From: danash@aol.com To: walkers@world.std.com Date: Sat, 26 Mar 94 15:54:57 EST ---------------- WHAT IS MULTIPLE PERSONALITY DISORDER Authored by a top researcher: Paul F. Dell, PhD. Eastern Virginia Medical School Department of Psychiatry & Behavioral Sciences Dissociative Disorders Program Multiple Personality Disorder MPD) is about pain...nothing else, Just pain-- emotional pain, total helplessness, traumatic humiliation, and overwhelming rage. MPD is the desperate and creative solution of the traumatized child. It is a crude and powerful and wonderful means of survival for children who are repeatedly terrified, abused, or trapped in inescapable pain. MPD arises in childhood, mostly ages 3 to 9 years. There is juvenile diabetes and adult onset diabetes, but there is no adult onset MPD. Only children have sufficient flexibility (and vulnerability) to respond to trauma by breaking their "still-coalescing" self into different, dissociated parts. It used to be thought that MPD is an exotic form of hysteria-- an elaborate means of escaping responsibility for dealing with life. It is not. It is usually an effort to "escape" from child abuse. It is often thought that MPD is a sham, a bizarre form of "play-acting" that is perpetrated by manipulative, attention-seeking individuals. It is not. MPD is a "disorder of hiddeness" wherein 80-90% of MPD patients do not have a clue that they are "multiple." Most know that there is something wrong with them; many fear that they are crazy-- but few know that they are multiple. It is sometimes thought that MPD is the last refuge of a criminal- a deceptive effort to provide an insanity defense- so that the criminal can evade responsibility for his/her crime. Far from it-- most multiples don't know that they are multiple. Moreover, once the diagnosis is made, the typical MPD patient consumes months denying the diagnosis and insisting that the therapist has a very vivid imagination. A recent study of convicted criminals (felons, murderers, etc.), who were diagnosed after being imprisoned, found that none of them wished to make use of their diagnosis in order to seek a new trial or to ameliorate their existing sentence. Finally, MPD is frequently misunderstood by the question, "Isn't MPD just an exaggeration of the different parts of our personality; aren't we all really "multiple?..." This is an enticing question. "Yes," we all have different parts to our personalities. "No," MPD is not "just an exaggeration" of these parts. Why? At least 6 reasons: 1) Because we all don't have a dissociative disorder; 2) Because we all don't suffer from severe and chronic child abuse or trauma; 3) Because we all do not have amnesia for what we are doing when a different part of our personality comes to the fore; 4) Because the "raison de etre" of the different sides to our personality is not to hide from ourselves information or feelings about trauma; 5) Because we all do not have "high" hypnotizability; and, 6) Because we all do not develop POST TRAUMATIC STRESS DISORDER when we begin to pay attention to our parts. "How many parts are there?..." The typical female multiple has about 19 alter personalities; male multiples tend to have less that half of that. The number of alters is explained by 3 factors: 1) the severity of the trauma; 2) The chronicity of the trauma; and, 3) the degree of vulnerability of the child. Thus, the male multiple from ages 7 to 10 who was sexually abused a half-dozen times by a distant relative is going to have far fewer alters than a female multiple who was severely physically, sexually, and emotionally abused by both parents from infancy to age 16. The latter patient, in fact could quite easily wind up with 30 to 50 (+) alters, even in the hundreds. (MY NOTE: more recent case studies have revealed higher numbers of alters, of which some are referred to as fragments. The increase seems a result of further follow up on earlier case studies where there were additional "layers" of concealed parts which only revealed themselves later into therapy) "How could a person have so many different personalities?..." and "How would you tell the difference among them?..." The answers to these questions require a clarification of several points. First, MPD is a misleading term-- DISSOCIATED SELF DISORDER would probably be better. There is but one self that is dissociated into multiple parts. MPD tends to be misunderstood to mean "multiple self disorder." In fact, there is only one self however divided or dissociated it may be. Secondly, there are usually only 3 to 6 alters who are particularly active (eg: assuming full executive control) on any given day. The rest of the alters are relatively quiet (even dormant for long periods of time). Third, THERE IS NO REQUIREMENT THAT DIFFERENT PERSONALITIES BE VISIBLY DIFFERENT TO AN OBSERVER. It is only necessary that each alter fulfill the basic function of an alter personality-- that is, to protect the host personality from the knowledge and experience of the trauma. This task is accomplished by means of dissociative barriers or walls of amnesia. Thus a multiple could conceivably have dozens of alters that look jut the same, but who, nevertheless, serve the function of walling off trauma from the host (and dispersing it among many alters). The answers to the above questions can now be more easily understood in light of the basic task of an alter personality. If the "raison d'etre" of alters is to sequester trauma from the host so that he/she is able to continue to function without becoming overwhelmed, then additional alters may be produced to help contain the trauma. It is not required that these new alters look different, nor is it necessary that they all be active at one time; it is only necessary that they do their job (of containing the trauma of the abuse). The typical alters that are found in a person with MPD include: 1) a depressed, depleted host; 2) a strong, angry protector; 3) a scared, hurt child; 4) a helper; and, 5) an embittered internal persecutor who blames (or persecutes) one or more alters for the abuse that has been suffered. While there may be other types of alters in any given MPD individual, most of them will be variations on the theme of these 5 alters. "How common is MPD?..." Although the data are not all in, the best estimate of the prevalence of MPD is that it approximates that of about 1% of the population. This estimate would translated into at least 2,000,000 cased in the US alone. "Why so many?..." Because MPD is directly linked to the prevalence of child abuse. And, unfortunately, child abuse is all too common. "How impaired is the person with MPD?..." The range of impairment across different persons with MPD is best analogized to that of alcoholism. Impairment due to alcoholism a) ranges from skid row bums to high functioning senators, congressmen, and corporate executives; and, b) varies in any given alcoholic from one period of time to another as a function of binges, patterns of drinking, life stresses, etc. It is much the same as MPD. There are some multiples who are chronic state mental patients, others who undergo recurrent hospitalization due to self-destructive behavior, and many more who raise children, hold jobs, and may even be high-functioning lawyers, physicians, or psychotherapists. There are two major factors that account for whether a multiple is low or high-functioning" PERSONALITY and POST TRAUMATIC STRESS DISORDER. Despite having many "personalities," every multiple, as a whole, has a personality (just like us). Thus, to the extent that a multiple has counter-productive traits (eg: irresponsibility, rampant denial and avoidance, strong narcissism, entitlement, masochism, addiction to interpersonal control, psychotherapy, etc), then that person will be impaired in his/her functioning as a competent and responsible adult. The only other way in which multiples differ from non-multiples in this regard is that their character traits not only typify how they deal with daily life, but also how alters deal with one another. Lower functioning multiples may have alters who are struggling with one another for dominance, stealing from one another, refusing to take responsibility for the mess that just made, grabbing control whenever they want (no matter what it interrupts- job, relationships, child-care, financial solvency, etc), and so on. Such negative character traits are the single biggest determinant of frequent crises or chronic dysfunctionability; they are also unquestionably the largest hindrance to therapeutic treatment of MPD. The second major factor that affects daily functioning in persons with MPD is POST TRAUMATIC STRESS DISORDER (PTSD) which consists of flashbacks, nightmares, and intrusive memories. Many people with MPD also have PTSD. To the extent that a person is troubled with recurrent intrusive re-experiencing (visual, auditory, or somatic) of trauma, he/she may also have depression, loss of concentration, suicidality, substance abuse, panic attacks, self-mutilation, etc. An upsurge of PTSD symptoms is probably the single most common cause of sudden crisis, decline in functioning, or psychiatric hospitalization for the "multiple." For many observers, MPD is a fascinating, exotic, and weird phenomenon. For the patient, it is confusing, unpleasant, sometimes terrifying, and always a source of the unexpected. The treatment of MPD is excruciatingly uncomfortable for the patient. The dissociated trauma and memory must be faced, experienced, metabolized, and integrated into the patient's view of him/herself. Similarly, the nature of one's parents, one's life, and the day-to-day world must be re-thought. As each alter metabolizes his/her trauma, then that alter can yield it's separateness and re-integrate (because that alter is no longer needed to contain undigested trauma). Recovery from MPD and childhood trauma takes something on the order of five years. It is a long and arduous process of mourning. LOOK FOR MPD IF THERE IS A PATTERN OF... 01. History of depression or suicidal behavior. 02. Childhood history of physical or sexual abuse... - reports one parent was very cold and critical - reports of "wonderful" parents by a person who is clearly emotionally troubled. 03. Abusive relationships in adulthood 04. Strong attacks of guilt; sees self as bad or undeserving - sacrifices self for others - feels does not deserve help; is a burden, reluctant to ask for help - is sure you do not want to be troubled with seeing him or her 05. Reports being able to turn off pain or "put it out of my mind." 06. Self-mutilation or self-injuring behavior. 07. Hears voices. 08. Flashbacks (visual, auditory, somatic, affective, or behavioral) 09. History of unsuccessful therapy. 10. Multiple past diagnoses (eg: major depression, schizophrenia, bipolar disorder, borderline personality disorder, substance abuse). 11. History of shifting symptom picture. 12. Reports of odd changes or variations in physical skills or interests. 13. Described by significant other as having 2 personalities or being a "Dr. Jekyll & Mr. Hyde." 14. Family history of dissociation. 15. Phobia or panic attacks. 16. Substance abuse. 17. Daytime enuresis or encopresis. 18. History of psychophysiological symptoms. 19. Seizure-like episodes. 20. History of nightmare and sleep disorders. 21. History of sleepwalking. 22. School problems. 23. Reports psychic experiences. 24. Anorexia or Bulimia. 25. Sexual difficulties. 2 positive items from among 1-15 mandates consideration of a diagnosis of a dissociative disorder (eg: DISSOCIATIVE DISORDER NOS=not otherwise specified or possible POST TRAUMATIC STRESS DISORDER. 4 or more positive items (especially among 1-15) mandates serious consideration of a diagnosis of MULTIPLE PERSONALITY DISORDER. (MY NOTE: In spite of all that, properly diagnosed and treated MPD has a very high success rate.)