Reading Room
Child Abuse And Multiple Personality
Disorder
Philip M. Coons, M.D.
Department of Psychiatry, Indiana University School of Medicine
page 2
Clinical Description Of Multiple
Personality
Multiple personality is defined by the DSM-III as:
- The existence within the individual of two or more distinct personalities.
Each of which is dominant at a particular time.
- The personality that is dominant at any particular time determines the
individual's behavior.
- 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]. Transient psychotic episodes may
occur in multiple personality [11]. Hallucinations during such episodes are
usually of a complex visual nature indicating an hysterical type of psychosis.
Sometimes a personality will hear the voices of other personalities. These
voices, which occasionally are of a command type, appear to come from inside
the head, and should not be confused with the auditory hallucinations of the
schizophrenic which usually come from outside the head. Most often stress
precipitates the transition between personalities. These transitions may be
dramatic or quite subtle. In a clinical situation the transition may be
facilitated by asking to speak to a particular personality or by the use of
hypnosis. The switching process usually takes several seconds while the patient
closes the eyes or appears to look blank, as if in a trance.
The onset of multiple personality generally occurs in childhood, although
the condition is not usually diagnosed until adolescence or early adulthood.
The sex incidence is about 85% female [11]. This increased incidence of
multiple personality in women may occur because sexual abuse and incest, which
are strongly associated with multiple personality, occur predominantly in
female children and adolescents. The degree of impairment in multiple
personality may vary from mild to severe. Although multiple personality was
thought to be quite rare, recently it has been reported to be more common [8].
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