nurse for MPDs, set boundaries. Clients with MPD need to feel safe with the nurses with whom they talk. It is essential to establish a trusting bond. Respect each patient's alters--and believe in them. They will come out when they feel safe. Be direct and honest. 3. Do not play games. Although it is fascinating to watch the switch take place, it can be extremely frightening for an MPD patient when a nurse tries to call alters out and send others back.
Although the syndrome of Multiple Personality Disorder (MPD) has received much interest in the international literature, there have been virtually no professional articles on the topic in German over the last 70 years. This is a report on two cases with nine and 70 persons respectively. Both had undergone severe and prolonged sexual abuse in childhood. Compared with DSM-III-R, the ICD-10 criteria seem to reflect historic reports on alternating personalities rather than recent empirical research on multiple personality. The proposed etiological model postulates that extreme trauma in childhood can result in dissociative vulnerability persisting into adulthood.
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The authors review the recent literature on multiple personality disorder (MPD), the most severe and chronic of the dissociative disorders, in relation to court cases of competence to stand trial, the insanity defense, and research on malingerers feigning MPD. Issues relevant in the assessment of competency and insanity are described. Features characteristic of MPD, including amnesia and alterations in consciousness and personality, have varying degrees of influence over the criminal behavior of an individual with MPD. As in other psychiatric disorders, the influence of MPD on an individual's competence to stand trial, and sanity, can be evaluated systematically. This article discusses a specific diagnostic tool, the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), an extensively field tested instrument that is potentially quite useful in forensic assessment of suspects manifesting dissociative symptoms and disorders. The particular advantages of the SCID-D will be reviewed in the context of some well known criminal cases involving MPD. Further research using diagnostic interviews for the systematic assessment of dissociative symptoms and MPD in criminal cases will continue to clarify the influence of these symptoms in a forensic context.
The author suggests a developmental psychoanalytic frame from which to understand the clinical phenomenology of multiple personality disorder (MPD). Annihilation anxiety and fears of nonbeing are understood as central; they are seen as resulting from actual early traumatic impingements at key developmental periods. Alter "personalities" are conceptualized as functional delusional processes that serve to maintain self-cohesion. The alters are brought about through the subject's lack of capacity for illusion. Some therapeutic implications regarding a psychoanalytic stance are discussed.
Recent reports suggest a link between eating disorders and dissociative phenomena. The author offers a psychodynamic perspective on this connection and proposes that these disorders may occur along a continuum. Viewing these conditions as related suggests that eating disorders, like dissociative disorders, may have not only self-destructive but also self-preserving aspects. The author explores treatment implications of this perspective.
The increasing prevalence of dissociative disorders has spawned a range of diagnostic tools. The authors describe the use of several current methods--screening instruments, structured interviews, psychological testing, and hypnosis--and they advocate enlisting the patient as an active collaborator in the diagnostic process.
Psychotherapeutic treatment of persons with multiple personality disorder frequently includes judicious use of hypnosis. The author outlines widely accepted essential features of this form of treatment: developing self-soothing techniques, "mapping" the system of alternate personalities, facilitating communication between alters and with the therapist, managing abreaction, and--when possible and appropriate--aiding the process of fusion. The author shows how dissociative processes that originally were used for sheer psychic survival can be drawn on to improve psychological health.
Group psychotherapy is a valuable part of the treatment of patients with multiple personality and dissociative disorders. After reviewing the sparse literature on the subject, the author describes the use of group psychotherapy with these patients alone, as well as with two types of groups in which these patients may participate: incest survivors and general group therapy patients. She concludes by emphasizing the need for expert training for therapists who conduct group psychotherapy with multiple personality and dissociative disorder patients.
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Although the overlap between childhood sexual and physical abuse and eating disorders is well known, little work has been done on the sequelae of childhood trauma in eating disorder patients. Dissociative phenomena are common in adult survivors of childhood abuse, with multiple personality disorder (MPD) being the most extreme form of dissociative disorder. We describe two women who presented for inpatient treatment of eating disorders who were subsequently found to have MPD. Because the eating pathology in these patients contained atypical features related to the MPD process, uncovering MPD was critical in the treatment of their eating behavior. MPD should be considered in any atypical or treatment-resistant eating disorder patient.
The rapid increase in numbers of MPD patients in the Anglo-American literature requires discussion of the diagnostic concept. The classification of MPD as Dissociative Disorders by DSM-III-R and ICD-10 follows the traditional conceptualization of hysteria and hypnosis. In the view of the majority of modern authors child abuse appears as a new etiological issue. This theme highly sensitive is critically discussed against the background of older psychopathological concepts of forgetting. A careful analysis of personality traits and motivation in the individual case help to avoid overuse of the new diagnostic label.
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