With more than 180 alter selves, by her reckoning, Cassandra is what psychiatrists call a "super-multiple." She would have astounded investigators of multiple personality prior to the present era, since most prior reports of MPD involved cases of dual personality. Much more rarely, multiples with three, four or possibly five alternate personalities were reported.

Cassandra is unusual even today, but her case is not unique. Dr. Richard Kluft of the University of Pennsylvania Medical School has found that the average number of alternate personalities in a multiple is 8 - 13, though dual personalities are still "not too uncommon" in men and there are other "super-multiples" with more than 100 alternates.

Dr. Frank Putnam of the National Institute of Mental Health reported similar findings at the 137th Annual Meeting of the American Psychiatric Association (APA) in Los Angeles. Putnam found an average number of 13 personalities (or personality fragments) in 100 multiples that he surveyed, and noted in addition that the greater the number of alternate personalities, the greater a multiple's self-destructiveness.

Putnam's survey also revealed that 75% of all multiples had child personalities under 12 years of age, 50% had alter personalities of the opposite sex, and over a third exhibited changes of handedness from one alter personality to another.

Inner Faces of MPD

Other common types of alter personalities found in multiples include Inner Self Helpers (ISHs) and persecutors. First identified by Dr. Ralpf Allison of Morror Bay, California, ISHs are exceptionally knowledgeable and helpful personalities who guide the multiple and sometimes aid the clinician in therapy. In his experience, said Allison in Minds in Many Pieces, ISHs often exist in a spiritual hierarchy with those highest in the hierarchy (those closest to God) being most reluctant to enter the body or communicate with the therapist.

Persecutors aim to dominate the multiple's inner family or even to destroy other alters. A product of the anger and hostility evoked by abuse, persecutors are nearly ubiquitous in multiples and are often responsible for sociopathic behavior which gets the multiple in trouble. They also embody strong masochistic tendencies, which psychiatrists say are common in multiples. Until they accept a cooperative role in the intrapsychic system (and like every other alter they personify important aspects of the whole personality), they are a source of misery and terror.

The fear that persecutors can elicit was described by Dr. Robert de Vito of Loyola University, who said in a paper prepared for the conference in Chicago:

If one could imagine the original personality "on stage" with one or more alters "in the wings" watching and/or talking to or about the original, one could begin to approximate the daily torment experienced by the original or host. When the original, host or presenting personality becomes aware that an alter or group of alters want to torture, humiliate, or even "murder" him/her, each waking moment is filled with dread. As a former patient of mine put it, "It is as if I took out a contract on myself."

The extent and strength of the dissociative barriers defining each personality vary tremendously. There may be personalities with continuos memory (given the name memory-trace personalities by Dr. Cornelia Wilbur of the University of Kentucky), personalities with continuous awareness, and yet others who are amnesiac for all or some of those with whom they are sharing a body. In short, Dr. Eugene Bliss of the University of Utah has observed, clinicians may find all gradations of awareness and control among the personalities in a multiple.

Alternate personalities who are aware of the thoughts, feelings or actions of other alters are said to be co-conscious (a term coined by one of the first U. S. investigators of multiple personality, Dr. Morton Prince). Frequently, a primary personality will be amnesiac for other alters, while one or more secondary personalities is co-conscious.

Co-presence is the ability of an alter to influence the experience or behavior of another personality. Psychiatrists such as Dr. Richard Kluft of the University of Pennsylvania (who coined the term) and de Vito think that co-presence may be a factor in producing many of the diverse symptoms that multiples exhibit. These encompass the full range of classical dissociative and conversion symptoms- blindness, paralysis, etc. - as well as unusual symptoms such as dissociative void, in which the body appears temporarily vacant of any personality. The latter, de Vito said, may reflect an internal struggle for executive control among alters.

Another unusual symptom sometimes observed in MPD is dissociative panic. This occurs when no alter can maintain control of the body for more than a few minutes, so that a rapid cycling or switching of personalities results. An episode of dissociative panic was described in The Minds of Billy Milligan following the administration of the anti-psychotic drug Thorazine to Billy:

They threw him into a small bare room...and locked the door. When Ragen heard the door slam, he got up to break it down, but Arthur froze him. Samuel took the spot, dropping to his knees, wailing, "Oy vey! God, why have you forsaken me?" Philip cursed and threw himself to the floor; David felt the pain. Lying on the mattress, Christene wept; Adalana felt her face wet in the pool of tears. Chistoper sat up and played with his shoes. Tommy started to check the door to see if he could unlock it, but Arthur yanked him off the spot. Allen started calling for his lawyer. April, filled with desire for revenge, saw the place burning. Devin cursed. Steve mocked him. Lee laughed. Bobby fantasized that he could fly out the window. Jason threw a tantrum. Mark, Walter, Martin and Timothy raved wildly in the locked room. Shawn made a buzzing sound. Arthur no longer controlled the undesirables.