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