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.
MPD does not exist in the abstract or as a freestanding target symptom. It
is found in a diverse group of individuals with a wide range of Axis II or
character pathologies, concomitant Axis I diagnoses, and many different
constellations of ego strengths and dynamics. It may take many forms and
express a variety of underlying structures. Generalizations drawn from the
careful study of single cases may prove grossly inaccurate when applied to
other cases. Perhaps MPD is understood most parsimoniously as the maladaptive
persistence, as a post-traumatic stress disorder, of a pattern which proved
adaptive during times when the patient was overwhelmed as a child.
In general, the tasks of therapy are the same as those in any intense
change-oriented approach, but are pursued, in this case, in an individual who
lacks a unified personality. This precludes the possibility of an ongoing
unified and available observing ego, and implies the disruption of certain
usually autonomous ego strengths and functions, such as memory. The
personalities may have different perceptions, recollections, problems,
priorities, goals, and degrees of involvement with and commitment to the
therapy and one another. Therefore, it usually becomes essential to replace
this dividedness with agreement to work toward certain common goals, and to
achieve treatment to succeed.Work toward such cooperation and the possible
integration of the several personalities distinguishes the treatment of MPD
from other types of treatment. Although some therapists argue that multiplicity
should be transformed from a symptom into a skill rather than be ablated, most
consider integration preferable. (I the typer of this page and the creator of
this website, Debbie would like to add a note right here: As an MPD patient and
one who talks with many other MPDs, I personally feel that it should be
transformed from a symptom into a skill rather than be ablated......most MPD
patients that I speak with do not consider integration preferable. thank you
for allowing me to interrupt.) In a given case, it is hard to argue with Caul's
pragmatism: "It seems to me that after treatment you want a functional
unit, be it a corporation, a partnership, or a one-owner business."
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