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PubMed1990

Dissociative phenomena and the question of responsibility.

There are many controversies regarding the prevalence, causation, possible iatrogenicity, and treatment of multiple personality disorder. Those who view the disorder as much more prevalent than has previously been suspected believe it is caused by experiences of severe child abuse and have used rather unorthodox techniques to help the patient relate the experience of abuse to current problems of dissociation. Other clinicians believe the disorder is overdiagnosed and that it may be created or made worse by therapists who unwittingly reinforce symptoms of dissociation. Many of the controversies about these issues can be clarified by considering the manner in which clinicians attribute responsibility for undesirable conduct associated with the disorder. In dealing with multiple personality patients, clinicians regularly must decide whether their therapeutic approach will emphasize the patient's responsibility for undesirable conduct or will minimize it. Practical and theoretical arguments can be made for both approaches. There are important consequences to patients using either approach, and particularly harmful consequences with inconsistent approaches. Clinical experience and wisdom dictate that until we have more objective data about the results of various forms of treatment, the preferred method of treatment of multiple personality patients should continue to focus upon maximizing their responsibility for any type of undesirable conduct.

Criminal Law↗
PubMed1991

Dissociation in hypnosis and multiple personality disorder.

The first part of this paper examines the concept of dissociation in the context of hypnosis. In particular, the neodissociative and social psychological models of hypnosis are compared. It is argued that the social psychological model, in describing hypnotic enactments as purposeful, does not adequately distinguish between behavior that is enacted "on purpose" and behavior that serves or achieves a purpose. 2 recent dissertations (Hughes, 1988; Miller, 1986) from the University of Waterloo are summarized, each of which supports the neodissociative view that hypnotic behavior can be purposeful (in the sense that the suggested state of affairs is achieved) and nonvolitional (in the sense that the suggested state of affairs is not achieved by high level executive initiative and ongoing effort). The second part of the paper employs a neodissociative view of hypnosis to help understand the current epidemic of multiple personality disorder (MPD). In particular, it is argued that many symptoms of MPD are implicitly suggested effects--particularly prone to occur in persons who have a lifelong tendency to use dissociative type defenses. The present author believes that this account is easier to sustain conceptually and empirically than the current view, which states that a secondary (tertiary, etc.) personality accounts for the striking phenomenological discontinuities experienced by MPD patients.

Adult↗
PubMed1992

Inadvertent hypnosis during interrogation: false confession due to dissociative state; mis-identified multiple personality and the Satanic cult hypothesis.

Induction of a dissociative state followed by suggestion during interrogation caused a suspect to develop pseudo-memories of raping his daughters and of participation in a baby-murdering Satanic cult. The pseudo-memories coupled with influence from authority figures convinced him of his guilt for 6 months. During this time, the suspect, the witnesses, and all the evidence in the case were studied. No evidence supported an inference of guilt and substantial evidence supported the conclusion that no crime had been committed. An experiment demonstrated the suspect's extreme suggestibility. The conclusion reached was that the cult did not exist and the suspect's confessions were coerced-internalized false confessions. During the investigation, 2 psychologists diagnosed the suspect as suffering from a dissociative disorder similar to multiple personality. Both psychologists were predisposed to find Satanic cult activity. Each concluded that the disorder was due to "programming" by the non-existent Satanic cult.

Adult↗
PubMed1995

On the belief that one body may be host to two or more personalities.

The belief in the validity of the multiple personality concept is discussed in this article. Two scaffolding constructions are analyzed: dissociation and repression. As generally employed, these constructions grant no agency to the multiple personality patient. The claim is made that the conduct of interest arises in discourse, usually with the therapist as the discourse partner. In reviewing the history of multiple personality and the writings of current advocates, it becomes clear that contemporary users of the multiple personality disorder diagnosis participate in a subculture with its own set of myths, one of which is the autonomous actions of mental faculties. Of special significance is the readiness to transfigure imaginings into rememberings of child abuse, leading ultimately to the manufacture of persons. The implications for both therapy and theory of regarding the patient as agent in place of the belief that the contranormative conduct is under the control of mentalistic faculties are discussed.

Adult↗
PubMed1990

Potential space and the Rorschach: an application of object relations theory.

This article examines the concept of potential space, developed by Winnicott (1971), and its relevance for Rorschach assessment. I propose that the response process can be viewed as occurring in the potential space between reality and fantasy and that various forms of psychopathology can be conceptualized as forms of the collapse of potential space. I suggest that this model can be of utility in interpreting the Rorschach protocols of a variety of difficult-to-diagnose patients. Examples from the Rorschach of a patient diagnosed with a dissociative disorder are presented to illustrate these points.

Arousal↗
PubMed2003

Unrelenting catastrophic trauma within the family: when every secure base is abusive.

This paper will present illustrations from Adult Attachment Interviews conducted with adult female survivors of chronic ritual abuse in their family of origin. A model of multiple personality disorder informed by the Adult Attachment Interview coding and classification system will be presented. A range of victim, perpetrator and bystander personalities may be identified in the same interview, indeed in the same speaker. For the speaker who believes herself to be one of a number of co-existing personalities, integration and coherence means death of a loved one, indeed death of the sense of self. Possibilities of re-birth into a single integrated self are posited.

Adult↗
PubMed2004

Establishing and running a trauma and dissociation unit: a contemporary experience.

OBJECTIVE: To evaluate the functioning of a trauma and dissociation unit that has run for the past 8 years in a private hospital, with particular regard to operating philosophy, operating parameters, challenges encountered, research and educational initiatives, and the applicability of the treatment model to other settings. CONCLUSIONS: Despite the challenges associated with significant difficulties in the corporate management of a private health-care system, it has been possible to operate an inpatient and day hospital programme tailored to the needs of patients in the dissociative spectrum, and the lessons learnt from this experience are valid considerations in the future planning of mental health services overall.

Cooperative Behavior↗
PubMed1977

Multiple personality and splitting phenomena: a reconceptualization.

Multiple personality and splitting phenomena described in the psychoanalytic literature are placed in juxtaposition. A reconceptualization of multiple personality is attempted. It is assumed that the splitting of multiple personality is qualitatively similar to the splitting in narcissistic character disorders and that the genetic antecedents of multiple personality can be traced to the narcissistic phase. Some of the literature pertaining to multiple personality is reviewed, followed by selected psychoanalytic sources referring to developmental issues and pathology in narcissistic character disorders. Material from three cases is briefly presented to illustrate the various levels of multiple personality and to show its continuity with narcissistic disorders.

Adolescent↗
PubMed1983

Multiple personality as a borderline state.

A case of multiple personality is presented. The primary personality met DSM-III criteria for borderline personality disorder, and displayed several "lower level" borderline defenses as well. The secondary personalities showed other borderline characteristics. Seen as a whole, the patient manifested a more complete spectrum of borderline features than did any of the personalities viewed individually. It is postulated that some patients with multiple personality may be a subset of borderlines, in whom the splitting of self and object representations is so severe that the disparate representations are partitioned and manifested in different "personalities." The importance of preoedipal, as opposed to oedipal, psychopathology suggests that multiple personality may be more properly considered a borderline condition than an hysterical condition.

Adult↗
PubMed1984

A symptom profile of patients with multiple personalities, including MMPI results.

Patients with multiple personalities are excellent hypnotic subjects, a capability demonstrated both clinically and on a standard hypnotizability test. They tend to experience a plethora of symptoms associated with anxiety states, hysteria, obsessional neuroses, phobic states, depression and mania, schizophrenia, alcoholism, sociopathy, and hyperactivity--although there are exceptions to this profile. Both males and females suffer from this disability, and an MMPI profile for female multiples is described.

Adult↗
PubMed1984

Hysteria and hypnosis.

Polysymptomatic female hysterics (Briquet's syndrome) are good or excellent hypnotic subjects with few exceptions, and many have multiple personalities. Furthermore, female patients with major conversion symptoms are excellent hypnotic subjects. The evidence supports spontaneous self-hypnosis as the prime mechanism in many patients with severe hysterical neuroses.

Adult↗
PubMed1985

Sexual criminality and hypnotizability.

Thirty-three sexual offenders, 18 of whom had been convicted of rape, nine of pedophilia, and six of incest, were studied. Two thirds of the subjects had histories of "spontaneous self-hypnotic" experiences (dissociations); seven of these were DSM-III multiples and six were probable multiples. This group had very high hypnotizability scores. The other one third without histories of "spontaneous self-hypnosis" had normal scores. It was concluded that spontaneous self-hypnosis contributed to the perpetration of the crimes in many of these cases, although other factors also directed the antisocial behaviors.

Adolescent↗
PubMed1986

Development, reliability, and validity of a dissociation scale.

Dissociation is a lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory. Dissociation occurs to some degree in normal individuals and is thought to be more prevalent in persons with major mental illnesses. The Dissociative Experiences Scale (DES) has been developed to offer a means of reliably measuring dissociation in normal and clinical populations. Scale items were developed using clinical data and interviews, scales involving memory loss, and consultations with experts in dissociation. Pilot testing was performed to refine the wording and format of the scale. The scale is a 28-item self-report questionnaire. Subjects were asked to make slashes on 100-mm lines to indicate where they fall on a continuum for each question. In addition, demographic information (age, sex, occupation, and level of education) was collected so that the connection between these variables and scale scores could be examined. The mean of all item scores ranges from 0 to 100 and is called the DES score. The scale was administered to between 10 and 39 subjects in each of the following populations: normal adults, late adolescent college students, and persons suffering from alcoholism, agoraphobia, phobic-anxious disorders, posttraumatic stress disorder, schizophrenia, and multiple personality disorder. Reliability testing of the scale showed that the scale had good test-retest and good split-half reliability. Item-scale score correlations were all significant, indicating good internal consistency and construct validity. A Kruskal-Wallis test and post hoc comparisons of the scores of the eight populations provided evidence of the scale's criterion-referenced validity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Phenomenological overlap of multiple personality disorder and obsessive-compulsive disorder.

Three patients with multiple personality disorder and three with obsessive-compulsive disorder were compared on a variety of self-report measures and on two structured interviews. Amytal Sodium interviews had been conducted on the obsessive patients; alter personality-like entities claiming responsibility for the obsessions and compulsions were contacted in two patients. The one obsessive patient with no alter personality differed markedly from the other five on the SCL-90, the Lynfield Inventory, and the Dissociative Experiences Scale. Structured interviews with the Anxiety Disorders Interview Schedule and the Dissociative Disorders Interview Schedule also clearly differentiated this patient from the other five. It appears that there is a phenomenological overlap between multiple personality disorder and some cases of obsessive-compulsive disorder. Obsessive patients with prominent dissociative features may be a psychologically and biologically distinct subgroup.

Adult↗