Child Abuse And Multiple Personality Disorder - Treatment of MPD

Written by Philip M. Coons, M.D.

Treatment Of Multiple Personality Disorder

Since several excellent reviews of the treatment of multiple personality disorder exist [6, 37-40], treatment will only be summarized here. Particular emphasis will be placed on treatment of multiple personality in children. In the initial phase of treatment, trust is an extremely important issue. Trust may be very difficult to obtain because of the previous childhood maltreatment. Trust may also be

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difficult to obtain because of previous misdiagnosis and disbelief. Once the patient feels understood and believed, however, the patient becomes a steadfast and willing partner in the treatment process.

In adults the making of the diagnosis and the sharing of the diagnosis with the patient is an important part of the initial therapy. This sharing process must be done in a gentle and timely manner to avoid the patient fleeing therapy after becoming fearful of the implications of dissociation. This particular step in therapy with children is relatively unimportant because of their relative lack of abstractive ability and the lack of narcissistic investment in separateness by the alter personalities.

A third task in the initial phase of treatment is to establish communication with all of the alter personalities in order to learn their names, origins, functions, problems, and relationships to the other personalities. In case any of the personalities are dangerous to themselves or others, contracts should be made against acting out in any harmful manner.

The initial phase of therapy may occur very rapidly or may take several months depending on the amount of trust present. The middle phase of treatment is the most lengthy phase and may extend into years of work.

The middle phase of treatment involves helping the original personality and the alter personalities with their problems. The original personality needs to learn how to cope with dissociated affects and impulses such as anger, depression, and sexuality. The traumatic experiences should be explored and worked through with all of the personalities. The therapeutic use of dreams, fantasies, and hallucinations can be very helpful in this working through process. Amnesiac barriers should be broken down during this middle phase. This may be accomplished through the use of audio tapes, videotapes, journal writing, hypnosis, and direct feedback from the therapist or significant relations. Intrapersonality cooperation and communication should be facilitated during this phase of treatment.

The final phase of therapy involves fusion or integration of the personalities. Although hypnosis may facilitate this process, it is not absolutely necessary. Therapy does not end with integration, however, as integrated patients must practice their newfound intrapsychic defenses and coping mechanisms or the risk of renewed dissociation is great. The patient's transference, especially the dependence, hostility, or seductiveness towards the therapist, may sorely test the therapist's patience. Likewise the therapist's counter transference feelings, which may include over fascination, over investment, intellectualization, withdrawal, disbelief, bewilderment, exasperation, anger, or exhaustion, should be closely monitored. Hospital treatment may be useful to protect the patient from self-destructive urges, treat psychotic episodes, or to treat a severely dysfunctional patient who is unable to provide for basic needs. Psychotropic medication does not treat the basic psychopathology of multiple personality. Antipsychotic medication may be useful temporarily to treat a brief psychosis. Antidepressants are occasionally useful for an accompanying affective disorder. Minor tranquilizers should be avoided except for temporary use to decrease massive anxiety because of the significant abuse potential in multiple personality. Alcohol and drugs are frequently used and abused by the patient to avoid painful affects and memories. The treatment of a child with multiple personality takes far less time than treatment of an adult. In the treatment of children Kluft and Fagan and McMahon utilized various techniques including play therapy, hypnotherapy, and abreaction in order to bring about integration [25, 26]. Kluft placed particular emphasis on family intervention and agency involvement both to prevent further abuse and to alter pathological patterns of interaction.

Conclusions

The psychiatric syndrome of multiple personality is associated with an extremely high incidence of physical and/or sexual abuse during childhood. The abuse is usually severe, prolonged, and perpetrated by family members. Multiple personality may be difficult to diagnose because of the subtlety of the presenting symptoms. the patient's fear of being labeled crazy and the clinician's mistaken belief that multiple personality is a rare condition. Currently multiple personality is usually diagnosed in adults who are in their late 20s or early 30s. The diagnosis of multiple personality in children is even more difficult because of the subtlety of symptoms and the ease with which these symptoms are confused with fantasy. Although individuals with multiple personality do not usually abuse their own children, the incidence of psychiatric disturbance in their children is high. Multiple personality is much easier to treat if diagnosed early in childhood or adolescence. Therefore, in order to decrease the morbidity of multiple personality and decrease the psychiatric disturbance in children of multiple personality parents, it behooves the clinician to become well acquainted with the syndrome of multiple personality, to diagnose multiple personality as early as possible, and to insure that the individual with multiple personality obtains effective treatment.

next: Multiple Personality Mirrors of a New Model of Mind?