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PubMed1990

Accuracy of the MMPI in identifying multiple personality disorder.

A number of previous studies have delineated Minnesota Multiphasic Personality Inventory (MMPI) characteristics in patients with multiple personality. To test the accuracy of the MMPI in identifying such patients, the authors blindly rated 63 MMPIs as being either multiple personality or not. The over-all hit rate for the entire sample was 71.4%, with a 68% hit rate for correctly identified patients with multiple personality. These hit rates compare favorably with the hit rates in similar studies of other psychiatric disorders and further demonstrate the clinical usefulness of the MMPI in the diagnosis of multiple personality.

Borderline Personality Disorder↗
PubMed1984

Multiple personality and borderline personality disorder.

The authors offer their theory that multiple personality represents a "special instance" of borderline personality disorder, that the introjects are composed of a representation of the self, a representation of the object, and an affective bond.

Adult↗
PubMed1991

Multiple personality disorder. A psychoanalytic perspective.

This article links multiple personality disorder (MPD) and dissociation to related theories of defense, resistance, and development in treatment. Trauma, conflict, and deficiency all play contributing roles in the genesis of MPD; the blend of each ingredient may be decisive in each patient. Internal conflict and deficiency tend to be overlooked, whereas trauma is emphasized. Other psychoanalytic concepts, such as transitional phenomena, identity, aggression, repetition, and the seeking after quiescence, are applied to MPD. In the discussion of working through, emphasis is placed on the process nature of MPD and on strategic integration.

Adaptation, Psychological↗
PubMed1993

Multiple personality disorder and iatrogenesis: the cautionary tale of Anna O.

An examination of Breuer's treatment of Anna O. illustrates some of the controversies surrounding the recent rise of case reports of multiple personality disorder. Anna O., the first patient of the cathartic method, psychoanalysis, and dynamic psychiatry, fits current criteria for multiple personality disorder. Breuer's treatment, however, may have contributed to her states of absence; the timing, type, and intensity of Breuer's interventions make it possible that he unwittingly encouraged and amplified Anna's dissociations, reified her ego fragments, and then explained Anna's symptoms with the pseudomemories and confabulations recovered from Anna while she was hypnotized. A review of Breuer's treatment highlights some of the controversial aspects of multiple personality disorder, specifically its possible vulnerability to iatrogenesis via suggestion and unconscious collusion and other factors. The current stance of some multiple personality disorder enthusiasts, opaque to their participation in interactions that may lead to certain patient productions, resembles the older psychoanalytic stance exemplified by the early Breuer and Freud. The dialectic of the therapist as a neutral observer versus as an influential participant continues to be a focus of controversy, both within psychoanalysis and psychotherapy and in the understandings of the etiology and treatment of multiple personality disorder.

Catharsis↗
PubMed1994

Incest: transference and countertransference implications.

It has not been the attempt of this paper to discuss the overall treatment of adults with a history of incest, but rather to elucidate and identify the various transference and countertransference implications that are emergent in psychoanalytic therapy. Despite this, some statements can be made regarding the analysis of these themes and the overall effectiveness of treatment with these patients. Analytically oriented treatment with adults with a history of incest concerns itself with three intertwined aspects. They are the reconstruction, integration, and validation of a past history of trauma (Alpert, 1991; van der Kolk, 1987), the analysis of its impact on self-identity and its effect on the person's object relations. This last component is deeply connected with the analytic relationship. This relationship is initially consciously and/or unconsciously consciously constructed by the patient as one that can typify his or her past and will be characterized by fears of abuse, neglect, and exploitation, as well as wishes and fantasies of merger, idealization, and reparation. "In the patient's psychic reality, the experience of the analytic situation then becomes the trauma, be it seduction or failure to protect" (Levine, 1990). The concept of projective identification explains how the patient may attempt to reenact his or her history and how this may be used as a vehicle for empathy and change. Throughout treatment, the analyst attempts to contain, understand, and make timely interpretations regarding herself, reactions to the patient, and their mutual interactive processes. Even when acting out inevitably occurs, it is hoped that it will be reflected on and eventually understood. At times, this process is shared with the patient and becomes a mutual endeavor. Individuals with a history of incest have been abused and exploited by those on whom they were dependent. The development of a realistic intimacy with the analyst that takes into account and respects each other's boundaries is a therapeutic goal in the treatment of adults who have been sexually abused. This can occur through the successful identification and analysis of transference/countertransference themes and the various projective identifications. Through this, the patient who has been a victim of incest is able to develop a new object relationship that is not characterized by deliberate abuse. As Horner (1987) states, the analyst and patient create a new history together, a new object relationship.(ABSTRACT TRUNCATED AT 400 WORDS)

Acting Out↗
PubMed1990

Relaxation and merging in the treatment of personality disorders.

A behavioral intervention specifically designed to merge split self-representations was found helpful as an adjunct to the psychotherapy of personality-disordered patients. The method, which is introduced only after signs of split self-representation have been identified through exploratory psychotherapy, consists of a series of steps. Patients are first taught a relaxation technique and are asked to practice at home. Once they are able to relax in the session, they are asked for visual images of first one and then another of the conflicting self-representations. After clear images have been elicited and discussed, they are encouraged to merge them. Finally, they are asked "Who's watching" or some similar question designed to elicit a statement about a unified self. Twenty-four of 27 patients meeting criteria for personality disorders in Clusters B and C of DSM-III-R responded with greater compliance, reduced resistance, and improved relationships at work and elsewhere. Comparison is made to the merging intervention commonly used in the treatment of Multiple Personality Disorder.

Adult↗
PubMed1980

Multiple personality. 165 years after Mary Reynolds.

The sudden surge of reports on multiple personality in the 1970s raises serious questions as to whether multiple personality is the rare phenomenon it has been believed to be, or whether it is a relatively common condition which is misdiagnosed with a high order of frequency. Recent research in ego psychology, particularly into the etiology of the borderline disorders, sheds considerable light on the origins of multiple personality which has traditionally, and probably mistakenly, been considered a wholly hysterical disorder. The author proposes a detailed theory of the genesis of multiple personality, based on the existing case literature and on contemporary theories of ego development. The issues of authenticity, nosology, diagnosis, personality structure, neuropathy, etiology, and treatment are considered at length.

Borderline Personality Disorder↗
PubMed1984

The syndrome of identity diffusion.

The author delineates the syndrome of identity diffusion as consisting of six clinical features: 1) contradictory character traits, 2) temporal discontinuity in the self, 3) lack of authenticity, 4) feelings of emptiness, 5) gender dysphoria, and 6) inordinate ethnic and moral relativism. This syndrome implies severe character pathology and is distinct from adolescent identity crisis. The conceptualization has a significant bearing on the differential diagnosis and psychotherapy of personality disorders.

Adolescent↗