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PubMed1993

Incorporating hypnosis into the psychotherapy of patients with multiple personality disorder.

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.

Communication↗
PubMed2003

Dissociative symptoms in posttraumatic stress disorder: diagnosis and treatment.

This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the development of posttraumatic stress disorder, and as a set of syndromal disturbances. The authors discuss various models proposed for the relationship between these. They outline developmental considerations in diagnosis and treatment and end by discussing further needed research.

Adolescent↗
PubMed1986

Interictal behavior disorders in epilepsy.

Psychiatric symptomatology is present in many epileptics and some is directly or indirectly related to the seizure activity. Interictal and chronic psychiatric problems are particularly troublesome; awareness of the symptom clusters may lead to better diagnosis and treatment of these problems.

Aggression↗
PubMed1984

Treatment of multiple personality disorder. A study of 33 cases.

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.

Adolescent↗
PubMed1998

Impact of a history of physical and sexual abuse in eating disordered and asymptomatic subjects.

The present study aimed to explore the impact of sexual and/or physical abuse among eating disordered patients (ED) and asymptomatic subjects. A total of 86 patients with anorexia nervosa, 69 patients with bulimia nervosa and 81 asymptomatic subjects were assessed. Among ED, we did not find a significant association between abuse experiences and the severity of the eating disorder, or between abuse and dissociative symptoms. Among ED, self-destructive behaviour appears to be the most important predictor of a history of sexual and/or physical abuse. In contrast, in the asymptomatic group, the score on the Dissociation Questionnaire is the only significant predictor of reported abuse experiences.

Adolescent↗
PubMed1998

Risk factors for spirit possession among school girls in southern Thailand.

In September 1993, at a school in the south of Thailand, an outbreak of spirit possession suddenly afflicted 32 girls aged 9-14 years. A case-control study was done to investigate factors that predispose a child to spirit possession. Psychiatric evaluation was done on 32 cases and 34 matched controls. Parents were interviewed regarding the child's psychosocial history. Results of the study were as follows. Children with spirit possession were first-born and came from small families with 1-3 children. Compared with the controls their family life was characterized by more psychosocial stressors and there were significantly higher rates of psychiatric disorders, anxious and fearful character traits, histrionic character traits and history of recurrent trance states. The history of traumatic experiences and exposure to spirit possession ceremonies were more frequent in spirit-possessed children than in the control group but the difference was not significant. This study showed that being first-born from a small family, individual vulnerability especially psychiatric disorders, problematic character traits and dissociative tendency were significant risk factors in the development of possession states in children.

Adolescent↗
PubMed1991

Treatment stabilization and crisis prevention. Pacing the therapy of the multiple personality disorder patient.

This article briefly reviews the tactical integrationist's perspective in the work with multiple personality disorder patients. Its foundation is a cognitively based treatment paradigm geared toward controlled abreactions with cognitive restructuring throughout therapy. It is a suppression-dilution-of-affect model that focuses on the achievement of control and mastery for patient and therapist alike.

Adaptation, Psychological↗
PubMed1991

Embodied alternative identities. Bearing witness to a world that might have been.

In all cultures, embodied alternative identities provoke powerful reactions among those who observe and interact with them. Although these entities are invariably understood to reflect intense subjective experiences, they represent much more than a public expression of a pathologic mental disorder. They form an integral part of the meaningful, highly complex, symbolic systems that both inform and reflect the local cultures in which they emerge. Consequently, an understanding of just how these entities learn to understand themselves may be the cross-cultural key to an understanding of just what they are.

Anthropology, Cultural↗
PubMed1994

[Multiple personality disorder. Presentation of 2 cases and a model of the etiology].

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.

Adolescent↗
PubMed1989

Current status of multiple personality disorder in India.

Three consecutive cases of multiple personality disorder seen over a period of 3 years at a psychiatric clinic in India are reported. The prevalence of this disorder at the clinic is about 0.15/1,000 patients per year. The authors discuss the infrequency of this diagnosis in India in contrast to the frequent diagnosis of possession syndrome for patients who have many of the same symptoms. Transcultural differences in diagnostic practices are also discussed.

Adolescent↗
PubMed2006

A preliminary study of cortisol and norepinephrine reactivity to psychosocial stress in borderline personality disorder with high and low dissociation.

The goal of the current study was to investigate subjective and neurohormonal reactivity to acute psychosocial stress in borderline personality disorder (BPD) as a function of dissociative symptoms. Five BPD subjects with high dissociation, 8 BPD subjects with low dissociation, and 11 healthy control subjects were compared in basal urinary cortisol and norepinephrine, as well as in plasma cortisol and norepinephrine reactivity to the Trier Social Stress Test (TSST). Subjective stress rating and emotional response to the TSST were also measured. The three groups differed significantly in cortisol stress reactivity, with the high-dissociation BPD group demonstrating the most robust response. The three groups did not significantly differ in norepinephrine stress reactivity. In the combined BPD sample, dissociation severity tended to be inversely correlated with basal urinary norepinephrine, was positively correlated with norepinephrine stress reactivity. Childhood trauma was inversely correlated with basal urinary cortisol. In conclusion, despite its small sample size this pilot study suggests that dissociative symptomatology may be a marker of heightened biological vulnerability to stress in BPD, and merits further study.

Acute Disease↗
PubMed1993

Toward a psychoanalytic understanding of multiple personality disorder.

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.

Dissociative Disorders↗
PubMed2002

Inferences from a community study about non-epileptic events.

OBJECTIVE: To demonstrate the epidemiological importance of the different types of non-epileptic events (NEE) in a low-income urban community. METHOD: The patients suspected of having epilepsy, who were detected in the first phase (screening one) of this prevalence study, were interviewed by a neurologist in a non-structured neurological interview. These NEE were classified as physiological and psychogenic, subdivided by various types. The psychogenic NEE were classified according to the DSM-IV criteria. RESULTS: We compared the cases suspected of having epilepsy (n=176) with those not suspected (n=806) and discovered that those cases suspected of having epilepsy had a greater median age (<0.01) and female predominance (p<0.01). Among the cases suspected of having epilepsy there were different diagnosis: epileptic events without identifiable cause (n=20) or with identifiable causes (e.g., febrile convulsions and eclampsia). The most prevalent diagnosis for those suspected of having epilepsy was syncope (n=63; 35.8%). In terms of physiological events, the most frequent were: epileptic seizures, paroxysmal toxic phenomena (including alcoholism) and brain trauma, besides syncope; in terms of psychogenic events the most frequent were: dissociative and anxiety disorders. Regarding gender differences, paroxysmal toxic problems were significantly more prevalent in men (p= 0.02), and dissociative disorders (p=0.01) in women. CONCLUSION: This survey confirms the epidemiological importance of syncope in a populational sample with NEE. However, among the psychogenic disorders of this NEE sample, the most frequent were dissociative and anxiety phenomena. This finding contrasts with the literature based on samples from tertiary epileptic centers with video-EEG resources, which found somatoform disorders to be more prevalent than dissociative and anxiety phenomena.

Adolescent↗
PubMed1991

Childhood traumas: an outline and overview.

Childhood psychic trauma appears to be a crucial etiological factor in the development of a number of serious disorders both in childhood and in adulthood. Like childhood rheumatic fever, psychic trauma sets a number of different problems into motion, any of which may lead to a definable mental condition. The author suggests four characteristics related to childhood trauma that appear to last for long periods of life, no matter what diagnosis the patient eventually receives. These are visualized or otherwise repeatedly perceived memories of the traumatic event, repetitive behaviors, trauma-specific fears, and changed attitudes about people, life, and the future. She divides childhood trauma into two basic types and defines the findings that can be used to characterize each of these types. Type I trauma includes full, detailed memories, "omens," and misperceptions. Type II trauma includes denial and numbing, self-hypnosis and dissociation, and rage. Crossover conditions often occur after sudden, shocking deaths or accidents that leave children handicapped. In these instances, characteristics of both type I and type II childhood traumas exist side by side. There may be considerable sadness. Each finding of childhood trauma discussed by the author is illustrated with one or two case examples.

Adolescent↗
PubMed2003

Unrelenting catastrophic trauma within the family: when every secure base is abusive.

This paper will present illustrations from Adult Attachment Interviews conducted with adult female survivors of chronic ritual abuse in their family of origin. A model of multiple personality disorder informed by the Adult Attachment Interview coding and classification system will be presented. A range of victim, perpetrator and bystander personalities may be identified in the same interview, indeed in the same speaker. For the speaker who believes herself to be one of a number of co-existing personalities, integration and coherence means death of a loved one, indeed death of the sense of self. Possibilities of re-birth into a single integrated self are posited.

Adult↗