Multiple Personality Disorder

There is considerable controversy over the validity about the diagnosis of multiple personality.

Multiple Personality Disorder (MPD), or Dissociative Identity Disorder (DID), is the existence in an individual of two or more distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment. At least two of these personalities are considered to routinely take control of the individual's behavior, and there is also some associated memory loss which is beyond normal forgetfulness. This memory loss is often referred to as "losing time". These symptoms must occur independently of substance abuse, or a general medical condition.

Dissociative identity disorder was initially named multiple personality disorder (MPD).   Regardless of whether the disorder is termed dissociative identity disorder or multiple personality disorder, it is in no way related to schizophrenia. Although schizophrenia and multiple personality disorder are commonly linked in the minds of lay people, it is a misconception.

Persons with dissociative identity disorder are often told of things they have done but do not remember and of notable changes in their behavior. They may discover objects, productions, or handwriting that they cannot account for or recognize; they may refer to themselves in the first person plural (we) or in the third person (he, she, they); and they may have amnesia for events that occurred between their mid-childhood and early adolescence. Amnesia for earlier events is normal and widespread.

When faced with overwhelmingly traumatic situations from which there is no physical escape, a person may resort to "going away" in his or her head. Children typically use this ability as an extremely effective defense against acute physical and emotional pain, or anxious anticipation of that pain. By this dissociative process, thoughts, feelings, memories, and perceptions of the traumatic experiences can be separated off psychologically, allowing the child to function as if the trauma had not occurred.

The dissociation process is a complex mental process that produces a lack of connection in a person's thoughts, memories, feelings, actions, or sense of identity. During the period of time when a person is dissociating, certain information is not associated with other information as it normally would be. For example, during a traumatic experience, a person may dissociate the memory of the place and circumstances of the trauma from his ongoing memory, resulting in a temporary mental escape from the fear and pain of the trauma and, in some cases, a memory gap surrounding the experience. Because this process can produce changes in memory, people who frequently dissociate often find their senses of personal history and identity are affected. Because the person suffering a dissociation does not completely disengage from his/her reality, they may appear to have multiple "personalities". In other words, different "people" (i.e., different personalities) to deal with different situations, but generally speaking, no one person (i.e., personality) who will retreat altogether.

Some people with a multiple personality disorder can hold highly responsible jobs, contributing to society in a variety of professions, the arts, and public service -- appearing to function normally to coworkers, neighbors, and others with whom they interact daily. Others with a dissociative disorder are not able to function at all in a normal capacity. Dissociative identity disorder is serious and chronic.  It is associated with a high incidence of suicide attempts and is believed to be more likely to end in suicide than any other mental disorder.

The current diagnostic criteria for multiple personality disorder or dissociative identity disorder is published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Multiple Personality Disorder or Dissociative Identity Disorder is defined as a condition in which "two or more distinct identities or personality states" alternate in controlling the patient's consciousness and behavior. Misdiagnoses include schizophrenia, borderline personality disorder, somatization disorder and panic disorder.

There is no known specific cause of dissociative identity disorder or multiple personality disorder.  Dissociative Identity Disorder and other Dissociative Disorders are now understood to be fairly common effects of severe trauma in early childhood, most typically extreme, repeated physical, sexual, and/or emotional abuse.

Dissociative identity disorder is attributed to the interaction of several factors: overwhelming stress, dissociative capacity (including the ability to uncouple one's memories, perceptions, or identity from conscious awareness), the enlistment of steps in normal developmental processes as defenses, and, during childhood, the lack of sufficient nurturing and compassion in response to hurtful experiences or lack of protection against further overwhelming experiences. Children are not born with a sense of a unified identity, but rather it develops from many sources and experiences. In overwhelmed children, its development is obstructed, and many parts of what should have blended into a relatively unified identity remain separate. North American studies show that 97 to 98% of adults with dissociative identity disorder report abuse during childhood.

Current research (Sidran Foundation) shows that Dissociative Identity Disorder may affect 1% of the general population and perhaps as many as 5-20% of people in psychiatric hospitals, many of whom have received other diagnoses. The incidence rates are even higher among sexual-abuse survivors and individuals with chemical dependencies. These statistics put Dissociative Disorders and multiple personality disorder in the same category as schizophrenia, depression, and anxiety, as one of the four major mental health problems today. Much of the current literature shows that Dissociative Disorders are found primarily among females. The latest research, however, indicates that the disorders may be equally prevalent (but less frequently diagnosed) among the male population. Men with Dissociative Disorders are most likely to be in treatment for other mental illnesses or drug abuse and alcohol abuse, or they may be incarcerated.

Multiple personality disorder patients often have a remarkable array of symptoms that can resemble other neurological and psychiatric disorders, such as anxiety disorders, personality disorders, schizophrenic and mood psychoses, and seizure disorders. Most have symptoms of depression, manifestations of anxiety (sweating, rapid pulse, palpitations), phobias, physical symptoms (severe headaches or other bodily pain), panic attacks, physical symptoms, sexual dysfunction, eating disorders, and post traumatic stress. Suicidal preoccupations and attempts are common, as are episodes of self-mutilation.

Some of the more common types of dissociation symptoms found in dissociative disorders include:

Amnesia in multiple personality disorder is marked by gaps in the patient's memory for long periods of their past, in some cases, their entire childhood. Most multiple personality disorder patients have amnesia, or "lose time," for periods when another personality is "out."  Amnesia involving an inability to recall important personal information relating to some of the identities is also present. Amnesia is not uniform in all personalities; what is not known by one personality may be known by another. Some personalities may appear to know and interact with other personalities in an elaborate inner world.

Depersonalization is a dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving. Some Multiple Personality Disorder patients experience depersonalization as feeling to be outside of their body, or as watching a movie of themselves.

Derealization is a dissociative symptom in which the patient perceives the external environment as unreal. Patients may see walls, buildings, or other objects as changing in shape, size, or color. Multiple Personality Disorder patients may fail to recognize relatives or close friends.

Identity disturbances in multiple personality disorder result from the patient's having split off entire personality traits or characteristics as well as memories. When a stressful or traumatic experience triggers the reemergence of these dissociated parts, the patient switches, usually within seconds, into an alternate personality. Some patients have histories of erratic performance in school or in their jobs caused by the emergence of alternate personalities during examinations or other stressful situations. Patients vary with regard to their alters' (other personalities) awareness of one another. Patients with multiple personality disorder experience their alters as distinctive individuals possessing different names, histories, and personality traits. It is not unusual for multiple personality disorder patients to have alters of different genders, sexual orientations, ages, or nationalities. Some patients have been reported with alters that are not even human; alters have been animals, or even aliens from outer space. The average multiple personality disorder patient has between two and 10 alters, but some have been reported with over one hundred.

Dissociative Disorders are responsive to individual psychotherapy, or "talk therapy," as well as to a range of other treatment modalities, including medications, hypnotherapy, and adjunctive therapies such as art or movement therapy.

Perhaps the most common approach to treatment aims to relieve symptoms, to ensure the safety of the individual, and to reconnect the different identities into one well-functioning identity. There are, however, other equally respected treatment modalities that do not depend upon integrating the separate identities (alters). Treatment also aims to help the person safely express and process painful memories, develop new coping and life skills, restore functioning, and improve relationships. The best treatment approach depends on the individual and the severity of his or her symptoms.

Treatment is likely to include some combination of the following methods:

Psychotherapy designed to encourage communication of conflicts and insight into problems.

Cognitive behavioral therapy which focuses on changing dysfunctional thinking patterns.

Medication to treat the dissociative disorders themselves is not available. However, a person with a dissociative disorder who also suffers from depression or anxiety often may benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine.

Family therapy to help educate the family about the disorder and its causes, as well as to help family members recognize symptoms of a recurrence.

Creative therapies such as art therapy or music therapy to allow the patient to explore and express his or her thoughts and feelings in a safe and creative way.

Clinical hypnosis uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness or awareness.  Hypnosis may help patients recover repressed ideas and memories. Further, hypnosis can also be used to control problematic behaviors that many multiple personality disorder patients exhibit, such as self-mutilation, or eating disorders such as bulimia nervosa. In the later stages of treatment, the therapist may use hypnosis to "fuse" the alters as part of the patient's personality integration process.

Behavior therapy: This involves operant conditioning techniques.  For example, a patient may be addressed and, responded to, only a single name.  The therapist(s) may refuse to speak with the patient as if she or he is a different sex, age, or person than initially presented. As the patient begins to respond more consistently to a single name, and speak in the first person, more traditional therapy for trauma may begin. Though many proponents of multiple personality disorder do not like this approach or criticize it as disrespectful of the client, it can be highly effective.

Alternative treatments that help to relax the body are often recommended for multiple personality disorder patients as an adjunct to psychotherapy and/or medication. These treatments include hydrotherapy, botanical medicine (primarily herbs that help the nervous system), therapeutic massage, and yoga. Homeopathic treatment can also be effective for some people.

For more information about Multiple Personality Disorder and other mental health problems, please click on the linked websites listed below.

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