Structured interview data on 102 cases of multiple personality disorder from four centers

Patients with multiple personality disorder (N = 102) at four different centers were interviewed with the Dissociative Disorders Interview Schedule. The presenting characteristics of the patients at all four centers were very similar. The clinical profile that emerged included a history of childhood physical and/or sexual abuse in 97 (95.1%) of the cases. The subjects reported an average of 15.2 somatic symptoms, 6.4 Schneiderian symptoms, 10.2 secondary features of the disorder, 5.2 borderline personality disorder criteria, and 5.6 extrasensory experiences; their average score on the Dissociative Experiences Scale was 41.4. The results indicate that multiple personality disorder has a stable, consistent set of features.     

Optical differences in cases of multiple personality disorder

Nine patients diagnosed with multiple personality disorder (MPD) and nine control subjects role-playing MPD were given complete ophthalmological examinations to test whether the MPD subjects would show greater variability in visual functioning across alter personalities than would control subjects role-playing MPD. An analysis of variability of eight optical measures in four prominent areas of vision was performed by comparing two covariance matrices for equality. The test on the equality of the two covariance matrices showed that the two groups were significantly different (p less than .05). That is, MPD subjects had significantly more variability in visual functioning across alter personalities than did control subjects. Because the test of equality of the two covariance matrices rejected the null hypothesis, univariate analyses of variance were performed on the eight individual ophthalmological measures that comprised the matrix. The results of these analyses showed that MPD subjects had significantly more variability across alter personalities than did their control counterparts on measures of visual acuity with correction, visual acuity without correction, visual fields, manifest refraction, and eye muscle balance. The data were also analyzed for clinical significance. Blind ratings of the data were performed by comparing the results of the individual dependent measures across the alter personalities of individual MPD and control subjects according to established ophthalmological criteria. The ratings for clinical significance showed that the MPD subjects had 4.5 times the average number of changes in optical functioning between alter personalities of the control subjects, with a mean of 2.56 clinically significant changes for the MPD subjects and .55 clinically significant changes for the control subjects. This difference was also statistically significant (p less than .01).     

Treatment of multiple personality disorder. A study of 33 cases

This article describes treatment results in 33 patients with multiple personality disorder with respect to the major identifying characteristic of the condition: the presence of separate personalities within a single individual. The author discusses responsiveness to treatment, apparent and stable fusion, follow-up, and reassessment.     

Adolescent multiple personality disorder: a preliminary study of eleven cases

The diagnostic features and treatment histories of 11 adolescents with multiple personality disorder (MPD) are presented. Clinical evaluation revealed that the majority of these adolescents manifested extremely variable school performance, disruptive behavior, trances, amnesias, mood swings, sharp changes in personality, apparent lying, voices heard in the head, and depression. All had a history of childhood trauma: Sexual abuse (73%), physical abuse (73%), and emotional abuse (82%). Seventy-three percent had a parent with a diagnosable dissociative disorder; 36% of the mothers had MPD. These adolescents had a mean number of 24.1 alter personalities and appear to have become multiple at a mean age of 3 years, 1 month. All patients had angry protector alters, depressed alters, scared alters, and child alters. Fifty-four percent of these cases have integrated during treatment or are progressing toward integration. The remaining cases dropped out of therapy.     

Clinical presentations of multiple personality disorder

It is hoped that this discussion of MPD will discourage stereotypic thinking about this condition and encourage the inclusion of MPD in virtually all differential diagnoses. The major thrust of what has been learned about the natural history of MPD is that most patients with this condition spend most of their lives not manifesting their MPD in classic manner. The typical presentation of MPD is the tip of a rather large iceberg. Covert and other nonclassic presentations are much more characteristic. An appreciation of this will help the clinician approach the diagnosis of MPD with a heightened sensitivity to the possibility of encountering it within his or her practice.     

Cognitive analysis of multiple personality disorder

Multiple personality disorder is not rare, and it can be treated using the principles of cognitive therapy. Noncognitive techniques are also required. The purpose of this paper is to define the basic cognitive map of multiple personality disorder, one which recurs in the majority of cases. Multiple personality patients commonly make the classical cognitive errors such as selective abstraction and dichotomization, but they also have a set of schemata and cognitions derived from their abusive childhoods that are specific for the disorder.     

Inpatient treatment of multiple personality disorder

Multiple personality disorder (MPD) was once thought to be rare, but there is increasing evidence that it is relatively common. In a period of a year the author had 73 inpatient admissions under his care, of which 8 were for MPD. Three of the MPD admissions were for previously undiagnosed cases in an unselected general adult population. Thus 4.4% of the author's inpatients, once MPD patients diagnosed prior to admission are excluded, had MPD. The implications of this finding are discussed. The diagnosis and inpatient treatment of MPD are reviewed.     

Suicide and parasuicide in multiple personality disorder

Multiple personality disorder (MPD) has been diagnosed with increasing frequency in the 1980s: according to one estimate 6,000 cases have now been diagnosed in North America (Coons 1986). The diagnosis of MPD can be difficult because patients usually present in a polysymptomatic fashion, and the specific features of their dissociative disorder may be difficult to elicit (Kluft 1985a, 1987). One of the most common presenting features consists of suicidal ideation and suicide attempts. Putnam et al. (1986), for instance, noted suicidality as a presenting symptom in nearly 70% of 100 cases of MPD reported to them by 92 clinicians throughout North America. We have collected a series of 236 cases of MPD reported to us by 203 clinicians throughout North America. Our results show that 72% of the patients attempted suicide. The purpose of this report is to compare 48 cases of MPD from this series with no previous suicide attempts to 167 cases that have attempted suicide to determine features that differentiate the patients who attempt suicide from those who do not.     

The clinical phenomenology of multiple personality disorder: review of 100 recent cases

The clinical syndrome of multiple personality disorder (MPD) is an unusual dissociative condition that has been poorly characterized. In an attempt to better delineate the clinical phenomenology of MPD, 100 recent cases were collected on a 386-item questionnaire completed by clinicians involved in the treatment of MPD patients. This study documents the existence of a clinical syndrome characterized by a core of depressive and dissociative symptoms and a childhood history of significant trauma, primarily child abuse.     

Recent research on multiple personality disorder

The last decade has seen the emergence of solid research on MPD and the dissociative disorders, particularly in the area of diagnosis and clinical phenomenology. A number of other areas have been opened up or advanced considerably. The most notable of these include child and adolescent dissociative disorders; investigation of dissociative memory disturbances; studies of differential alter personality psychophysiology and switching; cross-cultural comparisons of MPD, possession, and dissociative states; and the contribution of pathologic dissociation to the symptomatology of other psychiatric disorders. Yet to be attempted, however, are prospective clinical trials and treatment outcome studies. In addition to clinical and theoretical insights, recent research provides strong evidence for the validity of the diagnosis of MPD. The repeated replication of a core clinical phenomenology demonstrates a construct validity equal to or superior to that demonstrated for most DSM-III/IIIR disorders. The ability of several independently developed instruments to blindly discriminate MPD patients from nondissociative disorder patients with high rates of accuracy supports both the construct and discriminant validity of the diagnosis; and as the astute clinical observations of the last century continue to be confirmed, MPD manifests an historical validity absent in most modern era diagnoses. In the future, arguments about the "reality" of MPD cannot confine themselves merely to attacking one aspect of the disorder but rather must confront the broad range of evidence supporting the validity and reliability of the diagnosis. The future belongs to multicenter studies, although intensive single-case and personal-case series will continue to make important contributions in some areas. The essential elements necessary to begin prospective multicenter studies are rapidly coming together. Already one multicenter structured interview study of clinical phenomenology has been completed and other studies are underway or near publication. As these collaborative research networks mature, even more ambitious studies will be attempted. Adequate funding remains the principal obstacle and must be creatively addressed in this era of budgetary shortfalls, particularly as several research networks cross international boundaries. Exceptionally gratifying is the burgeoning interest of large numbers of psychiatric residents and psychology graduate students in the dissociative disorders. Thanks to a decade of hard work, the next generation of clinicians and researchers will know a great deal more about these patients than the last.     

Phenomenological overlap of multiple personality disorder and obsessive-compulsive disorder

Three patients with multiple personality disorder and three with obsessive-compulsive disorder were compared on a variety of self-report measures and on two structured interviews. Amytal Sodium interviews had been conducted on the obsessive patients; alter personality-like entities claiming responsibility for the obsessions and compulsions were contacted in two patients. The one obsessive patient with no alter personality differed markedly from the other five on the SCL-90, the Lynfield Inventory, and the Dissociative Experiences Scale. Structured interviews with the Anxiety Disorders Interview Schedule and the Dissociative Disorders Interview Schedule also clearly differentiated this patient from the other five. It appears that there is a phenomenological overlap between multiple personality disorder and some cases of obsessive-compulsive disorder. Obsessive patients with prominent dissociative features may be a psychologically and biologically distinct subgroup.     

An update on multiple personality disorder

Within the last decade, multiple personality disorder has been diagnosed, treated, and studied with increasing frequency. A growing body of literature suggests that this condition is not a rarity but that its manifestations, often coexisting with or obscured by other phenomena, frequently go unrecognized for years within the mental health care delivery system. The author reviews recent advances in the understanding of the etiology, diagnosis, and treatment of multiple personality disorder. The thrust of the contemporary literature is that it is a difficult-to-diagnose condition that usually follows severe child abuse, that it is most parsimoniously understood as a chronic dissociative posttraumatic stress disorder, and that it has an excellent prognosis when intensive and prolonged psychotherapy with an experienced clinician is available.     

Techniques in the treatment of multiple personality disorder

Multiple personality disorder, once considered to be rare, is being diagnosed with increasing frequency in the 1980s. The purpose of this paper is to present and discuss twenty techniques used in the treatment of multiple personality disorder. The primary treatment is psychotherapy but a number of adjuvant interventions are also required. The techniques discussed should be of use to therapists and represent a step towards definition of a treatment package for controlled trials, of which none have been conducted to date.     

Current status of multiple personality disorder in India

Three consecutive cases of multiple personality disorder seen over a period of 3 years at a psychiatric clinic in India are reported. The prevalence of this disorder at the clinic is about 0.15/1,000 patients per year. The authors discuss the infrequency of this diagnosis in India in contrast to the frequent diagnosis of possession syndrome for patients who have many of the same symptoms. Transcultural differences in diagnostic practices are also discussed.     

Epidemiology of multiple personality disorder and dissociation

A recent survey of a large sample of the general population in the city of Winnipeg, Manitoba, showed that multiple personality disorder related to childhood abuse affects about 1% of the adult population. About 10% of the adult population has had a DSM-III-R dissociative disorder of some kind. Pathologic dissociation appears to be a major form of emotional disturbance in North America, and it appears to be about as common as anxiety, mood, and substance abuse disorders. The dissociative disorders can no longer be considered rare.     

Schneiderian symptoms in multiple personality disorder and schizophrenia

We report structured interview data from a series of 102 cases of multiple personality disorder (MPD) diagnosed in four centers. Schneiderian first-rank symptoms of schizophrenia were equally common in all four centers. The average MPD patient had experienced 6.4 Schneiderian symptoms. When these 102 cases are combined with two previously reported series of MPD cases, an average of 4.9 Schneiderian symptoms in 368 cases of MPD is noted. This compares with an average of 1.3 symptoms acknowledged by 1,739 schizophrenics in 10 published series. Schneiderian symptoms are more characteristic of MPD than of schizophrenia.