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 1.) lack of appropriate emotional
response 2.) memory loss, lost time, not knowing what they have said or done 3.) feeling dream like 5.) experiencing
dissociation which might include dizziness, headaches, numbness in body, spontaneous trance states 6.) not
remembering childhood or major life events 7.) recurrent depression 8.) anxiety, panic, and phobias 9.) self
destructive thoughts and behavior 10.) substance abuse 11.) eating disorders 12.) sexual dysfunction, including
addictions and avoidance 13.) flashbacks, intrusive thoughts and images of trauma 14.) low self esteem, and feeling
damaged and/or worthless 15.) shame 16.) somatic pain syndromes 17.) sleep disturbances: nightmares, insomnia,
and sleepwalking and 18.) 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 severe, 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.
DISSOCIATION, 1, 4-23. American Psychiatric Association (1994) Diagnostic and statistical manual of mental
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 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 disorde 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
tramatic 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 then
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 of
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 of 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 trace represents
the one personality 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. Host is the major prenting personality.
Alters is a term used to describe all other personalities. And 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 1.) usually out of sheer depression 2.) complete mental and physical exhaustion 3.)
inability to sleep 4.) problems with drug or alcohol abuse 5.) suicidal thoughts or actions 6.) fear for life 7.) need for
safety and protection 8.) need for help with crises caused by remembering. ( Ross, C.A. (1989) Multiple Personality
disorder: Diagnosis, clinical features, and treatment. New York: Wiley.
The treatment of Dissociatve Identity Disorder ( MPD) is long – term psychodynamic / cognitive
psychotherapy facilitated by hypntherapy. It is not uncommon for survivors to need three to five years of intensive
therapy work. Setting the frame for 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. 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 abreactive work to safely contain the abreaction and relese the painful emotions faster. Some
patients may only be able to do abreactive work on an impatient 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 life 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 tramatic abuse. (Steinberg, M., et al. (1990). The structured
clinical interview for DSM III- R dissociative disorders: American Journal of Psychiatry.
The journey is painful, but the rewards are great. Successfully working through the healing journey can
significantly impact a survivor’s life and philosophy. Coming through this very intense process it may lead an
individual to discover a desire to contribute to society in a variet of important ways.