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Multiple Personality Disorder

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Multiple Personality Disorder Some Background Multiple personality disorder is more formally known as dissociative identity disorder MPD is one of a group of ... – PowerPoint PPT presentation

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Title: Multiple Personality Disorder


1
Multiple Personality Disorder
2
Some Background
  • Multiple personality disorder is more formally
    known as dissociative identity disorder
  • MPD is one of a group of disorders in DSM-IV-TR
    called the dissociative disorders

3
Dissociation
  • Alterations or detachments in consciousness or
    identity
  • May include derealization
  • feeling detached from ones surroundings
  • May include depersonalization
  • feeling detached from oneself

4
Dissociation (continued)
  • Most likely to happen after an extremely
    stressful event, when very tired, or when under
    significant physical or mental pressure
  • students who stay up all night cramming for exams
  • journalists who witnessed execution
  • People probably differ in ability to dissociate
  • When dissociation results in distress or
    impairment, we consider it to be pathological

5
Other Dissociative Disorders
  • Dissociative Amnesia
  • One or more episodes of inability to recall
    important personal information, usually of a
    traumatic nature, that is too extensive to be
    explained by ordinary forgetfulness
  • Can be
  • Generalized
  • Localized (selective)

6
Other Dissociative Disorders (continued)
  • Dissociative Fugue
  • DSM-IV-TR criteria include
  • Sudden, unexpected travel away from home or ones
    place of work, with inability to recall ones
    past
  • Confusion about identity or assumption of new
    identity
  • person leaves home and later finds himself in a
    new place, unable to remember how or why he got
    there
  • fugue state usually ends abruptly, person returns
    home, and is able to recall most (if not all) of
    what happened

7
Dissociative Identity Disorder (aka MPD)
  • Presence of 2 or more distinct identities or
    personality states
  • Each with its own relatively enduring pattern of
    perceiving, relating to, and thinking about the
    environment and oneself
  • At least 2 of these identities or personality
    states recurrently take control of persons
    behavior
  • Inability to recall important personal
    information that is too extensive to be explained
    by ordinary forgetfulness
  • Not due to direct effects of a substance or
    general medical condition

8
Clinical Description
  • In most cases, the original personality
    possesses little or no direct awareness of the
    alternate personalities
  • may be aware of substantial periods of lost time
  • Alters typically have some awareness of the
    original personality or each other
  • Transitions from one personality to another
    typically occur quite rapidly
  • within seconds to minutes

9
Clinical Description (continued)
  • Quite often, personalities are polar opposites
  • Number of personalities within a single
    individual can range from 2-100
  • average number is 15

10
Clinical Description (continued)
  • personalities have been reported to differ in
  • age
  • gender race
  • ethnicity
  • psychological test results
  • eyeglass prescriptions
  • handedness
  • allergies
  • IQ
  • susceptibility to alcohol

11
Prevalence
  • 3-6 of severely disturbed inpatients
  • 0.5-1 of general population
  • Ratio of females to males is 91
  • Note data suggest prevalence is increasing

12
Course
  • Onset is almost always in childhood
  • Often as young as 4 yrs of age
  • On average, about 7 years pass between when the
    symptoms first appear and when the person is
    formally diagnosed
  • Disorder tends to last a lifetime in the absence
    of treatment
  • Different personalities may emerge in response to
    new life situations

13
Comorbidity
  • Very large percentage of MPD patients have other
    psychological disorders
  • Substance abuse, depression, borderline
    personality disorder, panic attacks, and eating
    disorders

14
Causes
  • Majority of patients with MPD (97) report
    histories of significant early trauma
  • Sexual or physical abuse
  • Individual who is born with capacity to
    dissociate uses this to psychologically escape
    from the abuse
  • Child doesnt receive adequate protection or
    support
  • Dissociated memories and emotional responses
    eventually develop into alters

15
Treatment
  • Long-term psychotherapy
  • Goal is to integrate personalities
  • Treatment involves
  • Identify cues that provoke memories of trauma
    and/or dissociation and neutralize them
  • Re-expose patient to trauma (imaginally)
  • Work through terrible feelings and memories
  • Often involves hypnosis to help patient access
    unconscious memories

16
Treatment (continued)
  • No controlled studies
  • Clinical reports suggest approximately 20
    achieve full integration of identities
  • May take years

17
Controversy
  • Is it a real disorder?
  • Only 1/3 of American psychiatrists believe it
    should be included in DSM without reservations

18
Increase in Prevalence
  • 1800-1960 scattered cases reported worldwide
  • 1957 Three Faces of Eve is published
  • 1960-1970 8 cases reported
  • 1976 Sybil is released
  • 1980 DSM includes diagnosis for first time
  • 1980 Michelle Remembers is published
  • claims satanic, ritualistic abuse as cause of MPD

19
Increase in Prevalence (continued)
  • 1980-1991 media coverage escalates
  • talk shows, books that feature MPD victims
  • 1985 Psychiatrist Richard Kluft claims to have
    treated 250 MPD patients
  • 1986 6,000 cases reported in North America
  • 1987 first MPD inpatient treatment unit opened
    in Chicago
  • 1994 40,000 cases reported in North America
  • 1995 psychiatrist found guilty of malpractice
    for inducing MPD in vulnerable patient
  • 1996-present other successful lawsuits

20
Major Point
  • controversy surrounding MPD illustrates the
    scientist-practitioner gap

21
Practitioners Argue
  • MPD is a real disorder
  • MPD has been underdiagnosed in past
  • Cause of MPD is overwhelming trauma
  • Often use techniques such as hypnosis in
    diagnosis and treatment
  • Point to evidence suggesting differences in
    physiological patterns between alters
  • EEG activity

22
Scientists Argue
  • MPD is not real or is very rare
  • MPD is overdiagnosed
  • causes of MPD include
  • therapist who believe strongly in MPD suggest it
    to their clients through leading questions, etc.
  • therapists reinforce MPD-like behavior
  • clients are reinforced for display of MPD
    symptoms through relief from responsibility for
    their actions, etc.
  • MPD provides a way for some troubled people to
    understand and legitimize their problems.

23
Scientists Argue (continued)
  • studies supposedly illustrating differences in
    physiological patterns between alters are
    methodologically flawed
  • anecdotal
  • no control group
  • not replicated
  • subjects who are role-playing MPD show same
    degree of difference between alters as true MPD
    patients.
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