Multiple Personality Disorder and the DSM-III

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3facesofeve1980 saw the revision of the DSM-II by the American Psychiatric Association. Several changes were made to the publication in the DSM-III concerning different disorders. One of the changes in the DSM-III was a separate category for the dissociative disorders. This gave considerable credence to the disorder. Of course it must be remembered that this was the time when Sybil was still fresh in people’s minds. Also around that time, Christine Sizemore, the “Eve” in “The Three Faces of Eve“, released a second publication about her experience with multiplicity. It had the unique perspective of being written in the first person by an integrated person who had suffered and been healed from the disorder.Sybil and The Minds of Billy Milligan soon followed, a “true” third person account, first as a text, then as a film, about a man who raped three women and used multiplicity as a legal defense during his trial.

In spite of multiple personality disorder’s inclusion in the DSM-III psychiatrists worldwide argued against its validity. At that time, MPD was almost completely an American phenomenon. It was very seldom reported by European physicians. It was and remains, an almost strictly a female phenomenon, with women being diagnosed as multiples approximately 8 times more often than men. Is that due to gender prejudice in the psychiatric system? Consider there is a listing in the DSM-5 for Hysteria, a disorder that defines women who display abnormal behaviour due to various stressors.

Since the publication of the Eve, Sybil and Milligan books, sybilalong with the inclusion of multiplicity in the DSM-III, there was a virtual explosion in the publication of psychiatric journals, books, biographical accounts, of accounts about patients with MPD. In 1980 there were a number of landmark publications about the disorder including E. L. Bliss’ study of fourteen patients, P. M. Coons systematic information about making a diagnosis, G. B. Greaves review article, B, G. Braun’s treatment recommendations and S. S. Marmer psychoanalytic study.  In 1989, Frank W. Putnam of the National Institutes of Mental Health published “Diagnosis and Treatment of Multiple Personality Disorder”. In 1989 Colin A. Ross, a researcher, published “Multiple Personality Disorder: Diagnosis, Clinical Features, and Treatment”.

In 1994 the DSM-IV renamed MPD as Dissociative Identity Disorder (DID) and the publication of Guidelines for Treating Dissociative Identity Disorder In Adults” by the International Society for the Study of Dissociation. Screening instruments, diagnostic instruments, and a mental status exam were developed. There is increasing information to the general public. Yet the debate involving the existence of Dissociative Identity Disorder and Multiple Personality Disorder continues.
Fmo4FCdU5umEFakK2vaySzk2c5s (1)The evolving theory of thought about DID, that the patient needs to be cured of his or her belief that s/he possesses varying mental fragments, makes little sense to me personally. I wonder where the patient developed the idea that s/he was more than one person. If this diagnosis was given by a clinician who believes in MPD, but another clinician who does not insists the patient suffers from DID, who is right?

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The History of Multiple Personality Disorder

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MPD has been diagnosed very early in history. Some professionals believe that it was first “described” in the images of “shamans changed into animal forms” on cave walls during the Paleolithic Era. Throughout recorded history cases of demonic possession have been reported that many experts now believe are cases of of multiple personality. At that time, people interpreted these odd behaviours as best as they were able for such a primitive era.

Eberhardt Gmelin
Millenia later, in the 1800s, American psychiatrists began diagnosing what appeared to be cases of multiplicity. Eberhardt Gmelin’s 1791 account of “exchanged personality” is erroneously credited as being the first documented case of multiple personality.

Paracelsus 1646
However, in 1646, Paracelsus wrote of a woman who had “amnesia about an alternate personality who stole her money.” The case involved a 20-year-old woman living in Stuttgart who began speaking perfect bifurFrench and speaking German with a French accent. Tellingly, this case took place the year the French Revolution began. During this time many French aristocrats left France and fled to Stuttgart for safety. When she was the “French Woman” she remembered everything she did while she was the “German Woman”, but while she was the “German Woman” she denied knowing anything of the “French Woman“. Gmelin could cause the personalities to switch with a movement of his hand. That sounds like therapist manipulation to me, and this is the grey area surrounding DID.

Benjamin Rush
Benjamin Rush, the “Father of American Psychiatry“, and chief surgeon of the Continental Army wrote the first text “Medical Inquiries and Observations Upon Diseases of the Mind.”  Rush included the concept of MPD and theorized the doubling of consciousness related to a disconnection between the two hemispheres of the brain.

The Strange Case of Mary Reynolds
Dr. Samuel Latham Mitchel
 in 1860, publiMary-Reynoldsshed an account entitled “The Strange Case of Mary Reynolds” in “Harper’s New Monthly Magazine“. Reynolds was born in England in 1785 and moved to Pennsylvania. The Reynolds household was strongly religious. During her childhood Reynolds was very melancholy and spent significant time in religious devotions. At 19, she became blind and deaf for six weeks, in what might have been a form of somatic disorder. Three months later she suddenly forgot things she had learned. Eventually she learned how to read and write although her penmanship was crude. Mitchel described new nature her as “buoyant, witty, fond of company and a lover of nature”. After five weeks, she suddenly returned to her prior self. The alter egos switched between each other for sixteen years Reynold reached her mid thirties, when she remained in her “buoyant, witty” ego until she died at 61.

Estelle 1840
Estelle was an 11-year-old Swiss girl in 1840 who seemed to have paralysis and was extremely sensitive brain-0to touch. It was believed that she developed a second personality who could walk and play. Tellingly, this alter could not tolerate her mother’s presence.  Her paralysis and sensitivity was probably a form of somatoform disorder and was embodied in an alter. It was quite probable that the mother was her abuser and the sensitivity to touch was a result of painful abuse from her parent. The child was supposedly cured the through various treatment methods, some of which are currently utilized in the psychiatric community.

Eugene Azam 1843
In the late 19th century, Eugene Azam, a surgeon and hypnotist, published reports of Felida X, an alleged case of multiple personality. Born in 1843, Felida X’s father died in her infancy. Felida X experienced a difficult childhood, meaning she was very abused. She exhibited three different personalities, The second personality manifested when Felida was 13 years old. Switching happened every day after a strong pain in the temple and a solid sleep for three minutes. The switching happened every 25 to 30 days and lasted a few hours. The third personality exhibited anxiety attacks and hallucinations. Eventually the first personality became pregnant and the second personality took responsibility for it.

Pierre Janet early 20th century
In the late19th century and early 20th century, Pierre Janet described the five cases of Leonie, Lucie, Rose, Marie and Marceline. Leonie had three or more personality states including a child named Nichette. Lucie, had three personality states with an alter named Adrienne who experienced flashbacks of a traumatic childhood event. Rose suffered from somnambulistic states. Sometimes she was paralyzed and sometimes she could walk. Often these symptoms are clustered under somatoform disorder, making this DID diagnosis a case of co-morbidity.

Mortin Prince 1906
Mortin Prince published the Christine Beauchamp case in “The Dissociation of a Personality“. Beauchamp allegedly had three personality states including one calling herself Sally who was childlike. 3facesofeveSally differed greatly from an alter called a very regressed alter called Idiot. Eventually MPD was declared “extinct” by E. Stengel in 1943. Months later Prince released a landmark paper of “The Journal of Abnormal Psychology” which “was the most quoted reference in the history of the illness“. After this documentation however no mentioned was made of MPD in the journal until Prince’s published famous account of Christine Costner Sizemore. In 1957 the case was made into a film starring Joanne Woodward playing the title role in The Three Faces of Eve. It was presented as extremely rare and bizarre although since then psychiatric communities who accept the DID diagnosis state it is not as rare as once thought.

Dr. Cornelia Wilbur 1978
Most people are familiar with the famous case of “Sybil an alias for Shirley Ardell Mason, a woman Wilbur claimed possessed 16 personalities as a result of a traumatic and highly abusive childhood.Mason’s story Sybilfirst arrived as a best-selling book that was” ghost-written” by author Flora Shcreiber who told the story in the third person(s). It sold in the millions. Not long after the book’s release, Hollywood actress Sally Fields starred in the movie Sybil, along with Joanne Woodward as her psychiatrist.

The text has come under fire in recent years, significantly weakening the argument for MPD/DID. An author named Debbie Natham, released “Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case,” an account that disputes much of the information. She claims that Wilbur was a fraud and intentionally invented several of Mason’s so-called personalities using the hypnotic drug sodium pentothal. Wilbur’s method was to suggest abusive trauma to Mason, who agreed with Wilbur’s account. Medical records do not support Sally_Field_1971Wilbur’s claims about Mason’s physical and sexual abuse at her mother’s hands. Mason herself once asked a different psychiatrist who temporarily treated while Wilbur was away, which alter he would like her to portray, stating the name of an alter Wilbur especially preferred. Mason also admitted that if she didn’t agree she had multiplicity Wilbur wouldn’t treat her. Wilbur herself admitted that if she didn’t use the term multiple personality disorder in the account, her publisher would not publish the text.

H. Ellenberger published a paper entitled “The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry” that focused on multiple-personalities-paulo-zerbatomultiple personality disorder. Throughout the 1970s, a number of clinicians worked toward defining and establishing the legitimacy of the condition. Margareta Bowers along with six other contributors published “Therapy of Multiple Personality” in 1971. “Therapy of Multiple Personality” outlines rules for treating multiple personalities. Several psychiatrists in the 1970s and 1980s have written notable accounts of case studies and treatment methodology.

Cecil Adams 2003  The Straight Dope
Adams writes for an online publications called The Straight Dope, a site that is self-described as “fighting ignorance since 1973.” Adams answered a writer about the phenomenon of multiple personality disorder. In his view, the disorder resulted from nothing more than media influences, misguided clinical practices and mass hysteriaAdams emphasized that the disorder was manufactured  “under the influence of hypnosis and other techniques,” whereby patients were coaxed into “uncovering bloodcurdling stories of child abuse” or satanic cults. The whole satanic cult-thing has never appealed to me as especially legitimate. If so many of these abusive cults exist why aren’t more people being charged, arrested and thrown in prison for their abuse of children and youth?

The disagreement over the definition of personality also complicates the diagnosis of DID. Supposedly in DID is open-uri20120817-11927-1fr97jaalters are independent of one another, but this is difficult to prove. Speech and behavior can be faked. In support of DID brain-wave patterns may vary although some doctors insist this is not due to a genuine personality switch.  In a study of DID, patients and their alters, different sets of words. When different personality states were asked whether a word was recognized, if it supposedly belonged to a different alter, patients hesitated. The implication was —I’m not supposed to know this. Were those alters truly independent? Obviously not.

My personal feeling is that it may be possible for a single ego not to form due to repetitive, extreme trauma but this is extremely rare. I believe the many currently diagnosed cases are false. DID is just one of those “disorders” that is nigh impossible to prove. It appears to be extremely difficult for therapists to produce legitimate, longitudinal studies about DID, unlike almost all other disorders and illnesses listed in the DSM-5. I doubt that any current clinicians go so far as to use sodium pentothal with their patients but I do believe there is room for error and the use of false memory syndrome. I don’t believe most patients or clinicians do this on purpose. Very few people gain “fame and fortune from this disorder anymore, ergo the extrinsic rewards are nil. There may be intrinsic rewards for the patient but none thus far have been documented. Unlike Wilbur’s deliberate, false account of Mason, I believe it is misguided belief in an interesting, unique phenomenon.

Problems with Assessment of DID/MPD

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DSM-V defines DID/MPD as the presence of two or more distinct identities or personality states” that alternate control of the individual’s behavior, accompanied by the inability to recall personal 640px-Dissociative_identity_disorderinformation beyond what is expected through normal forgetfulness. In each individual, the behaviour varies and the level of functioning can change from severely impaired to adequate. Individuals with DID may experience distress from both the symptoms of DID (intrusive thoughts or emotions) as well as the consequences of the accompanying symptoms (dissociation rendering them unable to remember specific information).   Identities may be unaware of each other and compartmentalize knowledge and memories, resulting in chaotic personal lives. 

The primary identity, which usually has the patient’s birth name, is the original core, or the first personality the individual possesses. It is hypothesized that the person is dalia faceborn whole then “splits” into several alters due to ongoing, extreme trauma. The core personality is “passive, dependent, guilty and depressed“. The alters are “out” or active more often than the primary or core personality. They are usually more aggressive and tend to hold complete memories, something the core lacks. DID is a major change in the DSM-5. Heretofore, DID was listed as MPD (Multiple Personality Disorder). MPD itself was fraught with controversy. Across continents there has been considerable debate as to whether MPD/DID even exists. There are a number of valid reasons for this:

  1. It is almost strictly a North American phenomenon – MPD is diagnosed more frequently in NA than anywhere else in the world.
  2. Females are diagnosed 3 times more often than males.
  3. It became extremely popular in psychiatry after the sybilrelease of the boo Sybil, written by Flora Schreiber, and the release of the movie by the same name, Sybil, starring Sally Fields The story featured the supposed biography of Shirley Ardell Mason, although there has been much skepticism in the following decades about the validity of her account.
  4. Diagnosis dropped considerably into the 1980s when the disorder was called into question for inclusion in the DSM-IV-TR.
  5. MPD was linked with extreme sexual abuse but no scientific research has proven conclusively that this is true, particularly since a number of people who claim to have MPD have never been sexually or physically abused.
  6. There is no scientific methodology to prove the existence of MPD/DID.
  7. It is a disorder that many people have tried to fake for attention-seeking purposes and in some cases, for financial gain. This is co-morbid with a factitious disorder called malingering.
  8. MPD can be co-morbid with another disorder and therefore be difficult to assess.
  9. Psychiatrists have manufactured the existence of alternate personalities in patients.This is known as iatrogonesis.
  10. There is no such thing as several people within one body and one brain.
  11. No longitudinal studies have been conducted.
  12. No epidemiological studies have been conducted.
  13. Patients claim to have varying numbers of alters, yet there is no proof for these claims. The number of alters varies widely, with most patients identifying fewer than ten, 640px-Dissociative_identity_disorderthough as many as 4,500 have been reported.The average number of alters has increased over the past few decades, from two or three to now an average of approximately 16.
  14. DID/MPD has been diagnosed based on memory, a poor assessment tool.
  15. Only a small cluster of clinicians accept and use the diagnosis.

 

 

 

 

 

PowerPoint Presentation on MPD/DID

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I have to toot my own horn on this one. I put together a PP years ago on multiplicity.Recently I did another one. I got a picvery good response to them. Alas, many of the links in the old presentation are now broken (clearly they weren’t at the time). I cannot repair them since I no longer have the original work. Stupidly, I deleted it (definitely not with malice aforethought).

If you do decide to view them, forgive the many broken links. **Also there are warnings in each presentation that the presentation or certain videos could be triggering. ** Please keep this in mind regardless of the mental disorder you may possess. Now, pop open a microwaved bag of popcorn and enjoy!

Dissociative Identity Disorder – an examination of a controversial mental health phenomenon

Dissociative Identity Disorder and Multiple Personality Disorder – quite frankly this a more updated and sophisticated presentation. There is more information and hopefully it makes the phenomenon of DID a little easier to understand.

 

 

 

Causes

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Identifying causes is a major problem with diagnosing DID and this is one of many reasons why the inclusion and categorization of MPD/DID is an ongoing issue in the DSM-V. One reason is that there is no general consensus as picto what causes the disorder. There are debates but no scientific proof. There are no longitudinal studies. There are no epidemiological studies. There is no in-depth research on case studies. Diagnosis is dependent upon:

  1. Memory – a poor methodology at best
  2. Comparison of symptoms between case studies.
  3. Suspicion exists as to whether doctors themselves create alters through hypnotherapy and other methods (Iatrogenesis  or  brought forth by the healer).
  4. New discovery that DID development is possible after childhood
  5. prevalence rates across cultures and populations
  6. DID in children may partly result from a strong imagination used in coping skills. In adults however, DID may present as PTSD (post-traumatic stress disorder).


Possible causes:

  1. Trauma – sexual and physical abuse appear to occur frequently in these individuals The accuracy of these reports are disputed by professionals, witnessesParentsDaughterAug1931 and families.
  2. Other causes – early loss, serious medical illness or other traumatic event
  3. Lack of comfort by at least one parent or guardian during ongoing abuse. Individuals who have a chance to process the abuse and turn to a “safe” adult after
    abusive episodes seldom develop DID. Those who do not have this option frequently develop DID. However this too is called into question. How does the therapist know whether a traumatized individual would have potentially
    developed DID when this disorder doesn’t occur?
  4. Possible genetic connection. However, the gene theory hasn’t and cannot be proven. It is possible that forms of dissociation, such as dissociative fugue or amnesia, may be present in immediate or extended family members although this isn’t always the case.

Dr. Susan Taylor, a psychiatrist and expert in MPD (is there such a thing as an expert?) offers the explanation
that the higher self recognizes when a situation occurs that shouldn’t. That self acknowledges that “this is not right. I really shouldn’t do open-uri20120817-11927-1fr97jait. Just this once.” (She is referring to the splitting into another alter). Over time, the splitting becomes a kind of “belief system” and therefore ingrained. When that happens “we don’t remember the wisdom of the body and the wisdom of nature that told us, hey, don’t go down that road.” Inevitably, this leads to a “full-blown disease state.” Frankly this is one of the most comprehensive, if incomplete, explanations of the causes of multiplicity that I’ve ever heard.

 

 

 

 

 

 

 

Lady Gaga – Seriously

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I found this gem online. The public has wondered whether or not people like Britney Spears or Lady Gaga  and other celebrities possess multiplicity. Myself, I usually believe gagathese people are entertainers. They deliberately and consciously develop an “alter ego” in order to perform for the public. This isn’t multiplicity. Lady Gaga of course presents multiple alters. She plays different roles, some of whom interact with one another.

The jury’s out on Spears, however. People google Britney Spears – alter ego – and a video appears of Spears’ interview with Diane Sawyer  that seems to show a very different Spears. At one point, Sawyer asks Spears a question. Spears freezes, replies quite differently than she has earlier in the interview. Spears utters the word “weird.” Then in a very different voice, Ah! Weird! Hello!” (as if introducing herself for the first time in the interview). she tosses her hair around, acting very girlish, an inappropriate response to Sawyer’s question.If Spears is faking, I must admit, she is good at it. Her ex-husband, Kevin Federline, insists she is a multiple.

britwb1Why Spears is a multiple and where this disorder came from in her history, I can’t say. Many child celebrities however disclose abuse when they are adults. Often sexual abuse is ritualistic for a number of years, frequently at the hands of their agents, or other professionals associated with the industry.

Mel Gibson has told interviewers that he possesses a “viking alter” named Bjorn who he has to “bury in sand” in order to control Bjorn. Now and then however Bjorn “pushes a hand” through the sand. Personally I think Gibson uses multiplicity to excuse his racist and violent behaviours. “It wasn’t me,” he stated once. How convenient. Mind you, there wasn’t a silly “cover-up” about his arrest as was suggested in the enclosed video. He was arrested, charged, convicted.

Gibson studied with a rabbi for a time to make amends. He attended AA meetings. He completed 3 years of mel-gibson-braveheartmandatory conditions as set out by the court. It’s over already. Yet the public seems to think it is entitled to knowing what he acted like at the time of his arrest and how police reacted. That’s not true. Do they “have a dog in this fight?He hopes people will“graciously accept me back.” So do I.

If Gibson’s claim was helpful to him in court (it wasn’t), then anyone can state to a judge that “it wasn’t me, it was Bjorn.”. What nonsense.That’s just too easy. And it’s an insult to people possess MPD.

Attachment Theory

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Secure Attachment
A child whose parents exhibit consistent, positive, reassuring responses to a child’s needs tend to display 800px-Szymon_i_Krystian_003secure attachment behaviours. They will:

  1. approach the parent when s/he enters the room
  2. cry when the parent leaves
  3. confidently explore a room when the parent is present
  4. learn from a parent’s example when assistance is required
  5. express affection freely
  6. show curiosity about a stranger

Anxious-Resistant Insecure Attachment or Ambivalent Attachment

A child with anxious-resistant attachment style will typically 800px-Khmerchildrenexplore little and is wary of strangers even with the parent present. Now that makes sense to me. Aren’t most toddlers shy when a stranger enters the room? Perhaps this definition refers to older children. ARI is a response to unpredictable caregiving. This child cannot decide if s/he wants the parent’s attention or not. Typically this child will:

  1. display ambivalent behaviour when parent returns
  2. display resistant behaviour
  3. demonstrate an angry attitude, especially when parent
  4. is about to leave
  5. signal the parent when they want contact
  6. show distress when put down after being picked up

Anxious-Avoidant Insecure Attachment

A child with AAI ignores or avoids the caregiver.  The child ParentsDaughterAug1931shows little emotion when the parent arrives or leaves. The child doesn’t explore the environment. The apparently calm exterior of the avoidant child is actually a mask for distress. This child will:

  1. conspicuously avoid the mother
  2. pointedly turn away
  3. if there is a greeting it is a glance or a quick smile
  4. approaches mother only after excessive coaching
  5. attempts an approach by going past the parent
  6. If held, the child attempts to get down again

Disorganized Attachment

If the child doesn’t demonstrate consistency in achieving proximity or some relative proximity with the caregiver, then it is ‘disorganised’ since this indicates a disruption of Prayer_Time_in_the_Nursery--Five_Points_House_of_Industrythe attachment system (e.g. by fear). For some reason 52% of DA children approach the caregiver to seek comfort. This type of behaviour might exhibit itself when a rejected/neglected child approaches a caregiver for comfort, loses muscular control and falls to the floor, overwhelmed by the fear of the unknown. This behaviour is frequently observed in foster children and children who have inconsistent care. Most of these children’s mothers suffered major losses shortly before or after the child’s birth and became severely depressed. This child will:

  1. display obvious fear
  2. freeze and dissociate
  3. exhibit jerky movements
  4. display contradictory behaviour (eg. approaching and avoiding the caregiver)

The multiple child may exhibit all of these attachments since different selves may emerge at different times. For instance the child who is protected from abuse and trauma and only emerges when there is no threat in the environment may exhibit secure attachment. Disorganized attachment is probably the most prevalent. The child needs and seeks love and comfort, especially after a traumatic episode, but when the caregiver’s response is unpredictable, or when the affectionate caregiver is also the abuser, the child’s reaction will most certainly be dysfunctional as is the relationship. This isn’t to say that the manner in which a child shows attachment is a tool for assessing multiplicity. Rather, it would be indicative of the diagnosis that has already been made.