Multiple personality disorder syndrome of identity disorder. Multiple Personality Syndrome

Have you ever thought that maybe you don't know someone very well? That sometimes he seems completely different, alien, unfamiliar, as if he had been replaced? As if several completely different people live in his body?

Dissociative identity disorder (DID), also known as multiple personality disorder (MPD), multiplicity, split personality… what it is?In this article, psychologist Yulia Koneva will tell you everything about split personality disorder, what are its causes, signs, symptoms and manifestations, and you will also learn real stories from the lives of people with this disorder.

Split personality: 23 souls in one body

"Personalities" may differ in mental abilities, nationality, temperament, worldview, gender and age

Reasons for the development of DID

How does multiple personality arise? The etiology of a split personality is not yet fully understood, but the available data speak in favor of the psychological nature of the disease.

arises due to the mechanism of dissociation, under the influence of which thoughts or specific memories of ordinary human consciousness are divided into parts. Divided thoughts expelled into the subconscious spontaneously pop up in consciousness due to triggers (triggers), which can be events and objects present in the environment during a traumatic event.

Split personality, like other dissociative disorders, is psychogenic in nature. Its occurrence is associated with a whole range of factors. The trigger mechanism can sometimes be an acute stressful situation with which a person is unable to cope on his own. The multiple personality for him serves as protection from traumatic experiences. Many dissociative disorders develop in people who, in principle, are able to dissociate, to separate their perceptions and memories from the stream of consciousness. This ability, combined with the ability to enter a trance state, is a factor in the development of dissociative identity disorder.

The causes of a split personality often lie in childhood and are associated with traumatic events, the inability to defend against negative experiences and the lack of love and care towards the child from his parents. Research by North American scientists found that 98% of people with multiple personalities were abused as children(85% have documentary evidence of this fact). Thus, these studies have shown that a key factor provoking a split personality is violence in childhood. In other situations, a large role in the development of dissociative identity disorder is played by early loss of a loved one, complex disease or other acute stressful situation. In some cultures, war or a global catastrophe can become a key factor.

For multiple personality disorder to occur, a combination of:

Intolerable or strong and frequent stress.
Ability to dissociate (a person must be able to separate from consciousness their own perception, memories or identity).
Manifestations in the process individual development defense mechanisms of the psyche.
Traumatic experience in childhood with a lack of care and attention in relation to the affected child. A similar picture arises when the child is not sufficiently protected from subsequent negative experiences.

A unified identity (the integrity of the self-concept) does not arise at birth, it develops in children through a variety of experiences. Critical situations create an obstacle to the development of the child, and as a result, many parts that should be integrated into a relatively unified identity remain isolated.

A long-term study by Ogawa et al. shows that lack of access to a mother at two years of age is also a predisposing factor for dissociation.

The ability to generate multiple personalities does not appear in all children who have experienced abuse, loss, or other severe trauma. Patients suffering from dissociative identity disorder are characterized by the ability to easily enter a trance state. It is the combination of this ability with the ability to dissociate that is considered a contributing factor to the development of the disorder.

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Symptoms and signs

Dissociative Identity Disorder (DID) – modern name a disorder that is known to the general public as multiple personality disorder or split personality disorder. This is the most severe disorder of the group of dissociative mental disorders, which is manifested by the majority of known dissociative symptoms.

To major dissociative symptoms include:

Dissociative (psychogenic) amnesia, with which sudden loss memory is caused by a traumatic situation or stress, and the assimilation of new information and consciousness is not impaired (often observed in people who have experienced military operations or natural disasters). Memory loss is recognized by the patient. Psychogenic amnesia is more common in young women.
Dissociative fugue or dissociative (psychogenic) flight reaction. It manifests itself in the sudden departure of the patient from the workplace or from home. In many cases, the fugue is accompanied by an affectively narrowed consciousness and subsequent partial or complete loss of memory without awareness of the presence of this amnesia (a person may consider himself a different person, as a result of having a stressful experience, behave differently than before the fugue, or not be aware of what is happening around him).
Dissociative identity disorder, as a result of which a person identifies himself with several personalities, each of which dominates him with a different time interval. The dominant personality determines the views of a person, his behavior, etc. as if this personality is the only one, and the patient himself, during the period of dominance of one of the personalities, does not know about the existence of other personalities and does not remember the original personality. Switching usually occurs suddenly.
Depersonalization disorder, in which a person periodically or constantly experiences alienation of his own body or mental processes watching yourself as if from the sidelines. There may be distorted sensations of space and time, the unreality of the surrounding world, the disproportion of the limbs.
Ganser syndrome("prison psychosis"), which is expressed in the deliberate demonstration of somatic or mental disorders. Appears as a result of an internal need to look sick without the goal of gaining. The behavior that is observed in this syndrome resembles the behavior of patients with schizophrenia. The syndrome includes passing words (a simple question is answered out of place, but within the scope of the question), episodes of extravagant behavior, inadequacy of emotions, a decrease in temperature and pain sensitivity, amnesia in relation to episodes of manifestation of the syndrome.
dissociative disorder, which manifests itself in the form of a trance. Manifested in a reduced response to external stimuli. Split personality is not the only condition in which trance is observed. The trance state is observed with the monotony of movement (pilots, drivers), mediums, etc., but in children this state usually occurs after trauma or physical abuse.

Dissociation can also be observed as a result of a long and intense violent suggestion (processing the consciousness of hostages, various sects).

Signs of a split personality also include:

Derealization, in which the world seems unreal or distant, but there is no depersonalization (there is no violation of self-perception).
dissociative coma, which is characterized by loss of consciousness, a sharp weakening or lack of response to external stimuli, extinction of reflexes, changes in vascular tone, impaired pulse and thermoregulation. Stupor (complete immobility and lack of speech (mutism), weakened reactions to irritation) or loss of consciousness not associated with somato-neurological disease is also possible.
emotional lability(severe mood swings).

Anxiety or depression, suicide attempts, panic attacks, phobias, or nutrition are possible. Sometimes patients experience hallucinations. These symptoms are not directly associated with a split personality, as they may be a consequence of the psychological trauma that caused the disorder.

Diagnostics

Dissociative identity disorder is diagnosed when the following criteria are met:

The absence of alcohol, drug intoxication, the influence of other toxic substances and diseases. Lack of explicit simulation or fantasizing.
A person has obvious memory problemsthat have nothing to do with simple forgetfulness.
The presence of several distinguishable "I"-states with stable models of perception of the world, different attitudes to the surrounding reality and worldview.
The presence of at least two of the distinguishable identities capable of influencing the patient's behavior. Dissociative identity disorder (split or split personality, multiple personality disorder, multiple personality syndrome, organic dissociative personality disorder) is a rare mental disorder in which personal identity is lost and it seems that there are several different personalities (ego states) in one body .

Dissociative identity disorder is diagnosed based on four criteria:

The patient must have minimum two(possibly more) personal states. Each of these individuals must have individual features, character, their own worldview and thinking, they perceive reality differently and differ in behavior in critical situations.
These personalities control the person's behavior in turn.
The patient has memory lapses, he does not remember important episodes of his life (wedding, childbirth, attended a course at the university, etc.). They appear in the form of phrases “I can’t remember,” but usually the patient attributes this phenomenon to memory problems.
The resulting dissociative identity disorder is not associated with acute or chronic alcohol, drug or infectious intoxication.

Split personality needs to be distinguished from role-playing games and fantasies.

Since dissociative symptoms also develop with extremely pronounced manifestations of post-traumatic stress disorder, as well as with disorders associated with the appearance pain in the area of some organs as a result of an actual mental conflict, a split personality must be distinguished from these disorders.

The patient has a "basic" main personality, which is the owner of the real name, and which usually unaware of the presence of other personalities in his body, therefore, if the patient is suspected of having a chronic dissociative disorder, the psychotherapist should examine:

certain aspects of the patient's past;
current mental status of the patient.

How is the disorder diagnosed? Interview questions are grouped by topic:

Amnesia. It is desirable that the patient give examples of “time gaps”, since microdissociative episodes under certain conditions occur in absolutely healthy people. In patients who suffer from chronic dissociation, situations with time gaps are observed frequently, the circumstances of amnesia are not associated with monotonous activity or extreme concentration of attention, and there is no secondary benefit (it is present, for example, when reading fascinating literature).

At the initial stage of communication with a psychiatrist, patients do not always admit that they experience such episodes, although every patient has at least one personality who has experienced such failures. If the patient gave convincing examples of the presence of amnesia, it is important to exclude the possible connection of these situations with the use of drugs or alcohol (the presence of a connection does not exclude a split personality, but complicates the diagnosis).

Questions about the presence in the wardrobe (or on herself) of the patient of things that she did not choose help to clarify the situation with time gaps. For men, such “unexpected” items can be vehicles, tools, weapons. These experiences can involve people (strangers claim to know the patient) and relationships (deeds and words that the patient knows about from the stories of loved ones). If a strangers, addressing the patient, used other names, they need to be clarified, since they may belong to other personalities of the patient.

Depersonalization / Derealization. This symptom is most common in dissociative identity disorder, but it is also characteristic of schizophrenia, psychotic episodes, depression, or temporal lobe epilepsy. Transient depersonalization is also observed in adolescence and at moments of near-death experience in a situation severe injury so the differential diagnosis must be kept in mind.

The patient needs to be clarified whether he is familiar with the state in which he observes himself as stranger, watching a "movie" about himself. Such experiences are characteristic of half of patients with a split personality, and usually the main, basic personality of the patient is the observer. When describing these experiences, patients note that at these moments they feel a loss of control over their actions, they look at themselves from some external, located on the side or from above, a fixed point in space, they see what is happening as if from the depths. These experiences are accompanied by intense fright, and in people who do not suffer from multiple personality disorder and have had similar experiences as a result of near-death experiences, this state is accompanied by a feeling of detachment and peace.

There may also be a feeling of the unreality of someone or something in the surrounding reality, the perception of oneself as dead or mechanical, etc. Since such a perception manifests itself in psychotic depression, schizophrenia, phobias, etc., a wider differential diagnosis is needed.

Life experience. Clinical practice shows that in people suffering from split personality, certain life situations recur much more frequently than in people without the disorder.

Childhood abuse is a key factor in the development of DID

Usually, patients with multiple personality disorder are accused of pathological deceit (especially in childhood and adolescence), denial of actions or behavior that other people have observed. The patients themselves are convinced that they are telling the truth. Fixing such examples will be useful at the stage of therapy, as it will help to explain incidents that are incomprehensible to the main personality.

Patients with a split personality are very sensitive to insincerity, suffer from extensive amnesia, covering certain periods of childhood (the chronological sequence of school years helps to establish this). Normally, a person is able to consistently tell about his life, restoring in his memory year after year. People with multiple personalities often experience wild fluctuations in school performance, as well as significant gaps in the chain of memories.

Often, in response to external stimuli, a flashback state occurs, in which memories and images, nightmares and dream-like memories involuntarily invade consciousness. The flashback causes a lot of anxiety and denial (defensive reaction of the main personality).

There are also obsessive images associated with the primary trauma and uncertainty about the reality of some of the memories.

Also characteristic is the manifestation of certain knowledge or skills that surprise the patient, because he does not remember when he acquired them (sudden loss is also possible).

The main symptoms of K. Schneider. Multiple personality patients may "hear" aggressive or supportive voices arguing in their head, commenting on the patient's thoughts and actions. Phenomena can be seen passive influence(often this is an automatic letter). By the time of diagnosis, the main personality often has experience of communicating with his alternating personalities, but interprets this communication as a conversation with himself.

When assessing the current mental status, attention is paid to:

appearance (can change radically from session to session, up to sudden changes in habits);
speech (timbre, vocabulary changes, etc.);
motor skills (tics, convulsions, trembling of the eyelids, grimaces and reactions of the orienting reflex often accompany a change of personalities);
thinking processes, which are often characterized by illogicality, inconsistency and the presence of strange associations;
the presence or absence of hallucinations;
intelligence, which as a whole remains intact (only in long-term memory is mosaic deficiency revealed);
prudence (the degree of adequacy of judgments and behavior can change dramatically from adult to childish behavior).

*Mental status assessment in multiple personality disorder*
Sphere	Characteristics
Appearance	From session to session, there can be dramatic changes in the style of clothing, self-care, general appearance, and demeanor of the patient. During the session, noticeable changes in facial features, posture, mannerisms are possible. Habits and addictions, such as smoking, can change within a short period of time
Speech	Changes in speech rate, pitch, accent, volume, vocabulary, and use of idiomatic or vernacular expressions can occur within a short period of time
Motor skills	Rapid blinking, trembling of the eyelids, marked eye rolling, tics, seizures, orienting responses, facial tremors, or grimaces often accompany the personality switch.
Thinking processes	Sometimes thinking can be characterized by inconsistency and illogicality. Strange associations are possible, patients may experience thought blocking or breaks in the sequence of thoughts. This is especially true for fast switches or revolving door crises. However, the violation of thinking does not go beyond the crisis
hallucinations	Auditory and/or visual hallucinations may occur, including derogatory voices, voices commenting or arguing about the patient, or imperative voices. Usually the voices are heard inside the patient's head. There may be voices whose messages have positive character or traits of a secondary process
Intelligence	Short-term memory, orientation, arithmetic operations and the basic stock of knowledge as a whole remain intact. Long-term memory may show mosaic deficits
prudence	The degree of adequacy of the patient's behavior and judgments may fluctuate rapidly. These shifts often occur along a parameter of age (i.e. shifts from adult to child behavior)
insight	Usually the personality presented at the beginning of the treatment (in 80% of cases) is not aware of the existence of other alter-personalities. Patients show a marked learning disability based on past experience

Putnam F. "Diagnosis and treatment of multiple personality disorder"

Patients usually present with a marked learning disability based on past experience. EEG and MRI are also performed to exclude the presence of an organic brain lesion.

There are also other symptoms of a split personality:

mood swings, depression;
suicidal ideas and attempts;
increased level of anxiety up to an anxiety disorder;
sometimes there are dissociative disorders of a different nature;
violation of appetite, diet;
poor sleep, insomnia,;
the presence of various phobias, panic disorders;
a feeling of loss, confusion, sometimes derealization and depersonalization are manifested;
children may have variability of tastes, conversations with themselves, talking in different manners.

Since schizophrenia and dissociative identity disorder have many similar symptoms, even hallucinations sometimes occur with a split personality, a person is sometimes misdiagnosed as schizophrenia, although dissociative identity disorder is of a completely different nature.

Psychological testing

MMPI test

Test MMPI (Minnesota Multiscale Personality Questionnaire, Minnesota Multiphasic Personality Inventory, MMPI) - personality questionnaire, created at the University of Minnesota (USA) by psychiatrist Stark Hathway and clinical psychologist John McKinley in 1947. This test used in personality diagnostics.

In three studies, MMPI was performed on a sample of 15 or more patients with DID (Coons and Sterne, 1986; Solomon, 1983; Bliss, 1984b). All of these independent studies produced a number of consistent results. The MMPI profile of patients with DID is characterized by an increase on the F validity scale and on the Sc scale or the "schizophrenia" scale (Coons and Sterne, 1986; Solomon, 1983; Bliss, 1984b). Among the critical items on the schizophrenia scale, to which patients with DID often responded positively, was item 156: "I had periods when I did something and then did not know what I was doing," and item 251 : "I had periods when my actions were interrupted and I did not understand what was happening around" (Coons, Sterne, 1986; Solomon, 1983). Coons and Stern (Coons and Sterne, 1986) found in their study that 64% of patients on the first test and 86% of patients on retest gave a positive response to item 156, with an average interval between two tests of 39 months. They also found that 64% of patients responded positively to item 251. In addition, it was noted that these patients were much less likely to respond positively to the critical psychotic items of the questionnaire, with the exception of the item describing auditory hallucinations.

An increase in the F score, which is often the formal basis for considering the entire MMPI profile invalid, was found in all three studies (Coons and Sterne, 1986; Solomon, 1983; Bliss, 1984b). Solomon (1983) interpreted high values on this scale as a "call for help", he noted that this was due to suicidal tendencies in patients from his sample. In all three studies, the results of the application of MMPI to patients with DID indicate that the latter are polysymptomatic, in addition, it was suggested that many of the obtained profiles indicate the presence of borderline personality disorder.

Rorschach test

An even smaller number of patients with DID have been examined using the Rorschach test. Wagner and Heis (1974), in a study of the responses of patients with DID to the Rorschach test, noted two common features: (1) a large variety of motion responses and (2) labile and conflicting color responses. Wagner and colleagues (Wagner et al., 1983) supplemented these data obtained from four patients with DID. Danesino and colleagues (Danesino et al., 1979) and Piotrowsky (Piotrowsky, 1977) confirmed the first results of the Rorschach test by Wagner and Heis (Wagner and Heis, 1974) based on interpretations of the responses of two patients with DID. However, Lovitt and Lefkov (1985) objected to following the rules of interpretation followed by Wagner and his colleagues (Wagner et al., 1983), who used a different protocol for recording responses to the Rorschach test in a study of three patients with DID, as well as Exner's system for interpreting responses. Despite the fact that the number of cases that were examined using these protocols was too small to allow generalizations, the authors offered their conclusions about the specificity of the Rorschach test in determining DID and other underlying dissociative pathology (Wagner et al., 1983; Wagner, 1978).

Physical condition research

Psychiatrists in their practice, especially in outpatient appointments, as a rule, do not systematically assess the patient's physical status. There are many reasons for this, and the decision to conduct a physical status study is the prerogative of therapists. However, there are several considerations regarding the importance of examining the patient's physical status, or at least their neurological status, in diagnosing DID.

The single most characteristic pathophysiological feature in DID is amnesia, which manifests itself as difficulty remembering. Differential diagnosis of memory functioning requires the exclusion of organic disorders such as concussion, tumor, cerebral hemorrhage, and organic dementia (for example, in Alzheimer's disease, Huntington's chorea or Parkinson's disease). In order to exclude the possibility of these diseases, a complete neurological examination is necessary.

Examination of the physical status can also help to identify signs of self-inflicted physical injuries by the patient, i.e. . Commonly targeted areas of self-harm in DID, often hidden from superficial observation, include the upper arms (hidden under long sleeves), the back, inner thighs, chest, and buttocks. As a rule, the marks of self-inflicted wounds are in the form of neat cuts made with a razor blade or broken glass. In this case, thin scars are visible, similar to lines from a pen or pencil. Often the scars from repeated cuts form a certain figure on the skin, similar to Chinese characters or traces of chicken feet. Another common form of self-harm is cigarette or match burns on the skin. These burns leave circular or dotted scars. If the assessment of physical status reveals signs of repeated self-harm, then there are serious reasons to assume that this patient has a dissociative disorder, similar to DID or depersonalization syndrome.

Scars in patients with DID may also be related to childhood abuse. Sometimes patients with multiple personalities cannot explain the appearance of scars associated with a surgical operation - so we get another fact that gives reason to assume that the patient has amnesia for important events in his personal life.

Meeting with alter personalities

How to behave if you are dealing with a person suffering from multiple personality disorder? The diagnosis of DID (or CML) can only be made if the clinician directly observes the appearance of one or more alters and his observations confirm that at least one alter is characteristically distinctive and takes control from time to time. behind the individual's behavior (American Psychiatric Association, 1980, 1987). A discussion of the individuality and independence inherent in alter personalities and distinguishing them from mood swings and "ego states" is given later in this chapter. How should a specialist behave at the first contact with the alter personality of his patient? F. Putnam talks about this in his book “Diagnostics and Treatment of Multiple Personality Disorders”. Let's consider in more detail.

It follows from a review of NIMH publications and research data that the initiators of the first contact in about half of all cases are one or more alter personalities who “come to the surface” and declare themselves as individuals whose identity differs from the main personality of the patient (Putnam et al ., 1986). Quite often, the alter personality begins contact with the therapist with a phone call or letter, presenting himself as a friend of the patient. Typically, until this event, the therapist does not suspect that his patient suffers from DID. Spontaneous manifestation of this symptom is possible immediately after the first meeting with the patient, either if he is in a state of crisis, or if the diagnosis of DID is confirmed.

Let us suppose that the patient admits to having some dissociative symptoms and says that at times he feels like a different person or that he has a different personality, the other person being generally characterized as hostile, angry or depressed and suicidal. The clinician may then ask if it is possible for him to meet this part of the patient: "Can this part appear and speak to me?" After this question, patients with multiple personalities may have signs of distress. The main personalities of some patients know that they can prevent the appearance of undesirable personalities and do not want the therapist to try to establish contact with them. It often happens that the main personality, aware of the existence of other alter-personalities, competes with them for the attention of the therapist and is not interested in facilitating their acquaintance with the therapist. Different ways the therapist may be given to understand that the appearance of this or that alter personality is impossible or undesirable.

Therapists who are not experienced with DID may experience great anxiety before the first appearance of alter personalities. “How should I behave if some alter personality really suddenly appears in front of me?” “What can happen in this case, are they dangerous?” “What if I’m wrong and there aren’t really any alter personalities? Won't my questions lead to the artificial emergence of such a person? Usually, these and other questions are especially acute for therapists who have suspected a multiple personality in their patient, but have not yet experienced a clear change in alter personalities in their patient.

Alter personalities

The best way to connect with potential alters is to contact them directly. In many cases it makes sense to ask the patient about their existence directly and try to establish direct contact with them.

However, in some circumstances, it is possible to use hypnosis or special drugs to facilitate contact with alter personalities.

Appeal to alleged alter personalities

If the therapist has good reason to believe that his patient is suffering from DID, but contact with the alter personality has not yet been made, then sooner or later there will come a point when, in order to establish it, the therapist will have to contact the alleged alter personalities directly. This step may be more difficult for the therapist than for the patient. In such a situation, the therapist may feel foolish, but this must be overcome. First of all, you need to determine to whom exactly to address your question. If the patient is indeed a multiple personality, then in most cases the personality with which the therapist identifies the patient is probably the main personality. The main person, as a rule, is the person who is represented in the treatment. Usually this person is depressed and oppressed by the circumstances of his life (this may be less true for men), this person actively avoids or denies evidence of the existence of other personalities. If the patient in the sessions is represented by a personality that is not the main one, then this personality is most likely aware of the plurality of the patient's personality and seeks to reveal it.

Usually the therapist will address the alter personality he knows best about. The therapist, asking about situations that may be associated with manifestations of dissociative symptoms in a given patient, can, along with positive answers, also receive a description of specific situations that can help him. Let's say that the patient told about how he lost his job several times due to outbursts of anger, which he could not remember anything about. Based on this information, the therapist can assume that if the episodes that the patient cannot remember were the onset of DID, then most likely there is a person who became active at these moments and acted with the affect of anger. The therapist can use the description of this person's actions and, based on them, address her in the following way: “I would like to speak directly with that part [aspect, point of view, side, etc.] of you that was active last Wednesday at your workplace and said all sorts of things to the boss.” The more direct the appeal to the alleged alter personality, the higher the chances of causing its appearance. Usually, addressing by a specific name is most effective, however, the use of attributes or functions of the person being addressed will also help to establish contact (for example, "something dark", "someone angry", "little girl", "administrator") . The tone in which the request for a meeting with another part of the personality is expressed should be inviting, but not demanding.

Usually, the appearance of an alter personality does not occur immediately after the therapist's first contact with it. As a rule, this request needs to be repeated several times. If nothing happens at the same time, then the therapist should pause in order to assess how the patient's actions have affected the patient. The therapist should carefully watch for signs of behavior that indicate possible change patient alter personalities. If a visible signs there are no switches, the therapist must determine whether his questions caused the patient a feeling of discomfort. For most non-DID patients, questions about a hypothetical personality system structure do not cause significant distress. They just pause or say something like, "I don't think there's anyone else here with us, doctor." On the other hand, in response to the therapist's insistence on making contact with the alter personality, patients with multiple personalities usually show signs of severe discomfort. This can be regarded as proof of the existence of alter personalities. Most likely at such moments they experience very strong distress. Some patients may enter a trance-like state where they are unresponsive to their surroundings.

If the patient shows signs of severe discomfort, the therapist may be tempted to withdraw his request. In this state, the patient can squeeze his head with his hands, he has grimaces of suffering, he begins to complain of headaches or pains in other parts of the body, and some other signs of somatic suffering caused by the therapist's request are possible. This discomfort is due to the fact that a certain struggle is unfolding inside the patient. Perhaps the main or some other alter personality belonging to the personality system is trying to prevent the appearance of this or that personality to which the request was directed; either two or more alters attempt to appear at the same time; or the personality system is trying to push the alter personality to which the request was addressed to the surface, but this personality resists, she does not want to “come to the surface” and meet with the therapist. However, each therapist in each case must determine for himself the degree of his persistence. Not all alters appear the first time they are encountered, and of course the patient may not have DID.

If the patient undergoes a dramatic transformation and then says, "Hi, my name is Marcy," then the therapist has overcome the first hurdle. If the patient reacts differently, then the therapist should stop and explore with the patient what happened to the latter when the therapist was trying to establish contact with the alter personality. Patients with multiple personalities may report that after addressing their alleged alter personality, they seem to "gradually shrink", withdraw and withdraw, feel suffocated, feel very strong internal pressure or felt as if a veil of mist had descended on them. Such patient testimonies are strong grounds for the suggestion of dissociative pathology and indicate that the therapist should continue, perhaps in the next session, his attempts to contact the alter personality. In addition to trying to address those alter personalities that the therapist suspects exist from the examples given by the patient during the interview, one can try to establish contact with "some other" personality who may want to enter into communication with the therapist.

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If the patient does not have clear signs strong experiences and he denies any internal reaction to the therapist's request, then he may not have DID. However, it is possible that some strong alter personality or group of alter personalities is making an effort to hide the patient's multiple personality, and they may be able to do this for quite a long period of time. Most therapists experienced in the treatment of DID have experienced this on more than one occasion. Therefore, the therapist should not definitively rule out a diagnosis based on a single failed attempt to contact the alter personality. One way or another, the therapist should not be upset because he addressed his patient with this request. Patients who do not have DID tend to treat such questions as one of those routines that doctors usually do, like tapping patients on the knee with their little rubber hammers. Whereas patients with DID after such questions realize that the therapist is aware of the plurality of their personality and even wants to work with it. In general, the result of this intervention will be positive and it is quite possible that in response to it there will be a “spontaneous” appearance of an alter personality over the next few sessions. Sometimes a personal system just needs some time to get used to what was, perhaps, the first experience of addressing it as a kind of integrity and to decide on its answer.

If, however, the therapist fails to elicit an alter personality through direct appeal and the patient continues to show clear signs of frequent dissociative episodes, then hypnosis or drug-induced interviewing should be considered.

Ways to communicate with alter personalities

The simplest communication options include the appearance of an alter personality, which introduces itself and calls itself a specific name, after which it enters into a conversation with the therapist. Most likely, this development of relationships is the most common, and most patients with DID come to this sooner or later in therapy. However, at the very first stages of therapy, other ways of communication of alter personalities with the therapist are possible. They may approach the therapist indirectly, as if they were not "on the surface" (that is, they do not have direct control over the body). F. Putnam says that when he first came into contact with one patient's alter personality, she introduced herself as "Dead Mary" and communicated with him using the voice of the shocked and frightened main personality. First of all, Dead Mary spoke about her hatred that she feels towards the patient, and said that she dreams of "roasting her so that she turns into a firebrand"; later, when her actual appearance took place, she turned out to be much less vicious than her first lines would suggest. The main character's reaction to her first appearance was intense horror. The usual trained reaction of the therapist was to accept the statements of the emerging alter as an objective fact, to maintain a polite and interested conversation with Dead Mary. This approach has borne fruit, the dialogue has begun. Of course, main goal for the sake of which contact is established with the alter parts of the patient, is a productive dialogue.

Contact can also be made through internal dialogue. The patient may "hear" the alter personality as a kind of internal voice, which, as a rule, belongs to the "voices" that have sounded in the patient's head for many years. In this case, the patient transmits to the therapist the answers that he receives from the inner voice. Since the responses of the alter personality in this situation are controlled by another personality (usually the main personality), distortions of the transmitted messages are possible. Dialogues based on the transmission of answers from internal voices are, one way or another, rather uninformative. Perhaps this situation is caused by an insufficient degree of trust between the patient and the therapist to achieve more or less direct contact.

Another means of communication with the alter personality is automatic writing, that is, the patient's fixation in writing of the answers of the alter personality in the absence of volitional control on his part over this process. Milton Erickson published a case in which treatment was carried out using the automatic writing method (Erickson, Kubie, 1939). If the patient reports new entries in a diary he keeps regularly, and states that he cannot remember how he made them, then the therapist may try to use automatic writing to establish a channel of communication with the author of these entries, provided that previous attempts to establish direct contact with this alter personality were unsuccessful. Automatic writing takes a lot of time and creates a lot of problems, in addition, this method is not a very effective way to long-term therapy. However, in the early stages, the therapist can gain access to the personality system through this method, which may be important in the later stages of treatment. Another way to establish contact with alter personalities with whom direct contact is impossible at this stage of therapy is the technique of ideomotor signaling. Greatest effect achieved by combining this technique with hypnosis. The ideomotor signaling technique involves an agreement between the therapist and the patient to assign some signal (for example, raising the index finger of the right hand) to a certain value (for example, “yes”, “no”, or “stop”).

How to talk to alter personalities

Confirmation of the diagnosis

The therapist's contact with an entity whose identity is fundamentally different from the personal identity of the patient, which has become habitual for the therapist, is not a sufficient basis for confirming the diagnosis of DID. Further confirmation is needed that the alter personality, and other personalities that may follow it, are indeed independent, unique, relatively stable, and distinct from intermittent ego states. The task of the therapist is to determine as precisely as possible the extent to which the patient's alter-personalities are present in the external world, and in particular in therapy, and the role they have played in the patient's life in the past. The therapist must also assess the level of temporal stability of the alters. True alters are remarkably stable and resilient entities, whose "character" is independent of time and circumstance.

All currently known evidence suggests that the onset of DID is associated with a child's experience of extreme defenselessness during childhood or early adolescence. Over time, it is necessary to make efforts to find out the history of the emergence of certain alter-personalities of the patient, which first appeared under similar or other circumstances or earlier. In the case of other dissociative disorders, such as psychogenic fugue, the secondary identity usually lacks memories of independent activity before the fugue episode, since the emergence of a new personal identity is strictly due to the onset of the fugue.

Confirmation of the diagnosis of DID at the first stage of therapy may take some time, while the acceptance of the diagnosis by both the patient and the therapist may be followed by its rejection, etc. You need to be ready for this. Currently, there are no special methods for diagnosing DID. As a rule, data on the patient's response to the proposed treatment are needed to confirm the diagnosis. If it happens significant improvement condition of a given patient as a result of the use in his treatment of methods specially developed for the treatment of multiple personality, while other therapeutic approaches were less effective, then the criterion of truth, so to speak, is practice.

Treatment for multiple personality disorder

Dissociative identity disorder is a disorder that requires the help of a psychotherapist experienced in treating dissociative disorders.

The main directions of treatment are:

relief of symptoms;
the reintegration of the various personalities that exist in a person into one well-functioning identity.

For treatment use:

cognitive psychotherapy, which is aimed at changing stereotypes of thinking and inappropriate thoughts and beliefs by methods of structured learning, experiment, training in the mental and behavioral plans.
family psychotherapy aimed at teaching the family how to interact in order to reduce the dysfunctional impact of the disorder on all family members.
clinical hypnosis which helps patients achieve integration, relieves symptoms and promotes a change in the patient's character. Split personality needs to be treated with hypnosis with caution, as hypnosis can provoke the appearance of a multiple personality. Ellison, Kohl, Brown, and Kluft, the multiple personality disorder specialists, describe cases of using hypnosis to relieve symptoms, strengthen the ego, reduce anxiety, and create rapport (contact with the hypnotist).

Relatively successfully, insight-oriented psychodynamic therapy is used, which helps to overcome the trauma received in childhood, reveals internal conflicts, determines a person’s need for individual personalities and corrects certain defense mechanisms.

The treating therapist should treat all the patient's personalities with equal respect and not take any one side in the patient's internal conflict.

Drug treatment is aimed solely at eliminating symptoms (anxiety, depression, etc.), since there are no medications to eliminate personality splits.

With the help of a psychotherapist, patients quickly get rid of dissociative flight and dissociative amnesia, but sometimes the amnesia becomes chronic. Depersonalization and other symptoms of the disorder are usually chronic.

Generally all patients can be divided into groups:

The first group is distinguished by the presence of predominantly dissociative symptoms and post-traumatic signs, the overall functionality is not impaired, and due to the treatment, they fully recover.
The second group is characterized by a combination of dissociative symptoms and mood disorders, eating behavior and others. Treatment by patients is more difficult to tolerate, it is less successful and longer.
The third group, in addition to the presence of dissociative symptoms, is characterized by pronounced signs of other mental disorders, so long-term treatment is aimed not so much at achieving integration as at establishing control over symptoms.

First of all, a person who notices disturbing signs of a violation of self-identity should definitely contact a psychotherapist for help. If the patient does have a split personality, and not schizophrenia, intoxication, or another conversion disorder, then the main goal of treatment will be the integration of separate, distinguishable identities into one stable, well-adapted personality. And this can be done only under the supervision of a specialist using psychotherapy methods. This disease responds well to treatment with cognitive techniques, family therapy methods, and hypnosis. Medications are used solely to relieve associated symptoms, such as anxiety or depression. It is important in the process of treatment to help the patient overcome the consequences of psychological trauma, identify conflicts that provoked the separation of several identities and correct protective mental mechanisms. Not always the treatment of a split personality can help integrate different identities into one. However, ensuring the peaceful coexistence of different personalities is also quite a big success. In any case, you should trust the experts and tune in to a positive result.

Prevention of DID

Dissociative identity disorder is a mental illness, so there are no standard preventive measures for this disorder.

Since violence against children is considered the main cause of this disorder, many international organizations are currently working to identify and eliminate such violence.

As a prevention of dissociative disorder, it is necessary to timely contact a specialist if a child has psychological trauma or experienced severe stress.

Very little scientific literature provides information about dissociative identity disorder, however, modern human culture constantly addresses this issue in its works and fully shows the symptoms of this disease.

Notable cases of dissociative identity disorder

At the first sign of a violation of self-identity, you need to contact a psychotherapist

Louis Vive

One of the first recorded cases of a split personality belonged to the Frenchman Louis Vive. Born a prostitute on February 12, 1863, Vive was deprived of parental care. When he was eight years old, he became a criminal. He was arrested and lived in a correctional facility. When he was 17 years old, he was working in a vineyard, and a viper coiled around his left arm. Although the viper did not bite him, he was so terrified that he had convulsions and was paralyzed from the waist down. After being paralyzed, he was placed in a psychiatric hospital, but after a year he began to walk again. Vive now seemed like a completely different person. He didn't recognize any of the people in the asylum, he became more gloomy, and even his appetite changed. When he was 18 years old, he was released from the hospital, but not for long. Over the next few years, Vive constantly ended up in hospitals. During his stay there, between 1880 and 1881, he was diagnosed with a split personality. Using hypnosis and metal therapy (applying magnets and other metals to the body), the doctor discovered up to 10 different personalities, all with their own personalities and stories. However, after considering this case in recent years, some experts have concluded that he may have had only three personalities.

Judy Castelli

Raised in New York State, Judy Castelli suffered physical and sexual abuse and struggled with depression thereafter. A month after she entered college in 1967, she was sent home by the school psychiatrist. Over the next few years, Castelli struggled with voices in her head telling her to burn and cut herself. She practically crippled her face, almost lost sight in one eye, and one arm lost its ability to work. She was also hospitalized several times for suicide attempts. Each time she was diagnosed with chronic undifferentiated schizophrenia.

But unexpectedly, in the 1980s, she began to go to clubs and cafes and sing. She almost signed with one label but failed. However, she was able to find work and was the main number in one successful non-commercial show. She also began sculpting and making stained glass. Then, during a therapy session in 1994 with a therapist with whom she had been treated for more than a decade, she developed several personalities; at first there were seven. As the treatment continued, 44 personalities appeared. After she learned that she had a personality disorder, Castelli became an active supporter of movements associated with this disorder. She was a member of the New York Society for the Study of Multiple Personalities and Dissociation. She continues to work as an artist and teaches fine art for people with mental illness.

Robert Oxnam

Robert Oxnam is an eminent American scholar who has spent his entire life studying Chinese culture. He is a former college professor, former president of the Asiatic Society, and currently a private consultant on China-related issues. And although he has achieved a lot, Oxnam has to deal with his mental illness. In 1989, a psychiatrist diagnosed him with alcoholism. Everything changed after the sessions in March 1990, when Oxnam planned to stop therapy. On behalf of Oxnam, the doctor was approached by one of his personalities, an angry young guy named Tommy, who lived in the castle. After this session, Oxnam and his psychiatrist continued therapy and discovered that Oxnam actually had 11 separate personalities. After years of treatment, Oxnam and his psychiatrist reduced the number of personalities to just three. There is Robert, who is the main personality. Then Bobby, who was younger, a fun-loving, carefree guy who loves to roller-skate in Central Park. Another "Buddhist"-like personality is known as Wanda. Wanda used to be part of another personality known as the Witch. Oxnam has written a memoir about his life called A Split Mind: My Life with a Split Personality. The book was published in 2005.

Kim Noble

Born in the United Kingdom in 1960, Kim Noble said her parents were blue-collar workers who were unhappily married. She was physically abused from a young age, and then she suffered from many mental problems when she was a teenager. She tried several times to swallow pills, and was placed in a psychiatric hospital. After twenty years, her other personalities appeared, and they were incredibly destructive. Kim was a van driver, and one of her personalities, named Julia, took over her body and crashed the van into a pile of parked cars. She also somehow stumbled upon a gang of pedophiles. She went to the police with this information, and after she did, she began receiving anonymous threats. Then someone doused acid on her face and set fire to her house. She could not remember anything about these incidents. In 1995, Noble was diagnosed with dissociative identity disorder, and she has been receiving psychiatric care. She currently works as an artist, and while she doesn't know the exact number of personalities she has, she thinks it's somewhere around 100. She goes through four or five different personalities every day, but Patricia is dominant. Patricia is a calm, self-confident woman. Another notable person is Hailey, the one who was involved with pedophiles, which led to that acid attack and arson. Noble (on behalf of Patricia) and her daughter appeared on The Oprah Winfrey Show in 2010. She published a book about her life, All My Selves: How I Learned to Live with Many Personalities in My Body, in 2012.

Truddy Chase

Truddy Chase claims that when she was two years old in 1937, her stepfather physically and sexually abused her while her mother emotionally humiliated her for 12 years. When she became an adult, Chase experienced tremendous stress working as a real estate broker. She went to a psychiatrist and found that she had 92 different personalities that were significantly different from each other. The youngest was a girl about five or six years old, referred to as Lamb Chop. The other was Ying, an Irish poet and philosopher who was about 1,000 years old. None of the personalities acted against the other, and they all seemed to be aware of each other. She did not want to integrate all the personalities into one whole, because they went through a lot together. She referred to her personalities as "The Troops". Chase, along with his therapist, wrote the book When the Bunny Howls and it was published in 1987. It was made into a television mini-series in 1990. Chase also appeared in a highly emotional episode of The Oprah Winfrey Show in 1990. She died on March 10, 2010.

Trial of Mark Peterson

On June 11, 1990, 29-year-old Mark Peterson took an unknown 26-year-old woman out for coffee in Oshkosh, Wisconsin. They met two days later in a park, and as they walked, the woman stated, she began to show Peterson some of her 21 personalities. After they left the restaurant, Peterson asked her to have sex in his car and she accepted. However, a few days after this date, Peterson was arrested for sexual assault. Apparently, the two personalities disagreed. One of them was 20 years old, and she appeared during sex, while the other person, a six-year-old girl, just watched it. Peterson was charged and convicted of second-degree sexual assault because it is illegal to knowingly have sex with someone who is mentally ill and unable to consent. The verdict was overturned a month later, and prosecutors didn't want the woman to be stressed by yet another litigation. The number of her personalities rose to 46 between the incident in June and the trial in November. The Peterson case was never heard again in court.

Shirley Mason

Born January 25, 1923 at Dodge Center, Minnesota, Shirley Mason apparently went through difficult childhood. Her mother, according to Mason, was practically a barbarian. During numerous acts of violence, she gave Shirley enemas and then filled her stomach with cold water. Beginning in 1965, Mason sought help for her mental problems, and in 1954, she began dating Dr. Cornelia Wilbur in Omaha. In 1955, Mason told Wilbur about strange episodes when she found herself in hotels in different cities, having no idea how she got there. She also went shopping and found herself standing in front of scattered groceries with no idea what she had done. Shortly after this confession, different personalities began to emerge during therapy. Mason's story of her horrific childhood and her split personality became the best-selling book, Cybil, and was made into a very popular television series of the same name starring Sally Fields. While Sybil/Shirley Mason is one of the most famous cases of dissociative identity disorder, the public's judgment has been mixed. Many people believe that Mason was a mentally ill woman who adored her psychiatrist, who instilled in her the idea of a split personality. Mason even admitted to making it up in a letter she wrote to Dr. Wilbur in May 1958, but Wilbur told her that it was just her mind trying to convince her she wasn't sick. So Mason continued therapy. Over the years, 16 personalities emerged. In the television version of her life, Sybil lives happily ever after, but the real Mason is addicted to barbiturates and dependent on a therapist to pay her bills and give her money. Mason died on February 26, 1998 from breast cancer.

Chris Costner Sizemore

Chris Costner Sizemore remembers that her first personality disorder happened when she was about two years old. She saw the man pulled out of the ditch and she thought he was dead. During this shocking incident, she saw another little girl watching this. Unlike many other people diagnosed with multiple personality disorder, Sizemore did not suffer from child abuse and grew up in loving family. However, seeing that tragic event (and another bloody work injury later), Sizemore claims that she began to act strangely, and her family members often noticed this too. She often got into trouble for things she did and didn't remember. Sizemore sought help after the birth of her first daughter, Taffy, when she was in her early twenties. One day, one of her personalities, known as "Eva Black", tried to suffocate a child, but "Eva White" was able to stop her. In the early 1950s, she began dating a therapist named Corbett H. Siegpen, who diagnosed her with a split personality. While she was being treated by Zigpen, she developed a third personality named Jane. Over the next 25 years, she worked with eight different psychiatrists, during which time she developed a total of 22 personalities. All these individuals were very different in behavior, and they were different in age, sex, and even weight. In July 1974, after four years of therapy with Dr. Tony Cytos, all the identities came together and she was left with only one. Sizemore's first doctor, Siegpen, and another doctor named Harvey M. Cleckley wrote a book about Sizemore's case called The Three Faces of Eve. It was adapted into a movie in 1957, and Joan Woodward won the Academy Award for Best female role, playing the three personalities of Sizemore.

Juanita Maxwell

In 1979, 23-year-old Juanita Maxwell was working as a hotel maid in Fort Myers, Florida. In March of that year, 72-year-old hotel guest Ines Kelly was brutally murdered; she was beaten, bitten and strangled. Maxwell was arrested because she had blood on her shoes and scratches on her face. She claimed that she had no idea what had happened. While awaiting trial, Maxwell was examined by a psychiatrist, and when she went to court, she pleaded not guilty because she had multiple personalities. In addition to her own personality, she had six more, and one of the dominant personalities, Wanda Weston, committed this murder. During the trial, the defense team, with the help of a social worker, were able to force Wanda to appear in court to testify. The judge thought the change was quite remarkable. Juanita was a quiet woman, while Wanda was noisy, flirtatious and loved violence. She laughed when she confessed to hitting a pensioner with a lamp because of a disagreement. The judge was convinced that either she really had multiple personalities, or she deserved an Academy Award for such a brilliant transformation. Maxwell was sent to a psychiatric hospital, where, she says, she did not receive proper treatment and was simply stuffed with tranquilizers. She was released, but in 1988 she was arrested again, this time for robbing two banks. She again claimed that Wanda did it; internal resistance was too strong, and Wanda again gained the upper hand. She did not want to contest the charge, and was released from prison after serving time.

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Certified psychologist, candidate of economic sciences, accredited coach of ICF (International Coach Federation). Engaged in psychological practice since 2002, including as child psychologist and a crisis psychologist. Specialization - victimology. Teaching experience since 2000.

Multiple Personality - mental phenomenon in which a person has two or more distinct personalities, or ego states. Each alter - personality in this case has its own patterns of perception and interaction with the environment. People with multiple personalities are diagnosed with dissociative identity disorder, or multiple personality disorder. This phenomenon is also known as "split personality".

dissociative identity disorder

Name options:

Dissociative Identity Disorder (DSM-IV)

Multiple Personality Disorder (ICD-10)

Multiple Personality Syndrome

Organic dissociative personality disorder

split personality

Dissociative identity disorder (eng. split personality, or DID) is a psychiatric diagnosis accepted in the Diagnostic and Statistical Handbook of Mental Disorders (DSM-IV), describing the phenomenon of multiple personality. To define dissociative identity disorder (or multiple personality disorder) in a person, it is necessary to have at least two personalities who regularly take turns controlling the behavior of the individual, as well as memory loss that goes beyond normal forgetfulness. Memory loss is usually described as a "switch". Symptoms should occur regardless of substance abuse (alcohol or drugs) or general medical condition.

Dissociative identity disorder is also known as multiple personality disorder (eng. split personality, or MPD). AT North America This disorder is commonly referred to as "dissociative identity disorder" due to the divergence of opinion in the psychiatric and psychological environment regarding this concept, according to which one (physical) individual can have more than one personality, where personality can be defined as the sum total of the mental states of a given (physical) ) of an individual.

Although dissociation is a demonstrable psychiatric condition associated with a number of different disorders, especially those related to trauma and anxiety in early childhood, multiple personality as a real-life psychological and psychiatric phenomenon has been called into question for some time. Despite differences of opinion regarding the diagnosis of multiple personality disorder, many psychiatric institutions (such as McLean Hospital) have wards specifically designed for dissociative identity disorder.

According to one of the classifications, dissociative identity disorder is considered as a type of psychogenic amnesia (that is, having only a psychological, and not a medical, nature). Through such amnesia, a person gains the ability to repress memories of traumatic events or a certain period of life. This phenomenon is called the splitting of the "I", or, in other terminology, the self, as well as the experiences of the past. Having multiple personalities, an individual can experience alternative personalities with individually distinguishable characteristics: such alternative personalities can have different ages, psychological sex, different health conditions, different intellectual abilities, and even different handwriting. Long-term therapies are usually considered for the treatment of this disorder.

Depersonalization and derealization are distinguished as two characteristic features of dissociative identity disorder. Depersonalization is an altered (mostly described as distorted) perception of oneself and one's own reality. Such a person often appears detached from consensual reality. Patients often define depersonalization as "a feeling outside of the body and being able to observe it from a distance." Derealization is an altered (distorted) perception of others. With derealization, other people will not be perceived as really existing for this person; patients with derealization have difficulty identifying the other person.

As the study showed, patients with dissociative identity disorder often hide their symptoms. The average number of alternate personalities is 15 and usually appear in early childhood, which is probably why some of the alternate personalities are children. Many patients have comorbidity, that is, along with multiple personality disorder, they also have other disorders, such as generalized anxiety disorder.

Diagnostic criteria

dissociative identity disorder

According to the Diagnostic and Statistical Handbook of Mental Disorders (DSM-IV-TR), a diagnosis of dissociative identity disorder is made when a person has two or more distinct identities or personality states (each with its own relatively long-term pattern of perception and relationship to the environment). environment and oneself), at least two of these identities recurrently seize control over human behavior, the individual is unable to remember an important personal information that goes beyond ordinary forgetfulness, and the disorder itself is not caused by the direct physiological effects of any substance (eg, dizziness or erratic behavior in alcohol intoxication) or by a general medical condition (eg, complex partial seizures). It is noted that in children these symptoms should not be attributed to imaginary friends or other types of fantasy games.

The criteria for diagnosing dissociative identity disorder published by the DSM-IV have been criticized. One study (2001) highlighted a number of shortcomings of these diagnostic criteria: this study argues that they do not meet the requirements of modern psychiatric classification, are not based on a taxometric analysis of symptoms of dissociative identity disorder, describe the disorder as a closed concept, have poor content validity, ignore important data, hinder taxonomic research, have low reliability, and often lead to misdiagnosis, are inconsistent and artificially low in cases of dissociative personality disorder. This study proposes a solution to the DSM-V in the form of new, according to researchers, more convenient to use, polythetic diagnostic criteria for dissociative disorders.

Multiple personality disorder and schizophrenia

Distinguishing schizophrenia from multiple personality disorder is difficult to diagnose, and is mainly based on the structural features of the clinical picture, uncharacteristic of dissociative disorders. In addition, the corresponding symptoms are perceived by patients with schizophrenia more often as a result of external influences, and not belonging to their own personality. The splitting of personality in multiple disorder is massive or molecular, forming rather complex and self-integrated personality substructures. The splitting in schizophrenia, referred to as discrete, nuclear, or atomic, is the splitting off of individual mental functions from the personality as a whole, which leads to its disintegration.

Timeline of the development of the understanding of multiple personality

1640s - 1880s

Period of the theory of magnetic somnambulism as an explanation for multiple personality.

1646 - Paracelsus describes the case of an anonymous woman who claimed that someone was stealing money from her. The thief turned out to be her second personality, whose actions were amnesiac in the first.

1784 - Marquis de Puysegur, a student of Franz Anton Mesmer, with the help of magnetic techniques introduces his worker Victor Ras (Victor race) into a kind of somnambulistic state: Victor has shown the ability to stay awake during sleep. Upon awakening, he is unable to remember what he did in the altered state of consciousness, while in the latter he retained full awareness of the events that happened to him both in the normal state of consciousness and in the altered one. Puysegur comes to the conclusion that this phenomenon is similar to somnambulism, and calls it "magnetic somnambulism".

1791 - Eberhard Gmelin describes a case of "changing personality" in a 21-year-old German girl. She developed a second personality who spoke French and claimed to be a French aristocrat. Gmelin saw a similarity between this phenomenon and magnetic sleep, and felt that such cases could help in understanding the formation of personality.

1816 - The case of Mary Reynolds, who had a "dual personality", is described in the journal "Medical Codes".

1838 - Charles Despin describes a case of dual personality in Estella, an 11-year-old girl.

1876 - Eugène Azam describes a case of a dual personality in a young French girl whom he called Felida X. He explains the phenomenon of multiple personality with the help of the concept of hypnotic states, which became widespread at that time in France.

1880s - 1950s

Introduction of the concept of dissociation and that a person may have multiple mental centers that arise when the psyche tries to deal with traumatic experiences.

1888 - Physicians Burru (Bourru) and Burro (Burrot) publish the book "Variations of personality" (Variations de la personnalité), which describes the case of Louis Vive (Louis Vivé), who had six different personalities, each of which had its own patterns muscle contractions and individual memories. The memories of each person were rigidly tied to a certain period of Louis' life. As a treatment, physicians used hypnotic regression during these periods; they viewed the personalities of this patient as successive variations of one personality. Another researcher, Pierre Janet, introduced the concept of "dissociation" and suggested that these personalities were coexisting. mental centers within one individual.

1906 - Morton Prince's Dissociation of Personality describes the case of a multiple personality patient, Clara Norton Fowler, also known as Miss Christine Beschamp. As a treatment, Prince proposed to unite the two personalities of Besham, and push the third into the subconscious.

1915 - Walter Franklin Prince publishes the story of a patient, Doris Fisher - "Doris' Case of Multiple Personality" (Doris a case of split personality). Doris Fisher had five personalities. Two years later, he published a report on the physical experiments performed with the participation of Fisher and her other personalities.

1943 - Stengel states that the state of multiple personality no longer occurs.

After 1950s

1954 - Thigpen and Cleckley's The Three Faces of Eve (Three Faces of Eve), based on a psychotherapy story involving Chris Costner - Sizemore - a multiple personality patient, is published. The publication of this book stirred up the interest of the general public in the nature of the phenomenon of multiple personality.

1957 - Film adaptation of the book The Three Faces of Eve, starring Joanne Woodward.

1973 - Publication of Flora Schreiber's best-selling book "Sybil" (Sybil), which tells the story of Shirley Mason (in the book - Sybil Dorsett).

1976 - TV adaptation of "Sybil", starring Sally Field.

1977 - Chris Costner - Sizemore publishes the autobiography I Eve (I "m Eve), in which he claims that Thigpen and Cleckley's book misinterpreted her life story.

1980 - Publication of "Michelle Remembers" (Michelle Remembers), co-written by psychiatrist Lawrence Pazder and Michelle Smith, a patient with multiple personalities.

1981 - Daniel Keyes publishes Billy Milligan's Multiple Minds (Billy Milligan's Minds), based on extensive interview material with Billy Milligan and his therapist.

1981 - Publication of the book "When the Rabbit Howls" by Truddy Chase.

1995 - Web Launch of Astrea's website, the first Internet resource dedicated to the recognition of multiple personalities as a healthy state.

1998 - Publication of "The Making of Hysteria" by Joan Akocella in The New Yorker, describing the excesses of multiple personality psychotherapy.

1999 - Publication of Cameron West's book First Person plural A: My life is like a few.

2005 - Robert Oxnam's autobiography "Split Mind" (Fractured Mind) is published.

Definition of dissociation

Dissociation is a complex mental process that is coping - a mechanism for people suffering from painful and / or traumatic situations. It is characterized by the disintegration of the ego. Ego integration, or ego integrity, can be defined as the ability of a person to successfully incorporate external events or social experiences into their perception and then act in a consistent manner during such events or social situations. A person unable to cope successfully with this can experience both emotional dysregulation and potential ego-integrity collapse. In other words, the state of emotional dysregulation can in some cases be so intense as to force ego disintegration, or what, in extreme cases, is diagnosed as dissociation.

Dissociation describes such a strong collapse of the ego - integrity that the personality literally splits. For this reason, dissociation is often referred to as "splitting". Less profound manifestations of this condition are in many cases clinically described as disorganization or decompensation. The difference between a psychotic manifestation and a dissociative manifestation is that although the person experiencing the dissociation is formally detached from a situation that he or she cannot control, some part of that person remains connected to reality. While the psychotic "breaks" with reality, the dissociative detaches from it, but not completely.

Because the person experiencing dissociation does not completely disconnect from their reality, they can have multiple "personalities". In other words, there are different "people" (read personalities) to deal with different situations, but generally speaking, no one personality is completely separate.

Differences of opinion about multiple personality

Until now, the scientific community has not come to a consensus on what is considered a multiple personality, because in the history of medicine before the 1950s there were too few documented cases of this disorder. In the 4th edition of the Diagnostic and Statistical Handbook of Mental Disorders (DSM-IV), the name of the condition in question was changed from "multiple personality disorder" to "dissociative identity disorder" to remove the confusing term "personality". The same designation was adopted in ICD-9, however, in ICD-10, the variant "multiple personality disorder" is used. It should be noted that a blunder is often made in the media when confusing multiple personality disorder and schizophrenia.

A 1944 study of 19th and 20th century medical textbook sources on the topic of multiple personality showed only 76 cases. In recent years, the number of cases of dissociative identity disorder has increased dramatically (according to some reports, about 40,000 cases were registered between 1985 and 1995). However, other studies have shown that the disorder does have a long history, stretching back about 300 years in the literature, and that it itself affects less than 1% of the population. According to other data, dissociative identity disorder occurs among 1-3% of the general population. Thus, epidemiological evidence indicates that dissociative identity disorder is actually as common in the population as schizophrenia.

At the moment, dissociation is considered as a symptomatic manifestation in response to trauma, a critical emotional stress, and it is associated with emotional dysregulation and borderline disorder personality. According to a longitudinal (long-term) study by Ogawa et al., the strongest predictor of dissociation in young adults was lack of access to mother at age 2 years. Many recent studies have shown an association between early childhood broken attachments and subsequent dissociative symptoms, and there is clear evidence that childhood abuse and neglect often contribute to the formation of broken attachments (manifested, for example, when a child pays close attention to whether parental attention is on it or not).

Critical attitude to the diagnosis

Some psychologists and psychiatrists believe that dissociative identity disorder is iatrogenic or contrived, or argue that cases of true multiple personality are very rare and most documented cases should be considered iatrogenic.

Critics of the dissociative identity disorder model argue that the diagnosis of a multiple personality condition is a phenomenon that is more common in English-speaking countries. Prior to the 1950s, cases of split personality and multiple personality were sometimes described and treated as rare in the Western world. In 1957, the publication of the book "Three Faces of Eve" (Three Faces of Eve) and later the release of the film of the same name contributed to the growth of public interest in the phenomenon of multiple personalities. In 1973, the subsequently filmed book "Sybil" (Sybil) was published, describing the life of a woman with a multiple personality disorder. However, the diagnosis "multiple personality disorder" itself was not included in the Diagnostic and Statistical Handbook of Mental Disorders until 1980. Between the 1980s and 1990s, the number of reported cases of multiple personality disorder rose to twenty to forty thousand.

Multiple personality as a healthy state

Some people, including those who self-identified as having a multiple personality, believe that this condition may not be a disorder, but a natural variation of human consciousness that has nothing to do with dissociation. Truddy Chase, author of the bestseller When the Rabbit Howls, is one of the staunchest supporters of this version. While she acknowledges that in her case, multiple personalities came about as a result of violence, at the same time she claims that her group of personalities refused to be integrated and live together as a collective.

Within depth or archetypal psychology, James Hillman argues against defining multiple personality syndrome as an unambiguous disorder. Hillman supports the idea of the relativity of all personifications and refuses to acknowledge the "multiple personality syndrome". According to his position, to view multiple personalities either as a "mental disorder" or as a failure to integrate "private personalities" is to exhibit a cultural bias that misidentifies one private person, the "I", with the whole person as such.

Intercultural Studies

Anthropologists L. K. Suryani and Gordon Jensen are convinced that the phenomenon of pronounced trance states in the Bali community has the same phenomenological nature as the phenomenon of multiple personality in the West. It is argued that people in shamanistic cultures who experience multiple personalities define these personalities not as parts of themselves, but as independent souls or spirits. There is no evidence of an association between multiple personality, dissociation, and recollection of memories and sexual abuse in these cultures. In traditional cultures, plurality, such as that shown by shamans, is not considered a disorder or disease.

Potential Causes of Multiple Personality Disorder

Dissociative identity disorder is believed to be caused by a combination of several factors: intolerable stress, the ability to dissociate (including the ability to separate one's memories, perceptions or identity from consciousness), the manifestation of protective mechanisms in ontogeny and - during childhood - a lack of care and participation in relation to the child with a traumatic experience or lack of protection from subsequent unwanted experiences. Children are not born with a sense of a unified identity, the latter develops from multiple sources and experiences. In critical situations, child development is hindered and many parts of what should have been integrated into a relatively unified identity remain segregated.

North American studies show that 97-98% of adults with dissociative identity disorder describe experiences of childhood abuse and that abuse can be documented in 85% of adults and 95% of children and adolescents with multiple personality disorder and other similar forms of dissociative disorder. These data indicate that childhood abuse is the main cause of the disorder among North American patients, while in other cultures the consequences of war or natural disaster. Some patients may not have experienced violence, but may have experienced an early loss (such as the death of a parent), a serious illness, or another highly stressful event.

Human development requires the child to be able to successfully integrate various types of complex information. In ontogenesis, a person goes through a number of stages of development, in each of which different personalities can be created. The ability to generate multiple personalities is not observed or manifested in every child who has experienced abuse, loss or trauma. Patients with dissociative identity disorder have the ability to easily enter trance states. This ability, in relation to the ability to dissociate, is believed to act as a factor in the development of the disorder. Be that as it may, most children with these abilities also have normal adaptive mechanisms and are not in an environment that can cause dissociation.

Treatment

The most common approach to treating multiple personality disorder is to alleviate symptoms to keep the individual safe, and to reintegrate the different personalities into one well-functioning identity. Treatment can take place using various kinds psychotherapy - cognitive psychotherapy, family therapy, clinical hypnosis, etc.

Insight is used with some success - oriented psychodynamic therapy that helps to overcome the trauma, reveals conflicts, determines the need for individuals and corrects the corresponding defense mechanisms. A possible satisfactory result of treatment is the provision of a conflict-free cooperative relationship between individuals. The therapist is encouraged to treat all alters with equal respect, avoiding taking sides in an internal conflict.

Drug therapy does not allow to achieve noticeable success and is exclusively symptomatic; there is no pharmacological preparation for the treatment of dissociative identity disorder itself, however, some antidepressants are used to relieve comorbid depression and anxiety.

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Dissociative identity disorder is a rare mental illness that is characterized by the presence of several personalities (from two or more) in one person, one of which dominates the individual in certain moment. AT modern psychiatry this phenomenon is included in the group of dissociative disorders. The patient himself does not understand the multiplicity of his personal states. In certain life situations, ego-states switch, one personality abruptly replaces another.

Multiple personalities are very different from each other, not similar. They may have the opposite sex, character, age, intellectual and physical abilities, way of thinking and worldview, national identity, they behave oppositely in everyday life. In the ego-state transition phase, memory is lost. The dominant person cannot remember anything from the behavior of the other person. The trigger for switching can be words, life situations, certain places. For the patient, a sharp change of personalities is accompanied by somatic disorders- an unpleasant sensation of a lump in the throat, nausea, abdominal pain, increased heart rate and respiration, increased blood pressure.

The reasons

Presumably, the causes of the disorder are severe psycho-emotional trauma experienced in childhood, as well as cases of rude physical impact, sexual violence. In difficult life situations, the child starts a certain psychological defense mechanism, as a result, he loses a sense of the reality of what is happening and begins to perceive everything as if it is not happening to him. This mechanism of protection against damaging, unbearable influences for humans is, in a sense, useful. But, with its strong activation, dissociative disorders begin to appear. There is a common misconception that split personality is associated with schizophrenia. Dissociative Identity Disorder is a very rare disease, on average 3% of the total number of mental patients. The female sex is ten times more likely than the male. This fact is due to the peculiarities of the female psyche and the difficulty in diagnosing the splitting of the psyche in men.

Symptoms

Diagnostics

In modern psychiatry, there are four diagnostic criteria for dissociative identity disorder:

The patient has at least two (or more) personality states. Each person has individual characteristics, has his own character, worldview, thinking, perception of reality and behaves differently in critical situations.
One of the two (or more) alternately control the person's behavior.
The patient has memory lapses, forgets important details life (birth of a child, names of parents, profession).
The state of dissociative personality disorder is not the result of acute or chronic infectious, alcohol and drug intoxication.

Dissociative personality disorders should not be confused with various fantasies and "role-playing games", including those of a sexual nature.

There is a “basic personality” that has a real name, then a second one appears and, as a rule, the number of “parallel” ego states increases over time (more than 10). As a rule, the "basic" personality is unaware of the presence of other personalities living in the same human body. Physiological parameters (pulse, arterial pressure) may also differ. There is a lot of controversy regarding the criteria for diagnosing dissociative personality disorder in the association of psychiatrists in Western countries. Some researchers propose to classify dissociative disorders into simple, generalized, extensive, non-specific.

In addition to the above symptoms, patients with dissociative identity disorder experience anxiety states, depression, various fears, violation of the physiology of sleep and wakefulness, nutrition, sexual behavior (before abstinence), in the most severe cases, hallucinations and suicide attempts. There is no consensus on the issue etiological factors occurrence of dissociative personality disorder. It is possible that all these symptoms are an "echo" of experienced psychotraumatic situations. Dissociative disorder is closely related to psychogenic amnesia, which is also a psychological defense mechanism. In such patients, violations of physiological processes in the brain are not detected.

A person, by ousting traumatic life situations from his active consciousness, “switches” to another personality, but at the same time others are forgotten. important facts and moments. In addition to amnesia, there may be phenomena of depersonalization (distorted perception of oneself) and derealization (distorted perception of the world and other people). Sometimes, a person with dissociative identity disorder does not understand who he is.

Differential Diagnosis

It is important to carry out differential diagnosis with dissociative identity disorder with schizophrenia. The symptoms are very similar, but first look for signs of dissociation in schizophrenia. In patients with dissociative identity disorder inner personalities have very thin distinctive features. In schizophrenia, there is a gradual splitting (discrete) of various mental functions that lead the patient's personality to decay.

Controversy over dissociative identity disorders continues among psychiatrists. Some doctors consider this diagnosis of "dissociative identity disorder" a phenomenon, in the West they suggest removing the word "personality" from the diagnosis. Part of the culture of the English-speaking countries in their works of art (books, theater, cinema) show that dissociation is not a disease, but just one of the sides of the human psyche, a natural variation of human consciousness. This phenomenon is studied by anthropologists to explain the trance state. For example, on the island of Bali, representatives of the culture of shamanism plunge into an unusual state - a trance and experience several personalities inside themselves (demons, spirits or souls of dead people).

According to scientists, there is no direct relationship between the plurality of personality in shamanism and the facts of violence in childhood. Such dissociation in the cultural characteristics of small peoples is not a disorder. Dissociative disorder is thought to be caused by a combination of external and internal factors- severe stress, the predisposition of some people to dissociation, the implementation of a psychological defense mechanism in the process of ontogenesis. The formation of a unified identity occurs in the process of development and formation of a person, that is, this is not an innate feeling. If the development of a child is affected by external traumatic factors, then the process of integration of a unified personality is disrupted and a dissociative disorder occurs.

American scientists conducted a series of studies, as a result of which it was found that the majority of patients with a split personality in psychiatric clinics in America had documented facts of domestic violence in childhood. In other cultures, natural disasters and catastrophes, wars, the loss of parents in early childhood, and a serious illness had a greater impact on the child. In the process of human development, various types of information are integrated. A child in his psychological development goes through several stages, and at each of them separate personalities can be formed. However, not all people have the ability to generate different personalities under stress. Patients with dissociative identity disorder have the rare ability to go into a trance.

Trance arises as a special state of the psyche, in which there is a connection between the conscious and the unconscious, as a result of which the degree of participation of the conscious in the processing of information decreases. Many scholars define this state as slumber or a state of reduced mind control. The phenomenon of trance has not yet been studied, there are a lot of questions here. Trance is directly related to various religious rites, occult sciences, shamanism, meditation in Eastern cultures. In a state of trance, the consciousness of a person and the focus of his attention are turned inward (memories, dreams, fantasies). Very little scientific literature provides information about dissociative identity disorder, however, modern human culture constantly addresses this issue in its works and fully shows the symptoms of this disease.

Dissociative identity disorder (split or split personality, multiple personality disorder, multiple personality syndrome, organic dissociative personality disorder) is a rare mental disorder in which personal identity is lost and it seems that there are several different personalities (ego states) in one body .

ICD-10	F44.8
ICD-9	300.14
DiseasesDB	Comorbid
MeSH	D009105
eMedicine	article/916186

Personalities existing in a person periodically replace one another, and at the same time, the currently active personality does not remember the events that took place before the moment of “switching”. Some words, situations or places can serve as a trigger for a change in personality. The change of personalities is accompanied by somatic disorders.

"Persons" can differ from each other in mental abilities, nationality, temperament, worldview, gender and age.

General information

The syndrome of split personality was mentioned in the writings of Paracelsus - his notes about a woman who believed that someone was stealing money from her were preserved. However, in fact, the money was spent by her second personality, about which the woman knew nothing.

In 1791, the Stuttgart city doctor Eberhard Gmelin described a young city woman who, under the influence of the events of the French Revolution (Germany at that time became a refuge for many French aristocrats), acquired a second personality - a Frenchwoman with aristocratic manners, who spoke excellent French, although the first person (German girl) did not own it.

There are also descriptions of the treatment of such disorders with Chinese drugs.

Split personality is often described in fiction.

The disease was considered extremely rare - until the middle of the 20th century, only 76 cases of a split personality were documented.

The existence of split personality syndrome became known to the general public after research conducted in 1957 by psychiatrists Corbett Thigpen and Hervey Cleckley. The result of their research was the book "Three Faces of Eve", which describes in detail the case of their patient - Eva White. Interest in the phenomenon was also aroused by the book “Sybil” published in 1973, the heroine of which was diagnosed with “multiple personality disorder”.

After the release and screening of these books, the number of patients suffering from dissociative identity disorder increased (up to 40 thousand cases were registered from the 1980s to the 1990s), so some scientists consider this disease iatrogenic (caused by influence).

The Diagnostic and Statistical Handbook of Mental Disorders has included multiple personality disorder as a diagnosis since 1980.

In some cases, people who have multiple personality disorder do not consider the condition to be a disorder. Thus, the author of the bestselling book When the Rabbit Howls, Truddy Chase, refused to integrate her subpersonalities into a single whole, arguing that all her personalities exist as a collective.

Dissociative identity disorder currently accounts for 3% of all mental illnesses. In women, due to the peculiarities of the psyche, the disease is fixed 10 times more often than in men. This dependence on gender may be associated with the difficulty in diagnosing split personality in men.

Reasons for development

The etiology of a split personality is not yet fully understood, but the available data speak in favor of the psychological nature of the disease.

Dissociative identity disorder occurs due to the mechanism of dissociation, under the influence of which the thoughts or specific memories of ordinary human consciousness are divided into parts. Divided thoughts expelled into the subconscious spontaneously pop up in consciousness due to triggers (triggers), which can be events and objects present in the environment during a traumatic event.

For multiple personality disorder to occur, a combination of:

Intolerable stress or severe and frequent stress.
Ability to dissociate (a person must be able to separate from consciousness their own perception, memories or identity).
Manifestations in the process of individual development of the protective mechanisms of the psyche.
Traumatic experience in childhood with a lack of care and attention in relation to the affected child. A similar picture arises when the child is not sufficiently protected from subsequent negative experiences.

Studies by North American scientists have revealed that 98% of people suffering from a split personality were victims of violence in childhood (85% have documented evidence of this fact). The remaining group of patients faced serious illnesses, death of loved ones and other serious illnesses in childhood. stressful situations. Based on these studies, it is assumed that it is the abuse experienced in childhood that is the main cause of a split personality.

A long-term study by Ogawa et al. shows that lack of access to a mother at two years of age is also a predisposing factor for dissociation.

Symptoms and signs

Dissociative identity disorder (DID) is the modern name for the disorder that is known to the general public as multiple personality disorder. This is the most severe disorder of the group of dissociative mental disorders, which is manifested by the majority of known dissociative symptoms.

The main dissociative symptoms include:

Dissociative (psychogenic) amnesia, in which sudden memory loss is caused by a traumatic situation or stress, and the assimilation of new information and consciousness is not impaired (often observed in people who have experienced military operations or a natural disaster). Memory loss is recognized by the patient. Psychogenic amnesia is more common in young women.
Dissociative fugue or dissociative (psychogenic) flight reaction. It manifests itself in the sudden departure of the patient from the workplace or from home. In many cases, the fugue is accompanied by an affectively narrowed consciousness and subsequent partial or complete loss of memory without awareness of the presence of this amnesia (a person may consider himself a different person, as a result of having a stressful experience, behave differently than before the fugue, or not be aware of what is happening around him).
Dissociative identity disorder, in which a person identifies with several personalities, each of which dominates him with a different time interval. The dominant personality determines the views of a person, his behavior, etc. as if this personality is the only one, and the patient himself, during the period of dominance of one of the personalities, does not know about the existence of other personalities and does not remember the original personality. Switching usually occurs suddenly.
Depersonalization disorder, in which a person periodically or constantly experiences alienation of his own body or mental processes, watching himself as if from the outside. There may be distorted sensations of space and time, the unreality of the surrounding world, the disproportion of the limbs.
Ganser's syndrome ("prison psychosis"), which is expressed in the deliberate demonstration of somatic or mental disorders. Appears as a result of an internal need to look sick without the goal of gaining. The behavior that is observed in this syndrome resembles the behavior of patients with schizophrenia. The syndrome includes passing words (a simple question is answered out of place, but within the scope of the question), episodes of extravagant behavior, inadequacy of emotions, decreased temperature and pain sensitivity, amnesia for episodes of the syndrome.
A dissociative disorder that manifests itself in the form of a trance. Manifested in a reduced response to external stimuli. Split personality is not the only condition in which trance is observed. The trance state is observed with the monotony of movement (pilots, drivers), mediums, etc., but in children this state usually occurs after trauma or physical abuse.

Dissociation can also be observed as a result of a long and intense violent suggestion (processing the consciousness of hostages, various sects).

Signs of a split personality also include:

Derealization, in which the world seems unreal or distant, but there is no depersonalization (no violation of self-perception).
Dissociative coma, which is characterized by loss of consciousness, a sharp weakening or lack of response to external stimuli, extinction of reflexes, changes in vascular tone, impaired pulse and thermoregulation. Stupor (complete immobility and lack of speech (mutism), weakened reactions to irritation) or loss of consciousness not associated with somato-neurological disease is also possible.
Emotional lability (sudden mood swings).

Anxiety or depression, suicide attempts, panic attacks, phobias, sleep or eating disorders are possible. Sometimes patients experience hallucinations. These symptoms are not directly associated with a split personality, as they may be a consequence of the psychological trauma that caused the disorder.

Diagnostics

Dissociative identity disorder is diagnosed based on four criteria:

The patient must have at least two (possibly more) personality states. Each of these personalities must have individual characteristics, character, their own worldview and thinking, they perceive reality differently and differ in behavior in critical situations.
These personalities control the person's behavior in turn.
The patient has memory lapses, he does not remember important episodes of his life (wedding, childbirth, attended a course at the university, etc.). They appear in the form of phrases “I can’t remember,” but usually the patient attributes this phenomenon to memory problems.
The resulting dissociative identity disorder is not associated with acute or chronic alcohol, drug or infectious intoxication.

Split personality needs to be distinguished from role-playing games and fantasies.

Since dissociative symptoms also develop with extremely pronounced manifestations of post-traumatic stress disorder, as well as disorders associated with the appearance of pain in the area of some organs as a result of an actual mental conflict, a split personality must be distinguished from these disorders.

The patient has a "basic", main personality who is the owner of the real name and who is usually unaware of the presence of other personalities in his body, so if the patient is suspected of having a chronic dissociative disorder, the therapist needs to examine:

certain aspects of the patient's past;
current mental status of the patient.

Interview questions are grouped by topic:

Amnesia. It is desirable that the patient give examples of “time gaps”, since microdissociative episodes, under certain conditions, occur in absolutely healthy people. In patients who suffer from chronic dissociation, situations with time gaps are observed frequently, the circumstances of amnesia are not associated with monotonous activity or extreme concentration of attention, and there is no secondary benefit (it is present, for example, when reading fascinating literature).

Questions about the presence in the wardrobe (or on herself) of the patient of things that she did not choose help to clarify the situation with time gaps. For men, such “unexpected” items can be vehicles, tools, weapons. These experiences can involve people (strangers claim to know the patient) and relationships (deeds and words that the patient knows about from the stories of loved ones). If strangers used other names when addressing the patient, they should be clarified, as they may belong to other personalities of the patient.

Depersonalization/derealization. This symptom is most common in dissociative identity disorder, but it is also characteristic of schizophrenia, psychotic episodes, depression, or temporal lobe epilepsy. Transient depersonalization is also observed in adolescence and at moments of near-death experience in a situation of severe trauma, so one must be aware of the differential diagnosis.

The patient needs to clarify whether he is familiar with the state in which he observes himself as an outsider, watches a “movie” about himself. Such experiences are characteristic of half of patients with a split personality, and usually the main, basic personality of the patient is the observer. When describing these experiences, patients note that at these moments they feel a loss of control over their actions, they look at themselves from some external, located on the side or from above, a fixed point in space, they see what is happening as if from the depths. These experiences are accompanied by intense fright, and in people who do not suffer from multiple personality disorder and have had similar experiences as a result of near-death experiences, this state is accompanied by a feeling of detachment and peace.

There may also be a feeling of the unreality of someone or something in the surrounding reality, a perception of oneself as dead or mechanical, etc. Since such perception is manifested in psychotic depression, schizophrenia, phobias and obsessive-compulsive disorder, a broader differential diagnosis is needed.

Life experience. Clinical practice shows that in people suffering from split personality, certain life situations are repeated much more often than in people without this disorder.

Multiple personality patients are very sensitive to insincerity, suffer from extensive amnesia, covering certain periods of childhood (the chronological sequence of school years helps to establish this). Normally, a person is able to consistently tell about his life, restoring in his memory year after year. Individuals with multiple personalities often experience wild fluctuations in school performance, as well as significant gaps in the chain of memories.

Often, in response to external stimuli, a flashback state occurs, in which memories and images, nightmares and dream-like memories involuntarily invade consciousness (flashback is also included in the clinical picture of PTSD). The flashback causes a lot of anxiety and denial (defensive reaction of the main personality).

There are also obsessive images associated with the primary trauma and uncertainty about the reality of some of the memories.

Also characteristic is the manifestation of certain knowledge or skills that surprise the patient, because he does not remember when he acquired them (sudden loss is also possible).

The main symptoms of K. Schneider. Multiple personality patients may "hear" aggressive or supportive voices arguing in their head, commenting on the patient's thoughts and actions. Phenomena of passive influence can be observed (often this is automatic writing). By the time of diagnosis, the main personality often has experience of communicating with his alternating personalities, but interprets this communication as a conversation with himself.

When assessing the current mental status, attention is paid to:

appearance (can change radically from session to session, up to sudden changes in habits);
speech (timbre, vocabulary changes, etc.);
motor skills (tics, convulsions, trembling of the eyelids, grimaces and reactions of the orienting reflex often accompany a change of personalities);
thinking processes, which are often characterized by illogicality, inconsistency and the presence of strange associations;
the presence or absence of hallucinations;
intelligence, which as a whole remains intact (only in long-term memory is mosaic deficiency revealed);
prudence (the degree of adequacy of judgments and behavior can change dramatically from adult to childish behavior).

Patients usually present with a marked learning disability based on past experience.

EEG and MRI are also performed to exclude the presence of an organic brain lesion.

Treatment

Dissociative identity disorder is a disorder that requires the help of a psychotherapist experienced in treating dissociative disorders.

The main areas of treatment are:

relief of symptoms;
the reintegration of the various personalities that exist in a person into one well-functioning identity.

For treatment use:

Cognitive psychotherapy, which is aimed at changing stereotypes of thinking and inappropriate thoughts and beliefs by methods of structured learning, experiment, mental and behavioral training.
Family psychotherapy, aimed at teaching the family to interact in order to reduce the dysfunctional impact of the disorder on all family members.
Clinical hypnosis to help patients achieve integration, relieve symptoms, and change the patient's character. Split personality needs to be treated with hypnosis with caution, as hypnosis can provoke the appearance of a multiple personality. Ellison, Kohl, Brown, and Kluft, the multiple personality disorder specialists, describe cases of using hypnosis to relieve symptoms, strengthen the ego, reduce anxiety, and create rapport (contact with the hypnotist).

Relatively successfully, insight-oriented psychodynamic therapy is used, which helps to overcome the trauma received in childhood, reveals internal conflicts, determines a person's need for individual personalities and corrects certain protective mechanisms.

The treating therapist should treat all the patient's personalities with equal respect and not take any one side in the patient's internal conflict.

Drug treatment is aimed solely at eliminating symptoms (anxiety, depression, etc.), since there are no medications to eliminate personality splits.

In general, all patients can be divided into groups:

The first group is distinguished by the presence of predominantly dissociative symptoms and post-traumatic signs, the overall functionality is not impaired, and due to the treatment, they fully recover.
The second group is distinguished by a combination of dissociative symptoms and mood disorders, eating behavior, etc. Treatment is more difficult for patients to tolerate, it is less successful and longer.
The third group, in addition to the presence of dissociative symptoms, is characterized by pronounced signs of other mental disorders, so long-term treatment is aimed not so much at achieving integration as at establishing control over symptoms.

Prevention

Dissociative identity disorder is a mental illness, so there are no standard preventive measures for this disorder.

Since violence against children is considered the main cause of this disorder, many international organizations are currently working to identify and eliminate such violence.

As a prevention of dissociative disorder, it is necessary to timely contact a specialist if a child has psychological trauma or experienced severe stress.

Name options:

Dissociative Identity Disorder (DSM-IV)
Multiple Personality Disorder (ICD-10)
Multiple Personality Syndrome
Limited Dissociative Identity Disorder
split personality

Multiple Personality - a mental phenomenon in which a person has two or more distinct personalities, or ego states. Each alter personality in this case has its own patterns of perception and interaction with the environment. People with multiple personalities are diagnosed with dissociative identity disorder, or multiple personality disorder. This phenomenon is also known as "split personality" and "split personality".

dissociative identity disorder

dissociative identity disorder(English) dissociative identity disorder, or DID)- a psychiatric diagnosis accepted in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which describes the phenomenon of multiple personality. To define a person as dissociative identity disorder (or multiple personality disorder), it is necessary to have at least two personalities who regularly take turns in controlling the individual's behavior, as well as memory loss that would go beyond normal forgetfulness. Memory loss is usually described as a "switch". Symptoms must occur outside of any substance abuse (alcohol or drugs) or a general medical condition. Dissociative identity disorder also known as multiple personality disorder(English) multiple personality disorder, or MPD). In North America, it is decided to call this disorder "dissociative identity disorder" because of the disagreement in psychiatric and psychological circles regarding this concept that one (physical) individual can have more than one personality, where personality can be defined as the initial sum of mental states given (physical) individual.

Although dissociation is a psychiatric condition that can be proven and can be associated with a number of different disorders, especially those related to trauma and anxiety in early childhood, multiple personality as a real psychological and psychiatric phenomenon has been questioned for some time. Despite differing opinions regarding the diagnosis of multiple personality disorder, many psychiatric institutions (eg McLean Hospital) have wards specifically designed for dissociative identity disorder.

According to one of the classifications, dissociative identity disorder is considered as a type of psychogenic amnesia (that is, having only a psychological, and not a medical, nature). Through such amnesia, a person gains the ability to repress memories of traumatic events or a certain period of life. This phenomenon is called the splitting of the "I", or, in other terminology, the self, as well as the experiences of the past. Having multiple personalities, an individual can experience alternative personalities with individually different characteristics: such alternative personalities can have different ages, psychological gender, different health conditions, different intellectual properties, and different handwriting. For the treatment of such a disorder, long-term therapies are usually considered.

Two characteristic features of dissociative identity disorder are depersonalization and derealization. Depersonalization is an altered (mostly described as distorted) perception of oneself and one's own reality. Such a face quite often looks detached from consensual reality. Patients often define depersonalization as "a feeling out of the body and being able to observe it from a distance." Derealization - altered (distorted) perception of others. By derealization, other people will not be perceived as really existing for this person; patients with derealization have trouble identifying the other person.

As the study showed, patients with dissociative identity disorder quite often hide their symptoms. The average number of alternate personalities is 15. They usually appear in early childhood. This is probably the reason why some of the alternate personalities are children. Many patients have a comorbidity, that is, along with a multiple personality disorder, other disorders are also expressed in them, for example, generalized anxiety disorder.

diagnostic criteria

According to the Diagnostic and Statistical Handbook of Mental Disorders (DSM-IV), the diagnosis dissociative identity disorder is set if a person has two or more distinct identities or personal states (each has its own relatively long pattern of perception and relationship with the environment and with itself), at least two of these identities recurrently seize control over the person’s behavior, the individual is unable to recall important personal information beyond normal forgetfulness, and the disorder itself is not caused by the direct physiological effects of any substance (eg, loss of consciousness or erratic behavior due to alcohol intoxication) or a general medical condition (eg, complex partial seizures). At the same time, it is noted that in children such symptoms should not be attributed to fictitious friends or other types of games involving fantasy.

Despite the emergence of new personalities, the basic personality, which has the real name and surname of a person, remains among them. The number of personalities within can be large and grow over the years. This is mainly due to the fact that a person unconsciously develops new personalities that could help her cope better with certain situations. So, if at the beginning of treatment a psychotherapist usually diagnoses 2-4 personalities, then another 10-12 turn out to be during treatment. Sometimes the number of people exceeds a hundred. Individuals usually have different names, different manner of communication and gestures, different facial expressions, gait and even handwriting. Usually a person is not aware of the presence of other personalities in the body.

The criteria for diagnosing dissociative identity disorder published by the DSM-IV has been criticized. One of the studies (in 2001) highlighted a number of shortcomings of these diagnostic criteria: in this study, it is argued that they do not meet the requirements of modern psychiatric classification, are not based on a taxometric analysis of symptoms of dissociative identity disorder, describe the disorder as a closed concept, have poor content validity, ignore important data, interfere with taxometric testing, have a low degree of reliability and often lead to incorrect diagnosis, they contain a contradiction and the number of cases of dissociative personality disorder in it is artificially low. This study proposes a solution to the DSM-V in the form of novel, investigator-friendly, polythetic diagnostic criteria for dissociative disorders (Generalized Dissociative Disorder, Generalized Dissociative Disorder, Major Dissociative Disorder, and Non-Specific Dissociative Disorder).

additional symptoms

In addition to the main symptoms listed in DSM-IV, patients with dissociative identity disorder may also experience depression, suicide attempts, mood swings, anxiety and anxiety disorders, phobias, panic attacks, sleep and eating disorders, other dissociative disorders, in some cases hallucinations. There is no consensus as to whether these symptoms are related to the identity disorder itself or to experiences psychological trauma that caused the identity disorder.

Dissociative identity disorder is closely related to the mechanism of psychogenic amnesia - memory loss, has a purely psychological nature, without physiological disturbances in the brain. This is a psychological defense mechanism that allows a person to repress traumatic memories from consciousness, but in occasional identity disorders, this mechanism helps individuals "switch". Too strong activation of this mechanism often leads to the development of daily memory problems in patients suffering from identity disorders.

Many patients with dissociative identity disorder also experience depersonalization and derealization phenomena, bouts of embarrassment and loss, when a person cannot understand who she is.

Multiple personality disorder and schizophrenia

Distinguishing schizophrenia from a multiple personality disorder is difficult to diagnose and is mainly based on the structural features of the clinical picture, which are uncharacteristic of dissociative disorders. In addition, the corresponding symptoms are perceived by patients with schizophrenia more often as a result of external influences, and not as belonging to their own personality. The splitting of personality by multiple disorders is massive or molecular and forms quite complex and integrated personality substructures in relation to oneself. Splitting in schizophrenia, which is designated as discrete, nuclear or atomic, is a splitting of individual mental functions from the personality as a whole, which leads to its disintegration.

Timeline of the development of the understanding of multiple personality

1640s - 1880s

The period of the theory of magnetic somnambulism as an explanation of multiple personality.

1784 - The Marquis de Puysegur, a student of Franz Anton Mesmer, introduces his worker Victor Ras with the help of magnetic techniques (Victor Race) in a certain somnambulistic position: Victor showed the ability to stay awake during sleep. After awakening, he is unable to remember what he did in the altered state of consciousness, while in the latter he retained full awareness of the events that happened to him both in the normal state of consciousness and in the altered one. Puysegur comes to the conclusion that this phenomenon is similar to somnambulism, and calls it "magnetic somnambulism."
1791 - Ebergard Gömelin describes a case of "personality changing" in a 21-year-old German girl. She developed a second personality who spoke French and claimed to be a French aristocrat. Gmelin saw the similarity between such a phenomenon and magnetic sleep and decided that such cases could help in understanding the formation of personality.
1816 - The case of Mary Reynolds, who had a "dual personality", is described in the Medical Repository.
1838 - Charles Despina describes a case of dual personality in Estella, an 11-year-old girl.
1876 - Eugène Azam describes a case of dual personality in a young French girl whom he called Felida X. He explains the phenomenon of multiple personality through the concept of hypnotic states, which was popular at the time in France.

1880s - 1950s

Introducing the concept of dissociation and that a person can have multiple psychic centers that arise when the psyche tries to deal with traumatic experiences.

1888 - Burro Doctors (Bourru) and Burro (Burrot) publishes the book Personality Variations (Variations de la personnalite), in which the case of Louis Vivet is described (Louis Vive) who had six different personalities, each with their own muscle contraction patterns and individual memories. The memories of each person were rigidly tied to a certain period of Louis' life. As a treatment, doctors used hypnotic regression during these periods; they viewed the personalities of this patient as successive variations of one personality. Another researcher, Pierre Janet, introduced the concept of "dissociation" and suggested that these personalities were coexisting mental centers within the same individual.
1899 - Théodore Flournoy's book "From India to the Planet Mars: A Case of Somnambulism with False Languages" is published. (Des Indes à la Planète Mars: Etude sur un cas de somnambulisme avec glossolalie).
1906 - In Morton Prince's The Dissociation of Personality (The Dissociation of a Personality) describes the case of a patient with a multiple personality, Clara Norton Favler, also known as Miss Christine Bechamp. As a treatment, Prince suggested combining the two personalities of Besham, and pushing the third into the subconscious.
1908 - Hans Heinz Evers publishes the story "The Death of Baron von Friedel", which was originally called "Second Self". in the story we are talking about the splitting of consciousness into male and female components. Both components alternately take possession of the personality and, finally, enter into an irreconcilable dispute. The baron shot himself, and at the end of the story it says: “Of course, there can be no question of suicide here. Most likely this is: he, Baron Jesus Maria von Friedel, shot Baroness Jesus Maria von Friedel; or vice versa - she killed him. I do not know this. I wanted to kill - he or she - but not myself, I wanted to kill something else. And so it happened.”
1915 - Walter Franklin Prince publishes the story of a patient, Doris Fisher - "The Case of Doris' Multiple Personality" (The Doris Case of Multiple Personalities). Doris Fisher had five personalities. Two years later, they issued a report on the experiments performed on Fisher and her other personalities.
1943 - Stengel states that the multiple personality condition no longer occurs.

Post 1950s

1954 - The Three Faces of Eve, a book based on the history of psychotherapy with Chris Costner-Sizemore, a patient with multiple personalities, is published by Tippen and Cleckley. The release of this book has raised the interest of the general community in the nature of the phenomenon of multiple personality.
1957 - Film adaptation of the book "The Three Faces of Eve" with the participation of Joanne Woodward.
1973 - Publication of Flora Schreiber's best-selling book Sybil, which tells the story of Shirley Mason (Sibyl Dorsett in the book).
1976 - Television adaptation of "The Sibyl" (Sibyl), starring Sally Field.
1977 - Chris Costner Sizemore publishes his autobiography I'm Eve. (I'm Eve) in which she claims that Tippen and Cleckley's book misinterpreted her life story.
1980 - Publication of Michelle Remembers, co-authored by psychiatrist Lawrence Pazder and Michelle Smith, a patient with multiple personalities.
1981 - Keys publishes The Minds of Billy Milligan, based on extensive interview material with Milligan and his therapist.
1981 Publication of Truddy Chase's When the Rabbit Howls (When Rabbit Howls).
1994 - Publication in Japan of Daniel Keyes' second book about Milligan, titled Milligan's Wars. (Milligan Wars).
1995 - Launch of Astraea's Web, the first online resource dedicated to recognizing multiple personality as a healthy condition.
1998 - Publication of the article "Creating Hysteria" by Joan Akokella (Creating Hysteria) in The New Yorker, which describes the excesses of multiple personality psychotherapy.
1999 - Publication of Cameron West's book "First Person Plural: My Life as Several Lives" (First Person Plural: My Life as a Multiple).
2005 - Robert Oxnam's autobiography "Split Mind" is published. (A Fractured Mind).
2007 - Second television adaptation of The Sibyl.

definition of dissociation

Dissociation is a protective mechanism of the psyche, which usually works in painful and / or traumatic situations. Dissociation is characterized by the disintegration of the ego. Ego integrity can be defined as the ability of a person to successfully incorporate external events or social experiences into their perception and subsequently act in a consistent manner during such events or social situations. A person who is not able to cope successfully with this can feel both emotional dysregulation and a potential collapse of ego-integrity. In other words, the state of emotional dysregulation can in some cases be intense enough to force ego disintegration, or what, in extreme cases, is diagnosed as dissociation.

Dissociation describes the collapse of the ego-integrity so strong that the personality is literally split. For this reason, dissociations are quite often referred to as "splitting", although this term is reserved for a different mechanism of the psyche. Less profound manifestations of this condition are in many cases clinically described as disorganization or decompensation. The difference between a psychosomatic manifestation and a dissociative manifestation is that although the person experiencing dissonance is formal and detached from a situation that he or she cannot control, certain part that person remains connected to reality. Whereas the psychotic "breaks" with reality, the dissociative disconnects from it, but not completely.

Since the person who is experiencing dissociations is not completely disconnected from their reality, it can, in certain cases, have a large number of "personalities". In other words, there are various "people" (read personalities) to interact with different situations, but in general terms, none of the personalities are completely disabled.

Multiple personality controversy

Until now, the scientific community has not reached a consensus on what is considered a multiple personality, since in the history of medicine until the 1950s there were too few well-reasoned cases of this disorder. In the fourth edition of the Diagnostic and Statistical Handbook of Mental Disorders (DSM-IV), the name given state was changed from "multiple personality disorder" to "dissociative identity disorder" to remove the term, confusing, "personality". The same designation was adopted in ICD-9, but in ICD-10 the variant "multiple personality disorder" is used. It should be noted that the media quite often make a serious mistake when they confuse multiple personality disorder and schizophrenia.

A 1944 study of multiple personality sources in the medical literature of the 19th and 20th centuries found only 76 cases. In recent years, the number of cases of dissociative identity disorder has increased dramatically (according to some reports, between 1985 and 1995, about 40,000 cases were registered). But other studies have shown that the disorder does have a long history, stretching back about 300 years in the literature, and that the disorder itself affects less than 1% of the population. According to other sources, dissociative identity disorder occurs among 1-3% of the general population. Thus, epidemiological evidence indicates that dissociative identity disorder is actually as common in the population as schizophrenia.

Currently, dissociation is seen as a symptomatic manifestation in response to trauma, critical emotional stress, and it is associated with emotional dysregulation and borderline personality disorder. According to a longitudinal (long-term) study by Ogawa et al., the strongest predictor of dissociation in young adults was lack of access to a mother at age 2. Many recent studies have shown an association between early childhood attachment disorders and subsequent dissociative symptoms, and evidence is also clear that childhood abuse and child rejection quite often contribute to the formation of aroused attachment (which manifests itself, for example, when a child very closely observes that attention is paid to her parents or not).

Critical attitude to the diagnosis

Some psychologists and psychiatrists believe that dissociative identity disorder is iatrogenic or contrived, or argue that cases of true multiple personality are quite rare and most documented cases should be considered iatrogenic.

Critics of the dissociative identity disorder model argue that the diagnosis of a multiple personality condition is a phenomenon that is more common in English-speaking countries. Prior to the 1950s, cases of split personality and multiple personality were sometimes described and treated quite rarely in the Western world. The 1957 publication of the book The Three Faces of Eve and later the release of the film of the same name contributed to the growth of public interest in the phenomenon of multiple personalities. 1973 issued later filmed book "Sybil" (Sybil), which describes the life of a woman with multiple personality disorders. But the diagnosis of multiple personality disorder itself was not included in the Diagnostic and Statistical Handbook of Mental Disorders until 1980. Between the 1980s and 1990s, the number of reported cases of multiple personality disorder rose to twenty to forty thousand.

Multiple personality as a healthy state

Some people, including those who self-identified as having a multiple personality, believe that this condition may not be a disorder, but a natural variation of human consciousness that has nothing to do with dissociation. Truddy Chase, author of the bestseller When Rabbit Howls, is one of the staunch supporters of this version. Although she admits that her random multiple personalities were created as a result of violence, at the same time she claims that her personalities refused to be integrated and live together as a collective.

Within depth or archetypal psychology, James Gillman argues against defining multiple personality syndrome as an unambiguous disorder. Gillman supports the idea of all personifications and refuses to acknowledge the "multiple personality syndrome". According to him, to view multiple personalities as either a "mental disorder" or a failure to integrate "private personalities" is to exhibit a cultural bias that misidentifies one particular individual, the "I", with the entire personality as such.

intercultural studies

Anthropologists L. K. Suryani and Gordon Jensen are sure that the phenomenon of pronounced trance states in the society of the island of Bali has the same phenomenological nature as the phenomenon of multiple personality in the West. It is argued that people in shamanistic cultures who experience multiple personalities define these personalities not as parts of themselves, but as independent souls or spirits. There is no evidence of an association between multiple personality, dissociation, and recollection of memories and sexual abuse in these cultures. In traditional cultures, the multiplicity that is manifested, for example, by shamans, cannot be considered a disorder or disease.

Potential Causes of Multiple Personality Disorder

Dissociative identity disorder is believed to be caused by a combination of several factors: unbearable stress, the ability to dissociate (including the ability to separate one's memories, perceptions or identity from consciousness), the manifestation of protective mechanisms in ontogeny and - during childhood - a lack of care and participation in the child's relationships with a traumatic experience or lack of protection from subsequent unwanted experiences. Children are not born with a sense of a unified identity, the latter develops based on in large numbers sources and experiences. In critical situations, child development is hindered and many parts of what should be integrated in relation to a unified identity remain segregated.

North American studies show that 97-98% of adults with dissociative identity disorder describe situations of abuse in childhood and that the occurrence of abuse can be documented in 85% of adults and 95% of children and adolescents with multiple personality disorders and other similar forms of dissociative disorder. These data indicate that childhood abuse is the main cause of the disorder among North American patients, while in other cultures the effects of war or natural disaster may play a larger role. Some patients may not have experienced violence but have experienced an early loss (such as the death of a parent), a serious illness, or another highly stressful event.

Human development requires the child to be able to successfully integrate various types of complex information. In ontogenesis, a person goes through a number of stages of development, in each of which different personalities can be created. The ability to generate multiple personalities is not observed or manifested in every child who has been abused, lost or traumatized. Patients with dissociative identity disorder have the ability to easily enter trance states. This ability, in relation to the ability to dissociate, is believed to act as a factor in the development of the disorder. Be that as it may, most children who have these properties also have normal adaptive mechanisms and are not in an environment that can cause dissociation.

treatment

The most common approach to treating multiple personality disorder, which is to alleviate symptoms to ensure the safety of the individual, and to reintegrate different personalities into one identity, works well. Treatment can take place using various types of psychotherapy - cognitive psychotherapy, family therapy, clinical hypnosis, and the like.

Insight-oriented psychodynamic therapy is used with some success, which helps to overcome the resulting trauma, opens conflicts that determine the need for individuals, and corrects the corresponding defense mechanisms. Perhaps a positive result of treatment is the provision of a conflict-free relationship of cooperation between individuals. The therapist is encouraged to treat all alter personalities with equal respect, avoiding taking sides in an internal conflict.

Drug therapy does not allow to achieve noticeable success and is exclusively symptomatic; There is no single pharmacological drug available to treat dissociative identity disorder itself, but some antidepressants are used to relieve comorbid depression and anxiety.