Child Abuse And Multiple Personality Disorder - Child Abuse by MPD's

Written by Philip M. Coons, M.D.

Multiple Personality Disorder In Children

No cases of childhood multiple personality disorder were reported between 1840 and 1984 [24]. In 1840 Despine Pete reported the first case of childhood multiple personality in an Il-year-old girl [2]. Since 1984 at least seven cases of childhood multiple personality disorder have appeared in the literature [24-27]. The reported cases range in age from 8 to 12 years.

From these first few reported cases the symptoms characteristic of childhood multiple personality begin to emerge and reveal some marked differences when compared to adults [25]. In the childhood form of multiple personality the difference between personalities are quite subtle. In addition the number of personalities is fewer. So far an average of 4 (range 2-6) personalities have been reported in children. while the average number of personalities reported in adults is about 13 (range 2 to 100+). Symptoms of depression and somatic complaints are less common in children but the symptoms of amnesia and inner voices are not decreased. Perhaps most importantly, the therapy of children with multiple personality is usually brief and marked by steady improvement. In adults therapy may last anywhere from 2 to over 10 years. while in children therapy may only last a few months. Kluft believes this shorter therapy time is due to the lack of narcissistic investment in separateness [25].

Kluft and Putnam have derived a list of symptoms characteristic of childhood multiple personality disorder [24]. The main characteristics include the following:

1. A history of repeated child abuse.
2. Subtle alternating personality changes such as a shy child with depressed. angry. seductive. and/or regressive episodes.
3. Amnesia of abuse and/or other recent events such as schoolwork. angry outbursts, regressive behavior. etc.
4. Marked variations in abilities such as schoolwork. games. and music.
5. Trance-like states.
6. Hallucinated voices.
7. Intermittent depression.
8. Disavowed behaviors leading to being called a liar.

Childhood Abuse Perpetrated By Adults With Multiple Personality

Relatively little is known about multiple personality parents who abuse their children. In the only study to date. the children of parents with multiple personality disorder tend to have a higher rate of psychiatric disturbance when compared to a control group of children with parents having other psychiatric disturbances.. where. the incidence of child abuse between the two groups was not significant [28]:In this 'study child abuse occurred in 2 of 20 families which included at least one multiple personality parent. In one family the son of a multiple personality mother was severely neglected secondarily to the mother's frequent dissociation and the severe drug abuse by both parents. This child was subsequently removed from the home. In the second family the father. who was not a multiple personality. sexually abused his son. The abuse ceased when the parents divorced but began again when the father regained custody secondarily to the mother's inability to control her teenage son. Most of the multiple personality parents in this series tried to be very good parents in order to insure that their children did not suffer child abuse as they had.

In another reported case an 18-month-old girl was physically abused by her stepfather who was a multiple personality [29]. The abuse ceased when the parents divorced subsequent to the episode of physical abuse which left the child in a transient coma and a retinal hemorrhage.

The management of parents with multiple personality who abuse their children should be handled like any other case of child abuse. The child abuse should be reported to the appropriate child protective services and the child should be removed from the home if necessary. Obviously the parent with multiple personality should be in therapy and attempts to help the abusive personality should be of paramount importance. Management should then proceed on a case by case bases [30, 31].

Professional Reluctance To Diagnose Multiple Personality

Like child abuse, particularly incest, there is a professional reluctance to diagnose multiple personality disorder. In all likelihood this reluctance stems from a number of factors including the generally subtle presentation of the symptoms, the fearful reluctance of the patient to divulge important clinical information, professional ignorance concerning dissociative disorders, and the reluctance of the clinician to believe that incest actually occurs and is not the product of fantasy.

If the patient with multiple personality presents with depression and suicidality and if the differences between personalities is subtle, the diagnosis may be missed. The changes in personality may be attributed to a simple mood change. for instance. In other cases individuals with multiple personality may go through prolonged periods without dissociation, and, therefore, the diagnosis is missed because a "window of diagnosibility" did not exist at the time of the clinical examination [8].

In addition to the subtle presentation of multiple personality, most individuals with this disorder consciously withhold vital clinical information about memory loss, hallucinations, and knowledge of other personalities in order to avoid being labeled "crazy." Others withhold information out of distrust. Still others are totally unaware that they are symptomatic. For instance, they may be completely unaware of alter personalities, and the time loss or time distortion which they experience may have occurred for such a long time that they consider it to be normal.

Professional ignorance about multiple personality is likely to be due to several factors. Because multiple personality was thought to be a rare disorder, many clinicians assumed that they would never see one in their practice. This false assumption caused many clinicians not to consider multiple personality in their differential diagnosis. In addition multiple personality did not appear as an official disorder until the publication of DSM-111 in 1980. Finally. until the past ten years, many psychiatric journals refused to publish articles about multiple personality because the disorder was felt to be rare or nonexistent and of little interest to their readers.

The reluctance of the clinician to believe that incest occurred in their patients is perhaps the most troubling aspect regarding the misdiagnosis of multiple personality. In many cases stories of incest have been assumed to be fantasies or outright lies. This practice of nonbelief has occurred despite examples where sexual abuse has been carefully confirmed with collateral sources [5, 32]. A number of authors [33-35] have written about this problem of clinician disbelief which is thought to be a counter transference reaction to the traumatized victim [34].

Undoubtedly Freud's renunciation of his earlier belief in the seduction theory was a setback to understanding incest [36]. For many years after Freud's renunciation, clinicians assumed stories of incest to be fantasy. Benedek pointed out that the counter transference reactions to victim's traumatic abuse included extreme anxiety about the abuse and resultant avoidance of the topic, a conspiracy to maintain silence about the abuse, and blaming the victim for the abuse [34]. Goodwin suggested that the clinician's incredulity regarding the abuse functions to make one believe that the patient and her family are not as sick as they seem, and, therefore, the uncomfortable reality of having to report abuse or appear in court is unnecessary [35]. Goodwin also suggested that disbelief shields the clinician from the powerful rage expressed by the victim and her family if confrontation about the abuse occurs.