Multiple personality disorder

Multiple personality disorder (MPD) is a chronic (recurring frequently) emotional illness. A person with MPD plays host to two or more personalities (called alters). Each alter has its own unique style of viewing and understanding the world and may have its own name. These distinct personalities periodically control that person's behavior as if several people were alternately sharing the same body.

MPD occurs about eight times more frequently in women than in men. Some researchers believe that because men with MPD tend to act more violently than women, they are jailed rather than hospitalized and, thus, never diagnosed. Female MPD patients often have more identities than men, averaging fifteen as opposed to eight for males.

Causes of multiple personality disorder

Most people diagnosed with MPD were either physically or sexually abused as children. Many times when a young child is severely abused, he or she becomes so detached from reality that what is happening may seem more like a movie or television show than real life. This self-hypnotic state, called disassociation, is a defense mechanism that protects the child from feeling overwhelmingly intense emotions. Disassociation blocks off these thoughts and emotions so that the child is unaware of them. In effect, they become secrets, even from the child. According to the American Psychiatric Association, many MPD patients cannot remember much of their childhoods.

Not all children who are severely and repeatedly abused develop multiple personality disorder. However, if the abuse is repeatedly extreme and the child does not have enough time to recover emotionally, the disassociated thoughts and feelings may begin to take on lives of their own. Each cluster of thoughts tends to have a common emotional theme such as anger, sadness, or fear. Eventually, these clusters develop into full-blown personalities, each with its own memory and characteristics.

Symptoms of the disorder

A person diagnosed with MPD can have as many as a hundred or as few as two separate personalities. (About half of the recently reported cases have ten or fewer.) These different identities can resemble the normal personality of the person or they may take on that of a different age, sex, or race. Each alter can have its own posture, set of gestures, and hair-style, as well as a distinct way of dressing and talking. Some may speak in foreign languages or with an accent. Sometimes alters are not human, but are animals or imaginary creatures.

The process by which one of these personalities reveals itself and controls behavior is called switching. Most of the time the change is sudden and takes only seconds. Sometimes it can take hours or days. Switching is often triggered by something that happens in the patient's environment, but personalities can also come out under hypnosis (a trancelike state in which a person becomes very responsive to suggestions of others).

Sometimes the most powerful alter serves as the gatekeeper and tells the weaker alters when they may reveal themselves. Other times alters fight each other for control. Most patients with MPD experience long periods during which their normal personality, called the main or core personality, remains in charge. During these times, their lives may appear normal.

Ninety-eight percent of people with MPD have some degree of amnesia when an alter surfaces. When the main personality takes charge once again, the time spent under control of an alter is completely lost to memory. In a few instances, the host personality may remember confusing bits and pieces of the past. In some cases alters are aware of each other, while in others they are not.

One of the most baffling mysteries of MPD is how alters can sometimes show very different biological characteristics from the host and from each other. Several personalities sharing one body may have different heart rates, blood pressures, body temperatures, pain tolerances, and eyesight abilities. Different alters may have different reactions to medications. Sometimes a healthy host can have alters with allergies and even asthma.

Treatment

MPD does not disappear without treatment, although the rate of switching seems to slow down in middle age. The most common treatment for MPD is long-term psychotherapy twice a week. During these sessions, the therapist must develop a trusting relationship with the main personality and each of the alters. Once that is established, the emotional issues of each personality regarding the original trauma are addressed. The main and alters are encouraged to communicate with each other in order to integrate or come together. Hypnosis is often a useful tool to accomplish this goal. At the same time, the therapist helps the patient to acknowledge and accept the physical or sexual abuse he or she endured as a child and to learn new coping skills so that disassociation is no longer necessary.

About one-half of all people being treated for MPD require brief hospitalization, and only 5 percent are primarily treated in psychiatric hospitals. Sometimes mood-altering medications such as tranquilizers or antidepressants are prescribed for MPD patients. The treatment of MPD lasts an average of four years.