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Treatment of Multiple Personality Disorder

Issues in the Psychotherapy of Multiple Personality Disorder

Edited by: Bennett G. Braun, M.D.
Director, Dissociative Disorders Program,
Rush-Presbyterian-St. Luke's Medical Center

Multiple personality disorder (MPD) has been reclassified by the American Psychiatric Association (APA; 1980) in its Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) as one of four dissociative disorders. The essential feature of all such disorders is "a sudden, temporary alteration in the normally integrative functions of consciousness, identity, or motor behavior" (p.253). The specific criteria that differentiate MPD from other dissociative disorders are 1) the existence within the individual of two or more distinct personalities, each dominant at different times; 2) the personality that is dominant at any particular time determines the individual's behavior; and 3) each individual personality is complex and integrated with its own unique behavior patterns and social relationships. In addition, I proffer that each of these criteria should be observed on more than one occasion (that is, there should be consistency over time) before the formal diagnosis of MPD is made (Braun 1985a).

Although diagnoses of MPD were frequent around the turn of the century, a dramatic decrease in the reported incidence of this disorder appeared after 1910. Rosenbaum (1980) speculated that Bleuler's introduction of the term schizophrenia around 1911 led to misdiagnosis of many MPD patients as schizophrenic. Indeed, in their recent study of 100 consecutive MPD cases, Putnam et al. (1983) reported that some were previously misdiagnosed as schizophrenic. Multiple personality disorder patients have been misdiagnosed as suffering from a variety of other psychiatric problems as well.

Another attempt to account for the post-1910 decline in the incidence of MPD is Larmore, Ludwig, and Cain's (1977) proposal that because MPD was identified most often through hypnosis, the disorder could be an artifact of hypnotic suggestion. If it were, it did not merit classification as a genuine diagnostic entity. However, it has been argued (Braun 1984b; Kluft 1982) that although MPD is not a by-product of hypnotic suggestion, some superficial symptoms of MPD can be elicited in highly hypnotizable subjects. Indeed, several investigators have observed that MPD patients tend to be significantly more hypnotizable than normal subjects or other clinical groups (Bliss 1983; Lipman, Braun, and Frischholz 1984). These findings suggest that tests of hypnotizability may be useful in the differential diagnosis of MPD.

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