Multiple Personality Disorder
The most famous dissociative disorder is Multiple Personality Disorder,
also
known as Dissociative Identity Disorder (DID). It is estimated that one
in one
hundred people may suffer from Multiple Personality Disorder and
other
Dissociative Disorders. With correct diagnosis and appropriate
treatment, people
have the potential for complete recovery. Multiple
Personality Disorder is a
condition in which a person has more than one
identity, each of which speaks,
acts and writes in a very different way. Each
personality seems to have its own
memories, wishes, and (often conflicting)
impulses The symptoms of an individual
with Multiple Personality Disorder are
1.) lack of appropriate emotional
response 2.) memory loss, lost time, not
knowing what they have said or done 3.)
feeling dream like 5.) experiencing
dissociation which might include dizziness,
headaches, numbness in body,
spontaneous trance states 6.) not remembering
childhood or major life events
7.) recurrent depression 8.) anxiety, panic, and
phobias 9.) self destructive
thoughts and behavior 10.) substance abuse 11.)
eating disorders 12.) sexual
dysfunction, including addictions and avoidance
13.) flashbacks,
intrusive thoughts and images of trauma 14.) low self esteem,
and feeling
damaged and/or worthless 15.) shame 16.) somatic pain syndromes 17.)
sleep
disturbances: nightmares, insomnia, and sleepwalking and 18.)
alternative
states of consciousness or personalities. Many people displaying
MPD have
experienced events they would like to forget or avoid. The causation
of Multiple
Personality Disorder is when an individual has suffered
severe, horrific,
traumatic, unavoidable, persistent physical or sexual abuse
in childhood. Also
many people displaying MPD appeared to be skilled at self-
hypnosis through
which their psyche comes forward as a coping mechanism, to
protect them from the
pain ( they create a self- induced hypnotic like
trance) which allows the
individual to escape psychologically. Most people
suffering from Multiple
Personality Disorder found that they could escape
the trauma of abuse at least
temporarily by creating new personalities to
deal with the stress. ( Braun, B.
(1988). The BASK model of dissociation.
DISSOCIATION, 1, 4-23. American
Psychiatric Association (1994) Diagnostic
and statistical manual of mental
disorders. ( 4th ed) The separate
personalities known as alters, are usually
unknown to the host personality,
which operates the body most of the time.
Alters can take many forms, but
few types are common. Some typical
manifestations include a depressed or hurt
child, an internal caretaker, a
strong angry protector, and an envious
protector who is angry with the host.
Although these represent the most
common alter personality types, the reported
list of variations is fairly
long and includes perpetrator alters, avenger
alters, opposite sex alters,
different race, and even non- human alters. Most of
the writings dealing with
DID (Dissociative Identity Disorder reports that
individuals with the illness
flow in and out of the various personalities as the
environment changes,
usually unaware of what is taking place. (Putnam, F.W.
(1989). Diagnosis and
treatment of multiple personality disorder. New York:
Guilford Press.
There are many theories which attempt to explain DID, but the
central
component in all of them appears to be that the disorder occurs as
a
protective reaction to severe childhood trauma. Essentially, the self
appears to
dissociate, or split into separate and distinct personalities in
an effort to
repress the pain and terror of some tramatic event. The trauma
is often sexual
in nature. There is one such theory that implies that the
blocked pain, terror,
and awareness create compartments in the mind, which
hold the unprocessed
feelings. When these compartments leak says the theory,
the person has
flashbacks, panic attacks, and nightmares. Individuals
stricken with DID may
experience the onslaught of the disturbance suddenly or
gradually, and the
symptoms may become worse over a long period of time.
Recent studies indicate
that the age of onset is nearly always childhood, and
that it is much more
common among women then men; as much as three to nine
times more. Those who warn
that DID/MPD is alarmingly common mental illness
and cite numerous studies and a
long list of statistics in support of its
legitimacy. For example: in a 1990
study which appeared in The Journal of
Occupational Therapy, J.F. Higdon stated,
The past two decades have seen
a marked increase in the diagnosing of this
disorder, and we are seeing a
significant increase in the number of cases.
Another study, conducted by
B.G. Braun in the American Psychiatric Press and The
American Journal of
Occupational Therapy, revealed an increased complexity of
the cases. With a
patient population of over 1,000 under examination, the study
reported 95% -
98% of the patients had suffered a history of child abuse.
Another study
by Whitman and Munkel in Clinical Pediatrics, reported that as
many as 25% of
all children may suffer with MPD. ( Mills, A. and Cohen, B.M.
(1993)
Facilitating of the identification of multiple personality disorder
through
art: The Diagnostic Drawing Series. In E. Kluft (Ed.), Expressive
and
functional therapies in the treatment of multiple personality
disorder.
Springfield: Charles C. Thomas. There are two patterns of
Multiple Personality,
one pattern is 1.) Alternating. Alternating is each
personality has amnesia for
the others. The other pattern is 2.) Co-
Conscious , which is some personalities
are aware of the alter personalities.
There are many very important terms
dealing with Dissociative Identity
Disorder ( MPD). Some of these terms are
memory trace, polar opposites, drab
original, switching, host, alters, and
trigger. Memory trace represents the
one personality who harbors all the
memories for all the other personalities.
Polar Opposites are when a multiple ,
harbors two extreme personalities. Drab
original is a term used to describe the
core personality. Switching is a term
used to describe the change from one
personality state to another. Host is
the major prenting personality. Alters is
a term used to describe all other
personalities. And trigger is a term used to
describe anything that causes a
person to remember a traumatic event or switch
to another personality. There
are many different reasons why a person with
Multiple Personality
Disorder would seek professional help. Some of these
reasons are 1.) usually
out of sheer depression 2.) complete mental and physical
exhaustion 3.)
inability to sleep 4.) problems with drug or alcohol abuse 5.)
suicidal
thoughts or actions 6.) fear for life 7.) need for safety and
protection 8.)
need for help with crises caused by remembering. ( Ross, C.A.
(1989) Multiple
Personality disorder: Diagnosis, clinical features, and
treatment. New York:
Wiley. The treatment of Dissociatve Identity Disorder ( MPD)
is long - term
psychodynamic / cognitive psychotherapy facilitated by
hypntherapy. It is not
uncommon for survivors to need three to five years of
intensive therapy work.
Setting the frame for the trauma work is the most
important part of therapy.
After gathering important information, the therapist
and client should
develop a plan for stabilization (Turkus, 1991). Treatment
should be
carefully considered. These treatments are psychotherapy, group
therapy,
expressive therapies, family therapy, psychoeducation, and
pharmacotherapy.
Hospital treatment may be necessary. Developing a cognitive
framework is also
an important part of stabilization. This involves sorting out
how an abused
child thinks and feels, undoing damaging self- concepts, and
learning about
what is normal. Stabilization is a time to learn how to ask for
help and
build support networks. The stabilization stage may take a year or
longer- as
much time as is necessary for the patient to move safely into the
next phase
of treatment. ( Turkus, J.A (1991) Psychotherapy and case management
for
multiple personality disorder: Synthesis for continuity of care.
Psychiatric
Clinics of North America Stabilization involves the
survivor`s acceptance of the
diagnosis and commitment to treatment. Diagnosis
is in itself a crisis, and much
work must be done. The treatment frame for
DID/ MPD includes developing
acceptance and respect for each alter as a part
of the whole internal system.
Each alter must be treated equally, whether
it shows itself as a delightful,
happy child , or an angry persecutor.
Mapping of the dissociative personality
system is the next step, followed by
the work of internal dialogue and
cooperation between alters. This is the
critical stage in DID therapy, one that
must be in place before trauma work
begins. Communication and cooperation among
the alters helps the gathering of
ego strength that stabilizes the whole person.
The next stage is
revisiting and reworking the trauma. This may involve
abreactions, which can
release pain and allow dissociated trauma back into the
normal memory. An
abreaction can be described as the vivid re- experiencing of a
traumatic
event followed by the release of related emotion and the recovery
of
repressed or dissociated aspects of that event ( Steele and Colrain, 1990
)
Hypnosis when performed by a trained professional, is extremely useful
in
abreactive work to safely contain the abreaction and relese the painful
emotions
faster. Some patients may only be able to do abreactive work on an
impatient
basis in a safe and supportive environment. This leads into the
final phase of
therapy work. There is a continued processing of traumatic
memories and
cognitive distortions, and further letting go of shame. At the
end of the
grieving process, creative energy is released. The survivor can
reclaim self-
worth and personal power and rebuild their life after so much
focus on healing.
People with Multiple Personality Disorder are very
courageous, intelligent,
creative, socially skilled, talented people whose
dissociative abilities allowed
them to survive tramatic abuse. (Steinberg,
M., et al. (1990). The structured
clinical interview for DSM III- R
dissociative disorders: American Journal of
Psychiatry. The journey is
painful, but the rewards are great. Successfully
working through the healing
journey can significantly impact a survivor`s life
and philosophy. Coming
through this very intense process it may lead an
individual to discover a
desire to contribute to society in a variet of
important ways.