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Multiple Personalities

Multiple personalities is a psychological disorder, marked by the existence of two or more distinct identities, or personality states, in one individual. It involves the compartmentalization of the psychological domain into different identities, so that they form distinct manifestations of the same individual. There is no overlap or association between these several identities, each forming a separate personality state, dissociated from the other, each surfacing as the predominant personality state as a conditioned response to particular threats, each oblivious of the existence of the other personality state. The fragmented personality states are referred to as alters, and the patients have been observed to have an intrinsic predisposition to splitting, to survive tremendous trauma. The cause of multiple personality is attributed to severe and prolonged physical and/or psychological trauma, experienced by the victim in their childhood, generally by a care-giver, who may or may not be the victim's parent. The victims resort to dissociation from his central personality state, to cope with severe and repeated abuse, as a natural survival mechanism. Such a fragmentation of the central personality into different personality states, acts as an anaesthetic to the victim, so that they are able to divide the extreme trauma and survive the ordeals. The pattern of dissociation becomes an entrenched second nature to the victim, so that they are able to split their central personality into numerous fragments over the course of their life. The dominant personality bearing the real name of the individual is usually despondent, remorseful and resigned. The different identities have unique sets of characteristic traits, history and bear different names, so they are strikingly different from the primary self. Since, the phenomenon of multiple personalities involves the fragmentation of identities, rather than the proliferation of identities, it has also been referred to as Dissociative Identity Disorder.

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Causes of Multiple Personalities

According to psychologists, the primary cause of multiple personalities is childhood trauma or severe stress. The child resorts to dissociation as the coping mechanism for tremendous and prolonged/repeated trauma. The segregation of personalities into multiple fragments is usually adopted by the victims of severe physical, emotional or sexual abuse as a survival mechanism. Studies have revealed the presence of child abuse in 60-90% of the subjects tested for multiple personalities. This coping mechanism also referred to as our endogenous opioid, by psychologist Bethany Brand, alleviates pain by compartmentalizing the severe trauma into distinct personality states. These personality states have their own distinct sets of memory and behavioral patterns. When encountering a traumatic situation, the patient suffering from multiple personalities usually starts dissociating themselves, to form another alter which bears the pain, while the host personality bypasses the trauma. It is a conditioned reflex to repetitive physical or psychological threats. The spontaneous propensity to dissociate oneself in the face of trauma facilitates multiple personalities. The absence of a supportive family structure and the lack of attachment with the primary care givers also add to the distress. The phantoms or the imaginary personality states become their protectors and saviors. The ability to dissociate oneself from a traumatic situation becomes increasingly refined and frequent with repeated exposure to trauma. It has been observed that patients with multiple personalities can dissociate into as many as 16 personality states.

Symptoms of Multiple Personalities

The symptoms of multiple personalities usually surface in young people in their 20's or 30's. The primary premise of the disease rests on the presence of two or more distinct personality states in the same individual. The personality states are referred to as alters. The gender, voice, names, personality traits and behavioral patterns of the alters are distinct and sometimes in stark contrast to each other. The different personality states are compartmentalized, so that they generally have dim or no memory of each other. The phenomenon of shifts between alters is known as switching. The duration of switching varies. Multiple personalities are marked by severe lapses in memory, so much so that an entire episode of life may be erased from the patient's memory. Patients with multiple personalities often complain of blackouts which the psychologists explain as loss of time during shifts or switches between personality states. They deny the existence of each other. Therefore, there are evidences of unidentified commodities purchased, unknown notes found and unfamiliar people encountered. The patients suffering from multiple personalities also have out of body experiences, so that they often perceive their feelings and thought processes to be unreal. This symptom is known as depersonalization. Patients suffering from multiple personalities also harbor the notion that their surroundings are unreal. They may have problems recognizing their friends and family members, and this dissociative symptom is known as derealization. It is common for patients with multiple personalities to go into semi-conscious states. Their mental realm is covered by confusions and they often appear to be disoriented. People suffering from multiple personalities also exhibit moodiness and irrational deep-rooted fears, which also make them prone to extreme anxiety. The psychological disease also manifests in the form of self-destructive or suicidal tendencies. Recurrent hallucinations are common. Further, the existence of multiple identities within the same individual engenders identity disturbances.

Multiple Personalities: a Controversial Diagnosis

In the USA and Europe, 5% of the cases of multiple personalities in psychiatric wards remain undiagnosed. There is a huge controversy among the psychologists and psychiatrists about the very existence of multiple personalities. Psychologist Dell in his book Professional skepticism about multiple personality reveals the challenges faced by the psychiatrists inclined to treat the multiple personality disorder. The clinicians are reported to give the testament that a majority of their colleagues were hostile towards admitting patients with multiple personalities. The opponents were even bent on getting the patients discharged, on the premise that it is not a real mental disorder with distinct core symptoms. It is believed by the opponent group that the patients merely feign to be mentally sick or are induced with the bizarre disorder through hypnosis, by specialists. They are of the opinion that multiple personality is a sham. This opponent group also denies recognition to multiple personalities, owing to the fact that it would be an easy escape route for criminals. They believe ,the criminals would go free, with the superficial alibi that the crime was committed by the alter. Psychologists Frankal, Ganaway and Mc Hugh have ascribed cases of multiple personalities to wrong diagnosis, induced hypnotism, or social disease. This questions the very existence of such a disease. Psychologist Bethany Brand, in her interview to The Trauma and Mental Health Report points out that adequate training on unerring analytical methods for multiple personality disorder is essential. She further states that structured patterns of clinical interviews, for the diagnosis and assessment of individuals claiming to have multiple personalities, help in distinguishing the real cases from the fake ones. Dr. Brand cautions practitioners to be ultra-careful, since patients with multiple personalities can be easily hypnotized and are extremely receptive to suggested symptoms.

Multiple Personalities versus Borderline Personality Disorder and Schizophrenia

Psychologists Lauer, Black and Keen observed the symptoms of multiple personalities to be akin to borderline personality disorder. They believed that multiple personality syndrome does not have a distinctive history, or a set of distinguishing characteristic features, so as to deserve mention as a unique type of psychological disorder. However, Spira in his book Treating Dissociative Identity Disorder describes available options for treating multiple personalities, as outlined by its advocates. Psychologists observe self induced hypnosis and symptoms of Post Traumatic Stress Disorder in patients with multiple personality disorder, possibly as a consequence of extreme physical or emotional trauma encountered in childhood. Horevitz and Braun established that 70% of patients with multiple personalities exhibited symptoms of borderline personality disorder, and believe multiple personalities to be over diagnosed. The secondary characteristics associated with multiple personalities such as depression, moodiness, self-destructive tendencies, paranoid tendencies, and severe anxiety, validate their claims. However it has been observed that the degree of dissociation of identity is much more pronounced in multiple personalities, so much so that it is also referred to as Dissociative Identity Disorder. Also, the phenomenon of aggression or physical/sexual abuse is kept a secret in the family traditions of patients suffering from multiple personalities, as compared to the borderline personality disorder, where family members are more open to discussing it. This has a decisive impact on the psychological development of individuals. On occasions, multiple personalities have also been compared to schizophrenia. However, it is important to mention that while the imagined voices heard in schizophrenia comes from outside, the voices heard in multiple personalities may emanate from inside, as an echo from another identity. Herman draws an analogy between Post Traumatic Stress Disorder and multiple personalities and describes the latter as an offshoot of severe stress from prolonged and repeated trauma

Multiple Personalities: Making the Diagnosis

Since multiple personalities share many of its secondary characteristics with other psychological disorders, such as borderline personality disorder or schizophrenia, an accurate diagnosis is difficult. It takes some patients up to 7 years to finally receive the correct diagnosis. Statistics reveal that the prevalence of multiple personalities is substantially higher in women than in men, the ratio being 9:1. The root cause in 97% of the cases diagnosed, has been reported to be severe physical or sexual trauma in childhood. The diagnosis is usually reached at by using psychological tools, such as a carefully prepared questionnaire, to help the clinician to spot the existence of multiple personalities. The criteria for diagnosis involve the existence of two or more personality states in an individual, with distinct and autonomous thought, perception and interaction processes. The alters should surface and take control of the subject, so that the pattern of emergence of different identities existing in the subject, is consistent. Also the person being diagnosed should exhibit symptoms of severe memory lapses that defy the definition of ordinary forgetfulness. Diagnosis should reveal the presence of a traumatic stressor so that the response to the stimuli of severe stress is one of shock or terror. It is to be ascertained that these psychological characteristics or emotional responses are not due to substance abuse or other ailments. The formation of fragmented identities or alters usually begins around the age of six. Patients with multiple personalities are reported to have extreme suicidal or self destructive tendencies. They are also reported to have out of body experiences involving auditory hallucinations. The patients often refer to themselves as we rather than I. They also report about episodic lapses in memory, and are usually unable to keep track of days, hours or activities. They may fail to recognize their belongings or people around them, owing to frequent switches between alters.

It has been observed that it is the host identity that seeks out medical help, due to marked physical and psychological disruptions, threatening their very survival. The clinician attempting to diagnose multiple personalities has to eliminate the possibilities of other physical/psychological conditions or addictions/malingering on the part of the patients. Medical conditions, such as seizures, brain injuries, and AIDS are to be ruled out. Similarly, substance abuse, alcoholism, medication side-effects are to be evaluated and ruled out. The possibilities of presence of other psychological disorders, which exhibit similar symptoms, are also to be eliminated. An electroencephalograph is performed to rule out the possibilities of neurological anomalies, such as seizures. Patients are closely assessed to rule out spurious claims. The Dissociative Experiences Scale is next used by the practitioner to measure the level of dissociation in the suspected subject. The Structured Clinical Interview for Dissociative Disorders (SCID-D) is the final tool used by the psychiatrist to confirm the existence of multiple personalities in the patient. The SCID- D has 250 questions to evaluate various aspects of multiple personalities, including memory loss, identity switch, and disturbed identity. The gradation and magnitude of severity is visible in test results. Whereas hypnotic or drug facilitated interview sessions are perceived to be more productive by some psychologists, others negate the procedure on the grounds that the technique may potentially produce signs of the disease. Questions about out of body experiences, memory loss, childhood memories, auditory hallucination resulting in powerlessness, may help identify the symptoms exclusive to multiple personalities. A longer interview duration is pusued, to increase the likelihood of witnessing switches between alters. Multiple personality disorder can be ascertained after at least two personality states have been witnessed by the practitioner.

Treatment Options for Multiple Personalities

Treatment for multiple personalities is a protracted process, owing to the complexity of the symptoms of multiple personalities, and the hypersensitivity and/or emotional vulnerability of the subject. The stress factor associated with clinical evaluation may provoke the emergence of different personality states or alters. The clinician usually schedules extended interview sessions to witness and grasp the processes involving the switch between alters, with distinct personalities, voices and behavioral patterns. Kluft suggests that the identification of different personality states form the basis of treatment of multiple personalities. The approach incorporating, Cognitive Behavioral Therapy aids patients to discover alternative coping mechanisms, to deal with severe stress. Relaxation techniques and temporary breaks from stressful situations are suggested. During treatment, psychiatrists indicate the substitution of distorted patterns of thoughts, perceptions and interactions by simulating models of appropriate behavior. Psychologist Kluft states that about 80% of the patients with multiple personalities recover, with the eventual subsidence of the multiple alters, when treated by specialists. Management of malevolent personality states with anti-social personality traits forms a formidable challenge to the effective treatment of such cases. The treatment usually involves psychotherapy, supervised by an expert specialist in multiple personality disorders. The psychotherapy is intended to bring out the different personality states of the patient, also known as mapping. The deep seated trauma is dealt with, and an attempt to merge the various fragmented identities into one central personality is aimed at. Thereafter the specialist tries to stabilize the integrated personality. As the patient retrieves their lost memories, and develops skills to deal with their traumatic history, they are able to gradually shed off their alters. Therapy for family members and group therapy involving other patients suffering from the same disorder, are recommended, to help the patients in their path to recovery. Some specialists also prescribe tranquilizers to soothe the alters suffering from anxiety or depression. Hypnotic therapy is a a preferred mode of treatment for many therapists, which usually helps them to uncover the patient's deeply buried memories or traumas. Hypnosis is also used in the process of integration of alters. Hypnotherapy also helps in containing behavioral traits, such as self destructive tendencies. Medications are usually avoided during the treatment, given the disposition of patients to become dependent on them.

Conclusion

Multiple personalities is a disorder, characterized by dissociation of the central consciousness into at least two or more autonomous identities or personality states. Each personality states is referred to as alter. It has been observed by psychologists that the alters have separate identities, and separate sets of memory, thoughts and mannerisms. They usually have a sense of ownership over their actions, thoughts and behaviors, but are essentially detached from other alters. They exhibit no ownership or responsibility over thoughts and action of other alters. The process of dissociation makes the person forget about the experiences of other alters, allowing the patients to survive severe and repeated trauma. They have little or no memory of their other identities. The diagnosis of multiple personalities is shrouded in controversies, with at least 50% of the psychologists denying multiple personalities, as a real disease with core symptoms. This skepticism hinders the timely diagnosis and treatment of multiple personalities, as the patients are often misdiagnosed with Post Traumatic Stress Disorders, Borderline Personality Disorder, Schizophrenia, or depression/anxiety. Adequate training on the evaluation of multiple personalities, with a reliable set of structured questionnaire for identifying the symptoms, may remove the skepticism revolving around the actuality of the disease. Due precaution on eliminating artificial or induced symptoms, on the part of the therapist may help in expediting the treatment of multiple personalities, eradicating the agony and suffering of patients living confused or incoherent lives.

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