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PubMed1991

Childhood traumas: an outline and overview.

Childhood psychic trauma appears to be a crucial etiological factor in the development of a number of serious disorders both in childhood and in adulthood. Like childhood rheumatic fever, psychic trauma sets a number of different problems into motion, any of which may lead to a definable mental condition. The author suggests four characteristics related to childhood trauma that appear to last for long periods of life, no matter what diagnosis the patient eventually receives. These are visualized or otherwise repeatedly perceived memories of the traumatic event, repetitive behaviors, trauma-specific fears, and changed attitudes about people, life, and the future. She divides childhood trauma into two basic types and defines the findings that can be used to characterize each of these types. Type I trauma includes full, detailed memories, "omens," and misperceptions. Type II trauma includes denial and numbing, self-hypnosis and dissociation, and rage. Crossover conditions often occur after sudden, shocking deaths or accidents that leave children handicapped. In these instances, characteristics of both type I and type II childhood traumas exist side by side. There may be considerable sadness. Each finding of childhood trauma discussed by the author is illustrated with one or two case examples.

Adolescent↗
PubMed1991

The frequency of multiple personality disorder among psychiatric inpatients.

OBJECTIVE: A 2-year study was undertaken to determine the frequency of multiple personality disorder among general adult psychiatric inpatients. METHOD: All individuals admitted to two 23-bed acute care wards in a teaching hospital in Winnipeg, Man., were screened with the Dissociative Experiences Scale. Individuals with prior diagnoses of multiple personality disorder were excluded. All subjects scoring 20 or higher on the Dissociative Experiences Scale were interviewed with the Dissociative Disorders Interview Schedule. Then subjects with a diagnosis of multiple personality disorder and comparison subjects were interviewed by a clinician who was blind to all research data. RESULTS: A total of 299 subjects completed the Dissociative Experiences Scale and 80 received a structured diagnostic interview. Ten subjects (3.3%) had clinically confirmed multiple personality disorder. CONCLUSIONS: If these results are replicated and accepted, multiple personality disorder will become a serious consideration in the differential diagnosis of many psychiatric patients.

Adult↗
PubMed1991

Diagnosing dissociative disorders in The Netherlands: a pilot study with the Structured Clinical Interview for DSM-III-R Dissociative Disorders.

OBJECTIVE: To improve the ability to diagnose dissociative disorders in The Netherlands, the authors conducted a study using a Dutch version of the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D) with additional questions on childhood trauma and symptoms of borderline and histrionic personality disorders. METHOD: All interviews were audiotaped or videotaped and rated by two investigators separately. Forty-four patients (42 women and two men) participated in the study. Most of the patients had been referred for evaluation of dissociative symptoms; five had participated in a nationwide survey on incest. None of the patients had ever received a diagnosis of a dissociative disorder, and none had evidence of organic brain syndrome or mental retardation. All patients were in active treatment; 23 were being treated in an outpatient psychiatric service, 13 in an inpatient psychiatric service, and eight in private practice. Thirty-two patients had been psychiatric inpatients at least once. RESULTS: Four diagnostic groups of patients were identified: two with dissociative disorders (12 patients with multiple personality disorder and 11 with dissociative disorder not otherwise specified), one with DSM-III-R personality disorders (11 patients), and one without dissociative or personality disorders (10 patients). CONCLUSIONS: Dissociative disorders are clearly not only an American phenomenon. The diagnosis can be made outside of the United States if the symptoms are sought. The SCID-D proved to be a promising instrument.

Adolescent↗
PubMed1993

Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study.

OBJECTIVE: The Dissociative Experiences Scale has proved a reliable and valid instrument to measure dissociation in many groups, but its capacity to distinguish patients with multiple personality disorder from patients with other psychiatric disorders has not yet been conclusively tested. METHOD: A discriminant analysis was performed to classify 1,051 subjects as having or not having multiple personality disorder. Another discriminant analysis was performed on a subgroup of 883 subjects more closely representing patients in a typical psychiatric facility in terms of base rates of dissociative disorders. A cutoff score of 30 was also used to classify subjects, and Bayes's theorem, which allows for the calculation of the positive predictive value and the negative predictive value of a screening test, was applied. RESULTS: According to discriminant analysis of the total study group, the scale's sensitivity was 76% and its specificity was also 76%; according to discriminant analysis of the more representative subgroup, the scale's sensitivity was 76% and its specificity was 85%. Use of the cutoff score of 30 produced similar results. Results of the application of Bayes's theorem showed that 17% of the subjects scoring 30 or higher would actually have multiple personality disorder and 99% of those scoring less than 30 would not have multiple personality disorder. CONCLUSIONS: These results indicate that the Dissociative Experiences Scale performs quite well as a screening instrument to identify subjects with multiple personality disorder. In addition, the consistency of responses to scale items across centers indicates that the symptoms reported by patients with multiple personality disorder are highly similar across diverse geographic centers. This consistency supports the reliability and validity of the diagnosis of multiple personality disorder across centers.

Adult↗
PubMed1975

Behavior cytogenetics and Turner's syndrome: a new principle in counseling and psychotherapy.

In the orthodox theory and practice of psychotherapy and counseling, each case is considered to be unique or idiodynamic in terms of psychodynamic history. According to a new and still unorthodox principle, a syndrome may have a common psychodynamic denominator, shared by all or most carriers of the syndrome. As illustrated with reference to Turner's (45,X) syndrome, application of this new principle expedites the psychodiagnostic and psychotherapeutic procedures.

Androgens↗
PubMed1989

Dissociation in alternative healers and traditional therapists: a comparative study.

Nineteen psychiatry residents were compared to 12 community-based alternative healers on the Dissociative Experiences Scale and the Dissociative Disorders Interview Schedule. Neither group showed evidence of extensive psychopathology. However, the alternative healers reported more Schneiderian symptoms, extrasensory experiences, and secondary features of multiple personality disorder. Among the healers, these experiences did not seem to be indicative of psychopathology, and were in fact valued and sought after. Dissociative experiences are not necessarily indicators of psychiatric disorder in nonclinical groups.

Adult↗
PubMed1990

Twelve cognitive errors about multiple personality disorder.

Multiple personality disorder (MPD) is often responded to with extreme skepticism by mental health professionals. This skepticism is based in part on twelve cognitive errors about the disorder that can be corrected by argument and research evidence. The errors include the mistaken ideas that MPD patients have more than one personality; that the diagnosis means such patients are not responsible for their actions; that MPD patients are really just borderlines; that MPD is an iatrogenic artifact; that MPD can be created experimentally; that MPD must be rare; that MPD is a therapeutic metaphor; that everyone has different personalities; that MPD will go away if you ignore it; that patients pretend to have MPD in order to please the therapist; that the abuse histories of MPD patients are confabulated; and that one must be a hypnotist to treat MPD. It is important to correct these cognitive errors because MPD is not rare. It can be diagnosed with good reliability and its features are stable and consistent in a number of large published series. Although definitive treatment-outcome studies have not been conducted, clinical experience to date suggests that the disorder can often be cured with psychotherapy. After successful integration, MPD patients function much better than before, and can be released from the mental health system.

Borderline Personality Disorder↗
PubMed1990

Covert multiple personality underlying eating disorders.

Frequently, MPD patients present themselves to the clinician with a variety of psychophysiological symptoms. Eating-disorder symptoms may be one of these, and may include the following: binge eating, self-induced vomiting, laxative abuse, excessive exercising, body image distortion, self-starvation, fluctuations in body weight, and nausea. Following are five cases in whom the pathological eating behavior was a manifestation of an underlying multiple personality disorder. The pathological eating behavior was so severe that some patients matched DSM-III-R diagnostic criteria for an eating disorder. Clinicians dealing with eating disorders should be aware that some patients may represent a subgroup in whom the underlying cause for the eating disorder may be MPD. These patients seldom respond to conventional treatment modalities used in eating-disorders programs, and only when the underlying multiplicity is identified and treated by a trained clinician, will the patient's eating-disorder symptoms improve.

Adult↗
PubMed1991

Systemic treatment of multiple personality: response to a chronic disorder.

Multiple Personality Disorder (MPD) is a more and more frequently diagnosed disorder. In this article, MPD is considered the result of a dissociative defense in response to severe trauma during the formative period of personality formation. As the child dissociates to defend against the trauma, the fragments of personality develop as separate entities. The traditional focus of therapy is integration, or fusion of the various fragments of personality. The current article does not dispute this therapeutic goal, but does offer an alternative treatment process. Borrowing from the theoretical concepts of the family therapy literature, the person with MPD is described as a system. Therapy, then, must attempt to maintain balance within the system as a short-term goal, as well as striving for integration as a long-term goal. This article delineates the systemic approach, first from a theoretical, then a practical perspective. The concepts of coconsciousness (or awareness by all aspects of the system) and coexistence (a state of mutual cooperation between various personalities) are described, and fitted within the systemic model. Practical aspects of life with MPD, including activities of daily living and relationships, are then outlined within this model.

Activities of Daily Living↗