Multi-personality Disorder

Introduction Personality has a myriad of definitions though for the purpose of this paper, we shall use the general definition according to Jess Feist (1994, pp.6-7), she refers to personality as:“a pattern of relatively permanent traits, dispositions or characteristics within the individual that give some measure of consistency to that person’s behaviour .These traits may be unique, common to some group or shared by the entire species, but their pattern is different for each individual.” A disorder as defined by the Merriam Webster Online Dictionary as an abnormal physical and mental condition. Thus, multi-personality disorder, which is now known as Dissociative Identity Disorder (DID), is defined as a psychotic disorder characterized by having at least one “alter” personality that controls behaviour. The “alters” are said to occur spontaneously and involuntarily and function more or less independently of each other. (www.skepdic.com/mpd.html) According to Barlow & Brown (1996, p. 109), DID is characterized by the following in the DSM-IV: a) the presence of two or more distinct identities or personality states; b) at least two of these identities or personality states recurrently takes control of the person’s behaviour; c) inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness; d) the disturbance is not due to the direct effects of a substance, (for example a black-out attributed to alcohol or drug use), or a general medical condition. 1

Dissociation as defined in the DSM-IV is referred to as a disruption in a person’s consciousness, memory, identity, or perception of the environment (Barlow & Brown, 1996, p.105). DID in the DSM-IV, is included in a category referred to as the dissociative disorders which are characterized by alterations in perceptions or a sense of detachment from one’s self, from one’s world or from memory processes. The other types of dissociative identity disorders include: Dissociative Fugue, which according to Barlow & Brown (1996, p.109) is sudden and unexpected travel away from home or work, accompanied by an inability to recall one’s past and confusion about personal identity or assumption of a new identity. Dissociative Amnesia is described as the extensive inability to recall important personal information, usually traumatic or stressful in nature (Barlow & Brown, 1996, p.109). Depersonalization disorder is described as persistent or recurrent feeling of being detached from one’s mental processes or body that is accompanied by intact reality testing (Barlow & Brown, 1996, p.109).

Cause of Dissociative Identity Disorder

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An individual that suffers from dissociative identity disorder only displays one personality at one time and the alternation of personalities usually produces lapses in time in the personality that has been displaced (Bryant 1995). The alternation or “switching” between personalities can be quite abrupt and often takes just seconds (Putnam et.al., 1986). The general causes of dissociative identity disorder often (though they may vary) include: childhood abuse, over-exposure to repetitive traumatic events, and lack of proper support from someone (a friend or family member) in countering the stress-filled situations (http://www.buzzle.com/editorials/9-24-2004-59666-asp ). Dissociative Identity disorder is more prevalent in women, particularly those who report having suffered physical or sexual abuse during childhood (Boon & Draiger, 1993) and are often in their twenties or thirties though they generally range between the ages of eleven and sixty-seven (Vitkus, 1993, p.49). The case studies used by Vitkus (1993, pp. 37-45) and Barlow & Brown (1996, pp. 101-108), presents a case study of a patient called Sherry and Wendy respectively who suffer from dissociative identity disorder. Sherry was fortunate enough, as she only had two alter personalities while Wendy had several as her abuse was very severe and begun at a very tender age and persisted throughout to her teenage years. The statistics that support physical and sexual abuse as the main reason behind the development of multi-personality disorder are quite startling, out of a sample carried out of a hundred persons with DID, 97% had experienced significant trauma, usually physical and sexual abuse (Putnam et.al. , 1986). A history of incest was observed in 68% of this sample. In another sample, 95% of the ninety-seven cases reviewed, reported physical or sexual abuse (Ross et.al., 1990). Some patients reported being buried alive; others reported being tortured with burns or with cuts.

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The number of alter personalities varies widely among individuals with DID ranging from one to as many as fifteen. Though this figure may be off due to those who have very many personality disorders; an association has been found between the number of reported childhood traumas and the number of reported personalities (Putnam, et.al., 1986). A person with dissociative identity disorder develops two or more distinct personalities often called sub-personalities, each with a unique set of awareness, behaviours, thoughts, and emotions (Comer, 2004, p. 219). According to Vitkus (1993, pp.49-50), alter personalities generally form three basic clusters: “core” personalities, aggressive personalities and intermediary personalities. Core personalities contain the characteristics that generally describe the patient as he or she is known to most people. These personalities are usually meek, passive and obedient, and they aim to please others and avoid pain. The second cluster consists of one or more personalities that are self-confident, outgoing and assertive. These personalities often become aggressive, reckless or promiscuous. Many times these personalities attack people who have mistreated them in their lives such as abusive parents, though more often than not their anger is directed towards the core personality. Sometimes they may attempt to “punish” the core personality through suicide attempts or by inflicting painful wounds. Wendy Howe, the case study used by David Barlow & Timothy Brown (1996, p.108) to bring out DID, more often than not cut or burned herself during a dissociative state to make the memory stop. Although she momentarily felt better, she would rebuke herself for being so “perverse” as to cut or burn herself.

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The third cluster includes personalities that act as intermediaries between the submissive and the aggressive personalities. These intermediaries often not only serve as referees who reconcile the different needs of the other personalities but also function as rational spokespersons who can sympathize with the meek core personalities, yet at the same time understand the wild and disruptive actions of the aggressive personality. According to Vitkus (1993, pp.50-51) interactions among different personalities have two common properties: Firstly, these interactions are characterized by asymmetrical amnesia also called directional awareness. The core personality typically has no knowledge of the other personalities, whereas these other personalities at least have a limited knowledge of the core. In most cases the intermediary personality is omniscient (having infinite awareness, insight and understanding), thus becomes the focus of therapeutic attempts at integration. Secondly, the interaction between personalities is trance logic (a suspension of the rules of logic and reason). Alter personalities revert to trance logic to explain their attempts to harm the core personality. Fifty-three percent of the suicide attempts in the sample taken by Putnam et.al. (1986), resulted from an alter personality attempt’s to kill the core personality, a process referred to as “internal homicide” by researchers. Sherry had two alter personalities, her alter, Karla in this particular interaction was not concerned by the fact that if Sherry did manage to kill herself during her suicide attempts she would also die. To Karla this did not matter as she would simply float to another body but at present she had to be with Sherry (Vitkus, 1993, p.51). Though according to Comer (2004, p.220), the interaction varies from case to case, there are three kinds of relationships between the “alters” (sub-personalities):

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a) The mutually amnesic relationships, the sub-personalities have no awareness of one another (Ellenberger, 1970). b) Mutually cognizant patterns: each sub-personality is well aware of the rest. They may hear one another’s voices and even “talk” among themselves. c) One-way amnesic relationships: some sub-personalities are aware of others, but the awareness is not mutual. Those that are aware are called co-conscious sub-personalities, are “quiet observers” who watch the actions and thoughts of the other sub-personalities but do not interact with them. According to Comer (2004, pp.221-222), sub-personalities differ in terms of vital statistics, abilities and preferences and physiological responses. In terms of vital statistics, sub-personalities may differ in features as basic as age, sex, race and family history. Abilities and Preferences: sub-personalities may have different areas of expertise or abilities; one may be able to drive, speak a foreign language or play a musical instrument while others cannot (Coons et al., 1988); their handwritings may also differ (Coons, 1980). In addition to having different tastes in food, friends, music and literature. Physiological responses: sub-personalities may experience differences in autonomic nervous system activity, blood pressure levels and allergies.

Perspectives Two perspectives have been put forward to try and explain why dissociative identity disorder affects particular individuals: 6

I. Psychodynamic Perspective: This perspective views dissociative identity disorders as a result of the person’s use of repression to block from consciousness unpleasant or traumatic events (Sue et.al, 2000, p. 169). The split in personality may develop because of traumatic early experiences combined with an inability to escape them (Sue et.al, 2000, p.170). Some researchers believe that one or more personalities take on the “pain” to shield the other personalities (Shapiro, 1991). According to Kluft (1987a), there are four factors that are necessary in the development of multiple personalities and they are:a) The capacity to dissociate b) Exposure to overwhelming stress, such as physical or sexual abuse c) Encapsulating or walling off of the experience d) Developing different memory systems In addition to these factors an individual who is highly susceptible to hypnosis may also be able to develop multi-personalities (Barlow & Brown, 1996, p. 111). If a supportive environment is not available or if the personality is not resilient, multiple personality results from these factors (Irwin, 1998, p.70).

I. Behavioural Perspective The behavioural explanations of dissociative identity disorder include role playing and selective attention. Role playing may be combined with selective attention to certain cues. The person

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responds only to certain environmental stimuli and then behaves in a way that would be appropriate if only those stimuli were present (Sue et.al, 2000, p. 171).

Symptoms and Treatment of Dissociative Identity Disorder More often than not, individuals with DID are misdiagnosed with depression, personality disorder, anxiety, substance abuse and schizophrenia. The symptoms for DID is memory loss in the form of major chunks and depersonalization. 8

According to Barlow& Brown (1996, pp.111-112), the process of dismantling the walls that have developed between the personalities involves: a) Recognizing the existence and gradually getting to know the different alters b) Understanding the purposes that each alter has served c) Learning new coping strategies and obtaining increased supports so that more awareness of traumatic memories is tolerable d) Confronting and reliving the early traumas to understand the original need for the walls and to process the intense negative feelings and thoughts associated with these memories, and e) Coming to understand the ways in which the traumas affected many ways of coping and learning how the present differs from the past in ways that allow new and more adaptive strategies to be used. Psychologists have advanced psychotherapy in addition to hypnosis to comprehensively deal with dissociative identity disorder. Psychologists go through the steps with their patients and when they are ready, the psychologists help them to fuse the different personalities to the primary (core) personality.

Conclusion Dissociative Identity Disorder is largely a new personality disorder, and as such due to its complex nature and the number of misdiagnosed cases, an individual may have to undergo six to seven years of therapy before being accurately and conclusively diagnosed with multipersonalities. 9

In the recent past the number of reported cases has increased due to the reported increases in physical and sexual child abuse. The society as such has an even greater responsibility to ensure that children are well protected in order to prevent some of these personality disorders. The state as well through Social and Child Services should enact laws that protect vulnerable children and remove them from environments that are detrimental to their holistic development. Such children should be placed in environments that are loving and supportive in order to enable them to face the negative feelings and emotions associated with the abusive period in their lives. In this way they are able to move on and develop stable and secure personalities.

REFERENCES Barlow, D. H., & Brown, T.A. (1996). A Casebook in Abnormal Psychology. Pacific Grove: Brooks/Cole Publishing Company Boon, S., & Draiger, N. (1993). Multiple personality disorder in the Netherlands: A clinical investigation of 71 patients, American Journal of Psychiatry, 150, 489-494. In Sue, D.,

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Sue, D. W., & Sue, S. (2000). Understanding Abnormal Behaviour (6 Ed.). Boston, New York: Houghton Mifflin Company Bryant, R. A., (1995). Autobiographical memory across personalization in dissociative identity disorder: A case report. Journal of Abnormal Psychology, 98, 326-329. In Sue, D., Sue, D. W., & Sue, S. (2000). Understanding Abnormal Behaviour (6th Ed.). Boston, New York: Houghton Mifflin Company Comer, R. J. (2004). Abnormal Psychology (5th Ed.). New York: Worth Publishers Coon, P. M. (1980). Multiple personality: Diagnostic considerations. Journal of Clinical Psychiatry, 41(10), 330-336. In Comer, R. J. (2004). Abnormal Psychology (5th Ed.). New York: Worth Publishers Coons, P. M., Bowman, E. S., & Mulstein, V. (1988). Multiple personality disorder: A clinical investigation of 50 cases. Journal of Nervous& Mental Disorders, 176(9), 519-527). In Comer, R. J. (2004). Abnormal Psychology (5th Ed.). New York: Worth Publishers Ellenberger, H.F. (1970). The Discovery of the Unconscious. New York: Basic Books. In Comer, R. J. (2004). Abnormal Psychology (5th Ed.). New York: Worth Publishers

Feist, F. (1994). Theories of Personality (3rd Ed.). Fort Worth: Harcourt Brace College Publishers Irwin, H. J. (1998). Attitudinal predictors of dissociation: Hostility and powerlessness. Journal of Psychology, 132, 389-404. In Sue, D., Sue, D. W., & Sue, S. (2000). Understanding Abnormal Behaviour (6th Ed.). Boston, New York: Houghton Mifflin Company

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Kluft, R. P. (1987a). Dr. Kluft replies, American Journal of Psychiatry, 144,125. In Sue, D., Sue, D. W., & Sue, S. (2000). Understanding Abnormal Behaviour (6th Ed.). Boston, New York: Houghton Mifflin Company Omniscient. (2009). In Merriam-Webster Online Dictionary. Retrieved March 10, 2009, from http://www.merriam-webster.com/dictionary/omniscient Disorder. (2009). In Merriam-Webster Online Dictionary. Retrieved March 10, 2009, from http://www.merriam-webster.com/dictionary/disorder Putnam, F. W., Guroff, J. J., Silberman, E. K., Barban, L., & Post, R. M. (1986). The clinical phenomenology of multiple personality disorder: Review of 100 recent cases. Journal of Clinical Psychiatry, 47, 285-293. In Barlow, D.H., & Brown, T.A. (1996). A Casebook in Abnormal Psychology. Pacific Grove: Brooks/Cole Publishing Company Putnam, F. W., Guroff, J. J., Silberman, E. K., Barban, L., & Post, R. M. (1986). The clinical phenomenology of multiple personality disorder: Review of 100 recent cases. Journal of Clinical Psychiatry, 47, 285-293. In Vitkus, J., (1993). Casebook in Abnormal Psychology (2nd Ed.). New York: McGRAW-HILL, INC. Ross, C, A., Miller, S. D., Reagor, P., Bjornson, L., Fraser, G. A., & Anderson, G. (1990). Structured interview data on 102 cases of multiple personality disorder from four centres. American Journal of Psychiatry, 147, 596-601. In Barlow, D.H., & Brown, T.A. (1996). A Casebook in Abnormal Psychology. Pacific Grove: Brooks/Cole Publishing Company Vitkus, J., (1993). Casebook in Abnormal Psychology (2nd Ed.). New York: McGRAW-HILL, INC.

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