Multiple Personalities???

[docjolly]

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Hi Everyone,

Right now, I'm watching "The Many Faces of Bill," on Dateline right now on NBC. It's essentially about a man who has had up to 20-21 different personalities.

I'm very interested in this, and have few questions for anyone who can help me. Is schizophrenia the same as having multiple personalities? What causes someone to have multiple personalities? Is it a genetic chemical imbalance? How can a psychiatrist differentiate between someone who has multiple personalities, and someone who is simply acting?

Thanks in advance for your help 🙂

 

[MTpsych]

Sorry, but couldn't resist to post. I've been doing some research about dissociation, may be the following links can help you a little.

International Society for the Study of Dissociation:

http://www.issd.org/

The Sidran Institute

http://www.sidran.org

One more thing... multiple personality disorder is NOT the same as schizofrenia. (although it is often misdiagnosed/confused)

Psychiatry residents, we are waiting for your answers, we want to know what you people think about this disorder. There is a lot of controversy about it.

Almost forgot, make a search on the internet on "satanic ritual abuse" it is related to this topic. By the way, what do you people think of SRA?

 

[Anasazi23]

What was previously called Multiple Personality Disorder (MPD), now termed Dissociative Identity Disorder, is thought to be a complexity of defense mechanisms, each used in varying situations. These dissociative identities (DIs) eventually become separate from each other, and are manifested when particular life situations conjure them. The DIs often have no memory of parallel personalities.

Neurobiologically, it appears that virtually all MPD patients have comorbid psychiatric conditions...most often PTSD. Other theories include temporal lobe seizure-like activity and the like.

In my personal experience, the PTSD theory hold true....my own opinion is that PTSD combined with a latent borderline personality disorder is a formula for "multiple personality disorder." Credence is given to my little theory through the fact that the majority of MPDers are female. --just a thought

 

[PublicHealth]

Sorry...I went "google happy."


DSM criteria for Dissociative Identity Disorder (DID):

http://www.behavenet.com/capsules/disorders/did.htm


More info about DID:

http://www.sidran.org/didbr.html

http://www.healthubs.com/dissociative/

http://www.psychiatrictimes.com/p981107.html


Treatment guidelines for DID:

http://www.issd.org/indexpage/isdguide.htm

 

[MTpsych]

Best researchers/writers on the subject:

Frank W. Putnam

Richard P. Kluft

 

[twodrunkduck]

Hi, sorry for bumping an old thread, but I think this is the right place for me to ask my question about DID, if not, please move.

I came here because I am curious about DID after reading the book of Billy Milligan who has 24 different personalities. Actually it is hard to believe that a person can have many personalities, which are so different by ability, emotion, age, sex etc. In Billy's case, there are a five year old girl and a teenage boy. I just realized that they never age. It is similar to schizophrenia like in 'A Beautiful Mind', the figures never ages. CMIIW

Can someone explain about this? Sorry if it sounds stupid, FYI I never study or work in the field of psychology.

Looking forward to your answer

 

[twodrunkduck]

If someone has only some symptoms of DID, can it be diagnosed as DID or does it have to cover all of the symptoms?

For example, my friend who experienced similar abuse like Billy when she was a kid, she lost some memories from the past but not entirely. And when she's grown up she has flashback that makes her have bad headache and other body pains. The point of losing time is the biggest problem of her. But, she thinks she doesn't have depersonalization, derealization and never hears voices.

 

[whopper]

I felt I had to add this...

Several people do not believe DID exists. Why? Several use it as a legal defense to achieve a not guilty by reason of insanity plea. Others use it as a excuse ("I didn't steal your money, my other personality did!").

Some data shows that if the "alters" (the other personalities other than the main one), are ignored, they tend to appear less. Other data shows that in psychiatry units, if the patient is held responsible for breaking the rules, even if it's done by an "alter", the behavior goes down.

As for DID, several try to gauge it using dissociation assessment tools. Several criticize this because while we all agree that dissociation likely is real (hey, I dissociate everytime I get into an argument with my wife), it's hard to scientifically peg this down as a phenomenon.

Here's a recent article from someone arguing against the existence of DID
http://www.currentpsychiatry.com/article_pages.asp?AID=7830&UID=13981

Me? Personally I think it may exist. I have encountered people who believed they had it, but an attending of mine that I highly respect told me he believed the person was made to believe she had it by her previous therapist, and because she enjoyed playing the victim role, she played the part. She may have even believed she truly had it but did not.

He likened it to the phenomenon of using hypnotism to bring forth submerged memories. This practice, it turned out, was not scientifically valid. Several therapists up until the 90s (I'm sure there are others who still do it) got their patients to believe they were molested, kidnapped, what have you based on the results of using hypnotism. People were even convicted based on the testimony of mental health professionals claiming that this was a valid method--which it was not.

Yet despite the data proving that hypnotism to bring forth submerged memories was declared not reliable, several of the same people clung onto the beliefs they formed after the hypnosis.

Every time I encounter a DID patient, and it's extremely rare, I still feel like I'm walking on unestablished territory. I did consider that on a research level, we should start performing specific types of psychometric testing such as possibly using an f-MRI during an interview, incorporation of a SIRS among other tests to see how reliable this diagnosis truly is. Problem is this is such a rare phenomenon, it's hard to do this type of study.

 

[OldPsychDoc]

I felt I had to add this...

Several people do not believe DID exists. Why? Several use it as a legal defense to achieve a not guilty by reason of insanity plea. Others use it as a excuse ("I didn't steal your money, my other personality did!").

Some data shows that if the "alters" (the other personalities other than the main one), are ignored, they tend to appear less. Other data shows that in psychiatry units, if the patient is held responsible for breaking the rules, even if it's done by an "alter", the behavior goes down.

As for DID, several try to gauge it using dissociation assessment tools. Several criticize this because while we all agree that dissociation likely is real (hey, I dissociate everytime I get into an argument with my wife), it's hard to scientifically peg this down as a phenomenon. .....

"whopper's not here now... but we don't think you needed $200 shoes either!"

 

[Shalom77]

If you are really interested in Dissociation - you should check out this book.
Dissociation and the Dissociative Disorders: DSM-V and Beyond

It is quite comprehensive an an excellent resource on Dissociative Disorders. From what I recall it has chapters that actually address each of the OPs questions. 🙂

http://www.amazon.com/Dissociation-...=sr_1_5?ie=UTF8&s=books&qid=1272319029&sr=8-5

The journal Dissociation (1988-1999) is archived on line.
https://scholarsbank.uoregon.edu/xmlui/handle/1794/1129
Some older (but still interesting) articles there. The more current Journal (Journal of Trauma & Dissociation - is not freely accessible but they do sometimes have freely accessible articles.


for the layperson: the sidran website is a good resource:
http://www.sidran.org/sub.cfm?contentID=75&sectionid=4

 

[sunlioness]

Several people do not believe DID exists. Why? Several use it as a legal defense to achieve a not guilty by reason of insanity plea. Others use it as a excuse ("I didn't steal your money, my other personality did!").

Some people do do this, it is true. I think if there is a way to abdicate personal responsibility someone will probably try it. However, one of the fundamentals of therapy for DID is that such excuses don't fly. "I didn't do it, my alter did" is never an acceptable excuse. The whole person is responsible for all of their behavior whether they remember it or not. Therefore it actually behooves them to develop co-consciousness sooner rather than later to avoid engaging in potentially illegal or embarrassing behaviors for which they are amnestic.

 

[sunlioness]

If someone has only some symptoms of DID, can it be diagnosed as DID or does it have to cover all of the symptoms?

In order to be diagnosed with DID, the patient must meet criteria according to the DSM-IV-TR just like any other disorder. Which for DID means at the very minimum they have at least two personality states which recurrently take control of the persons behavior and amnesia barriers ("losing time"). Not being able to remember a traumatic event or having flashbacks aren't enough for the dx. Actually flashbacks aren't part of the diagnostic criteria for DID at all. Neither is hearing voices, though patients with DID do so commonly.

 

[whopper]

he whole person is responsible for all of their behavior whether they remember it or not. Therefore it actually behooves them to develop co-consciousness sooner rather than later to avoid engaging in potentially illegal or embarrassing behaviors for which they are amnestic.

That actually is my opinion as well. Despite that the above attending I mentioned, IMHO has more experience and better judgment than I do, this is one area where I felt he was being a bit too extreme in his judgment against DID.

The only theory I can come up as to why IMHO he had a very critical opinion of the diagnosis is a close friend of his was convinced by a psychologist that the friend was molested by his father using hypnosis. Since then, the friend and father, who once had a close relationship, don't talk to each other. The attending became convinced that the psychologist was inappropriately using hypnotism to create false-memories. I was wondering if this possibly pushed him against the idea that someone could have DID--because in every case where the person had it, they had gaps in their memory.

But in DID, in several of the reported cases, there are memory gaps, allegedly because they become submerged as a result of dissociation.

Personally, I'm of the opinion that it could exist, but if we encounter it, we have to have some suspicion, and still hold the person responsible for their actions. As you said, each personality is part of the person as a whole.

 

[loveoforganic]

Is DID not an applicable illness for NGRI then?

 

[sunlioness]

As far as I know it isn't. Or at the very least it would involve being able to show that the alter who committed the crime didn't know it was wrong, not that the "host" personality didn't know the alter did it. And DID is not an illness that impairs one's ability to know what is right and wrong.

And Whopper, yeah, the false memory thing is creepy. And unfortunately there are a lot of highly boundary impaired therapists out there who seem to gravitate toward the tx of trauma. Colin Ross writes about this a lot in his books. And I always have a pretty high index of suspicion when anyone presents to me claiming to be DID, but I still believe the disorder exists.

 

[whopper]

Is DID not an applicable illness for NGRI then?

It all depends on the state and if the judge and jury are willing to accept it.

In NGRI, in general, the person, due to their mental state at the time of the crime, could not have known that the nature and quality of their act was wrong. Now that is a general definition because it highly varies in some states, but for most, that's the general idea.

To support NGRI: it's in the DSM-IV, one could argue that if the main personality didn't do the crime, then that main personality is being punished for the act of an alter. The main personality didn't know the nature and quality of the act, only the alter did.

Against: Despite it being in the DSM, several argue it should be removed and those articles are published (one example I put above). There are 2 legal standards where scientific evidence should be accepted in Court: the Daubert and Frye standard, to be honest, I can see a lot of argument where one could say it does or does not fit either standard.

Another argument against is that even if DID does exist, several argue that the alters really are just other manifestations of the same person. So if an alter did a crime, why shouldn't the person be punished if they are really the same person? There is data that once the personalities have been merged, the main personality is often different.

In general, NGRI is a dangerous defense. It's only used in about 1% of crimes, and it usually fails. I'd say the odds are even tougher with a DID defense.

But like I said, it really boils down to what the judge allows and what the jury thinks after the expert witnesses give all their testimony.

The area of NGRI in terms of criminal responsibility is murky and grey because psychiatrists' opinions are the same. If the APA or AAPL were to make recommendations on the legal responsibility on DID, it could shed some light on the subject.

 

[Cruzinman]

Read the Bennett Braun Story:

http://www.illinoisfms.org/Braun.html

 

[sunlioness]

Recovered memory therapy is crap and dangerous crap at that. "Recovering memories" has nothing to do with appropriate therapy for any trauma based disorder. Memories do come up in therapy, but even so you can't say with any degree of certainty that they describe actual events rather than symbolic ones. And for the sake of therapy, it doesn't matter anyway because you work through the surrounding emotions in the here and now, according to the principle of therapeutic neutrality. The point of therapy for DID is not remembering and hashing through the horrible things that happened to you. It's about developing inner communication, co-consciousness and being able to function in society as a responsible adult human being. I don't think hypnosis or sodium amytal interviews or other such things are ever part of appropriate treatment for DID.

But again, just because there are unethical providers out there and just because "false memories" are a real phenomenon, that doesn't invalidate DID as a diagnosis. It just means some people really oughtn't be practicing medicine/psychotherapy.

 

[whopper]

I was amazed that this type of therapy as went as far as it did without a concerted effort to see if it had any validity to it.

 

[twodrunkduck]

Thank you for all answers.

 

[whopper]

What causes someone to have multiple personalities?

I didn't answer this. One of the most common theories is that it's a form of dissociation, so severe, that it causes a person to actually dissociate to a new personality.

A problem here, and I'm not saying it's not real (though I have my suspicions), is that dissociation is hard to gauge. We all dissociate. If you ever go into a daydream while at the dentist, while he's drilling your tooth, that's dissociation. If you heard the Beatles song "A Day in a Life", that song beautifully captures dissociation. But like I said, how to you measure it?

It's hard.

It turns out that there's data supporting that those who have been abused are more likely to dissociate. Borderline PD for example is often associated with dissociation, and in that disorder, people were often abused or abandoned as children.

As for gaps in memory, that are often associated with DID, this too happens in other phenomenon. E.g. women who give birth, if their pain was severe, sometimes don't remember the event. It's theorized this may actually have evolutionary benefits because if the woman remembered, it may decrease the odds she'd want to have more children.

And if you look at borderline PD, the people with that disorder often have disturbances of identity. It's actually one of the DSM criteria.

So the theory is that the person, as a child, suffered from abuse so horrific, that they dissociate to a degree so severe that the main personality becomes so submerged that a new one comes out.

This is a very controversial disorder because in addition to the problems I mentioned above, it's hard to figure out a biological theory for it.