Multiple Personality Disorder
Multiple Personality Disorder
Causes of multiple personality disorder
Multiple personality disorder (MPD) is a chronic and recurrent emotional illness. A person with MPD plays host to two or more personalities. Each identity has its own unique style of viewing and understanding the world and may have its own name. These distinct personalities periodically control that person’s behavior as if several people were alternately sharing the same body. Because those diagnosed with multiple personality disorder often are not aware of the alternate personalities, called alters, inside themselves, they cannot account for blocks of time when these other identities control their memory, thinking, and behavior. Unlike depression or anxiety disorders, which have been recognized for centuries, the earliest cases of persons reporting DID symptoms were not recorded until the 1790s. Most cases were considered medical oddities or curiosities until the late 1970s, when increasing numbers of cases were reported in the United States. In 1994, multiple personality disorder was renamed Disassociative Identity Disorder by the American Psychiatric Association.
History and incidence
Some psychologists and psychiatrists believe that instances of demon possession recorded over the centuries may have really been MPD, but the first complete account of a patient with multiple personality disorder was written in 1865. Four years later, French neurologist Pierre Marie Felix Janet (1859–1947) discovered that a system of ideas split off from the main personality when he hypnotized his female patients. Soon afterward, American psychologist William James (1842–1910) uncovered a similar phenomenon and termed the condition disassociation. In 1886, American author Robert Louis Stevenson popularized the disorder in his novel The Strange Case of Dr. Jekyll and Mr. Hyde. Although this work of fiction captured popular imagination, the concept of multiple personalities was rejected by Austrian physiologist, medical doctor, psychologist Sigmund Freud (1856–1939) and later by the behaviorists. The mental health community believed the disorder was extremely rare if it existed at all.
Despite well-known movies such as The Three Faces of Eve and Sibyl, which recounted the life stories of women with MPD, by the beginning of the 1970s only about 200 cases had been documented in world psychiatric literature. Finally in 1980 the American Psychiatric Association officially recognized multiple personality disorder as a genuine emotional illness.
Today, MPD is a relatively popular diagnosis with 20,000 cases recorded between 1980 and 1990 in the United States. As of 2006, it is possible that about 1% of the U.S. population is afflicted with some form of MPD. However, that percentage could be spread out from 0.01 to 10%, according to medical researchers. In addition, the percentage of patients in psychiatric hospitals could range up to 20%. In both popuations, MPD is a popularly diagnosed illness but one that is, in actuality, difficult to diagnosis properly. MPD occurs from three to nine times more frequently in women than in men. Some researchers believe that because men with MPD tend to act more violently than women, they are jailed rather than hospitalized and never diagnosed. Female MPD patients often have more identities than men, averaging 15 as opposed to males who average eight.
Because of the high number of MPD cases being diagnosed in the United States today, some professionals speculate that the diagnosis is culture-specific and caused by some unique characteristic of American society such as the high incidence of child abuse. Other experts, while not denying that MPD exists, believe that the high rate of MPD has been inflated by recent media attention focusing on criminal trials in which defendants use multiple personality disorder for the insanity defense. They also think that overly eager therapists may unknowingly encourage highly-suggestible patients to display symptoms during hypnosis. Experts who counter these assertions state that normal people cannot be taught, even under hypnosis, to imitate the measurable physical changes shown by those diagnosed with multiple personality disorder. They claim that in the past the condition was underreported, a situation now being corrected by a heightened awareness of the disease and its symptoms.
Causes of multiple personality disorder
Fifty-nine to ninety-eight percent of people diagnosed with multiple personality disorder were either physically or sexually abused as children. Many times when a young child is subjected to abuse, he or she splits off (spaces out) from what is happening, becoming so detached that what is happening may seem more like a movie or television show than reality. This self-hypnotic state, called disassociation, is a defense mechanism that protects the child from thinking and feeling overwhelmingly intense emotions. Disassociation walls these thoughts and emotions off so that the child is unaware of them. In effect, they become secrets, even from the child. According to the American Psychiatric Association, many MPD patients cannot remember much of their childhoods.
Not all children who are severely and repeatedly abused develop multiple personality disorder, but if the sexual or physical abuse is extreme and repeated, disassociated clusters of thoughts and feelings may begin to take on lives of their own, especially when the child has no time or space in which to emotionally recover between abuses. Each cluster tends to have a common emotional theme such as anger, sadness, or fear. Eventually, as the walls of disassociation thicken, these clusters develop into full-blown personalities, each with its own memory and characteristics.
Some researchers believe the reason some abused children develop MPD may have a biological basis. Studies of how brainchemistry affects memory indicate that when an intensely traumatic experience occurs, the brain’s neurochemicals may be released in such large amounts they influence the area of the brain responsible for memory to pigeonhole what is remembered into separate compartments. Depending on their individual brain chemistry, some human beings may be better able to disassociate than others. About one-third of people with MPD have complex partial seizures of the right temporal lobe of the brain. Some researchers think this form of epilepsy might also affect memory and be yet another cause for the disorder.
Although some studies show that the illness may be more common in first-generation relatives of MPD patients, there is no proof the disorder is inherited.
Symptoms
A person diagnosed with multiple personality disorder can have as many as a 100 or as few as two separate personalities. About half of the recently reported cases have ten or fewer. These different identities can resemble the main personality or they may be a different age, sex, race, or religion. Alters may resemble each other or be very unique. Each personality can have its own posture, set of gestures, and hairstyle, as well as a distinct way of dressing and talking. Some alters may speak in foreign languages or with an accent. Sometimes alternate personalities are not human, but are animals or imaginary creatures instead.
The process by which one of these personalities reveals itself and controls behavior is called switching. Most of the time the change is sudden and takes only seconds. Sometimes, however, it can take from hours or days. Switching is often triggered by something that happens in the patient’s environment, but personalities can also come out under hypnosis or when the patient is given amyl nitrate (truth serum).
Sometimes the most powerful personality serves as the gatekeeper and tells the other weaker personalities when they may reveal themselves. Other times personalities fight each other for control. Most patients with MPD experience long periods during which the host personality, also called the main or core personality, remains in charge. During these times, their lives may appear normal.
When an alter dominates, however, chaos often reigns. Ninety-eight percent of people with MPD have some degree of amnesia when an alternate personality surfaces. When the host personality takes charge once again, the time spent under control of the alter is completely lost to memory. In some cases of MPD the host personality may remember confusing bits and pieces of the past. In some cases alters are aware of each other, while in others they are not.
Because alternate personalities are formed by childhood disassociation as a result of trauma, it is not surprising that 86% of people with MPD have one alter with a child’s personality. Childhood and adolescent alters handle and act out emotions the abused child could not, such as rage or terror. Some act in very negative ways, avenging and persecuting the host personality to be self-destructive. Other alters, called internal self helpers, watch what is going on and give advice. Sometimes people with MPD describe these alters as seeing everything and feeling nothing. Other alternate personalities, however, act as friends.
One of the most baffling mysteries of multiple personality disorder is how alternate personalities can sometimes show very different biological characteristics from the host and from each other. Several personalities sharing one body may have different heart rates, blood pressures, body temperatures, pain tolerances, and eyesight abilities. Different alters may have unique reactions to medications. Sometimes a healthy host can have alternate personalities with allergies and even asthma. An alter’s blood glucose (sugar) may respond differently to insulin than the host’s. Since studies done on people with such dramatically different alters have been small, no conclusions can be drawn and the puzzle remains to be solved.
Diagnosis and treatment
Most people with multiple personality disorder are diagnosed between the ages of 20 and 40 years. By that time they have been seeking help for their problems for an average of seven years and have usually been hospitalized several times. In some cases this happens because in addition to having multiple personality disorder, those who suffer from it are often anxious or depressed. In other cases, the rapid mood swings that occur when personalities switch can appear to be symptoms of bipolar illness, more commonly called manic depression. Finally, the voices of the personalities a person with MPD may report hearing are interpreted as the auditory hallucinations of schizophrenia.
Without treatment, MPD does not disappear by itself, although the rate of personality switching does seem to slow down in middle age. The most common treatment for MPD is long-term psychotherapy twice a week. During these sessions, the therapist must develop a trusting relationship with the core personality and each of the alters. Once that is established, the emotional issues of each personality regarding the original child abuse are addressed. The host and alters are encouraged to communicate with each other in order to integrate or come together. Hypnosis is often a useful tool to accomplish this goal. At the same time, the therapist helps the patient to acknowledge and
KEY TERMS
Alter —An alternate personality that has split off or disassociated from the main personality, usually after severe childhood trauma.
Disassociation —The separation of a thought process or emotion from conscious awareness.
Host —The main or core personality of a person with Multiple Personality Disorder, developing since the time of birth.
Hypnosis —A trance state during which people are highly vulnerable to the suggestions of others.
Personality —A group of characteristics that motivates behavior and set us apart from other individuals.
Trauma —An extremely severe emotional shock.
accept the physical or sexual abuse he or she endured as a child and to learn new coping skills so that disassociation is no longer necessary. Usually this process takes place in the therapist’s office.
About half of all people being treated for MPD require brief hospitalization, and only 5% are primarily or exclusively treated in psychiatric hospitals. According to the National Institute of Mental Health, although sometimes mood altering medications such as tranquilizers or antidepressants are prescribed for MPD patients, they are often diagnosed as having anxiety or depression rather than the multiple personality disorder. The treatment of MPD lasts an average of four years.
Alternative treatments that help to relax the body are often recommended for DID patients as an adjunct to psychotherapy and/or medication. These treatments include hydrotherapy, herbal medicine, therapeutic massage, and yoga. Meditation is usually discouraged until the patient’s personality has been reintegrated.
Some therapists believe that the prognosis for recovery is excellent for children and good for most adults. Although treatment takes years, it is often ultimately effective. As a general rule, the earlier the patient is diagnosed and properly treated, the better the chances for improvement.
Resources
BOOKS
Chefetz, Richard A. Dissociative Disorders: An Expanding Window into the Psycholbiology of the Mind. Philadelphia, PA: Saunders, 2006.
Haddock, Deborah Brav. The Dissociative Identity Disorder Sourcebook. Chicago, IL: Contemporary Books, 2001.
Krakauer, Sarah Y. Treating Dissociative Identity Disorder: The Power of the Collective Heart. Philadelphia, PA: Brunner Routledge, 2001.
Oxnam, Robert, B. A Fractured Mind: My Life with Multiple Personality Disorder. New York: Hyperion, 2005.
Sinason, Valierie, ed. Attachment, Trauma and Multiplicity: Working with Dissociative Identity Disorder. Hove, UK: Brunner-Routledge, 2002.
Weissberg, Michael P. The First Sin of Ross Michael Carlson: A Psychiatrist’s Personal Account of Murder, Multiple Personality Disorder, and Modern Justice. New York: Delacorte Press. 1992.
PERIODICALS
Golden, Frederic. “Mental Illness: Probing the Chemistry of the Brain.” Time 157 (January 2001).
Kay Marie Porterfield
Multiple Personality Disorder
Multiple Personality Disorder
Definition
Multiple personality disorder, or MPD, is a mental disturbance classified as one of the dissociative disorders in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It has been renamed dissociative identity disorder (DID). MPD or DID is defined as a condition in which "two or more distinct identities or personality states" alternate in controlling the patient's consciousness and behavior. Note: "Split personality" is not an accurate term for DID and should not be used as a synonym for schizophrenia.
Description
The precise nature of DID (MPD) as well as its relationship to other mental disorders is still a subject of debate. Some researchers think that DID may be a relatively recent development in western society. It may be a culture-specific syndrome found in western society, caused primarily by both childhood abuse and unspecified long-term societal changes. Unlike depression or anxiety disorders, which have been recognized, in some form, for centuries, the earliest cases of persons reporting DID symptoms were not recorded until the 1790s. Most were considered medical oddities or curiosities until the late 1970s, when increasing numbers of cases were reported in the United States. Psychiatrists are still debating whether DID was previously misdiagnosed and underreported, or whether it is currently over-diagnosed. Because childhood trauma is a factor in the development of DID, some doctors think it may be a variation of post-traumatic stress disorder (PTSD). DID and PTSD are conditions where dissociation is a prominent mechanism. The female to male ratio for DID is about 9:1, but the reasons for the gender imbalance are unclear. Some have attributed the imbalance in reported cases to higher rates of abuse of female children; and some to the possibility that males with DID are underreported because they might be in prison for violent crimes.
The most distinctive feature of DID is the formation and emergence of alternate personality states, or "alters." Patients with DID experience their alters as distinctive individuals possessing different names, histories, and personality traits. It is not unusual for DID 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 DID patient has between two and 10 alters, but some have been reported with over one hundred.
Causes and symptoms
The severe dissociation that characterizes patients with DID is currently understood to result from a set of causes:
- An innate ability to dissociate easily
- Repeated episodes of severe physical or sexual abuse in childhood
- The lack of a supportive or comforting person to counteract abusive relative(s)
- The influence of other relatives with dissociative symptoms or disorders
The relationship of dissociative disorders to childhood abuse has led to intense controversy and lawsuits concerning the accuracy of childhood memories. The brain's storage, retrieval, and interpretation of childhood memories are still not fully understood.
The major dissociative symptoms experienced by DID patients are amnesia, depersonalization, derealization, and identity disturbances.
Amnesia
Amnesia in DID is marked by gaps in the patient's memory for long periods of their past, in some cases, their entire childhood. Most DID patients have amnesia, or "lose time," for periods when another personality is "out." They may report finding items in their house that they can't remember having purchased, finding notes written in different handwriting, or other evidence of unexplained activity.
Depersonalization
Depersonalization is a dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving. Some DID patients experience depersonalization as feeling to be outside of their body, or as watching a movie of themselves.
Derealization
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. DID patients may fail to recognize relatives or close friends.
Identity disturbances
Identity disturbances in DID 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' awareness of one another.
Diagnosis
The diagnosis of DID is complex and some physicians believe it is often missed, while others feel it is over-diagnosed. Patients have been known to have been treated under a variety of other psychiatric diagnoses for a long time before being re-diagnosed with DID. The average DID patient is in the mental health care system for six to seven years before being diagnosed as a person with DID. Many DID patients are misdiagnosed as depressed because the primary or "core" personality is subdued and withdrawn, particularly in female patients. However, some core personalities, or alters, may genuinely be depressed, and may benefit from antidepressant medications. One reason misdiagnoses are common is because DID patients may truly meet the criteria for panic disorder or somatization disorder.
Misdiagnoses include schizophrenia, borderline personality disorder, and, as noted, somatization disorder and panic disorder. DID patients are often frightened by their dissociative experiences, which can include losing awareness of hours or even days of time, meeting people who claim to know them by another name, or feeling "out of body." Persons with the disorder may go to emergency rooms or clinics because they fear they are going insane.
When a doctor is evaluating a patient for DID, he or she will first rule out physical conditions that sometimes produce amnesia, depersonalization, or derealization. These conditions include head injuries; brain disease, especially seizure disorders; side effects from medications; substance abuse or intoxication; AIDS dementia complex; or recent periods of extreme physical stress and sleeplessness. In some cases, the doctor may give the patient an electroencephalograph (EEG) to exclude epilepsy or other seizure disorders. The physician also must consider whether the patient is malingering and/or offering fictitious complaints.
If the patient appears to be physically normal, the doctor will next rule out psychotic disturbances, including schizophrenia. Many patients with DID are misdiagnosed as schizophrenic because they may "hear" their alters "talking" inside their heads. If the doctor suspects DID, he or she can use a screening test called the Dissociative Experiences Scale (DES). If the patient has a high score on this test, he or she can be evaluated further with the Dissociative Disorders Interview Schedule (DDIS) or the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). The doctor may also use the Hypnotic Induction Profile (HIP) or a similar test of the patient's hypnotizability.
Treatment
Treatment of DID may last for five to seven years in adults and usually requires several different treatment methods.
Psychotherapy
Ideally, patients with DID should be treated by a therapist with specialized training in dissociation. This specialized training is important because the patient's personality switches can be confusing or startling. In addition, many patients with DID have hostile or suicidal alter personalities. Most therapists who treat DID patients have rules or contracts for treatment that include such issues as the patient's responsibility for his or her safety. Psychotherapy for DID patients typically has several stages: an initial phase for uncovering and "mapping" the patient's alters; a phase of treating the traumatic memories and "fusing" the alters; and a phase of consolidating the patient's newly integrated personality.
Most therapists who treat multiples, or DID patients, recommend further treatment after personality integration, on the grounds that the patient has not learned the social skills that most people acquire in adolescence and early adult life. In addition, family therapy is often recommended to help the patient's family understand DID and the changes that occur during personality reintegration.
Many DID patients are helped by group as well as individual treatment, provided that the group is limited to people with dissociative disorders. DID patients sometimes have setbacks in mixed therapy groups because other patients are bothered or frightened by their personality switches.
Medications
Some doctors will prescribe tranquilizers or antidepressants for DID patients because their alter personalities may have anxiety or mood disorders. However, other therapists who treat DID patients prefer to keep medications to a minimum because these patients can easily become psychologically dependent on drugs. In addition, many DID patients have at least one alter who abuses drugs or alcohol, substances which are dangerous in combination with most tranquilizers.
Hypnosis
While not always necessary, hypnosis is a standard method of treatment for DID patients. Hypnosis may help patients recover repressed ideas and memories. Further, hypnosis can also be used to control problematic behaviors that many DID patients exhibit, such as self-mutilation, or eating disorders like 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.
Alternative treatment
Alternative treatments that help to relax the body are often recommended for DID 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. Art therapy and the keeping of journals are often recommended as ways that patients can integrate their past into their present life. Meditation is usually discouraged until the patient's personality has been reintegrated.
Prognosis
Some therapists believe that the prognosis for recovery is excellent for children and good for most adults. Although treatment takes several years, it is often ultimately effective. As a general rule, the earlier the patient is diagnosed and properly treated, the better the prognosis.
Prevention
Prevention of DID requires intervention in abusive families and treating children with dissociative symptoms as early as possible.
Resources
BOOKS
Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis and Treatment, 1998, edited by Stephen McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.
KEY TERMS
Alter— An alternate or secondary personality in a patient with DID.
Amnesia— A general medical term for loss of memory that is not due to ordinary forgetfulness. Amnesia can be caused by head injuries, brain disease, or epilepsy as well as by dissociation.
Depersonalization— A dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving.
Derealization— A dissociative symptom in which the external environment is perceived as unreal.
Dissociation— A psychological mechanism that allows the mind to split off traumatic memories or disturbing ideas from conscious awareness.
Dissociative identity disorder (DID)— Term that replaced Multiple Personality Disorder (MPD). A condition in which two or more distinctive identities or personality states alternate in controlling a person's consciousness and behavior.
Hypnosis— An induced trance state used to treat the amnesia and identity disturbances that occur in dissociative identity disorder (DID).
Multiple personality disorder (MPD)— The former, though often still used, term for dissociative identity disorder (DID).
Primary personality— The core personality of an DID patient. In women, the primary personality is often timid and passive, and may be diagnosed as depressed.
Trauma— A disastrous or life-threatening event that can cause severe emotional distress. DID is associated with trauma in a person's early life or adult experience.
Multiple Personality Disorder
Multiple personality disorder
Multiple personality disorder (MPD) is a chronic and recurrent emotional illness. A person with MPD plays host to two or more personalities. Each identity has its own unique style of viewing and understanding the world and may have its own name. These distinct personalities periodically control that person's behavior as if several people were alternately sharing the same body. Because those diagnosed with multiple personality disorder often are not aware of the alternate personalities, called alters, inside themselves, they cannot account for blocks of time when these other identities control their memory , thinking, and behavior. In 1994 multiple personality disorder was renamed disassociative identity disorder by the American Psychiatric Association.
History and incidence
Some psychologists and psychiatrists believe that instances of demon possession recorded over the centuries may have really been MPD, but the first complete account of a patient with multiple personality disorder was written in 1865. Four years later, French neurologist Pierre Janet discovered that a system of ideas split off from the main personality when he hypnotized his female patients. Soon afterward, William James, the father of American psychology , uncovered a similar phenomenon and termed the condition disassociation. In 1886, American author Robert Louis Stevenson popularized the disorder in his novel The Strange Case of Dr. Jekyll and Mr. Hyde. Although this work of fiction captured popular imagination, the concept of multiple personalities was rejected by Sigmund Freud and later by the behaviorists. The mental health community believed the disorder was extremely rare if it existed at all.
Despite well-known movies such as The Three Faces of Eve and Sibyl, which recounted the life stories of women with MPD, by the beginning of the last decade only about 200 cases had been documented in world psychiatric literature. Finally in 1980 the American Psychiatric Association officially recognized multiple personality disorder as a genuine emotional illness.
Today, MPD is a relatively popular diagnosis with 20,000 cases recorded between 1980 and 1990. Researchers currently believe that from 0.01-10% of the general population has this mental illness. MPD occurs from 3-9 times more frequently in women than in men. Some researchers believe that because men with MPD tend to act more violently than women, they are jailed rather than hospitalized and never diagnosed. Female MPD patients often have more identities than men, averaging 15 as opposed to males, who average eight.
Because of the high number of MPD cases being diagnosed in the United States today, some professionals speculate that the diagnosis is culture-specific and caused by some unique characteristic of American society such as the high incidence of child abuse. Other experts, while not denying that MPD exists, believe that the high rate of MPD has been inflated by recent media attention focusing on criminal trials in which defendants use multiple personality disorder for the insanity defense. They also think that overly eager therapists may unknowingly encourage highly-suggestible patients to display symptoms during hypnosis. Experts who counter these assertions state that normal people cannot be taught, even under hypnosis, to imitate the measurable physical changes shown by those diagnosed with multiple personality disorder. They claim that in the past the condition was underreported, a situation now being corrected by a heightened awareness of the disease and its symptoms.
Causes of multiple personality disorder
Fifty-nine to ninety-eight percent of people diagnosed with multiple personality disorder were either physically or sexually abused as children. Many times when a young child is subjected to abuse, he or she splits off from what is happening, becoming so detached that what is happening may seem more like a movie or television show than reality. This self-hypnotic state, called disassociation, is a defense mechanism that protects the child from thinking and feeling overwhelmingly intense emotions. Disassociation walls these thoughts and emotions off so that the child is unaware of them. In effect, they become secrets, even from the child. According to the American Psychiatric Association, many MPD patients cannot remember much of their childhoods.
Not all children who are severely and repeatedly abused develop multiple personality disorder, but if the sexual or physical abuse is extreme and repeated, disassociated clusters of thoughts and feelings may begin to take on lives of their own, especially when the child has no time or space in which to emotionally recover between abuses. Each cluster tends to have a common emotional theme such as anger, sadness, or fear. Eventually, as the walls of disassociation thicken, these clusters develop into full-blown personalities, each with its own memory and characteristics.
Some researchers believe the reason some abused children develop MPD may have a biological basis. Studies of how brain chemistry affects memory indicate that when an intensely traumatic experience occurs, the brain's neurochemicals may be released in such large amounts they influence the area of the brain responsible for memory to pigeonhole what is remembered into separate compartments. Depending on their individual brain chemistry, some human beings may be better able to disassociate than others. About a third of people with MPD have complex partial seizures of the right temporal lobe of the brain. Some researchers think this form of epilepsy might also affect memory and be yet another cause for the disorder.
Although some studies show that the illness may be more common in first-generation relatives of MPD patients, there is no proof the disorder is inherited.
Symptoms
A person diagnosed with multiple personality disorder can have as many as a 100 or as few as two separate personalities. (About half of the recently reported cases have ten or fewer.) These different identities can resemble the main personality or they may be a different age, sex, race, or religion. Alters may resemble each other or be very unique. Each personality can have its own posture, set of gestures, and hairstyle, as well as a distinct way of dressing and talking. Some alters may speak in foreign languages or with an accent. Sometimes alternate personalities are not human, but are animals or imaginary creatures instead.
The process by which one of these personalities reveals itself and controls behavior is called switching. Most of the time the change is sudden and takes only seconds. Sometimes, however, it can take from hours or days. Switching is often triggered by something that happens in the patient's environment, but personalities can also come out under hypnosis or when the patient is given amyl nitrate ("truth serum").
Sometimes the most powerful personality serves as the gatekeeper and tells the other weaker personalities when they may reveal themselves. Other times personalities fight each other for control. Most patients with MPD experience long periods during which the host personality, also called the main or core personality, remains in charge. During these times, their lives may appear normal.
When an alter dominates, however, chaos often reigns. Ninety-eight percent of people with MPD have some degree of amnesia when an alternate personality surfaces. When the host personality takes charge once again, the time spent under control of the alter is completely lost to memory. In some cases of MPD the host personality may remember confusing bits and pieces of the past. In some cases alters are aware of each other, while in others they are not.
Because alternate personalities are formed by childhood disassociation as a result of trauma, it is not surprising that 86% of people with MPD have one alter with a child's personality. Childhood and adolescent alters handle and act out emotions the abused child could not, such as rage or terror. Some act in very negative ways, avenging and persecuting the host personality to be self-destructive. Other alters, called internal self helpers, watch what is going on and give advice. Sometimes people with MPD describe these alters as seeing everything and feeling nothing. Other alternate personalities, however, act as friends.
One of the most baffling mysteries of multiple personality disorder is how alternate personalities can sometimes show very different biological characteristics from the host and from each other. Several personalities sharing one body may have different heart rates, blood pressures, body temperatures, pain tolerances, and eyesight abilities. Different alters may have unique reactions to medications. Sometimes a healthy host can have alternate personalities with allergies and even asthma . An alter's blood glucose (sugar) may respond differently to insulin than the host's. Since studies done on people with such dramatically different alters have been small, no conclusions can be drawn and the puzzle remains to be solved.
Diagnosis and treatment
Most people with multiple personality disorder are diagnosed between the ages of 20 and 40. By that time they have been seeking help for their problems for an average of seven years and have usually been hospitalized several times. In some cases this happens because in addition to having multiple personality disorder, those who suffer from it are often anxious or depressed. In other cases, the rapid mood swings that occur when personalities switch can appear to be symptoms of bipolar illness, more commonly called manic depression . Finally, the voices of the personalities a person with MPD may report hearing are interpreted as the auditory hallucinations of schizophrenia .
Without treatment, MPD doesn't disappear by itself, although the rate of personality switching does seem to slow down in middle age. According to a 1993 study of 640 MPD patients, the most common treatment for MPD is long term psychotherapy twice a week. During these sessions, the therapist must develop a trusting relationship with the core personality and each of the alters. Once that is established, the emotional issues of each personality regarding the original child abuse are addressed. The host and alters are encouraged to communicate with each other in order to integrate or come together. Hypnosis is often a useful tool to accomplish this goal. At the same time, the therapist helps the patient to acknowledge and accept the physical or sexual abuse he or she endured as a child and to learn new coping skills so that disassociation is no longer necessary. Usually this process takes place in the therapist's office.
About half of all people being treated for MPD require brief hospitalization, and only 5% are primarily or exclusively treated in psychiatric hospitals. According to the NIMH (National Institute of Mental Health) study, although sometimes mood altering medications such as tranquilizers or antidepressants are prescribed for MPD patients, they are often diagnosed as having anxiety or depression rather than the multiple personality disorder. The treatment of MPD lasts an average of four years.
Resources
books
Cohen, Barry M., ed. Multiple Personality Disorder from theInside Out. Baltimore: Sidran Press, 1991.
Putnam, Frank W. Diagnosis and Treatment of Multiple Personality Disorder. New York: Guilford Press, 1989.
Sizemore, Chris Costner. A Mind of My Own: The Woman Who was Known as Eve Tells the Story of Her Triumph Over Multiple Personality Disorder. New York: Morrow, 1989.
Weissberg, Michael P. The First Sin of Ross Michael Carlson:A Psychiatrist's Personal Account of Murder, Multiple Personality Disorder, and Modern Justice. New York: Delacorte Press, 1992.
periodicals
Braun, Bennett G. "Multiple Personality Disorder: An Overview." The American Journal of Occupational Therapy 44, no. 11 (1990): 971-976.
Curtin, Sharon Lynne. "Recognizing Multiple Personality Disorder." Journal of Psychosocial Nursing 31, no. 2 (1993): 29-33.
Golden, Frederic. "Mental Illness: Probing the Chemistry of the Brain." Time 157 (January 2001).
Hyman, S.E. "The Genetics of Mental Illness: Implications for Practice." Bulletin of the World Health Organization 78 (April 2000): 455-463.
Kay Marie Porterfield
KEY TERMS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- Alter
—An alternate personality that has split off or disassociated from the main personality, usually after severe childhood trauma.
- Disassociation
—The separation of a thought process or emotion from conscious awareness.
- Host
—The main or core personality of a person with multiple personality disorder, developing since the time of birth.
- Hypnosis
—A trance state during which people are highly vulnerable to the suggestions of others.
- Personality
—A group of characteristics that motivates behavior and set us apart from other individuals.
- Trauma
—An extremely severe emotional shock.
Multiple Personality Disorder
Multiple personality disorder
Multiple personality disorder (MPD) is a chronic (recurring frequently) emotional illness. A person with MPD plays host to two or more personalities (called alters). Each alter has its own unique style of viewing and understanding the world and may have its own name. These distinct personalities periodically control that person's behavior as if several people were alternately sharing the same body.
MPD occurs about eight times more frequently in women than in men. Some researchers believe that because men with MPD tend to act more violently than women, they are jailed rather than hospitalized and, thus, never diagnosed. Female MPD patients often have more identities than men, averaging fifteen as opposed to eight for males.
Causes of multiple personality disorder
Most people diagnosed with MPD were either physically or sexually abused as children. Many times when a young child is severely abused, he or she becomes so detached from reality that what is happening may seem more like a movie or television show than real life. This self-hypnotic state, called disassociation, is a defense mechanism that protects the child from feeling overwhelmingly intense emotions. Disassociation blocks off these thoughts and emotions so that the child is unaware of them. In effect, they become secrets, even from the child. According to the American Psychiatric Association, many MPD patients cannot remember much of their childhoods.
Not all children who are severely and repeatedly abused develop multiple personality disorder. However, if the abuse is repeatedly extreme and the child does not have enough time to recover emotionally, the disassociated thoughts and feelings may begin to take on lives of their own. Each cluster of thoughts tends to have a common emotional theme such as anger, sadness, or fear. Eventually, these clusters develop into full-blown personalities, each with its own memory and characteristics.
Symptoms of the disorder
A person diagnosed with MPD can have as many as a hundred or as few as two separate personalities. (About half of the recently reported cases have ten or fewer.) These different identities can resemble the normal personality of the person or they may take on that of a different age, sex, or race. Each alter can have its own posture, set of gestures, and hair-style, as well as a distinct way of dressing and talking. Some may speak in foreign languages or with an accent. Sometimes alters are not human, but are animals or imaginary creatures.
The process by which one of these personalities reveals itself and controls behavior is called switching. Most of the time the change is sudden and takes only seconds. Sometimes it can take hours or days. Switching is often triggered by something that happens in the patient's environment, but personalities can also come out under hypnosis (a trancelike state in which a person becomes very responsive to suggestions of others).
Words to Know
Alter: Alternate personality that has split off or disassociated from the main personality, usually after severe childhood trauma.
Disassociation: Separation of a thought process or emotion from conscious awareness.
Hypnosis: Trance state during which people are highly vulnerable to the suggestions of others.
Personality: Group of characteristics that motivates behavior and sets us apart from other individuals.
Switching: Process by which an alternate personality reveals itself and controls behavior.
Trauma: An extremely severe emotional shock.
Sometimes the most powerful alter serves as the gatekeeper and tells the weaker alters when they may reveal themselves. Other times alters fight each other for control. Most patients with MPD experience long periods during which their normal personality, called the main or core personality, remains in charge. During these times, their lives may appear normal.
Ninety-eight percent of people with MPD have some degree of amnesia when an alter surfaces. When the main personality takes charge once again, the time spent under control of an alter is completely lost to memory. In a few instances, the host personality may remember confusing bits and pieces of the past. In some cases alters are aware of each other, while in others they are not.
One of the most baffling mysteries of MPD is how alters can sometimes show very different biological characteristics from the host and from each other. Several personalities sharing one body may have different heart rates, blood pressures, body temperatures, pain tolerances, and eyesight abilities. Different alters may have different reactions to medications. Sometimes a healthy host can have alters with allergies and even asthma.
Treatment
MPD does not disappear without treatment, although the rate of switching seems to slow down in middle age. The most common treatment for MPD is long-term psychotherapy twice a week. During these sessions, the therapist must develop a trusting relationship with the main personality and each of the alters. Once that is established, the emotional issues of each personality regarding the original trauma are addressed. The main and alters are encouraged to communicate with each other in order to integrate or come together. Hypnosis is often a useful tool to accomplish this goal. At the same time, the therapist helps the patient to acknowledge and accept the physical or sexual abuse he or she endured as a child and to learn new coping skills so that disassociation is no longer necessary.
About one-half of all people being treated for MPD require brief hospitalization, and only 5 percent are primarily treated in psychiatric hospitals. Sometimes mood-altering medications such as tranquilizers or antidepressants are prescribed for MPD patients. The treatment of MPD lasts an average of four years.