Dissociative identity disorder (formerly called Multiple Personality Disorder or MPD)

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Dissociative identity disorder (formerly called Multiple Personality
Disorder or MPD)

copied with permission

Dissociative identity disorder (formerly called Multiple Personality
Disorder or MPD) is defined in the DSM-IV-TR as the presence of two or
more personality states or distinct identities that repeatedly take
control of one’s behavior. The patient has an inability to recall
personal information. The extent of this lack of recall is too great
to be explained by normal forgetfulness. The disorder cannot be due to
the direct physical effects of a general medical condition or
substance.[1]

DID entails a failure to integrate certain aspects of memory,
consciousness and identity. Patients experience frequent gaps in their
memory for their personal history, past and present. Patients with DID
report having severe physical and sexual abuse, especially during
childhood. The reports of patients with DID are often validated by
objective evidence.[1]Physical evidence may include variations in
physiological functions in different identity states, including
differences in vision, levels of pain tolerance, symptoms of asthma,
the response of blood glucose to insulin and sensitivity to allergens.
Other physical findings may include scars from physical abuse or self-
inflicted injuries, headaches or migraines, asthma and irritable bowel
syndrome.[1]

DID is found in a variety of cultures around the world. It is
diagnosed three to nine times more often in adult females than males.
Females average 15 or more identities, males eight identities. The
sharp rise in the reported cases of DID in the U.S. may be due the
greater awareness of DID’s diagnosis, which has caused an increased
identification of those that were previously undiagnosed.[1]The
average time period from DID’s first presentation of symptoms to its
diagnosis is six to seven years. DID may become less manifest as
patients reach past their late 40′s, but it can reemerge during
stress, trauma or substance abuse. It is suggested in several studies
that DID is more likely to occur with first-degree biological
relatives of people that already have DID, than in the regular
population.[1]

Contents
* 1 Symptomatology
* 2 Causes
* 3 DSM inclusion
* 4 History
* 5 Physiological Evidence
* 6 References
* 7 Bibliography
* 8 External links

Symptomatology

Individuals diagnosed with DID demonstrate a variety of symptoms with
wide fluctuations across time; functioning can vary from severe
impairment in daily functioning to normal or high abilities.
[2]Patients may experience an extremely broad array of other symptoms
that resemble epilepsy, schizophrenia, anxiety disorders, mood
disorders, post traumatic stress disorder, personality disorders, and
eating disorders.[2]

Causes

The causes of dissociative identity disorder are theoretically linked
with the interaction of overwhelming stress, traumatic antecedents,[3]
insufficient childhood nurturing, and an innate ability to dissociate
memories or experiences from consciousness.[2] Prolonged child abuse
is frequently a factor, with a very high percentage of patients
reporting documented abuse[4] often confirmed by objective evidence.
[1]

The Diagnostic and Statistical Manual of Mental Disorders states that
patients with DID often report having a history of severe physical and
sexual abuse. The reports of patients suffering from DID are “often
confirmed by objective evidence,” and the DSM notes that the abusers
in those situations may be inclined to “deny or distort” these acts.
[1] Research has consistently shown that DID is characterized by
reports of extensive childhood trauma, usually child abuse.[5][6][7]
Dissociation is recognized as a symptomatic presentation in response
to psychological trauma, extreme emotional stress, and in association
with emotional dysregulation and borderline personality disorder.[8] A
study of 12 murderers established the connection between early severe
abuse and DID[9].

DSM inclusion

DID meets all of the guidelines for inclusion in the DSM and is
supported by taxometric research.[10] Research has established DID as
a valid diagnosis.[10] In one study, DID was found to be a genuine
disorder with a constant set of core features.[11]

History

The 19th century saw a number of reported cases of multiple
personalities which Rieber estimated would be close to 100.[12]By the
late 19th century there was a general realization that emotionally
traumatic experiences could cause long-term disorders which may
manifest with a variety of symptoms.[13] Between 1880 and 1920, many
great international medical conferences devoted a lot of time to
sessions on dissociation.[14]Starting in about 1927, there was a large
increase in the number of reported cases of schizophrenia, which was
matched by an equally large decrease in the number of multiple
personality reports.[14] Bleuler also included multiple personality in
his category of schizophrenia. It was found in the 1980s that MPD
patients are often misdiagnosed as suffering from schizophrenia.[14]
Multiple personality disorder began to emerge as a separate disorder
in the 1970s when an initially small number of clinicians worked to re-
establish MPD as a legitimate diagnosis.[14]

Physiological Evidence

Physiological evidence has provided additional evidence to back the
existence of DID. One review of the literature found “physiologic and
ocular differences across alter personalities.” [15]. Additional
studies have been found showing optical differences in DID cases.[16]
[17] One study found that “eight of the nine MPD subjects consistently
manifested physiologically distinct alter personality states.”[18].
Other reviews have found additional physiological differences[19].
Brain mapping has also found physiological differences in alternate
personalities[20]. A variety of psychiatric rating scales found that
multiple personality is strongly related to childhood trauma rather
than to an underlying electrophysiological dysfunction[21].

References

1. American Psychiatric Association (2000-06).Diagnostic and
Statistical Manual of Mental Disorders DSM-IV TR (Text Revision).
Arlington, VA, USA: American Psychiatric Publishing, Inc..
http://books.google.com/books?id=3SQrtpnHb9MC&pg=PA527&lpg=PA535&sig=25ML_7zbvvLZl6ySYCF4DomqeRU
DOI:10.1176/appi.books.9780890423349 ISBN 978-0890420249.

2. Dissociative Identity Disorder, doctor’s reference. Merck.com
(2005-11-01). http://www.merck.com/mmpe/sec15/ch197/ch197e.html

3. Pearson, M.L. (1997). Childhood trauma, adult trauma, and
dissociation (PDF). Dissociation 10 (1): 58–62
https://scholarsbank.uoregon.edu/xmlui/handle/1794/1837

4. Kluft, RP (2003). Current Issues in Dissociative Identity
Disorder (PDF). Bridging Eastern and Western Psychiatry 1 (1): 71–87.
http://web.archive.org/web/20071015145151/http://www.psyter.org/allegati/180/Kluft.pdf

5. Putnam FW, Guroff JJ, Silberman EK, Barban L, Post RM (June 1986).
“The clinical phenomenology of multiple personality disorder: review
of 100 recent cases”. J Clin Psychiatry 47 (6): 285–93. PMID 3711025.
http://www.ncbi.nlm.nih.gov/pubmed/3711025?dopt=Abstract

6. Ross CA, Miller SD, Bjornson L, Reagor P, Fraser GA, Anderson G
(March 1991). “Abuse histories in 102 cases of multiple personality
disorder”. Can J Psychiatry 36 (2): 97–101. PMID 2044042.”The patients
reported high rates of childhood trauma: 90.2% had been sexually
abused, 82.4% physically abused, and 95.1% subjected to one or both
forms of child abuse….Multiple personality disorder appears to be a
response to chronic trauma originating during a vulnerable period in
childhood.” http://www.ncbi.nlm.nih.gov/pubmed/2044042?dopt=Abstract

7. Boon S, Draijer N (March 1993). Multiple personality disorder in
The Netherlands: a clinical investigation of 71 patients. Am J
Psychiatry 150 (3): 489–94. PMID 8434668.”A history of childhood
physical and/or sexual abuse was reported by 94.4% of the subjects,
and 80.6% met criteria for posttraumatic stress disorder….Patients
with multiple personality disorder have a stable set of core symptoms
throughout North America as well as in Europe.”
http://www.ncbi.nlm.nih.gov/pubmed/8434668?dopt=Abstract

8. Marmer S, Fink D (1994). “Rethinking the comparison of Borderline
Personality Disorder and multiple personality disorder”. Psychiatr
Clin North Am 17 (4): 743–71. PMID 7877901.
http://www.ncbi.nlm.nih.gov/pubmed/7877901?dopt=Abstract

9. Lewis, D., Yeager, C., Swica, Y., Pincus, J. and Lewis, M. (1997).
Objective documentation of child abuse and dissociation in 12
murderers with dissociative identity disorder. Am J Psychiatry,
154(12):1703-10. “Signs and symptoms of dissociative identity disorder
in childhood and adulthood were corroborated independently and from
several sources in all 12 cases; objective evidence of severe abuse
was obtained in 11 cases. The subjects had amnesia for most of the
abuse and underreported it. Marked changes in writing style and/or
signatures were documented in 10 cases. CONCLUSIONS: This study
establishes, once and for all, the linkage between early severe abuse
and dissociative identity disorder.”

10. Gleaves, D.H.; May MC, Cardeña E (2001) An examination of the
diagnostic validity of dissociative identity disorder. 21(4) 577-608
http://leadershipcouncil.org/docs/gleaves2001.pdf

11. Ross, C.; Norton, G. & Fraser, G. (1989). Evidence against the
iatrogenesis of multiple personality disorder (PDF). Dissociation 2
(2): 61–65. https://scholarsbank.uoregon.edu/xmlui/handle/1794/1424

12. Rieber RW (2002). “The duality of the brain and the multiplicity
of minds: can you have it both ways?”. History of psychiatry 13 (49 Pt
1): 3–17. DOI:10.1177/0957154X0201304901. PMID 12094818.
http://www.ncbi.nlm.nih.gov/pubmed/12094818?dopt=Abstract

13. Borch-Jacobsen M, Brick D (2000). “How to predict the past: from
trauma to repression”. History of Psychiatry 11: 15–35. DOI:
10.1177/0957154X0001104102.

14. Putnam, Frank W. (1989). Diagnosis and Treatment of Multiple
Personality Disorder. New York: The Guilford Press, 351. ISBN
0-89862-177-1.

15. Birnbaum MH, Thomann K. Visual function in multiple personality
disorder. J Am Optom Assoc. 1996 Jun;67(6):327-34 “BACKGROUND:
Multiple personality disorder (MPD) is characterized by the existence
of two or more personality states that recurrently exchange control
over the behavior of the individual. Numerous reports indicate
physiological differences, including significant differences in ocular
and visual function, across alter personality states in MPD. METHODS:
The existing literature was reviewed to provide an overview of the
nature and characteristics of MPD, with emphasis on reported
physiologic and ocular differences across alter personalities. In
addition, a case is reported of an MPD patient seen over a 3-year
period. RESULTS: Physiologic differences across alter personality
states in MPD include differences in dominant handedness, response to
the same medication, allergic sensitivities, autonomic and endocrine
function, EEG, VEP, and regional cerebral blood flow. Differences in
visual function include variability in visual acuity, refraction,
oculomotor status, visual field, color vision, corneal curvature,
pupil size, and intraocular pressure in the various personality states
of MPD subjects as compared to single personality controls.
CONCLUSIONS: The possibility of MPDs should be considered in patients
who demonstrate unusual variability in ocular and visual findings,
particularly with a positive psychiatric history. The existence of
visual and other physiologic differences across alter personalities in
MPD offers a unique potential for the study of mind-body
relationships.” http://www.ncbi.nlm.nih.gov/pubmed/8888853

16. Miller SD. Optical differences in cases of multiple personality
disorder. J Nerv Ment Dis. 1989 Aug;177(8):480-6 “MPD subjects had
significantly more variability in visual functioning across alter
personalities than did control subjects.” http://www.ncbi.nlm.nih.gov/pubmed/2760599

17. Miller SD, Blackburn T, Scholes G, White GL, Mamalis N. Optical
differences in multiple personality disorder. A second look. J Nerv
Ment Dis. 1991 Mar;179(3):132-5. “In the present study, data from 20
patients diagnosed with MPD and 20 control subjects role playing MPD
were analyzed for statistical and clinical significance. The findings
from the present study appear to confirm results from the earlier
study that individuals with MPD experience differences in some aspects
of visual functioning between alter personalities. The results further
confirm that MPD subjects experience more differences across visual
measures than control subjects simulating the disorder.”
http://www.ncbi.nlm.nih.gov/pubmed/1997659

18 Putnam FW, Zahn TP, Post RM. Psychiatry Res. 1990 Mar;31(3):
251-60.Differential autonomic nervous system activity in multiple
personality disorder. “Numerous clinical reports suggest that these
alter personality states exhibit distinct physiological differences.
We investigated differential autonomic nervous system (ANS) activity
across nine subjects with MPD and five controls, who produced “alter”
personality states by simulation and by hypnosis or deep relaxation.
Eight of the nine MPD subjects consistently manifested physiologically
distinct alter personality states.” http://www.ncbi.nlm.nih.gov/pubmed/2333357

19. Miller SD, Triggiano PJ. The psychophysiological investigation of
multiple personality disorder: review and update. Am J Clin Hypn. 1992
Jul;35(1):47-61. “psychophysiologic differences reported in the
literature include changes in cerebral electrical activity, cerebral
blood flow, galvanic skin response, skin temperature, event-related
potentials, neuroendocrine profiles, thyroid function, response to
medication, perception, visual functioning, visual evoked potentials,
and in voice, posture, and motor behavior.” http://www.ncbi.nlm.nih.gov/pubmed/1442640

20. Hughes JR, Kuhlman DT, Fichtner CG, Gruenfeld MJ. Brain mapping in
a case of multiple personality. Clin Electroencephalogr. 1990 Oct;
21(4):200-9. “Brain maps were recorded on a patient with a multiple
personality disorder (10 alternate personalities). Maps were recorded
with eyes open and eyes closed during 2 different sessions, 2 months
apart. Maps from each alternate personality were compared to those of
the basic personality “S”, some maps were similar and some were
different, especially with eyes open. Findings that were replicated in
the second session showed differences from 4 personalities, especially
in theta and beta 2 frequencies on the left temporal and right
posterior regions.” http://www.ncbi.nlm.nih.gov/pubmed/2225470

21. Coons PM, Bowman ES, Milstein V. Multiple personality disorder. A
clinical investigation of 50 cases. J Nerv Ment Dis. 1988 Sep;176(9):
519-27. “50 consecutive patients with DSM-III multiple personality
disorder were assessed using clinical history, psychiatric interview,
neurological examination, electroencephalogram, MMPI, intelligence
testing, and a variety of psychiatric rating scales. Results revealed
that patients with multiple personality are usually women who present
with depression, suicide attempts, repeated amnesic episodes, and a
history of childhood trauma, particularly sexual abuse….These data
suggest that the etiology of multiple personality is strongly related
to childhood trauma rather than to an underlying electrophysiological
dysfunction.” http://www.ncbi.nlm.nih.gov/pubmed/3418321

Bibliography

* Baer, Richard A. (2007). Switching Time: A Doctor’s Harrowing Story
of Treating a Woman with 17 Personalities. [New York]: Crown. ISBN
0307382664.

* Braun, B.G. (1989). Dissociation: Vol. 2, No. 2, p. 066-069:
Iatrophilia and Iatrophobia in the diagnosis and treatment of MPD
(PDF). https://scholarsbank.uoregon.edu/xmlui/handle/1794/1425

* Brown, D; Frischholz E, Scheflin A. (1999). “Iatrogenic dissociative
identity disorder – an evaluation of the scientific evidence”. The
Journal of Psychiatry and Law XXVII No. 3-4 (Fall-Winter 1999): 549–
637.

* Gleaves, D. (July 1996). The sociocognitive model of dissociative
identity disorder: a reexamination of the evidence. Psychological
Bulletin 120 (1): 42–59. DOI:10.1037/0033-2909.120.1.42. PMID 8711016.
“Most recent research on the dissociative disorders does not support
(and in fact disconfirms) the sociocognitive model, and many
inferences drawn from previous research appear unwarranted. No reason
exists to doubt the connection between DID and childhood trauma.
Treatment recommendations that follow from the sociocognitive model
may be harmful because they involve ignoring the posttraumatic
symptomatology of persons with DID.”
http://psycnet.apa.org/index.cfm?fa=search.displayRecord&uid=1996-01403-003

* Goettmann, B. A.; Greaves, B. G., Coons M. P. (1994).Multiple
personality and dissociation, 1791-1992: a complete bibliography.
Lutherville, MD: The Sidran Press, 85. ISBN 0-9629164-5-5.
http://boundless.uoregon.edu/cdm4/item_viewer.php?CISOROOT=/diss&CISOPTR=38

* Kluft, R.P. (1989). Iatrogenic creation of new alter personalities
(PDF). Dissociation 2 (2): 83–91. https://scholarsbank.uoregon.edu/xmlui/handle/1794/1428

* Underwood, Anne. Identity Crisis – What is it like to live with 17
alternate selves? A survivor of multiple personality disorder
discusses the disease and the painful integration process that made
her whole. Newsweek, October 22, 2007. http://www.newsweek.com/id/57861

External links

* United States of Tara – Learn More About D.I.D. – Showtime supports
the awareness for Dissociative Identity Disorder
http://www.sho.com/site/video/brightcove/series/title.do?bcpid=1847322218&bclid=5253538001&bctid=6803420001

* Basic Information on DID http://ritualabuse.us/research/did/basic-information-on-didmpd/