Sunday, April 17, 2011

Is Multiple Personality Disorder Real?

Although it is very rare, early in my career I met two (different) people with Dissociative Identity Disorder (DID; formerly known as Multiple Personality Disorder). The first person I met with DID was a patient at a clinic in Harvard Square, where I was conducting research. Over the course of my two years there, I watched her slowly unravel from displaying one personality to many. By the time I left, she had the voice and demeanor of a seven year old child. Frankly, witnessing this was quite unsettling.

The second person I met with DID was in the psychiatric emergency room at Massachusetts General Hospital, where I was working on another study. I remember the conversations amongst the staff about her case well - some thought she was faking it, while some thought a diagnosis of DID was legitimate.

In short, this is what I think:

People with Borderline Personality Disorder, which is characterized by self-injury, suicide attempts, extreme mood swings, and stormy relationships also has another very important feature that is often less discussed - identity disturbance. Basically, very different personae are displayed depending on the situation. As Kiera Van Gelder describes in The Buddha and The Borderline, a memoir about recovery from this disorder, she would be a hippie one day and a goth the next if it would get her the sexual attention she wanted. In other words, she would drastically change her personality from day to day (in this case, it was for social approval).

The problem is this: A therapist looking at someone who is a goth one day and a hippie the next might conclude that these are just various forms of the self that need to be expressed. (Yikes!)

While chameleoning can be viewed as adaptive in a sense, the person with BPD / identity disturbance seems to be paying little attention to whether or not they actually enjoy a given activity they are engaging in for social approval. Often, people use these different personae as a tool - and a tool only. The who acts as a hippie today has no real affinity for hippie culture in itself. Expression of one's "hippie side" is resoundingly not to be encouraged.

Introducing certain types of therapy that emphasize different parts of the self to people who already have identity disturbance, may cause further polarization. The patient may be reinforced for behaving in certain ways and expressing themselves from various personalities. Hence, the development of DID. Without a question in my mind, this is what happened with the first patient with DID I watched unravel - she initially had a diagnosis of Borderline Personality Disorder (w/ the identity disturbance feature) - and in two years time (after "parts therapy") she had multiple personalities.

People with identity disturbances crave belonging and unity of their behaviors by definition. Slapping a label of DID on someone who is desperately trying to figure out who they are is dangerous. The person knows that a lot effort needs to be put in to establish a sense of self. These uncharted territories of not living for social approval are scary. This unifying label is an excuse to avoid all the anxiety that will come with establishing a sense of self. It is easier to exaggerate the different forms of self that already exist and diverge further.

In the effort to display many personalities, a unifying role of being an interesting patient is maintained.

While the presentation of someone having several personality disorders is certainly real, I highly doubt this is organic. It seems to me that this disorder is related to the same underlying identity disturbance seen in Borderline Personality Disorder. In fact, I'd be willing to bet that a very large number of DID cases are really Borderline cases gone horribly astray due to treatment with talk therapies that have not been supported by research.

I'd also like to add that after having worked with people who have schizophrenia, there is a definite psychotic flavor to DID as well. My gut feeling is that the core underlying feature is the identity disturbance seen in BPD on top of a psychotic tendency to believe what the mind is constructing. It is these two underlying features that combine to the expression of different personalities. In no way do I think there are actually two different personalities encased in one person. In short, I'd reason that DID is simply a specific form psychosis with the core BPD component of identity disturbance.

In treatment, instead of focusing on expression of various external presentations, focus should be on developing a sense of self. Figuring out what the person likes independent from the approval or opinions of others seems vital.

Lastly, unlike depression or anxiety, there is an ego-syntonic feel to multiple personality disorder. In other words, people like having the disorder to some degree and want to continue any associated dysfunctional behavior. Another example of ego-syntonic disorders would be anorexia, where people typically want to continue restricting food intake. In the case of DID, people want to keep their multiple personalities, as they are potentially useful in different circumstances. As such, the expression of different personalities should be particularly discouraged by all staff members at a facility once rapport has been developed and treatment is underway.

15 comments:

stacy said...

This is my Good luck that I found your post which is according to my search and topic, I think you are a great blogger, thanks for helping me outta my problem..
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Tara Deliberto said...

Thanks!

Harry said...

Nice post tara . It helps us in understanding the multiple personality disorder.

preeti said...

Very nice post tara. I like your studies done for multiple personality disorder.

Tara Deliberto said...

Thanks, Harry.

Tara Deliberto said...

Thanks, Preeti. I actually haven't conducted any studies per se though, these are just my thoughts. Thanks again for reading!

Jeanette Bartha said...

I appreciate you writing about your observations. I think MPD does not exist. Period.

I once believed I had MPD, but came to my senses - thankfully.

Keep researching & writing. You are helping patients and the general public know about this bogus diagnosis.

If I can offer my blog: Multiple Personalities Don't Exist www.jeanettebartha.wordpress.com

I would also know if I may have permission to reprint your article on my blog?

Thank you for your consideration.
Jeanette Bartha

Tara Deliberto said...

Hi Jeanette,
Thank you for reading. Sure, feel free to link to this post!
Best,
Tara

Anonymous said...

Quoting and actual expert in trauma and dissociative disorders "People who think BPD and DID are related, don't know much about either."

Anonymous said...

chances are you won't approve a comment that doesn't agree with you. Wonder if thats a BPD thing :)

Anonymous said...

Hello, I live with a former kidnap victim (kidnapped while in Greece). We have been together 7 years. She explained to me recently that she is 'Terrified that someone is coming into the house and moving her things, changing her passwords, marking up her magazines. This has caused her to run several times, and contact the police. She explained that this 'person' is female in nature (she can 'feel it' and is somehow connected to me. I asked if she could explore the possibility that this unseen 'person' was in fact, her? 'No way', she explains. I have attempted to get her proper therapy, but it seems almost non existant for this type of case. No one wants to believe it - not even the patient.

Tara Deliberto said...

Regarding the comment above from 4/28/12:

Interesting. While I wouldn't consider myself specifically a BPD expert, I do have several years of research under my belt on suicide, self-injury, and DBT - which, of course, relate to BPD.

I am certainly not a DID expert, having only met two people with the disorder; however, I still stand by the opinions expressed in my post.

Since two experts on a given subject often disagree, I'm not inclined to lessen my degree of belief in this faith without an explanation as to why.

That being said, do you happen to know why the expert quoted doesn't think the two relate?

And no, fortunately, I have never been diagnosed with BPD. All comments that are respectful / not spam will be published! Thanks for reading and commenting!

Tara Deliberto said...

To the anonymous reader from 6/13/12:

Of course I cannot diagnose anyone from a second-hand mini description of symptoms over blog commentary; however, what you're describing sounds like it could be addressed in Cognitive Therapy.

I'm not sure this sounds like DID per se, but might be something in the more paranoid realm. Again, I cannot say what the issue is from this amount of information and in this context.

It should be noted that paranoia and multiple personalities are two very different presentations, but in my experience, often confused by the public.

Cognitive therapy has been shown to be effective for some people who have more paranoid thinking than the norm. This may be an option to look into.

Best,
Tara

Anonymous said...

This blog post reads like it was written by someone who's never read a book or an article on DID, who's never worked with people with DID, who's just making wild assumptions. There are people dx'ed with both DID and BPD. There are also people dx'ed with BPD who don't have BPD at all, but have DID. You also make no mention of PTSD which all DID patients have, but not all BPD patients have. Look at somewhere that actually treats DID and PTSD specifically like the trauma Ward at Sheppard Pratt. But your theories seem a little half cocked.

Tara Deliberto said...

Fair enough - I've admittedly not had much experience with DID - however; allow me a belated response (apologies for the delay).

First, I was generally very impressed when visiting Sheppard Pratt in May 2012. My impression was that they offer top-of-the-line treatment.

As for DID though, I have read a bit about it. For a summary, I would see Prof. Rich McNally's book "What is Mental Illness?" from 2011, copyright, President and Fellows at Harvard College.

In short, the book explains right after the book Sybil was published, "from near-nonexistence, MPD spread throughout North America, with the number of diagnosed cases soaring to 50,0000." And then the "epidemic of MPD ended abruptly" because a study showing that asking leading questions is more likely to "create false memories than to recover them" (Ceci & Loftus, 1994).

The book also reads "MPD therapists inadvertently undermined the credibility of their own field when they began helping patients recall alleged memories of satanic ritual abuse" (McNally, Remembering Trauma). And that the FBI failed to uncover any physical evidence of these types of abuses (Lanning, 1992).

Interestingly enough, stories about abuse and trauma Sybil herself endured were also unfounded. What seems to be the (even more disturbing) truth is that Sybil sought treatment with Dr. Cornelia Wilbur, who appears to have implanted false memories with the (unwitting) use of leading questions and social positive reinforcement. When treatment tapes of the sessions between Wilbur and Sybil were researched, convincing evidence of this was revealed. The book also states "indeed, Sybil admitted in writing to Wilbur that she had manufactured her MPD symptoms."

As such, while the symptoms of DID are in the DSM-IV, this does not mean that the disorder is not socially constructed, at least for the vast majority of cases.

[By the way, I'm not saying that there was never an organic (non-socially constructed) case of DID out there. Saying that 100% of DID cases are socially constructed is a bit like meeting 50,000 Elvis impersonators in the year 2013 and then concluding Elvis Presley never existed. It stands though, that the ratio of hypothetical Elvis impersonators to Elvis Presley himself is still 50,000:1.]

If someone presents with a case of DID, undoubtedly the situation is severe; however, I would argue that give the citations provided above, the idea that the etiology (or cause) of the disorder is organic seems dubious at best. Of course, understanding etiology is extremely important for treatment - especially if the treatment itself is indicated as a possible cause, as in the case of Dr. Cornelia Wilbur.

For the cases that are not organic, but socially-constructed, which the evidence seems to suggest is most of them - perhaps a BPD identity disturbance / delusional quality may be present. That's all.