Reading Room
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
page 2
In 1944 a review of the literature by Taylor and Martin found only 76
documented cases of MPD. However in the last decade the number of reported MPD
cases has increased more than tenfold (Braun 1984c). This raises a new
question: Why the dramatic increase in the incidence of MPD over the last
decade?
One factor that has been associated with the increase in the number of
reported MPD cases is a growing public awareness and popular fascination with
this disorder. For example, the film The Three Faces of Eve and the
books about Sybil and Billy Milligan are widely known. In addition, improved
diagnostic criteria for MPD may have facilitated diagnostic precision. In
contrast to its classification as one of the hysterical neuroses in DSM-11 (APA
1968), its current classification (DSM-111; APA 1980) as a dissociative
disorder is much more specific. The credibility of this explanation is
supported by the finding of Putnam et al. (1983) that it takes an average of
6.8 years after first entry into the mental health system before the typical
MPD Patient is accurately diagnosed. I have observed a similar figure (6.88
years) in a study of 126 cases by different therapists (un-published data,
October 1985).
Although we are now beginning to be able to reliably identify MPD, we still
do not clearly understand what causes and maintains the symptoms of this
disorder. Unfortunately, most theories about MPD formed before 1944 were based
on clinical observation of only a few cases or a single case study. However,
during the last decade, a number of investigating practitioners have
systematized their observations on a large number of MPD cases (Bliss 1980;
Braun 1980, 1984c, 1985; Fagan and McMahon 1984; Kluft 1984a, 1984b; Putnam et
al. 1983). Although most of these clinicians have not yet formulated a
comprehensive theory about MPD, they have made some important observations
about some of its distinguishing features.
Two recent theories about MPD have been useful in identifying the unique
therapeutic needs of patients suffering from this disorder. The first of these
is Kluft's (1984a) four-factor theory, which attempts to identify the various
factors associated with the initiation and course of MPD. The other theory has
been called the 3-P
model of MPD (Braun and Sachs 1985) because it focuses on the predisposing,
precipitating, and perpetuating factors that are associated with development of
the syndrome. Because the 3-P
model forms the basis for the 13 psychotherapeutic considerations I
introduce later in this chapter, a brief description of the model is in order.
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