Reading Room
The Treatment Of Multiple
Personality Disorder (MPD):
Current Concepts
Richard P. Kluft, M.D., PH.D F.A.P.A.
Dr. Kluft is Assistant Clinical Professor Psychiatry,
Temple University School of Medicine, and Attending Psychiatrist,
The Institute of the Pennsylvania Hospital, Philadelphia.
This is an exciting but confusing epoch in the history of the treatment of
Multiple Personality Disorder (MPD. On the one hand, as noted in the first part
of this lesson, an increasing number of MPD patients are being identified, and
seeking psychiatric help. On the other hand, despite the upsurge in the
literature on their treatment remains in a pioneering phase. The first outcome
studies are quite recent; controlled studies are not available. A considerable
number of articles offer advice generalized from single cases or from small or
unspecified data bases. Since MPD patients are quite diverse, it is not
surprising to find that citations can be found which appear to argue both for
and against many therapeutic approaches. "Multiple personality disorder
delights in puncturing our generalizations, revels in shattering our security
about our favorite techniques and theories, and exhilarates in the role of
gadfly and disturber of the peace." In contrast, among those workers who
have seen many patients with MPD, most of whom taught their techniques in
workshops but were unpublished prior to the 1980's, fascinating convergence's
as well as differences have been noted. Braun, observing commonalties of
videotaped therapeutic behavior among experienced MPD therapists who professed
different theoretical orientations, inferred that the clinical realities of MPD
influenced clinicians from diverse backgrounds toward similar approaches and
conclusions. He offered the hypothesis that in actual treatment settings
experienced workers behaved much more alike than their own statements would
suggest. Many authorities concur. There is also increasing agreement that the
prognosis for most patients with MPD is quite optimistic if intense and
prolonged treatment from experienced clinicians can be made available. Often
logistics rather than untreatability impede success.
Despite these encouraging observations, many continue to question whether
the condition should be treated intensively or discouraged with benign neglect.
Concern has been expressed that naive and credulous therapists may suggest or
create the condition in basically histrionic or schizophrenic individuals, or
even enter a folie à deux with their patients. Arguments to the contrary
have been offered. Over a dozen years, this author has seen over 200 MPD cases
diagnosed by over 100 separate clinicians in consultation and referral. In his
experience, referral sources have been circumspect rather than zealous in their
approach to MPD, and he cannot support the notion that iatrogenic factors are
major factors. Although no controlled trials compare the fates of MPD patients
in active treatment, placebolike treatment, and no treatment cohorts, some
recent data bears on this controversy. The author has seen over a dozen MPD
patients who declined treatment (approximately half of whom know the tentative
diagnoses and half who did not) and over two dozen who entered therapies in
which their MPD was not addressed. On reassessment, two to eight years later,
all continued to have MPD. Conversely, patients reassessed after
treatment for MPD have been found to hold onto their rather well.
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