Child Abuse And Multiple Personality Disorder

Written by Philip M. Coons, M.D.

Department of Psychiatry, Indiana University School of Medicine

Abstract: The syndrome of multiple personality is associated with a high incidence of physical and/or sexual abuse in childhood. Occasionally those with multiple personality abuse their own children. Multiple personality is difficult to diagnose both because of the nature of the syndrome and because of professional reluctance. Although multiple personality is most difficult to diagnose during childhood because of the subtlety of the syndrome. The much higher morbidity found in adult cases makes it

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imperative that it be diagnosed and treated early in order to avoid further abuse and greater morbidity and to shorten treatment time. This review describes the history, clinical features and treatment of multiple personality, particularly in children, in addition to exploring the professional reluctance to make the diagnosis.

Introduction: MULTIPLE PERSONALITY DISORDER is of special interest to clinicians interested in child abuse and neglect because patients with multiple personality were almost invariably abused either physically or sexually when they were children. Like other victims of child abuse. sometimes those with multiple personality abuse their children. Also. like child abuse. there is a professional reluctance to diagnose multiple personality. Perhaps most importantly, clinicians working in the area of child abuse have the opportunity of diagnosing incipient multiple personality in children and initiate early intervention leading to successful treatment.

History Of Multiple Personality

The history of the dissociative disorders, which include multiple personality, extends back into the New Testament times of the first century when numerous references to demon possession, a forerunner of multiple personality, were described [1, 2]. The phenomenon of possession continued to be prevalent until well into the 19th century and is still prevalent in certain areas of the world [2, 3]. However, beginning in the 18th century, the possession phenomenon began to decline and the first case of multiple was described by Eberhardt Gmelin in 1791 [2]. The first American case, that of Mary Reynolds, was first reported in 1815 [2]. The late 19th century saw a flurry of publications about multiple personality [4], but the relationship of multiple personality to child abuse was not generally recognized until the publication of Sybil in 1973 [5]. The growth of interest in multiple personality has paralleled that of incest with which it is closely related. The reports of both incest and multiple personality have greatly increased since 1970 [6].

Clinical Description Of Multiple Personality

Multiple personality is defined by the DSM-III as:

1. The existence within the individual of two or more distinct personalities. Each of which is dominant at a particular time.
2. The personality that is dominant at any particular time determines the individual's behavior.
3. Each individual personality is complex and integrated with its own unique behavior patterns and social relationships [7].

Unfortunately the description of multiple personality in the DSM-111 has led, in part, to frequent misdiagnosis and under diagnosis [8]. Multiple personality most often presents with depression and suicidality rather than personality changes and amnesia which are obvious clues to dissociation |3, 8]. The amnesia in multiple personality includes amnesia for traumatic experiences in the remote past and amnesia for recent events which occurred while the individual was dissociated into another personality. Often emotional stress precipitates dissociation. The amnesiac episodes generally last from a few minutes to a few hours but occasionally may last from a few days to a few months. The original personality is usually amnesiac for the secondary personalities while the secondary personalities may have varying awareness of one another. Sometimes a secondary personality may exhibit the phenomenon of co-consciousness and be aware of events even when another personality is dominant. Generally the original personality is rather reserved and depleted of affect [5]. The secondary personalities usually express affects or impulses unacceptable to the primary personality such as anger, depression, or sexuality. Differences between personalities may be quite subtle or quite striking. Personalities may be of different age, race, sex, sexual orientation, or parentage from the original. Most often the personalities have chosen proper names for themselves. Psychophysiologic symptoms are extremely frequent in multiple personality [9]. Headaches are extremely common as are hysterical conversion symptoms and symptoms of sexual dysfunction [3, 10].