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[Personal identity and multiple personality].

The present study analyses the internal organization of self concepts in a woman who meets the DSM III criteria of multiple personality disorder. The aim of this single case study, was to assess the personal identity of this patient, the degree of internal coherence and the hierarchical structure of the descriptions of self and others in the frame of cognitive theories of personality. After the clinical observation, the experimental procedure is presented. It consists in asking the patient to describe her different roles or alternated personalities (N = 12), as well as the target persons of her familial and social environment (N = 8) on the basis of a preestablished list of adjectives (extracted from the 16 P.F. Cattell sphere of personality). The factorial analysis of the contingency table: traits attributed x persons described shows a Guttman like hierarchical structure. Similarities and differences between the descriptions can be ordered on a unidimensional order, the multiple roles or personalities being no more complex nor simple than the target persons. The present results have been discussed in reference to cognitive theories of personality and their utility in studying personal identity and multiple personality.

Adult↗
PubMed2006

Similar or disparate brain patterns? The intra-personal EEG variability of three women with multiple personality disorder.

Quantitative EEG was used to assess the intra-personal variability of brain electrical activity for 3 women diagnosed with Multiple Personality Disorder (MPD). Two separate control groups (within-subject and between-subject) were used to test the hypothesis that the intra-personal EEG variability between 2 alters would be less than the interpersonal EEG variability between 2 controls, and similar to the intra-personal EEG variability of a single personality. This hypothesis was partially supported. In general, the 2 EEG records of a MPD subject (alter 1 vs. alter 2) were more different from one another than the 2 EEG records of a single control, but less different from one another than the EEG records of 2 separate controls. Most of the EEG variability between alters involved beta activity in the frontal and temporal lobes.

Adult↗
PubMed1992

The psychophysiological investigation of multiple personality disorder: review and update.

In 1984 Putnam reviewed the literature on the psychophysiological investigation of multiple personality disorder (MPD). Since his review, a large number of studies have been conducted and reported in the literature and at professional conferences. Currently, psychophysiologic differences reported in the literature include changes in cerebral electrical activity, cerebral blood flow, galvanic skin response, skin temperature, event-related potentials, neuroendocrine profiles, thyroid function, response to medication, perception, visual functioning, visual evoked potentials, and in voice, posture, and motor behavior. We review the new research on the psychophysiological investigation of MPD from published, unpublished, and ongoing studies, and we attempt to place current findings into a conceptual framework. We have noted findings from unpublished and ongoing studies, and, perhaps unfortunately, they represent a large amount of the data presently available. We conclude with a critical analysis of current research methodology and suggestions for future research.

Brain Mapping↗
PubMed1994

Satanism, ritual abuse, and multiple personality disorder: a sociohistorical perspective.

During the past decade in North America, a growing number of mental health professionals have reported that between 25% and 50% of their patients in treatment for multiple personality disorder (MPD) have recovered early childhood traumatic memories of ritual torture, incestuous rape, sexual debauchery, sacrificial murder, infanticide, and cannibalism perpetrated by members of clandestine satanic cults. Although hundreds of local and federal police investigations have failed to corroborate patients' therapeutically constructed accounts, because the satanic etiology of MPD is logically coherent with the neodissociative, traumatic theory of psychopathology, conspiracy theory has emerged as the nucleus of a consistent pattern of contemporary clinical interpretation. Resolutely logical and thoroughly operational, ultrascientific psychodemonology remains paradoxically oblivious to its own irrational premises. When the hermetic logic of conspiracy theory is stripped away by historical and socio/psychological analysis, however, the hypothetical perpetrators of satanic ritual abuse simply disappear, leaving in their wake the very real human suffering of all those who have been caught up in the social delusion.

Animals↗
PubMed1993

Psychiatric health care costs of multiple personality disorder.

The lifetime psychiatric health care costs of 15 women with multiple personality disorder (MPD) who were admitted to the senior author's inpatient service over a four-year period were tabulated. A calculation of the projected costs of treatment based on costs incurred since diagnosis was made, and this was compared to prediagnosis baseline costs projected forwards for ten years. The result of the calculation was a saving of $84,899.44 per patient over ten years due to the diagnosis and psychotherapeutic treatment of MPD. If the length of time in the health care system prior to diagnosis was reduced from the average of 98.77 months experienced by these 15 women to 12 months, the savings would be over $250,000.00 per case. Because the potential savings from the diagnosis and treatment of MPD appear to be so large, replication of the study with a longer followup is required.

Adult↗
PubMed1989

Autobiographical memory in a case of multiple personality disorder.

Previous research on multiple personality disorder (MPD) has been concerned with between-personalities amnesia, and little attention has been paid to within-personality memory function. This study examined the autobiographical memory of a multiple personality patient, I.C., with cueing procedures that have proven useful in previous studies of normal and abnormal memory. Results indicated that I.C. was able to retrieve autobiographical episodes from the recent past, although her performance differed in several respects from that of matched controls. The study also revealed a striking deficit in I.C.'s autobiographical memory for childhood: She was unable to recall a single episode from prior to the age of 10 in response to various retrieval cues, whereas control subjects had no difficulty recalling numerous childhood episodes. This phenomenon of extended childhood amnesia has not been reported previously in studies of MPD.

Adult↗
PubMed1990

The use of hypnosis in a deaf patient with multiple personality disorder: a case report.

We present the first report of multiple personality disorder (MPD) in a prelingually deaf patient and the first description of alter personalities as the source of auditory hallucinations in a nonpsychotic deaf person. This young woman's history and clinical symptoms of MPD did not differ from those of hearing patients. A hypnotic trance was induced by instructing the patient in muscle relaxation, modeling relaxation with exhalation, and having the patient focus her gaze on the hypnotist repeatedly fingerspelling R-E-L-A-X. Hypnosis facilitated automatic handwriting, allowed the first meeting with an alter personality, and speeded the diagnostic process. Fingerspelling has not previously been reported in hypnosis of the deaf. It is a practical means of induction for a therapist who lacks fluent signing skills. It provides a narrow fix of gaze and avoids induction by physical stimulation, a process that some abused patients find upsetting.

Adult↗
PubMed1989

Playing for time: temporizing techniques in the treatment of multiple personality disorder.

The treatment of multiple personality disorder (MPD) is often a prolonged and grueling enterprise, which imposes taxing demands upon the therapist and the patient alike. It becomes quite important to pace the therapy, lest the already beleaguered patient become both acutely and chronically overwhelmed. The majority of the extant literature on the use of hypnosis for the treatment of MPD addresses the processes of accessing the alters, abreacting traumata, arranging reconciliations among the alters, and facilitating integration. This communication discusses the necessity of titrating the amount of discomfort the patient must endure against the patient's resources and capacity to achieve mastery and self-efficacy. Several hypnotherapeutic techniques for offering respite and temporary asylum are explained and illustrated: alter substitution, the provision of sanctuary, distancing maneuvers, bypassing time, bypassing affect and/or memory, attenuating affect and/or memory retrieval, and rearranging the configuration of the alters by bartering or "shuffling the deck."

Affect↗
PubMed1991

Iatrogenesis and malingering of multiple personality disorder in the forensic evaluation of homicide defendants.

In this article I have addressed the possibility of iatrogenesis and/or malingering of MPD in 19 individuals who were charged with homicide. Due to the fragmentary nature of most of these case reports, it is not possible to state definitively who had genuine MPD and who did not. There is a strong possibility that a substantial proportion were malingering, however, because of their rather atypical presentations. Data from other sources suggest that the use of hypnosis in individuals accused of homicide may iatrogenically produce MPD-like phenomena when coupled with the defendant's desire to escape criminal responsibility. Finally, I have offered guidelines for the forensic evaluation of homicide defendants in whom MPD is suspected. Although hypnosis should generally be avoided in such defendants if it is used, rather strict guidelines should be followed. Clinicians using hypnosis with such individuals should be forewarned that such use will be strongly challenged in court and could pose an extreme threat to the defense position.

Diagnosis, Differential↗
PubMed1993

The association of multiple personality and temporolimbic epilepsy. Intracarotid amobarbital test observations.

OBJECTIVE: What is the relationship of "multiple personality disorder" in patients with temporolimbic epilepsy to certain types of hemispheric interaction? DESIGN: Case series. SETTING: Tertiary care referral center. PATIENTS: Two patients with temporolimbic epilepsy considered to be surgical candidates referred for the intracarotid amobarbital sodium procedure (IAP). Each individual had presented with different "personalities" in a characteristic temporal relationship to their seizures. INTERVENTIONS: Intracarotid amobarbital sodium procedure, Wada test, and electroencephalogram. MAIN OUTCOME MEASURES: Behavioral observations made during the performance of the IAP. RESULTS: During the IAP, each patient's peri-ictal "personality" changes were precisely replicated. No seizure activity was noted during the IAPs. CONCLUSIONS: These observations suggest that the association of multiple personality and temporolimbic epilepsy is not dependent on seizure discharges per se, but rather may be related to certain types of hemispheric interaction.

Adolescent↗
PubMed1995

Psychiatrists' attitudes to multiple personality disorder: a questionnaire study.

OBJECTIVE: To assess the attitudes of a random sample of Canadian psychiatrists to Multiple Personality Disorder (MPD) and assess the relative prevalence of the condition in three comparable cities in Ontario. METHOD: A questionnaire was sent to all psychiatrists who were members of the Canadian Psychiatric Association and who were resident in Ottawa, Kingston and London. Questions were asked on the respondent's personal clinical experience of MPD and his/her attitude to this condition. Some personal and demographic questions were also included. RESULTS: 180 out of 294 questionnaires (61.2%) were returned. The existence of MPD was doubted by 27.8% of psychiatrists who responded to the questionnaire, with a significantly higher proportion in London than in Kingston or in Ottawa. A substantial majority in all three cities agreed that media publicity and the psychiatrist's own belief system affected the prevalence of MPD. CONCLUSION: These results confirm that there is a split in the profession regarding belief in the existence of MPD as a diagnosis.

Attitude of Health Personnel↗
PubMed1993

Adult reconstruction of childhood events in the multiple personality literature.

The author reviews the dependability of adult reports of childhood abuse and trauma, which are emerging in therapy with increasing frequency. He reviews the literature on multiple personality disorder to explore the extent to which corroboration of adult reports of childhood events is recorded. He also summarizes the relevant studies of memory both with and without the aid of hypnosis. He finds that there is minimal corroboration in the literature of the adults' reports of childhood abuse. Memories brought forth with the aid of hypnosis are undependable because of the large number of inaccuracies introduced by hypnotized subjects. Memories brought forth without hypnosis have been shown to be prone to distortion by intentional as well as by unwitting cues. The author concludes that the recent enthusiasm for the adult discovery of childhood abuse has been accompanied by little attention to factors that potentially affect recall of childhood abuse, including the bias of therapy. The use of hypnosis might well be an aggravating factor in distorted recollections of childhood abuse. Validation without corroboration by the therapist of the patient's memories has serious ethical and possibly legal consequences.

Adolescent↗
PubMed1990

Brain mapping in a case of multiple personality.

Brain maps were recorded on a patient with a multiple personality disorder (10 alternate personalities). Maps were recorded with eyes open and eyes closed during 2 different sessions, 2 months apart. Maps from each alternate personality were compared to those of the basic personality "S", some maps were similar and some were different, especially with eyes open. Findings that were replicated in the second session showed differences from 4 personalities, especially in theta and beta 2 frequencies on the left temporal and right posterior regions. A rank ordering of the differences in the brain maps of the alternate personalities from S were similar to the rank ordering of the differences in personality characteristics, as judged by the psychiatrist dealing with this patient. Maps from S acting like some of her personalities or from a professional actress portraying the different personalities did not reveal significant differences. Some of these findings are consistent with those in the literature, and the importance of detecting artifact in the raw EEG recording is emphasized.

Adult↗
PubMed1997

Bariatric surgery and multiple personality disorder: complexities and nuances of care.

BACKGROUND: Multiple personality disorder (MPD) can occur in patients with morbid obesity in need of bariatric surgery, though few reports noting this association exist in the literature. Herein we address MPD in morbid obesity, in the context of a patient presenting to us seeking surgical treatment of her morbid obesity. METHODS: A 31-year-old morbidly obese (BMI 49 kg/m2) Hispanic female presented in early 1994 requesting bariatric surgery. She had been a victim of violent sexual abuse as a young girl. Subsequently, she developed at least three personalities, including one male personality. RESULTS: Although she has lost nearly 45 kg after gastroplasty, her care has been complicated by her named multiple personalities. While MPD are infrequent and unfamiliar to most care providers, successful outcomes can be promoted with a proper approach. CONCLUSIONS: This patient's care illustrates that: (1) all personalities must agree to proposed operative intervention; (2) consent must be obtained from the 'true' patient; and (3) postoperative care and follow-up must address all personalities for an optimal outcome.

Adult↗
PubMed1997

Does the mind fall apart in multiple personality disorder? Some proposals based on a psychoanalytic case.

A psychoanalytic study of some of the phenomena of multiple personality disorder (MPD), this paper takes issue with the view that a falling apart, fragmentation, or disaggregation of the mind is at the bottom of MPD's characteristic symptoms. Since first proposed by Janet in 1889, the view that ordinarily integrated parts of the mind separate from the center, accounting for the appearance of separate "selves," has prevailed among workers in this field. The close psychoanalytic study of a case of MPD suggests that, to the contrary, the appearance of multiplicity may derive from an essentially unitary but nonetheless powerful set of organizing fantasies centering on the idea that one's body and mind can be taken over and controlled by persons other than oneself. The data of the case under study suggest, further, that certain of the details of these patients' histories of childhood sexual and physical abuse may be of great importance in explaining the extraordinary organizing power of their fantasies of being occupied and controlled. In this connection, special attention is directed to the very commonly reported experiences of forced violation and the involuntary filling and emptying of their bodies during childhood.

Adult↗
PubMed1986

Treatment progress in 20 patients with multiple personality disorder.

Attempts to follow the treatment progress of patients with multiple personality have been limited to a few single case studies and, in the only large series, to those most successfully treated. This study followed the treatment progress of 20 patients for a mean of 39 months after intake. The study included a detailed history, neurological examination, and psychological testing on each patient. At follow-up each patient was interviewed and a questionnaire was completed by his or her therapist to assess treatment response. Although nine patients achieved partial or full integration, complete integration was maintained by only five. During therapy the unintegrated patients experienced emotional trauma at approximately twice the rate as did the patients who eventually became integrated. Psychodynamic psychotherapy and hypnosis were the most widely prescribed therapies. The improvement in multiple personality appeared to proceed in a stepwise fashion from acceptance of the diagnosis to integration. The progress of therapy was hindered most commonly by the overuse of the mental mechanisms of repression and denial, the continued utilization of secrecy, which began during child abuse, and the production of numerous crises. The most common countertransferences included anger, exasperation, and emotional exhaustion. Although the psychotherapy of patients with multiple personality is tedious and time consuming, it can be eminently successful if the patient and therapist persevere.

Adolescent↗
PubMed1996

Visual function in multiple personality disorder.

BACKGROUND: Multiple personality disorder (MPD) is characterized by the existence of two or more personality states that recurrently exchange control over the behavior of the individual. Numerous reports indicate physiological differences, including significant differences in ocular and visual function, across alter personality states in MPD. METHODS: The existing literature was reviewed to provide an overview of the nature and characteristics of MPD, with emphasis on reported physiologic and ocular differences across alter personalities. In addition, a case is reported of an MPD patient seen over a 3-year period. RESULTS: Physiologic differences across alter personality states in MPD include differences in dominant handedness, response to the same medication, allergic sensitivities, autonomic and endocrine function, EEG, VEP, and regional cerebral blood flow. Differences in visual function include variability in visual acuity, refraction, oculomotor status, visual field, color vision, corneal curvature, pupil size, and intraocular pressure in the various personality states of MPD subjects as compared to single personality controls. CONCLUSIONS: The possibility of MPDs should be considered in patients who demonstrate unusual variability in ocular and visual findings, particularly with a positive psychiatric history. The existence of visual and other physiologic differences across alter personalities in MPD offers a unique potential for the study of mind-body relationships.

Adult↗
PubMed1989

Optical differences in cases of multiple personality disorder.

Nine patients diagnosed with multiple personality disorder (MPD) and nine control subjects role-playing MPD were given complete ophthalmological examinations to test whether the MPD subjects would show greater variability in visual functioning across alter personalities than would control subjects role-playing MPD. An analysis of variability of eight optical measures in four prominent areas of vision was performed by comparing two covariance matrices for equality. The test on the equality of the two covariance matrices showed that the two groups were significantly different (p less than .05). That is, MPD subjects had significantly more variability in visual functioning across alter personalities than did control subjects. Because the test of equality of the two covariance matrices rejected the null hypothesis, univariate analyses of variance were performed on the eight individual ophthalmological measures that comprised the matrix. The results of these analyses showed that MPD subjects had significantly more variability across alter personalities than did their control counterparts on measures of visual acuity with correction, visual acuity without correction, visual fields, manifest refraction, and eye muscle balance. The data were also analyzed for clinical significance. Blind ratings of the data were performed by comparing the results of the individual dependent measures across the alter personalities of individual MPD and control subjects according to established ophthalmological criteria. The ratings for clinical significance showed that the MPD subjects had 4.5 times the average number of changes in optical functioning between alter personalities of the control subjects, with a mean of 2.56 clinically significant changes for the MPD subjects and .55 clinically significant changes for the control subjects. This difference was also statistically significant (p less than .01).

Adult↗