medical information

Multiple Personality Disorder | History and incidence | Causes | Symptoms | Diagnosis and treatment

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, multiplepersonality 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 multiplepersonality 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’spersonality 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 IdentityDisorder. 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.