Reading Room
Aspects of the Treatment of
Multiple Personality Disorder
by Richard P. Kluft, M.D.
page 4
The Practical Psychopharmcology Of MPD
Kline and Angst tersely state pharmacological treatment of MPD is not
indicated. 11 There is general consensus 1) that drugs do
not affect the core psychopathology of MPD; and 2) that, nonetheless, it is
sometimes necessary to attempt to palliate intense dysphoria and/or to try to
relieve target symptoms experienced by one, some, or all personalities. At this
point in time treatment is empirical and informed by anecdotal experience
rather than controlled studies.
Different personalities may present with symptom profiles which seem to
invite the use of medication, yet the symptom profile of one may be so much at
variance with another's as to suggest different regimens. A given drug may
affect personalities differently. Alters who experience no effect, exaggerated
effects, paradoxical reactions, appropriate responses, and various side effects
may be noted in a single individual. Allergic responses in some but not all
alters has been reported and reviewed. 12 The possible
permutations in a complex case are staggering.
It is tempting to avoid such a quagmire by declining to prescribe. However,
distressing drug-responsive target symptoms and disorders may coexist with MPD.
A failure to address them may leave the MPD inaccessible. The author has
reported cross-over experiences on six MPD patients with major depression.
4,1,3 He found if dissociation alone was treated, results were
unstable due to mood problems. Relapse was predictable if medication was
omitted. Medication alone sometimes reduced chaotic fluctuations which were
chemically triggered, but did not treat the dissociation. An example is a
depressed MPD woman who repeatedly relapsed on therapy alone. Placed on
imipramine, she became euthymic but continued to dissociate. Therapy abated
dissociation. With medication withdrawn, she relapsed in both depression and
dissociation. Imipramine was reinstituted and fusion was achieved with
hypnosis. On maintenance imipramine she has been asymptomatic in both
dimensions for four years.
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