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Child Abuse And Multiple Personality
Disorder
Philip M. Coons, M.D.
Department of Psychiatry, Indiana University School of Medicine
page 3
Types Of Child Abuse Experienced By Multiple
Personality Victims
Trauma has long been recognized as an essential criterion for the production
of dissociative disorders including multiple personality [12]. The various
types of trauma include childhood physical and sexual abuse. rape, combat,
natural disasters, accidents, concentration camp experiences, loss of loved
ones, financial catastrophes. and severe marital discord [12]. As early as
1896, Freud recognized that early childhood seduction experiences were
responsible for 18 female cases of hysteria, a condition closely associated
with dissociative disorders [13]. In the famous case of Dora. the patient's
complaint of a sexually seductive adult was corroborated by other family
members [14. 15]. In another famous case of hysteria, Anna O, who suffered from
dual personality, the initial trauma was the death of Anna O's father [16. 17].
It was not until the publication of Sybil in 1973 that childhood physical
and sexual abuse became widely recognized as precipitants of multiple
personality [5]. Since 1973 numerous investigators have confirmed the high
incidence of physical and sexual abuse in multiple personality [6, 18, 19]. In
100 cases Putnam found an 83% incidence of sexual abuse, 75% incidence of
physical abuse, 61% incidence of extreme neglect or abandonment. and an overall
97% incidence of any type of trauma [20]. In Bliss' series of 70 patients, of
whom only 32 met the DSM-111 criteria for multiple personality, there was a 40%
incidence of physical abuse and a 60% incidence of sexual abuse in the female
patients [21]. Coons reports a 75% incidence of sexual abuse. a 55% incidence
of physical abuse, and an overall 85% incidence of either type of abuse in a
series of 20 patients [10]. The types of child abuse experienced by victims of
multiple personality are quite varied [22]. Sexual abuses include incest, rape,
sexual molestation. sodomy. cutting of the sexual organs, and inserting objects
into the sexual organs. Physical abuses include cutting, bruising. beating,
hanging. tying up, and being locked in closets and cellars. Neglect and verbal
abuse are also common.
The abuse in multiple personality is usually severe, prolonged. and
perpetrated by family members who are bound to the child in a love-hate
relationship [IO, 22, 23]. For example, in one study of 20 patients. abuse
occurred over periods ranging from 1 to 16 years. In only one instance was the
abuser not a family member. The abuses included incest. sexual molestation,
beating, neglect, burning and verbal abuse.
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:
- A history of repeated child abuse.
- Subtle alternating personality changes such as a shy child with depressed.
angry. seductive. and/or regressive episodes.
- Amnesia of abuse and/or other recent events such as schoolwork. angry
outbursts, regressive behavior. etc.
- Marked variations in abilities such as schoolwork. games. and music.
- Trance-like states.
- Hallucinated voices.
- Intermittent depression.
- Disavowed behaviors leading to being called a liar.
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