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 complete recovery. 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 conflicting) impulses 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
disorders. ( 4th ed) 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 disorder occurs as a
protective reaction to severe childhood trauma. Essentially, the self appears to
dissociate, or split into separate 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
Clinics of North America 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.