Multiple Personality Disorder
Multiple Personality Disorder
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.
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 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 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 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 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.
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 of DID may last for five to seven years in adults and usually requires several different treatment methods.
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.
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.
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 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.
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 of DID requires intervention in abusive families and treating children with dissociative symptoms as early as possible.
Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis and Treatment, 1998, edited by Stephen McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.
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." Gale Encyclopedia of Medicine, 3rd ed.. . Encyclopedia.com. (December 18, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/multiple-personality-disorder
"Multiple Personality Disorder." Gale Encyclopedia of Medicine, 3rd ed.. . Retrieved December 18, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/multiple-personality-disorder
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.
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.
"Multiple Personality Disorder." UXL Encyclopedia of Science. . Encyclopedia.com. (December 18, 2017). http://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/multiple-personality-disorder
"Multiple Personality Disorder." UXL Encyclopedia of Science. . Retrieved December 18, 2017 from Encyclopedia.com: http://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/multiple-personality-disorder
multiple personality, a very rare psychological disorder in which a person has two or more distinct personalities, each with its own thoughts, feelings, and patterns of behavior. The personalities often are direct opposites and dominate at different times, with abrupt transitions triggered by distressful events or memories. Each may be entirely unaware of the other but aware of unexplained gaps in remembered time. In psychiatry the condition is known as dissociative identity disorder. The term
denoting schizophrenia, refers to an unrelated disorder in which the split (separation) is between thought and feeling.
Multiple personality was first recognized and described by the French physician Pierre Janet in the late 19th cent. Public awareness of the disorder increased in contemporary times after a case was the subject of The Three Faces of Eve (1957). In the 1980s and early 90s, such factors as recognition of child abuse, public interest in memories recovered from childhood (whether of actual or imagined events), allegations of so-called satanic ritual abuse, and the willingness of many psychotherapists to assume a more directive role in their patients' treatment, led to what came to be regarded as a rash of overdiagnoses of multiple personality.
The cause of multiple personality is not clearly understood, but the condition seems almost invariably to be associated with severe physical abuse and neglect in childhood. It is believed that amnesia, the key to formation of the separate personalities, occurs as a psychological barrier to seal off unbearably painful experiences from consciousness. The disorder often occurs in childhood but may not be recognized until much later. Social and psychological impairment ranges from mild to severe. The primary treatment is psychotherapy to help the individual integrate the separate personalities.
See study by J. Acocella (1999).
"multiple personality." The Columbia Encyclopedia, 6th ed.. . Encyclopedia.com. (December 18, 2017). http://www.encyclopedia.com/reference/encyclopedias-almanacs-transcripts-and-maps/multiple-personality
"multiple personality." The Columbia Encyclopedia, 6th ed.. . Retrieved December 18, 2017 from Encyclopedia.com: http://www.encyclopedia.com/reference/encyclopedias-almanacs-transcripts-and-maps/multiple-personality
multiple personality disorder
"multiple personality disorder." A Dictionary of Nursing. . Encyclopedia.com. (December 18, 2017). http://www.encyclopedia.com/caregiving/dictionaries-thesauruses-pictures-and-press-releases/multiple-personality-disorder
"multiple personality disorder." A Dictionary of Nursing. . Retrieved December 18, 2017 from Encyclopedia.com: http://www.encyclopedia.com/caregiving/dictionaries-thesauruses-pictures-and-press-releases/multiple-personality-disorder