Vol. I (1),4-23,1988 ofuse, making it likely that uhimately di5S0ciatian will be under The BASK Model of Dissociation stood along muhiple lines ofstudy. TM BA.SK modd amaptualM the complex phenommowgy ofdis For reprints write: sociation along with dimensionsof&hauior, Affed, Sensation, alld Walter C. Young, M.D. KnfJWkd~. The jmJUSJ ofdissocia'ion ilstlf, h)'Jmosis, and tkclin National Center for the Treaunent of ital mental d.i.umlers that constitute the dissociative disorders art Dissociative Disorders tk$cribui in tenru ofthis nUJ(M. alld iUustraud. 1300 Soulh POlomac, Suite 152 For reprints write: Aurora, CO 80012 Bennen G. Braun, M.D. 9701 Knox Avenue, Suite 103 Vol. I (I), 3946,1988 Skokie, lL 60076 DSM-Ill-R Revisions in the Dissociative Disorders: An Exploration or their Derivation and Rationale Vol. I (1),24-32,1988 The authors liescribt and explore changes in the dissociative disor The Switch Process in Multiple Personality Disorder and ders indutkd in the new DSM-IlI-R. The classification itself was Oilier State-Change Disorders redefined to minimize inadvertent areas ofuumap with other clas This papn- aplurts the properties ofstales ofrons~as they sifications. Rtantfindings hawmassitaUd substantial mri.sions art revtakd by the jJrtJaS$ ofstak-duln~orswilchi1lg. Drawingon oftlu critrna and texl for muhipk personality disorder. Ga'lser'S examples ofstate of ronsci()US1USS tronsiLi01ts in infants, alU:Ttd Syndrome, listed as afaditious disorckr in DSM-ill, is reclassified states ofconsciousness, and psychUUric disorders, a number ofrom on the basis ofrtU1lt research as a dissociatiw disorder not other mon prinaples arederiV«i. TheYindwktheobseroation thai states wise specijiLd. The examplesfor dissociative disorder not otherwise ofronsciousness art dismteSLlf-organixingpatJerns ofbehaviordif sfJecifml. hUlJi! been exj>atukd to bttur accommodate recogtliud dis feri'llg along axes ofaffed, access to memory, allention and cogni sociative .ryndromes toot dv notJall within thefourfonnally dtfirud tion, regukltory physiology, and sense ofself. State transitions are dissociative disorders. Several novel diagnostic entities and reclas marked by non-linear changes in these variables. A developmental sifications were !n'Oposed that were reJltcted for DSM-I1I-R because model is outlined and the implications Jor treatment and further there is insufficient S11P/Jmting dala at this point in time. Thesepro research an discu.s.sed. posals idenlifj issues that will requirt reconsideration for DSM-IV. For reprints write: For reprints wrile: Frank W. PUUlam, M.D. Richard P. KJuft, M.D. Room 105 Dissociative Disorders Program Building 15-K., NIMH The Institute of Pennsylvania Hospital 9000 Rockville Pike III onh 49th Street Bethesda, MD 20892 Philadelphia, PA 19139
Vo!. I (1),33-38,1988 Vo!'1 (1),47-53,1988 Psychodynamics and Dissociation: AU iliat Switches Psychophysiologic Aspects of Multiple is nol Splil Personality Disorder: A Review This paper amtrosiS the roles ofsplitting and dissociation in mul Muhiple personality disorder has been associated with marked ps~ tiplepersonality disorder. /l is proposed that dissociation is aunique chophysiologic alterations ever since careful clinical observations defensive process that serves to protect the patient from the over have bem TIUUie on this perplexingdisorrkr. Physical symptoms known whelmingtlJects ofseuere trauma and that multiple personality dis to be associated with multiple personality include headaches, con order nuti not call ufHm splitting as its central defensive process. vtrrionsymptoms, changesin voice, stUurt-likeadivity, untxfJklintd Fantasies ofrestitution may be incorporaUd into the dissociativt pain or insensitivity to pain, alterations in hantkdnLSS f7f" hand defense. Psydwiogical, physiological, and behavioral mOlhls aLL an! wriling style, palpitations, aheralions in respiration, gastroinlesti-
43
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naldisturoanas im:luding bulimia and anorexia, menstrual img ddnminants. ull'lrities, 5l!XUol dJ$Ju nclion, andthnnaloWgimiamdiuon$indutt For reprints write: ing unusual alhrgic responses and differential respoTUe5 to nmii George B. Greaves, Ph.D. rntion.EarlyscimlijiCSludiesonthegalvanicskinmportMinmulJiple 529 Pharr Road personality disortkr were conducted by PritlU in lM early twentieth Atlanta, GA 30305 U1ltUry. Since 1970 IMrf has been a murgenu afinterest in mul liple personality disorder includingsophisticated studies a/physical Vol. I (1),67-72,1988 symptoms, brain-wave activily, visual evoked pOlentia~ rtgional The Management of Malevolent Ego States in Multiple cerebral blood flow, visual refraction, muscle activity, cardiac and Personality Disorder respiratory activity, galvanic skin rtsponse, and the switch process. "Malevolmt" persolwlities create tremendous frroblems to both tM In addition 10 tkscribing these studies, the etioroliJ ojmultlpte per patient and the therapist. The dangers ofpossible suicide, homicide sonalily duorderand!uturedinctions in resLaTCh will be disl.'U.JMd. and other nding-old by such angry states multiply tM diffilUllitts For reprints write: in achieuing jJt:r3onality inugration. Such entities originally devel Philip M. Coons. M.D. oped to jJrrHed tM individuaL They represent a defenufor- the abusM Larue D. Carter Memorial Hospital child wlw was conJronud with a situation with which he could not
1315 West 10th Srreet cope. Suggestions by tM therapist that the trMJ,ment gool is ".fusion B Indianapolis, IN 46202 constitute a threat to the e:mtmce ofaller personalities, and mobi liu their resistance. E~stale tMary Iwlds that "dividing B lies on a Vol. I (1). 54-60,1988 continuum, rangingJrom normal, adaptive difJermtiu.tion (as rep Munchausen's Syndrome as a Dissociative Disorder restmted by different moods) to jJalhowgical dissociation (as rejm A patient is described who was diagnosed as havingMunchausen 's sented by tnu multiplepersonality disorder). &tween lie covert "egcr Syndrome and Munchausen's by Proxy as wells as Multiple states"which areorganizations ofbehaviorandexperitmu separated Personality Disorder. Commonalities belween Munchaust11 j (lnd by snni-permeable boundaries. In this theory, treatment ofMultiple Multiple Personality Disorder include: multigenerational patterns, Pmonality Disorder involves reducing the rigidity ofthe boundarie.s selfmutilating fNhaviors, mllitiple .fOmatic symptoms, having been a'nd mOIlingthem down tM continllU m11 ntilthey fNcomugo-stat~ accused ofLying. use ofmany difJermt natll~, andfuguelilu dis such as are found in normal subfrcts under hJPnosis. From this appearances. Com/'1Wflalities fNtwmt Mundulllsni 's andchild abuse point ofview malevolent alters nNt! nol to be threatened with non nlated ~haviors incllUk hospitalperegrination and tM productitm existence, but are promised amtinutd selfness and identity within ofirnukquak explanations for injlided injuries. The pment case a larguorganiUJti01wljramDJJtl'fk. Such an approach lowers thrir is one ofa snies ofMunchausen 's Syndrome uue rrpoTts in which resistance to treatment, and "integration" (which is 'not the same as extreme abuse has been documented in the patient schildhood. ".fusWn") is moreMSilyattairud. ThetherapistfNcomes their jriend" For reprinlS write: rather than their "enem)'. " Jean Goodwin, M.D., M.P.H. For reprints write: Depanment of Psychiatry John G. Watkins, Ph.D. University ofTexas Medical Branch 413 Evans Street Galveston, TX 77550 Missoula, MT 59801
Vol. 1 (1),61-66, 1988 Vol. I (1),73-76,1988 Common mors in the Treatment of Multiple Multiple Personality Disorder and Transference Personality Disorder The aptn"eciation, interpretation, and management oftransJermce Psydwthnafrists report withl:y different expmenas in tMiraunnplS constitutes a crucial dimension in the treatment of multiple per at treating multiple personality disonin' (MPD) patients. So~ have sonalilJ disorder. TM auilwroffers remarks atui observations bastd dnpened thrir intmsts and d~lopedfulJAiJ7U specialiud practius on a considerable body ofdirea clinico.l expmenct! and consulta with this clinical population. OthDJ have declined to have anyfur tions to colJeagu~. The most commonly encountered problematic ther contact with them at all, nfe:rri"g possible MPD patients to col transference in work with MPD, tM hostile, erotic, and dependent. !Lapes when they first susput that this disordermll)' be presmt. Still are illustrated and discussed. others have decided against treating more than one or two MPD For reprinlS write: patients. These diverse decisions are examined with a focus upon Cornelia B. Wilbur, M.D. tM effects oftherapist' uneven allention to the fonnal paperties of 408 .Bristol Road the dyadicpsychotherapeutic experiences as apossible i njluence upon Lexington, KY 40502 thnrfuture work with MPD. Problems concerning tM..framework of psychotherapy andthe cou nterlra'nsff:'(ence conflicts which oflen mow the therapist unconsciously and irrationally to altf:'( tM canons of psychotherafrJ in mutually detrimental ways appear to be crucial
44 0I'11,(1( 1\[10\ \,,1 \ \" I \I~,,~ 1'I'Il~ ! VOLUMES 1-IV, 1988 - 1991
Vol. I (1),77-83,1988 Vol. I (2), 16-23, 1988 Multiple Personality Disorder Misdiagnosed as Mental The BASK Model of Dissociation: Clinical Applications Retardation: A Case Report This article is a continuation ojthe BASK Modd ofDissociation: A woman was diagnosed as mLntolly morded when SM was)nM Part I, which disCUSSLd the phnJornena and tlmTry ofdWodation. a~ Jtars of and spenl 1M next 35 years so classifud. She also was It wtS1MjJrntiou.sly dt:scribtd BASKModd (&havi«, A/fN1, Smsation, amsidemf schiwphrenic. Incongruities in her clinicalpresentation Kl'lawkdge lewis within a tim~ continuum) and applies it to treat ultimately led to lhe suspicion tllljl she suffered mulJiple personali menlo Si"ce tnatment is a dJnamic amupt and knawkdge is a stat Iy disorder. !l was found that she had ntrtated into an adaptation iclerm, BASKischang«/ toB.4TS, wheei" theadivetenn '"thought" consistent with the superficial manifest appearance ojmental utor· is substitutHifor '"knuwkdge. "The intcrr~lationshipofthe wriow datiqn, and lhat the intrusion ofher diJrociative psychopatholOf:fJ dimensions ofthe BATS mod~l is demonstraUd and describM. Th~ was mistaken for schiwphTfmia. Cmrtctly diagnosed and treated, BASK format is used to describe huw a behavior, affect, thought sill. has made nolromrthy gains. Selected issues relevant to the mis and/or sensation due is used to track down and synthesize the diagnosis ofIHPD are discussed. BASK/BATS components in psychotherapy Ihrough work wilh dif For rcprints write: ferenlJ)ersonalilies and/or fragmenls. A main thesis is thaI con,. Gail Alias, A.C.S.W., CAe. gruence ofthe BASK/BATS tev"l across the space/lime conlinl/Um is 909 Boulevard required for healthy functioning. It is hoped from lhis discussion Westfield, 1\'] 07090 that the relUUr" wiU get a sufficimt understanding ofthe practical use ojthe BASK 11llXkl and thai he/she might apply ilto her/his Vol. I (2),2-15,1988 school and pradice ofpS}'cholherapy. Toward a Psychobiological Theory of For reprints wrile: Borderline Personality Disorder Bennett G. Braun, M.D. This paper proposes a psyc1wlDgical Tn()(k[ oj1M bonkrline condi 9701 Knox Avenue, Suile 103 tions that explores tkroleoja hyperirritability that may either anu. Skokie, IL 60076 date parenkhildinteradUms orstand apartfrom traditional devel opmental stages. It suggests that one pathway toward this Vol. I (2), 24-26, 1988 hJperirrilabililJ is the traumatic effect ojabuse, which 'IW)' alter the Detennining Prognosis in the Treatment of Multiple nel.lroregulatory response system in ways that cannot be accountM Personality Disorder Jor in purely dnJelopmentaJ nuxiL/.5. The therapeutic implications oj lktmnining the prognosis ofa multiplepersonality dirordc (AfPD) this model an rt:vitwtd. The brain is placed betwt:tTl two orders oj patit:nt has reaived litll~sysJemalic aUmtilm in th~lilemlure. Drawing stimuffltion, those which proc«dJrom the Ilerot:S oJthentemalsens on clinical experitlice. the author offers mtmi questions that he es, and those which it receives from the nt:1Vts ojthe intt:nwl vis finds useful in gauging whethtr or 'lot an lUI'D patient is likely to cca....(once) Excitants...having acted with too great tllerlfj, and have a good or poor PrOWlOsis for a relatively straighiforvJard psy during too umg a lime, Ihe brain...assu mes a state ofirritalion; chotherapy and constructive outcom~. In the author's exjJerience, innervation becomes excessive, which appears by an augmtlltation patients who have less favorable prognosis in terms ofthese ques ofsensalionandmolion.FJ. V. Bro-ussais, On Irritation & ItlSatlity, tions generally will have difficult and prolonged therapies, and are 11'.: T 0xJper, M.D. 1831, p. 233. So then, this exuberant activi more likely to interrupt treatmelll, reach a stalemate in tmllment, ty ofl1WMry, its bizarre combinations ofthe imagination, reduCt: or fare poorly. tll£1l1.selves, physiologically speaking, to anexcessively /iVi!ly andtena David Caul, M.D. cious action-toan irrilatWn ofthe ill{racronial nervous substance c/o Richard P. Kluft, M.D. sub.servillgtheoperationsoftheintelkct... memcrycanrwtbeexplairud The InstiLute of Pennsylvania Hospital other than as a a:rebra1 e:u:ilalion, which renews itselfeven in the Dissociative Disorders Program absmaoJthecausewhit:h hadlongagoprovokdit. FJ V: Broussais, III North 49th Street 1828, pp. 447-8. (Tr. by the author). May not these melandwly Philadelphia, PA 19139 thpartuns from ordinary and hea/1hy modes. by thought, impulse and adi01l amstiiutet:viMnu.. oJundeJeatM, unpnuived, unm· Vol. I (2), 27-33, 1988 ogniud mental disease, in all probability arisingfrom cerebral irri Diagnosis of Covert and Subtle Forms of Multiple tatUm ... 1F lVins/ow, 1861 (p. 160). Personality Disorder For reprints write: Thenandifferenlfrmns ofmultiplepmonalilJ disorder (AfP/)) that Michael H. Slone, M.D. wry on a dWociative continuum from subtle forms in which the Box 125 altm are 1lot very distinct or ~laboralM and often influence each NY SLale Psychiatric Instinue other without assumillgJll11 control, to patients withfull)' developed 722 Wesl 168Lh Street MI'D, whose alters are distilld, elaboratM, assumefull control, and New York, NY 10032 emerguromly. Most MPf) patientsl»?Senl amvertly, amiso'TU!patients with covm presentalions will later show overt classic symptoms,
45 \1~I(h Igq~ , [)l'i'iO( 1\110\ \(11 \ \0 1 - DISSOCIATION: ABSTRACTS
while those with subtleforms wiU often remain mild and subdued. For reprints write: Mosl MPD patients hUh ordisguise IMrcondition, whilethdT alkn Colin A. Ross. M.D., F.R...C.P.c. express Ihn,. tlwuglus andfulings through subtk dissociative signs Charter Hospilal ofDallas that oaurwhen the alJers inJlULnu etUh other, partly emerge, and 6800 Preston Road subtly shift. These signs consist offmlurot, sonuti71U!S sudden,fluc· Plano, Texas 75024 tuations in affects, thoughts and behaviors, transferences. deveVJj> mmlallevels, and pyschiatric sympwms, and 11/{lrW discrepancits Vol. I (2), 43-47, 1988 in rnemO'rUs, viewjXJint, and attitum, which may indicate the pos The Core Self: A Developmental Perspective sible frmena oJ alters and of MPD or Dissociative Disorder Not on the Dissociative Dison:l.ers Otherwise S~ci.fied: variants of MPD. The cast ofsubtle form oj Multipk Pmonalily Disordrr and tlu Dissociative Disorderl are MPD is frnMnUd which illustrates some ojthe subtk signs ofdw(} charactniud by tlusubpctive orperienus ofextremefragmentation, ciaticm and oth6dissociativesymptoms oftm Stt1I in theM palin1ls. disorgunization, and disintngration. Whik our current system of For reprints write: classifications idmtifiLs these specifically. lUcentfindingsfrom devd Jean Franklin, M.D. opmentalpsycJwlogy and infant rt:WJrch pruvitkobservati01laldata 274 North Pleasant Street which de.st.ribe stages of~lfd.etNlopment. The carifulfocus in thiJ Amherst, MA 0I002 worlc on tkfiningand describing tM domllins of~lfexperiencepr0 vides a UM:ful framework for stud)'ing Dissociative Disor~. Vol. I (2). 34-38, 1988 For reprints write: Some Aspects of Resistance in the Treatment of Multiple David L. Fink, M.D. Personality Disorder Dissociative Disorders Program Therapists who trtat patients with Multiple Personality Disorder The Institute ofPennsylvania Hospital (MPD) rommonly experiencediscomfortandfrustration. This paper III North 49th Street contends that the 1IlO$t significant cause oftherapist discomfort is Philadelphia, PA 19139 tM particular resistances ttlcountoul in th~ trrotment ofMPD. In MPD, dioibgic childhood traumlltic npmmus ar~ tkfrnsivdy Vol. I (2). 48-5 I. 1988 rtjmssLd and di.ssot:iakd. In addition. tM normtll ability to mgage A Case of Concurrent Multiple Personality Disorder and in trusting intopmona/ rdatiunshi/M is dirruptul. Thw, a p~ Tran.ssexualism chIXhLrapy which rrquires the rttrieval ofpast traumas in tM con A transsexual patient su.IJntd a coai.sting mulJ.ipk personality 00 Uxtofan i~tMapeuticrdationship is trr:mmdm.uly thfflJt~ ortkr that wtU not diagnosed until aftrr the wmpktiOTl ofsexual ening to tM patient with MPD. In the normal mum of the rMSSignment su~. This rqxm mMws this patient J hisrory and psycJwthDnpy ofMPD. intmR resistances are ttlmunterul at ~ experienas in pS)·dwtherapy. It is important to ronsUkr the possi stage. This pajxr outlirm the nature ofmistance in the treatment bilil)' that th~ patient who Jmsents with IJufMtures ofa gmtkridm ofpatients UJith MPD, presents a numhn- ofclinical examples, and tily disorfkr may halMa concomitant dissoci1ltilM disordn". It is high discusses the importance ofun~tandingand working UJith resis ly questionable whl!tlur a patient with both t)pes ofdisorder slwuld tance as an intrinsic part ofthe treatment. reoove sexual reassignmmt surgery until the dissociative disorder For reprints write: has bern treated to a successful usolution. James A Chu, M.D. For reprints write: McLean Hospital Pearl G. Schwartz, M.Ed. 115 J\1i1l Street 416 E. South Hutchinson Street Belmont, MA 021 i8 Philadelphia, PA 19147
Vol. I (2). 39-42. 1988 Vol. 1 (3). 3-12,1988 Multiple Personality Dison:l.er Patients with A Prior Open Trial of Oonazepam in the Treatment of Diagnosis of Schizophrenia Posttraumatic Stress Symptoms in Multiple Personality The autlum roJkd.ed a series of236 cases ofmulJ.ipk persoTUJlity Disorder disordn"patients rtjxJtUd to them by 203clinic:Wns througlwut North Ft:W consistently helPful pS)'chopharmacological inlmlmtions have Amenca. The series inclutkd 81 patients who had reuived a past been de.st.ribt:d in the treatment ofmultipkpersonalit)· disorder. We diagnosis ofschiwphrenia and 96wlw had not. The patients UJith report a successful open trial ofclonaupam for posttraumatic stress a past diagnosis of schizophrenia were more st:lf-destructivt and symptoms in'a group ofpatients with multipkpersonality disorder. spent mort: ti11U! in the mentalhealJ.hsystem priorto diagnosis. During Patients rqxmed notable, sustained improvement in slap, night this period tJu:y reaived nwrt: other psychiatric diagnosis and treat mares, jla5hbacJr.s, panic attacJr.s and other posttraumlltic stress dis ments. TJu:y had nwrt: Schndnianfirst~ranJr. symptoms but did nIX order symptoms whik undergoing clonaupam treatment. The haw more auditury hal/uciTUJtions. authors discuss tJu limitatiuns oftlu current study and suggro:st a phenomenologicaljraFMJJOT1c for phamuuoiogical inU7Vtntiuns in
46 VOLUMES I- IV, 1988 -1991
mul1ipk persorwlity duorder. explores consultations regarding the "surround ~ ojtreatmmi, form For reprints write: sicnUJ1tns, theuseofhyprwsls, andamsu/talions iniliokdby patienl.S; RichardJ. Loewenstein, M.D. it amdudn with a briLf discu.s.sWn. In genn-al. tM author's erJ» Sheppard and Enoch Pratt Hospital rinlce indicated that tM Pu.blication oJDSM-III-R in 1980 and tM 6501 North Charles Strccl publicatilm ojJoor special journal issu~ in 1984 were watershtd Baltimore, MD 21285-6815 events, and marked notabk shifts in 1M naturt! ofmany ojthe con suhation requests that Iu rt!cnved. Vol. I (3), 1~20, 1988 For reprints write: Observations on Fantasy in the Fonnation of Multiple Richard P. K1ufl, M.D. Personality Disorder Dissociative Disorders Program This paper prwmls observations onJantasy as it participates in the The Institute of Pennsylvania Hospital jtm1Ulfion oftIlultipk personality disorder. It focuses on the func 111 North 49th Street tum ojreslitlltion in the fantasy life ofchildren during the devel Philadelphia, PA 19139 opmmt ofthe di.wrder. It is propomllha1 one pathway to the drvel opmml'jmulJip"pmonnlitydismdn-u'ili=..pmsMMrlydUldIwod fantasies ojmastny mmtrauma and thai these early/oulasiesform Vol. 1(3).30-35,1988 a psychological $lmcture which is amalgamated with dissociative On Giving Consultations To Therapists Treating Multiple defenses to evol~ the clinical picture ofmullipk pn-sonality disor Personality Disorder: Fifteen Years' Experience - Part II ,)d. (The "Surround" ofTreatment, Forensics, Hypnosis, For reprints write: Patient-Iniatiated Requests) Walter C. Young, M.D. Thif paper revimlS 1M author's experima in serving as a consul lational Center for the Treatment lant to uveral hundred colleagues worki'ng with patil'1lts suffer· of Dissociative Disorders ing multiple personality disorder (MPD) over the 15 year period 1300Somh Potomac, Suite 152 1973-1988. Aurora, CO 80012 For reprints write: Richard P. K1uft. M.D. Vol. I (3),21-22,1988 Dissociative Disorders Program The Dissociative Experiences Scale: A Replication Study The Institute of Pennsylvania Hospital The authors administered the Dissociative t"xperiences Scale to med III North 49th Street ical student controls and patients with multiple personality disor Philadelphia, PA 19139 da, sdliwphmlia, panu:disO'tlkr-.and cMmicald4Jendmcy. Patimls with Afro srortd significantly highhthan tM otMrdinimlgroups Vol. I (3), 36-40, 1988 and tM ",mimi student controls. A Reexamination of Freud's Basic Concepts For reprints write: From Studies of Multiple Personality Disorder Colin A. Ross, M.D., F.R.C.P.C. Fnmd derived his fundamental concepts, which became the basis Charter Hospital orDallas for his ttU:tapsychowgy, primarily from his early experU:nces with 6800 Preston Road hysteria. Thesebasicronapts indwkdtMunconsciou.s, rrpress;on, Plano, TX 75024 resistance, tlu OMipus CQmplex and psydwserunl tlewlopmen1. Later speculations were predimted ufxm thde postulales. It if c0n Vol. I (3),23-29,1988 tended that these concepu were fauUtd by both his failure to accept On Giving Consultations To Therapists Treating Multiple Breuer's observations on selfhypnotic (hypnoid) states and by his Personality Disorder: Fifteen Years' Experience - Part I creation ofaJantasy themy ofsexual molestation. (Diagnosis and Treatment) • For reprints write: Thif paper mnews the author's o:pm.ena in serving as a amsul Eugene L Bliss, M.D. tant to several hundred colleagues working with patients suffering Department of Psychiatry multiple personality disorder (AY'D) wer the 15 )'ear period 1973 University ofUtah Medical Center J988. It discusses gmeraltrmds in the tYlHJS ojpatients with regard Salt Lake City, UT 84132 to whom consuUatwns were sought and in tM t)'/JeS ojissues raised, and 7Wles rtCIJ.rrent issues that appror to troublt large numM"s oj Vol. I (3),41-46,1988 amsuUees. ftauo mMwstM/Jatient-gmerated consultation request, The Development of Symptoms of Multiple Personality which rejkcts both inmasedconsumerismandtMavidity with which Disorder in a Child ofThree MPD palimts seek infonnation about their condition. Part I offers The deveropmmt ofmultiple personality disorder (MPD) in a three ageneral orientation, ou tliTU!S the methods ofthtstudy, anddescribes year old girl is described. She had been Jollowed since the age of 14 consuUations r~arding diagrwstic and tUlltment issues. Part J1 months. TM subject oja custody dispute, SM suffered from multi-
47 mSS()(IITlO\ \ul.\.\n I \lJnhl'lll~ ple on-going traumas, which caused a dissociative state to develop. Vol. I (4), 17-23, 1988 The traumata wen MfJaration from the primary kroe object, physi A Comparison Study of Dissociative Symptoms in Patients cal and sexual abuse, and deliberate attnnpts by her genetic family with Complex Partial Seizures, Multiple Personality oforigin 10 O'QS(! her rWJll ofher early history. TIlL deudopmrot of Disorder, and Posttraumatic Stress Disorder herAfPD is doru:menUd on vid(!()tapes that bq;i.n before an alter~ Depmonaliuztionanddissociative symptoms havebeen wid~ly report sonalilJ is fully ckutJoped and continlU! to the time whm the altO' ed in chronic wure disordD" patimLs, especiaUy those with tempo /JDlonality is clearl.yMfJarate. Finan" they show tlutreatmentpha.se rallobe involvtment and complex partialwures(CPS). it Iw.s bun during which integraJion occurred. This is probably theearlitstdoc throriud that ~lopment oJmultiple personality discm:kr (MPD) umented case ofMPD and itgi'lMS CTedence to patients' retrospective may be relaud to temporal wbe pathology. We administered tM "fHn1s oftlu u.seoflhis adnptive strattgy at such an Mrly age. This DissociativeExpmmas Scale (DES) to 12 male patimls with 5efJUt case rnay also indicate thal IIIO'I'r attention n«ds to be paid to the chronic epilepsy. primarily oJthe compiLx partial type. PaJimls had impad ofongoing traumas and tlu deutltJpment ofacute disurdm had ~ilepsy from one to thirty years. Most were bringevaluatedJor as a means ofminimizing post-traumatic damage. intmdable seiz.ures occurring several times per wah. DES data on For reprints write: the tpikptic patimts were compared with DES data on 9 male AfPD John Mead, M.D. patients and39 male PTSD patients. MPD and PTSD patimls were 65 North Madison significantly different from CPS patients on median DES sccres and Pasadena, CA 91101 allDES sub-soole scores. AfPD and PTSD patimts wereJar more sim· ilar on the DES, although MPD patimts had a significantly higher Vol. I (4),5-10,1988 SCOTt on tlu dissodation/psyclwgmic amnma sub-scale oJthe DES. Thoughts on the Cognitive Perceptual Substrates of The authors conclude that there is little data to support a rtlation· Multiple Personality Disorder ship betwnn MPD, dissociation, and epilepsy. AlJJwugh MPD patimts typically presnzt to treatment with affidive For reprints "'Tite: S)'mploms, trauma-relaled infOfflUltion is originally encoded in tlu RichardJ. Loe....'enstcin, M.D. patients' perceptions and mediated by their cogTlitions. This paper Sheppard and Enoch Pratt Hospital will describe tludJsfu ndionalassu mptive andfxrc~tualcategrrrin 6501 Nonh Charles Street thatform the buildingblodu oJMPD patimts'distorUd experirnas. Baltimore. MD 2128~15 Perceptual shifting techniques and cognitive reframing will const qutmtly be tlu recommendul interventions prior to thera~tic abn Vol. I (4),24-32, 1988 adiw war*. Ten Traps fOT Therapists in the TreabDenl of For reprints ....Tite: Trauma Survivors Catherine G. Fine, Ph.D. Patients who have suroived lrauma, parlicularly those who have Dissociative Disorders Program txperienced tarly childhood abuse, stand out in the clinical apm The Institute of Pennsylvania Hospital ena ojmany therapists as bring among tlu mast difficult patimts 111 lonh 49th Street to treat. ThesepatientshaveparlicularpattemsoJrtlatedness, along Philadelphia, PA 19139 with intense neediness and deperu/mCJ which maJu them superb testers ofthe abilities ojtheir therapists. Thry oflm push therapists Vol. 1(4),11·16,1988 to examine the rationales and limits ojtheir therapeutic abilities, Def1ning A Syndrome of Severe Symptoms in and.frequentlyJorCf! therapists to examine thnrown personal issues Survivors of Severe Incestuous Abuse andethical beliefs. AconceptualfraT1ltUJOTh for understanding treat &vnt symptoms are described in 10 women trrotM in a group Jor ment traps is presentHl, along with ten traps which these patimts adult inast mdims who had bun psychiatrically hosfritaliud at present, consciously or unronsciousl)~ in the (;()Ut:St ojtreatment. kost ona. AU these patimts suffered at least 7 oJtheJollowing 11 IncludedaretrapsaroundtTUSt, distana, boundaries, limits, respon seven symptoms: dissociative symploms, bcm:krline perSQ1lality dis sibility, control, denial, projection, idealiuJtion, and motivation. order, legal involvements eitherwithfamily (;()Urt orotherwwenJorce These are urtainly not the only traps which oaur in the (;()Ut:St of ment systems, substanCf! ainue, subsequent rapes, physical abuse l'j treatment, but lhey highlight the expt:rience ojtreatment and diffi sexual partners, multiple suici~ attempts, affective disorder, mul culties which are encountertd between the therapist and tlupatient. tiplepsychiatric hospitalizations, somatization disortkr, andeating This paper is intended 10 be clinical in orientation to help pr~re disortkr. AU md critLria Jor post-troumatic stress di.sartU:r. Their and support thn'apists in their worlr. child abuse histories wen extreme. For reprints write: For reprints write: James A. Chu, M.D. Jean Goodwin, M.D. , M.P.H. McLean Hospital Depanmem of Ps)'chiatry 115 Mill Street Uni\'ersity ofTexas Medical Branch Belmont, MA 02178 Galveston, TX 77550
48 OI\'I()(I\TIO\.\,,1 \ \" I \1lr,blW! , I VOLUMES I-IV, 1988 - 1991
Vol. I (4), 33-40.1988 useJultlts.I oftlu paradigms and Imtaplum ojsplitti'lg and divi Art. Interpretation and Multiple Personality Disorder sion as hrorislicsfor the understandingojAfPD is challengtd. and This paper explQrtj both pr&jective and sj>(mtaneow drawings of a paradigm/metaphor ofredoubling and TtConfiguration is offered school childrtm wId compares themio drawings ofmultipk person forJurther study. ality disorder (MPD) patients. IUsults ofmany scholarly studies indi For reprints write: caU toot children typica11y follow pmiicJabk stogr:s in their artistic Richard P. Kluft, M.D. growth with Q~ stage ur sd ofdrawing bthaviON building upon Dissociative Disorders Program lhe preuding sta~. It will be shown thaI MPD palinltsfimctiDn TIle Institute of Pennsylvania Hospital artistically at dif!~t stage;s ofcrrative growth, thw precluding III lonh 49th Street artistic growth to j1qw smoothly, gradually, and pndutably as it Philadelphia, PA 19139 does in non-i\® individuals. The discontinuity in rt:pmentatiw stages in lJu artwork ofAfPD patients wiU be addressed. Vol. II (1),3-16,1989 For reprints write: A Reader's Guide to PierreJanet On Dissociation: Nancy L. Fuhrman, M.Ed. A Neglected Intellectual Heritage 1118 Williamsburg Road A century ago there oCC1lrred a peak ofintertst in dissociation and Lancasler, PA 17603 the dissociative disorders, then lo.beled hysteria. The most important .scientific and clinical im~stigator ofIhis subject was PierreJanet Vol. I (4),41-46,1988 (1859-/947), whose early body ofwork is reuiewed hn-e. TJu ev0 The Differential Diagnosis of Multiple Penonality lution ojhis dissociation th«Jry and its major principia are tmud Disorder from Borderline Personality Disorder throughout his wrilin~. Jand ~ inJrodlldion oftJu term ·subam Con5ithrahk controversy sum:tunds the mnliomhip ~tWMn mul scious" and his conupt ojtJu existence ojconsciOUS1lts.I outside of tiple perwnality disorder (MPD) and bcmlerlint fJtrsonality disordtr jN:r.J01lQl awareness art explained. TJu viability and rtleuallCl: of (BPD). Smne aulhors argue thai WI) isa varianl oJBPD, and most dissociati()n as tlu underlying phmome/l()Fl in a wide Tan~ ojdis agree thai the differential diagnosis ofthe two is often very difficult. orders is pre.sented. It is proposed that janet's them) and m~thodol In this artick data are presenled from a stu.dy comparing histori ogy oJpsyclwwgical analysis and dynamic j)sychotherapy are cogent cal, demographic and psydwlcgical testing variabks belW«n the and relevant for today's studmts and practitioners. twogroups. Nostatisticallysignificantdifftrniuswerefoundbetween For reprints write: tlu two groups on tkse variabhs. However, certain trends nnerged Barbara Friedman, MA, M.F.C.C. which may serot a.J a caUJiysl forfurthn mearch. TJu relo1ionship 864 South Robertson Boulevard, Suite 302 beti«m tJu disorders may ~ complex; clinicians may n«d to use Los Angeles, CA 90035 man sophisticalNl nsearch uchnirpus and deveibp more sensitiw diagnostic criteria before it is understood. ... Vol. n (I), 17·23, 1989 For reprillls write: Childhood Stress and Dissociation in a Moshe S. Torem, M.D. College Population Depanmcnt ofPsychiatry and Behavioral Sciences Two studies are repmed demonstrating that individual differences Akron General Medical Center in dissociation in college students are positively related to differences 400 Wabash Avenue in self"'"/JOrted strwfulor traumatic experiences in}'Outh. In Study Akron, OH 44307 I differences in thetkgmofstres.s or unpredidablephysical vWlena expnienud in childhood or early adolescence were shown to be relat Vol. I (4),47-58,1988 ed to scores on the Dissociatiw Experiences &ale (DES). Study II The Phenomenology and Treatment of Extremely replicaud t~ rt!lationship.s and extended them to anolher dissoci Complex Multiple Personality Disorder ation mtosure. tJu Bliss scale. Study II also demQ1Utrattd that both Cuntemporary reports indicated lhat the averap number ojperson dissociation measures correlate positively with reported physical and alities in recently reported patients with multipk personality disor psychological altuse. These findings Jor a nonclinical populatirm der (MPD) is larger than that reported in the older literatU1't, A are discussed in relation to the etiology ofdissociation in clinical minority ojtJwe recent patients (/emonstrate exlrtmt! complexity. A groups. group of26patients with 26or more personalities and uniUr obser For reprints write: vation for a minimum ofthm Jean was studiNl. Their prtstnta Barbara Sanders, Ph.D. tions, the reasons that appeared to urukrlU tluir complerity, and University ofConnecticut tkir coones ojtrealmmt are mMwtd. Firulings indica1L thai this Box U-20, Room 107 group ofpatients is diverse, wilh .s01m provingreadily trealahlL, and 406 Babbedge Road olhns provingquite rt!fradory. ObmvaliQ1U that appear ronstrnc Storrs, cr 06269-1020 tivefor the treatment ojsuch patients are offered. The concept oJper sonality is discussed and an alternative descriptian is explmtd. The
49 m~\(I(I\110\ \fil \ \" I 'I.i.. bl"'~ DISSOCIATION: ABSTRACTS
VoL II (I). 24-31,1989 fragmmlLd or partially dissocialtxi memor1D ojadual roents. As Linking the Psychological and the Social: Feminism, early as the Jourth untury dements oja satanic mass wt'rt! wtU Poststructuralism and Multiple Pel"SOoality described: 1) a ritual tabk or altar; 2) ritual orgiastic sn:; 3) rever In tIlL 1Ja51 tnI yeaTS ince.st and child abuse have bun brought into sals ojlhe Catholic mllJS; 4) ritual use ojncntions; 5) inJa'nt or public awarmtU as social probkms. During the saml! tinu period child .JfJcrifiU and cannibalism often anmnd initiatiem and often thnzhIJsiNnl.asignificantinmaseinJrnowkdgJ!andundmtanding involving use oja knife, and ritual use ot 6) animals; 7) fire or about 1M phnlomenon of mulJ.ipu pn-sonaliry. HOUJeIMr, tlwugh candles; and 8) chanting. Extending the historical search from 400 multipupnsonality is almost invariably an outc017U! ofsevtre child to 1200 A.D. yields only aJDJJ mw elements: 9) ritual we ojdrugs, hood abt.l5e. it has bten thw far m'7t almost entirtly in a pSJcho and 10) ofthecircle, and 11) rilualdismembmnent oJWT/JYS. Two lDgicallight, as a fN:rsonal probkm If)( rufftring indiuiduQu. This clinical acaJUnu oj.JfJtanic rituals are compand with historical artick explmes the iuueojmultiple />"Sona/it] from afeminist per acamnts. IdeaU)', thepossibility that apatient hadexperinlud actu s/Ndive, using basic concepts ojpoststructuralism 10 elucidate this al involvement in some biulrn and abuSl've ritual T/xtuld be one oj viewpoint. Examining llu sodal and political asptdJ ofthe issue many possible viewpoints aplcred in the therapeutic unrawllingoJ ojmulliplt pnwnality expands our capacity 10 address the proh/em such materiaL in the broadest possible way and to look at questions o!Jm:umtioll For reprints write: as weU as asstSsment and mtUmetlt. Jean Goodwill, M.D., M.P.H. For reprints write: Department of Psychiatry Margo Rivera, Ph.D. University ofTexas Medical Branch The Muskoka Meeting Place for Galveston. TX 77550 Coun~lingand Education Box 2242 Vol. II (1),45-51,1989 Gravenhurst, Ontario POC IGO Multiple Personality Disorder: Phenomenology of CANADA Selected Variables in Comparison to Major Deprt'SSion Various findings from a mTOSpective sul'W)' oj355 multiple pn- Vol.U (1),32-38,1989 sonalitydisorder{MPD) patients and 235 majorckpressiempatients, Integrating Research 00 Dissociation and Hypnotizability: who served as a comparison group, are discussed. The survey was Are There Two Pathways 10 Hypnotizability? completed by 448 independent clinicians, 142 oJwlunn contribut- Attmtitm to ilu rmtiqn.ship bttwan hypruJiizability and dissoda ttl. inJormation on both an MPD and a major depression patient titm has ~ limiltxi to dnu. A. [DJJ studies haveaaminL(/ in.stances The study confirms rtct1It findings in the literature that MPD is not ofdissotiation in the amta!Ofh)prwsis. Only recently have rmarclu:rs a rare disorder, its sufJerers include a pretxmderance o/Jemales, and begun to ask questions about the relationship between an individ it is highly comlated with childhood trauma, esptciaUy sexual and ual's hypnotizability and his or lin tmdenCJ to dissociau on a day physical abuse. In addition, the stud] indicaus that clinicians who ttHiay basis. A. rr:uiLw ofthe litn-ature and nant research in this diagnou AfPD peruiw clinical phenomena in a mannersimilar to area invius netmSilkratitm ofJ Hilgrzrd s theory oftwo droe~ t1wse clinicians who haw not )'~t made this diagnosis. mmwl pathways to h)'Pnotizability. The paralkl question is also For reprints write: raisM ofwhether the diJfarot pathways result i'n the experienu of Rosalyn Schultz, Ph.D. qun./itivtly different hJImolic stales, 8631 Delmar, Suite 204 For reprints write: SL Louis. MO 63124 Eve B. Carlson. Ph.D. 806 Racine Street Vol. 11 (2),52-56,1989 Delavan, WI 53115 Multiple Personality Disorder with Human and Non-Human Subpersonality Components Vol. 11 (I), 39-44, 1989 Qinicaldnta arepresented on a NatiwAmericanpatient diagnostd Satanism: Sim.ilarities Between Patient Accounts and with multiplepersonalily disorder. Eleven subperscmalilies wt'rt!Jound Pre-Inquisition Historical Sources to containJoorhumanandseven nem-human componmts. Findings Today patients who describe to a thrrapist fragmentary jlashbadc indica1ed child abuse was at the core ojilu deveIopmenkll process. like sunes ofparticipation in satanic rituals faa the.JfJ~ cmli HOUJnJer, onual1ercomponents manifeslLd lhemselves. culturalJae- bility jrrrJbkms that twentyyears ago would have confronted apatient tors reinforced and maintained the process. Evaluation ojhpyno who was recounting SU1W ofsadistic inmlUQUS abuse. Some clin tic susceptiln.'lity indicated aU subpersonalities were highly hypnoti icians have only om conaptual fra'HlLWO'rlc within which to plau zable. A. nalysis ojvisual acuity tm two occasions, separaltxi by 30 such matnial; they hear it as chlusional. This papn-presents anoth days., indicaUdsignificant difJemues amonga numbtroJthea1lers., er set ofdescriptions ofsatanic rituals: those drawn by historians i.e., 20/15 to 20/50. Test/retest scores indicated the visual acuity from pre-Inquisition primary sQUrus. The aim is to assist clinicians scores were highly realiahk. Evaluation ojneurosensory memory em in amsitkring as one possibility that such a patient is describing two occasions, separatni by 30 dJJ]S. indicalLd significant differ-
50 l VOLUMES I-IV, 1988 - 1991
mas;n visual, auditory, and kinesthetic test resulls fur SmnI! aflM Vol. II (2),70-76,1989 altm. Test/utest scores indicated the lIt'Urosenscry lest results were Iatrogenic Factors in the Misdiagnosis of Multiple highly reliable. The -results art discussed in terms ofaJ impliml;on Personality Disorder oJlest differences. b) the reliability oJtest r&wlts, and c) treatment Thediagnosis o/multiplepmonality disorder(itfPD) isfraught with probkms encountertd with human and animal subpmonalities. difficulties leading to a Jrtquent false negative diagnosis and an For reprints write: occasionalfalse positive diagnosis. Proper diagnostic evaluation of Stanley G. Smilh, Ph.D. a patient susfJet:iM ofIuJ.IJing MPD requires afamiliarity with MPD, Department of Psychology hypnoticphenomena, anda wide TJ(Jridy ofothndinicalsyndromes. Mississippi State University, MS 39762 17Ie clinician must use collateral daJa from old rerords and otMY individuals as ~ll as prauide su./ficknt tiw for the evaluation. Vol. II (2), 61-65, 1989 Extreme caution is urged in forensic contexts. Tlu use ofextrnndy Evidence Against the Iatrogenesis of Multiple suggestive interoiewingand/orhypnotic techniques is to bed4Jlortd. PCnionality Disorder At times proumged obstroation in the hospital or wet" the coune of The authors present data which argue against lhe iatrogenesis of therapy is required. Clinicians should be patient, skilled in listen multipk personality disorder (MPD). Twenty-two cases reported by ing, and should. keep an "'aj)en mind." Patient/actors involved in one Canadian psychiatrist, 23 cases reported by a seamd Canadian producing misdiagnosis include distrust, parofbeing labeled crazy, psychiatrist, 48 cases seen by 44 Ammcan psychiatrists specializ insislmct on secrecy, amnesia, and conscious oruncorucious decep ing in MPD, and 44 cases SHtl l1y 40 Canadian gmLral psychia lion. trists without asINealinumtin AlPD aucompartd. TM Canadian For reprints write: gmerolpsychiahists hadsml an awmgtof2.2castSofMPD, while Philip M. Coons, M.D. the Amnicans had seen an avera~ of16.0. Tht:rt war: no dilftr Lame D. Carter Memorial Hospital roleS fJetwun lhtJt groups on the diagnoslic criteria fM MPD M lhe ]315 West 10th Street number ofpers()llalities idrotifitd. Specialists in MPD are not influ IndianaJXllis, IN 46202 mcing their jJatients to create an increased number ()f jJers07lalities &r to endorse m&re diagnostic criteria. Exposure to hypnosis does not Vol. II (2), 77-82, 1989 appear to injIuenct the phnwmerlology ofMPD. Treatment Errors and Iatrogenesis Across Therapeutic For reprillls write: Modalities in Multiple Personality Disorder and Allied Colin A. Ross, M.D., F.R.C.P.C. Dissociative Disorders Charter Hospital of Dallas David u-mls special interest in iaJrogrnesis buaw theopportuni 6800 Preston Road ty to explore Iww trmlmnlt modo.litin may impad on tlu iatrogmit: Plano, TX 75024 creation ofalter personalities in patiertts who already have multi ple perwnality disorder (MPD). This paper reuiews basic traruJer Vol. II (2),66-69,1989 ences and countertransferences that can be monitored in the treat latrophilia and latrophobia in Diagnosis and ment ofAII'D which can, ifunchecked, uad to the creation ofnew Treatment Multiple Personality Disorder allers. It ap/Jears that thesej)henomenarather than treatment modal Multiplepersonality disorder(MPD) was underdiagnosed to thepoint ities per se pr()1Jw.e the nuljor impetus to iatrogmic incT/!ases in lhe oftuardisappenranct for most ofIhis century, and continues to be complexity in MPD patients. mi..tW ordismUud quiufrequently today. Coons, Firu, Tomn and For reprints write: Kluft discuss sowofthe maj&r rmsoruJ&r this elsewhere in this sym. Oltherine G. Fine, Ph.D. posium. &surgrnu ofinurest in AlPD about 10yMrs ago brought Dissociative Disorders Program with it tlu Sffli.s ofthe opposile probkm: owrdiagnoris, or the Im The Institute of Pennsylvania Hospital deney to find MPD when it is not. Coons and Tornn elsewht:rt in III North 49th Street this symposium providesuccinct discwsion ofinadvertent and 0lH:I' Philadelphia, PA 19139 ly enthusiastic falM-positive diagnosis. It is probably the case that therapist attitudes about iatrogenesis can piny significant roles in Vol. II (2), 83-91,1989 both under- and ()1Jer-diagnosis. Iatrongenic Creation of New Alter Personalities For reprints write: TM initial as~t ofa patient suffering multiple personality Bennell G. Braun, M.D. disorder (MPD) rarely discloses the full complexity ojtluJ.t patient's 9701 Knox Avenue, Suite 103 $]Stem off'mCnaliliLs. Like most othLTmmtaldis~, AfPD reveals Skokie, IL 60076 its inrur structure gradually, in the ClJUTSe of1M unrotJtring ~ cess oftherapy. This CQtII1I1()n sense observation, /wuJnMr, is oJtm disugarded due to the widnfmad conarn that the very procedures desigmd to alJ.euiate and inlegrate MPD may augment rather tlldn reduce its complexity. This palm" will review factors inherent in tlu
51 1Il~~O(llll()\ 1,,1 \ \0 1 Il~f(n l'lQ~ DISSOCIATIOS: ABSTRACTS
Ireatment, the patient, and lhe therapist that may contribute to an fQCl.tjes on the "iatrogenitdebate" overMPD in itsintensionalform, actual increment in llu patient's annplexity or to the appearance augmentingthe stope oJthe discussion considerably. His comments lfuzt this has occurred. Most apparent cm:zlions of new alter per are based on extnuiw ctm1Jt!'f$atioru with David Caul about tlu Slmlllitil!S rejlect the useo/personality/ormation to cushion the trail-" subjett during the year prradingDr. Caul's death. malic impact oJlhe treatment, which is inherently pajnJu~ or to p~ For reprints write: teel against intercurrmt traumata. Others (the majority) rtpresent George B. Greaves, Ph.D., P.C. in/ad the discovery ofpr«ristingbutprroiowly unrrrogniudaUm. 529 Pharr Road, NE Scme alhrs emerge in responst to therapists' nT"071" in tuhnique or Atlanta, GA 30305 j nappropriatt: behavior. For reprints write: Vol. II (2), 105-109, 1989 Richard P. Kluft, M.D. Integrating a Dissociative Disorders Curriculum into Dissociative Disorders Program Residency Training The Institute ofPennsylvania Hospital This paper will descrilM the comp!Lxities encounterttl in developing III North 49th Street a dissociaJiw diwrdn3 curriculum for psychiatric residents. A oon Philadelphia, PA 19139 ttptualiwtion ofthis educationalprrxess has been synthesiudfrom the observational perspectives ofboth faculty and resident. Vol. n (2),92-98.1989 For reprints ",Tile: Iatrongenic Factors in the Perpetuation of Splitting Ronald Batson, M.D. and Multiplicity The Courtyard, Suite 8 The purpo~ ojthis paper is to increase the awartness ojclinicians Chapel Hill, NC 27514 who treat mulJiple~nality disurdupatitnts to thepossibility lho.t misuse ojtreatment tulmiques may perpdrau splitting and mull; Vol. Il (2), 110-115, 1989 plicil)', and thus rontnOOte to thronicicity in MPH patients. Man)' Multiple Personality Disorder and Homicide: AU>£) patintts tnld to lw.ve rapidly dissociative switchingfrom one Professional and Legal Issues q:o-state to anolher. These trant~ states make the patintts high Unfortunau complexities encountLrtd during the tnatmnlt ofa 49 ly suggestible to outside influmaswhich indude tM therapists' ver )'ear-old male with diagnosed multiple penonality (MPD) are bal and non-verbal communication. Somi! therapists may have an described. Treatment sessions ~xtending over a one year period were uvninvestment in morealterjJersonalitUs, and thusignore the needs abruptly terminated after the potintt's murder ofhis live-in girl ofthe wlwk pernm. Tnating an adul1 patient WM is in an age friend. CJinical hypotheses regarding the medumIDn ofthe dissoci regressed ~state, or aller personality, presents a particular chal ation which Qt:cumd prior to and msuing the killing are present· lenge as to the patintt's boundan'es since violatingthose boundaries ttl. Theruedforspedalattention to conaaledaspects ofthedi.ssociation may too perpetuate splitting and multiplicity, The paper reviews is addressttl. The difficulties ojca.se management on an outpotintt and discusses such issues as therapeutic limit .Idting, the issue of basis in a largt urban hospital are outlined, with implications for trust, and counter-transferena elemmts as t~ ma)' contribute to optimal treatment conditioru, Slctpticism among service prouidn's the perpetuation ofsplittingand multiplicity in MPD patients, Case regarding the diagnosis ofAfPD is also discusstd. uignettes are lWd 10 iUustrate lhe aiJtJw points, and suggest ways For reprints ",Tite: to avoidpotentialpitfalls50that therapy wiUpromoteprogrtss towards Pamela E. Hall, Psy.D. integration and improvedjundioningofthe whole pmon. 192 State Street For reprints write: Perth Amboy, NJ 08861 Moshe S. Torem, M.D. Department ofPsychiatry and Behavioral Sciences Akron General Medical Center 400 Wabash Avenue Akron, QH 44307
Vol, II (2), 99-104,1989 Observations on the Claim of latrogenesis in the Promulcation of Multiple Personality Disorder: A Discussion The term "iatrogenesis" has both intensional and extensional (i.e., amnotatiw and denolative) meanings which are frequently con fused. While thefour previ0U5 papers oJtM David Caul Memurial Symposiu mon iatrogmicissms i n multiplejJerso1ullity disorderexplore the txtensional.sense ofthe term, the discussant ofthis symposium
52 1ll\\1J([\T10\ \,~ \ \" I " ..,~l""! , t VOLUMES I- IV, 1988 -1991
VoL II (3), 119-127, 1989 personality disorder (MPD) have been described try a small number Dissociative Disorders and Dissociative Symptoms at a ojtherapists. This study broadens the base ojinJonnation relating CommWIity Mental Health Center to ISHs. Forty respondents who wllectively had been therapistsJor a This paper presents the authaT's experience with dissociative disor total of690 MPD patients participated in the study. The findings dm ami dissociative s)'mptoms among 125 patients seen for ongo ojthis study suggest that a) ISH occurrence within MPD clients is ingpharmacowgic treatment at a community mental health center. not uncommon; b) ISHs can be valuable assets in the therapeutic Eleven werefound to have a diagnosable dissociative disorder, and process; c) therapists differin their explanations ojand beliefs about 16 others to have marked dissociative symptoms. The natun ofthe ISHs, as well as the manner in which they relate to and utiliu fSHs; dissociative symptoms is discussed, as are the implications ojthese d) ISHs are reported to be mostly knowledgeable, reliable, and hel~ findings, should they prove replicable. jul; e) ISHs ckmonstrate a wick variety ojabilities; andj) while there For reprints write: is no one explanation regarding the etiowgy and nature ojISHs, Stuart M. Graves, M.D. therapists most commonly tend to describe fSHs as possessing uni Thomas Chittenden Health Center fying, centering, and protectiveJunctions within MPD persons. Oak Hill Road For reprints write: Williston, \IT 05495 M. Ann Adams, R.N., M.N.Sc. #15 Hale Street Vol. II (3), 128-131, 1989 Eureka Springs, AK 72632 Preliminary Observations on Multiple Personality Disorder in Puerto Rico Vol. II (3), 144-150, 1989 A considerable numberofcases ofmultiplepersonality disorder (MPD) Nonnal and Pathological Dissociations of have been Teporied by clinicians working in the continental United Early Childhood States of America (USA). However, there has never been a docu The authors hypothesize that multiple personality disarder is relat mentation ofMPD in a Latin American country. Here I report three ed to the processes that lead to the Jonnation in children oja dis cases ofPuerto Rican patients with MPD whose S)'mptom profile and tinct and cohesive self. Three clinicalpropositions concerning MPD etiological background are strikingly similar to the ones reported in derived Jrom this hypothesis are: first, mul1iple personality disorder the USA. It is recommended that LatinAmerican mental health pro should be seen as a childhood disorder; second, cohesion ofthe self Jessionals should become more aware ofand clinically sensitive to is best understood as a devekpmental achievement mediated try spe this increasingly recogniud condition. cific experiences in the earl)' )'ears oflife; third, some dissociative dis For reprints write: orders, including multiple personalit), disorder, are survivals ofan Alfonso Manfnez-Taboas, M.A. earlier personality organization in which distinct centers ofexperi 17 Street, Suite 1088 ence and initiative existed within a single individual. Villa Nevarez For reprints write: Rio Piedras, PR 00927 Theresa K. Albini, M.S.W., L.C.S.W., A.C.S.W. 300 North State Street, Suite 3707 Vol. II (3), 132-137, 1989 Chicago IL, 60610 Breaking the Code: Identification of Multiplicity Through Art Productions Vol. II (3), 151-159, 1989 The authors organized the art productions ojclients diagnosed as A Model for Abreaction with Multiple Personality sufferingmultiplepersonality disorderinto ten basic categories reflect Disorder and Other Dissociative Disorders ingthematic, st111ctura~ andprocess elements. These categories were A conceptual mmlel for abreactive work with multiple personalit), derived from tm study ojnearly two thousand pictures drawn over and other dissociative disorders is presented. The context and pro a period ojnine years. Designed to aid therapists in the identifica cess ofabreaction are described. The model includes the following: tion ojmultiplicity, these categories can also be used as aJramework Providing safety and protection (preparation); eliciting dissociated to help therapists understand the spontaneous drtwork oJmultiples. aspects oftm trauma (identification); alleviating thefixation point For reprints write: in exislential crisis ojthe trauma (resolution); creating a gestalt Barry M. Cohen, M.A., ATR with the dissociated aspects within reconstructed cognitive schema Center for Abuse Recovery (assimilation); empowering the patient through the return ofan 4228 Wisconsin Avenue internal wcus of contro~ restoration of contiguous consciousness Washington, DC 20016 and memory, and assimilation ofidentity (application). For reprints write: Vol. II (3), 138-143, 1989 Katherine H. Steele, M.N., R.N. Internal SelfHelpers of Persons with Multiple North Georgia Psychotherapy Scmces Personality Disorder 1847 Highway 92 W, Suite 4 In tm past, Internal Self Helpers (ISHs) ofpersons with multiple Woodstock, GA 30188
53 lJISSO( 1\110\. \ "I \. \". l. \I~nh I~~ DlSSOaATIO;\,; ABSTRACTS
Vol. II (3), 160-168, 1989 of1M Cll.W (including lhat oJIMjungle cat), with distinctly alJered, Dissociation and State-Specific Psychophysiology During complex, repetitiw and lmgthJ INhaviors emerging S'lI.lUknly from the Nineteenth Century sustailledelectrot'7laphaJographicwaJcqullUSS.PSGstlUkrsupportLd This paper rnriews examples ofstau-specific psychaphysiowf!S in the diagnosis oJDD as 1M cause ojnocturnal injury in the other 50 ninmenlhanluryreportsoJdi5socitzJirMdisonJm. ~aue:so€Cumd ptrant (4/8) oJthecases: i) by notdetectingsei....""Ureadiuity. NREM/REM in the context oJrapid drodopmenu both in neurology and in the slNp motorabnormalityorslNpbmuhingdisturbance, andii) whm untkrstanding ojpherwmma suggesting the possibk irifluma of rorrewt«l with tM clinical history ojchronic da),ti~ DDs. the mind, emotions, or psychological states on gmt'Tol health Q1ld For reprints write: specific bodily fundions (e.g., tJu study ofhypnom and hystma). Carlos H. Schenck. M.D. It is argued tMt interest in such co..sa was part oja grneral con Minnesota Regional Sleep Disorders Cemer um with the mind-body interactions. The explanations offered to Hennepin County Medical Center acwunt for thLse caRS n.fkctLd different Qn'enlations to tk mind 701 Park Avenue body probkm frmHllent during this era. Minneapolis. MN 55415 For reprints write: Carlos S. Alvarado, M.S., MA Vol. II (4).205-220.1989 4635-E Hope Valley Road Historical Truth Venus Narrative Truth: Clarifying the Durham. 'e 27iQ7 Role of Exogenous Trauma in the Etiology of Multiple Personality Disorder and its Variants Vol. II (3), 169-189, 1989 TM author notes a current trend toward viewing mulJiple person The Dissociative Disordeno Interview Schedule: ality disorder (MPD) andits variants asaJonn ojchronic post-trau A Structured Interview matic stress disorder based solely on ncogenous childhood trauma, TJu Dissociative Di.wrders lntnview SdlLduk (DDlS), a structured andcautions againstjJremalureJy reductionistichypotheses. HeJocu.s intLrvirw. has bmt delHJi¥d to maJuDSM-lil diagnoses oflhedis u on Klufl's Third Dialogical Factor, which includes tM various sociative disordm, somatization disorrUr. major depmsive epis~, developmental, biological, interpersonal, sociocultural, andpS)'c!w and Ixmlnline personality disortkr. Additional ilnnsprovitk infor dynamic shaping influences and substraus that ddnmine 1Mfonn mation aboutsubstanceabuse. childhoodphysicaland.sexuala~. taJten by the di.ssociatiw tkJense. He hJPolhesiu:s a credibility con aruf secondaryfeaturr:s ofmulJiple perwnality tfuorrkr. ThLse items tinuum ofchildhood and contemporary memories arising primari ~ informalion useful in tM differential diagnosis ofdisso ly from n:ogenous trauma at one end, and endogelIous lrauma cialiw disorders. TM DDIS has an uvemll inter-rain' reliability of (stemmingJrom intrapsychic addptational needs) at tMOlher. The 0.68. Forthediagnosis ofmultipleperscnality disortkrit hasa speci author offm alternative muuidnermirud explanations for artain fity of 100% and a sensitivity of90%. unverifud trauma mnMriu that cunmtly are bring accepted and For reprints write: validated as factual expmences by many thn-apists. He lhscribes Colin A. Ross, M.D., F.R.C.P.C. some potentially tkJeterjous effeds ojvalidating unveriJWl trauma Charter Hospital ofDallas mmwriesduringPSJchotJv:rofrJ. and rrwmmnuls that theAfPDpatients' 6800 Preston Road nudfar unconditional cru/ibitity be respondul to in tlu sa~ mall Plano, TX 75024 ,uras Olhd trQ1uJerenu-gen.eraUtl productions. For reprints write: Vol.ll (4). 194-204, 1989 George K. Ganaway, M.D. Dissociative Disorders Presenting as Somnambulism: Program Director Polysomnographic, Video and Clinical Documentation Ridgeview Center for Dissociali"e Disorders (Egbt ease.) Ridgeview Institute A polysomnographic (PSG) and clinical study of /.50 consecutive 3995 South Cobb Drive patients fn"t5e1ltingto a sleep disurtkrs center during a 7.5 yearperi Smyrna, GA 30080 od Jor evaluation ofreptakd slnp-relat«l injury (ecchymoses, bu erations, fractures) identified 5.3 percenl (N-8) with Dissociative Vol.ll (4), 221·223, 1989 Disordm (DDs) as tM cause ojtM injurUs, and wJwse presenting A Validation of the Dissociati"e Experiences Scale diagnosis was somnambulism. 87.5 percent (7/8) wt:Tefemale, and in the Netherlands tM mean age at referral was 29.5 (+/-SD 6.1) years. Two patients In tM Netherliinds we did a smaU-scale validation study oj tM fulfilled DSM-lII-R criteriafor Multiple Pemmatity Disortkr (AIPD). Dissociatiw Experimces Scale (DES) deutlopM by &rnstein and TM six Olher patients wmdiagrwsetf as DWociatiwDisorden NOl Putnam (1986). The questionnaire was administLffli in two vn Otherwise specijUd, but were strrmgiy susp«ud to have MPD. One sions, with and without dummy tpUStions. to 80 students (40 stu patient had an exclusively nocturnal, animali.sticDD: a 19j'earold dents in each condition) and in one version /0 20 students with a male who had aeled like a la~ jungle cat twice uwJdy Jor 4 years. clinically diagnOstd dissociatiw disortkr (7 with muUipJe person PSG studies wt:Te diagnosticJor nocturnal DD in 50 percent (4/8) ality disorrkrand 13 with Olhn-di.ssociatiwdisortkrs). The resulU
54 nr,,()(]\[U)\ 1,,1 \ \" I I[~"h['l'l~ ',' I VOLUMES)· IV, 1988 -1991
show that the DES has a good internal consistency and a good ai Vol. II (4), 239-242, 1989 fmon validity. !JIMDES is adminuterm to nOT1TUJls it is advisabk Dissociative Experiences in Adolescents and Ibin.strt dummies (less extremedWociatiw items 1Wl rounud in the College Students statistics). This counUmcls normal subjtctJ' reactions to tlteextrnn TM autlion tulminisln"td the Dissociative Expnimm Scale to 168 ity ofthe DES item. The wrrt ofthe Dutch normaLJ is highn tJum childrm agM 12-14, 345 collegt sludnits with tJu median age oj for Ammcan normals. Then may be cultural difJt:rmCl!S rilMr in 24 ~an, and 30 patimts in a gtrialric day Iwspito.L Sa:wts were aUill/des toward and/or in the levt/ ofactual dissociation INtW«n distribukd ina highly left-SkewedJashi(}fl, with nodifferenmIxtween the populations ojNorth America and tlu Netherlands. malLs andJmmles among the adokscents or college students. Tlu For reprints write: m.edian score Jor the adolescents was J7. 7, Jor tlu col~ stlldents BernardineJ. Ensink. Ph.D. 7.9andJor theekl~ly 4.8. Thestfindi'ngs suggest that dissociative Department of Psychology experimces are more common in early adolescence than in ]'YUng University ofAmsterdam adulthood, and that they continue to decline with increasing age Weesperplein 8,1018 XAAmstcrdam after the third decade. THE NETHERLANDS For reprints write: Colin A. Ross, M.D. F.R.Gr.G Vol. II (4),224-230,1989 Charter Hospital of Dallas Precursors of Integration in the Treatment of Multiple 6800 Preston Road Personality Disorder: Clinical Reflections Plano. TX 75024 AI tJu prese'llt time it is, as a practico.l matter, quiU impossibk to describe a '"almml paradigm by which multiple pnsono.lil)' disOT Vol. II (4),243-249,1989 der(MPD) is cum!. FatlwmingtM umguagrs ofthediscourse among The Rehabilitation ofTherapists O"'erwhelmed by their the various schools ojpsychmhLrapy is itulfmuch like trying to (X1Ift, Work with Multiple Personality Disorder Patients mun;cau with tJu myriad worlrmen who sQUght to build tk TOUJa It is gmn-aily recogniud that the treatment ojmulLiple pnsonality ojBakJ. Desfrite this problem, patients t~lws rrgularly frnsnil di..sm1Ur (MPD) may prove an ardu0U5 undmakingJorptJtimt a'ld "marlier tutnts" which indicatl! thq are gtUing Ixtter or wor.Je. This tMrapist aliJte. Tluliteratureis repletl! with description.r oJthe i mpaCl paJN:r is 011 analysis ojruch remts. oJtreatment upon AfPD patinlts, but has b«n undnJtandnbly cir For reprints write: cumspect about the elJuts ojthis prom.s upon therapists. This dis George B. Greaves, Ph.D. crete silence belies tlu intense concentration upon this aspect ojwork 529 Pharr Road, NE with MPD patients inworJuhopand C01l$Ultation settings. AltJwugh Atlanta, GA 30305 the 1lumber oJnew tMrapists in thefiekl continues to expand, it is well known that there is a milch S1TUJlltr, but not inconsiderable Vol. II (4),2314238,1989 stream. ojclinicians whotxit thefield, anddiscontinueworkingwith Understanding and Responding to Religious Material MPD patimts. Furlht1mart, a largt!Y group continues to work with in the Therapy of Multiple Personality Disorder MPD patin/ts, but at a diminished leuel ofeffectiveness. This prIJ A review ojliterature on religion and MPD shows numerous asso sentation will review someofthe stressors inherent in work with MPD ciations between Jl,fPD and a fundamentalist religious upltringing patients, and describe characteristic sequences in the reactions oj and demonstrates that primary and ucondary personalities differ those who work with AiI'D (e.g., from fascination with MPD and greatly in God images and religious practices. TM suffering and MPD patin/Is to various expression.r ojwithdrawal., tM breaJuWwn abuse experiences oj AfPD patin/ts raise religious and existmtial ojtmpathy and rapport. tlu ross ojan optimd. therapeutic stance, qu.eslions in pS)'c/wtMrapy. &ligioU$ questionsJail into thraarros: and actingout in the countertransJtrtmz). &ueral patterns oJther Cod and tlu existnuzoJernl., an~at God or institutional n!ligion, apist distress willIx noted. A modelJor diagnosingtluproblnn areas andspiritualgrowthlflUStiomthataa:ompanypsyciwlofjadgrowth. ojouerwhelmed tMrapists will be described, and types ojintmJen. T1u dynami£ signijicana ojreligioU$ ideation and ojfive compo tiom targeted at the alleviation ojthe probkm arras will be nokd. flnlts oJGod imagr::s areexplainhi. SuggtStions areofferedJorelic· Corrective mt'OSUres will Ix outlined, in the Jrameworlt ojeduca iting and intcpreting religiow badcground and idAUion. PitJalls tional domains. ObsmxJtions on the tfJ«t ojrehabilitating tlu tMr origi11ating in positive and negative cmmttrtransJemue are idnr. aput upon the therapist's patients will be offered. tifted and a neutral aptmxuh ta religion is suggtSkd. Examples are For reprint!; write: givmJordealingwith religious material thatfundionsas mist01lce Richard P. Kluft, M.D. and suggtSticms areofferedJorcollaboratingwith clergy inthe treat Dissociative Disorders Program ment ojreligi0U5 MPD patients. The Institute ofPennsylvania Hospital For reprints write: III North 49th Street Elizabeth S. Bowman, M.D., S.T.l\1. Philadelphia, PA 19139 University Hospital, N-604 926 W. Michigan Street Indianapolis, IN 46202-5250
55 DISSOCIATION: ABSTRACTS
Vol. III (1),3-9,1990 Jtatures thai are maladaptivt in a rapidly t:hanging milieu like Diagnosis of Childhood Multiple Personality Disorder tooay ~ tLchnical socitties (dissociation, btu rrtd intupnsonal boun~ From Ou uant surge of intn~t in mulliple pnsonality di.wrder aries, cognitive distortion, rigidification, and affuHirivnr lKhav (MPD), proliferation ofclinical and scinltific publicaiionJ on t~ ior), may ensure pnsonal survival andJamily bonding in a c0m JUbj«t has emngtd. MPD is unthntood to have its roots in ,hjJd~ paratively stable milieu wMnthrMts artcatastrophicbut inJnquent hood; Iunueva, little is known about this condition in youth. In and stn?ol)1Jed; e.g., tkanlt'll within which Mrrw sapims probably many oftlu rqxnts ojchildhood MPD the subjerufaU slutrt ofmut evolwd. 2) SpontanMlLS hypnotic dissociation often accompanies ing llufull criteria as appliM to adults. In this paptr clucklists of llu txperiena ojtrauma, which may (a) promote iml1udiale sur signs and symptoms ofAfPD in youth are compared. TheM check vival; (b) pennitlater gmwlh and dnJtlopmrnt, at cost ojpnfNtu lists artorganiud into symptom groups. Casevignmes ojchildhood atingsome impairment; and (t:) Jaci/iUJtedeaptifm ojolMrs by dLap MPD whidl ncmt/y have bMn ~ by ~I autlum are rom tion ojS€1J. 3) Traumatic afftd may pruuide a driving Jora Jor parnJ 10 thesesigns and symptoms. Most significantly, a snofdiag ongoing cuUural evolution. nosti{; criteria which may beapplied to children and adokscents with For reprints write: dissociation and major lNhatiior disturbanas and who may or Ina)' John O. Beahrs, M.D. not have MPD have bun projJostd. The suggtsttd designation for Portland VA Medical Center tllne diagnostic criteria is dissociation idnltity disorder. Outpatient Mental Health Clinic (116A-OPC) For reprints write: 3710 SW U.S.Veterans Hospital Road Gary Peterson, M.D. P.O. Box 1036 Southeastern Institute for Group and Family Therapy Ponland, OR 97207 103 Edwards Ridge Chapel Hill, NC 27514 Vol.lI1 (1), 22-30,1990 Multiple Personality Disorder and Satanic Ritual Abuse: Vol. UI (1),10.14,1990 The Issue of Credibility The Need for Marriage Therapy in the Treatment of The issue oJsatanic ritual abuse ha.J gairud widesprUJd frublit: and Multiple Personality Disorder professional attention in the past 10JMr'$. During the'a"" man] Most litnalurt: that examina MPD focuses on llu trrotmrnl ofindi oduU AfP/) (multiple JNnonalil)' di.sorrhr) patients describe mtm() vidual clients and only OC«lSitmally discusses the use of marital Ties ojsuch abuse btginning in childhood. SimuUaneousl)', thhe therapy as a supplementalfrmn oftreatment. We propose that mar are pr~sclwol children reporting current i1lcidents ojsexual aM ital therapy is a critical part ofworleing with MPD patients in that physicalabuse involvingsatanism inday care Jettings. ProJessionals it inamses the spnd and t/ftctivmm ojindividual therapy and spuificaUJ oddnssing the day can aJ.S€S have attLmptLd to delin solidifies gains math with inugratitm. TIlL foiklwing spmfic mar taleJMtUTeS whit:h distinguish rilual abuse Jrom troditional cqn ita/ issues aTt: ocnmirud: 1) tducating the ~ 2) undmtand aptua/izatiom ojchild abuse. T1u duJ.radLristia ojritual aiJuse ing supa~ (affwive pervasion, 3) Iu:Jndling conjliding tkmo.ru1s which they have identified artpresentLd, as Wt!U as similarities and oJalJrrs; 4) responding to child alters; 5) supportinglhesexualrda differenas betwtrn the child and adult A1PD patients'rq>orts. IlUVitlJhle tionship; 6) adjusting to integrations; and 7) havingpatience with questions regardingthevalidity andaccu rat) oJAfPD patients'satan thetherapeutic process. In addition, both maritaltherapy techniques ic abuse memories are explored. The substantiaUd oct:Ul'Ttna ojrit ami goals are examinnf in cUtaiL ual abuse in contemporary, non-satanic, dangmnu cults is dis For reprifil5 write: c:uss«fasaJramewor*Joramsidningtheauthentitil]oJAfPDpaiimls' Patrick Panos. M.S., M.S.W. satanic abuse accounts. It is /J'roIJOS€d that an attitude ojcritical 11820 Sourn Mapleridge Circle judgmrent concerning uports ojsaUJnic ritual abuse is nemsary, Sandy, lTT 84094 10 avoid dthh denying the issue or ~a/izing the natunand extend ojtluproblml. Vol. UI (1), 15-21, 1990 For reprints write: The Evolution of Post-Traumatic Behavior. Susan C. Van Benschoten, R.l ., M.Ed., MA Three Hypotheses Department of Psychology Catastrophic stressct'3" regularly kad to flu oJkn~isab/jngsymptoms Georgia State Uniyersity oJthe post-traumatit: stress dis 56 DlW)( I\Tlll\ \,~ \\ .. I \t.rlIl~ Vol. III (1),31·33,1990 For reprints wrile: Tr.msculturallssues in Psychiatry: The Ataqueand Slewarl Gabel, M.D. Multiple Personality Disorder New York Hospita1-Comell Medical Center Du~ 10 lhe difficulty in thlection of multiple !JerS0,IQ!ity diMmier Weslchester Division (MPfJ), this dissociativ~ disorder is frequently mi,sdiagnostd and 21 Bloomingdale Road i neffectivdy treated. In this casereport ofMPD in aHispanic woman, While Plains, NY 10605 the aUlhor compares and contrasts her presentalion ofsymptoms with those ofthe cu1Jurally aeapted alaque de nnviDs, or "Pumo Vol. In (1),48-53,1990 RiaJn syndrome. " It is lheoriud lhat the similarities may increase Dissociative Disorders in Impaired Psychiatry Residents the inddenu ofmisdiagnosis ofAfPD in Hispanics and it is nc and Graduate Students in Psychology omwmded that the dia~wsis ofAfPD be considered in Hispanics Altlwugh the dissociative di.sarders remain c01ltraversialentities with with histories ofalaque. in American psychiatry. they are being recognized and treated with For reprints wrile: incnasingfrequtmcy. In recent yrors the recognition ofsuch condi Marlene Steinberg, M.D. tions in very high functioning individuals. induding phJSidan.s Deparunent of PS)"chiatl)' and psychoJDgists, has bten rtptrrUd. The tunmt communiaJtion Yale UniversilY School or Medicine describes the OCtu1TenCe ofdissodative disorders in distressed p~ 27 Sylvan Avenue chiatry residents and graduate students in psychology. Illustrative New Haven, cr 06508 vignettes are offered, and the manner in which these individuals may dnnonstrau sugpstive signs ofsuch conditions is discussed. Vol. III (1),34-37,1990 The optimistic prognaris far high-functinning dissocMliw disortkr Contemporary Interest in Multiple Personality Disorder patinlts and the liMlihood ofprolonged difficulJies ifSU€h condi and Child Abuse tions are not r«ogniud makes it usiful to hawa high intUx ofsus in the Netherlands picion jar such conditions in the troubled resident orgraduate stu Interest in multiple personality disorder (MPD) as well as sexual dm'- child abuse is rapidly growing in the Netherlands. perhaps mon-.so For reprints write: /han in otherEuroptan counlries. Clinical, l/uordical, and re.sw.rch Richard P. Klufl, M.D. dewlcpmtnts in these respects are outlined, and it is menlianed that Dissociative Disorders Program patients stating that they have bten victimJ ofsatanic cult abuse The Institute of Pennsylvania Hospital are also enco-untered in the Netherlands. 'l1le need jor more inter III North 49th Slreet na/ional cooperalion is expresS6i Philadelphia, PA 19139 For reprints wrile: Onno van der Hart, Ph.D. Vol. III (2), 57-59,1990 RiaggZ/NW Is Multiple Personality Disorder Really Rare inJapan? P.O. Box 71505 Despite the ruent high numberojreports on multipkpersonality dis 1008 DA Amsterdam arder (MPD, especially in the United Stales, Japanese psychiatrists THE NETHERlANDS still belicue that MPD is a very rare psychiatric problem. A review of 489 inpatients diagnosed DSM III or DMS-IlI-R criteria was used Vol. III (I), 38--47, 1990 to dttennine the incidenaofAlPD awmgaUinpatitnlS in aJapanese Dreams and Dissociative Theory: Speculations on mtdirolc~ hospitalduringthef>modoffivtyears bttwtmOcIobw BeneficialAspects of their Linkage 11. 1983 and Oclober 10, 1988. No diagnosis ofMPD was math. The linkage between dreams and various dissociative phenomena Further study based on lhe same diagnostic criteria should be con has often bten noted on an intuitive or dillical basis. DrMm theo ducted 10 thtnmim differences in tI~ indfk,l(;e ofMPD across dif ry during this untury. Iwweuer. has been assodpl61 with andhelped ferent cultures. to pruuitk theJra'newor* for pSJchoanalJlic t~ry. nol dissociation For reprints write: theory. In recent Jrors interest in dissociation theory and dissocia Yoshilomo Takahashi, M.D. tive phenomena has grown. This has also b«n true ofthe interest Department of Neuropsychialry in dreams as understoodjrom vantage points that dispute classical Yamanashi Medical College pS)'choarut.lytic uiews on dreaming and that emphasize a role for 1110 Shimogalo. Tamaho,Yamanashi 409-38 drMming in IMming and adaptive behavior. This paper reuinus JAPAN sO"'Mfth~ iJ.nus in grtawddail. /l emphasius the apparent /inJr. age between dream phtnomena and parlicular dnam thtoritS with dissociation theory. Possible benefits to dream theory and to dissoci ation theory when dreams are considered within a broader frame llXJrk ofdissociation are disr:u.sstd from several uiewpoints. 57 [)[~~()(I\II()\.',,1 \.\" 1 \l.llhll/ Vol. III (2), 70-80,1990 lUcomplish thissomnimes difficult task offosUringcooperation. The Dreamlike Thought and Dream Mode Processes in VAT IILips personalities clarify underl:,.ing values the)'find person the Fonnation of Personalities in Multiple ally meaningfuL The personalities' undnl)ing values may show Penonality Disorder more similarities than are sun in their uuert bthaviors, thus s~ In mulJipkpmonnlity di.sorder(MPD), tJu ovnwMlming traumas ing common grounds Jrom which tIlL therapist can initiate discus· indua dissociative state5 ofton.tetou.rntlSS in which 1m child ustS siOTU about TMSOTU Jor cooperation. This paper outlims the VAT ~lcpmentaldnamlilu thought in a dnam moth ofmental pro and offers two case studies, each with two pnsonalities, to dnrum ussingto funn personalities to copt with or tkftnd against the trau strate use ojIhe VAT infostering cooperation among personalities 11Ul.l'. Thepersonalities may then contjnu~tobestnu;turedbyschemas in tIlL sucassJuI treatment ojAfPD. and substTOles basm on rrolity,jantasy,jurlMrdrtamliJre thought, For reprints write: and othershaping influt7lce.s, such as itkntification. EvidenceJor Robert R. Hutzell, Ph.D. this uiw is: (1) When AfPD first droelops, much a/llu childs nor Clinical Psychologist and mal thought u dreamlike. (2) The nature and elaboration of the Director of the Behavioral Health Clinic pmonn/itiesfrom childhood to adult MPD pora/hl the lkwlcpmmt VA,.\iC1l6B ofd!i/drm swaking thought and tMT dreams. (3) AlPD palimts Kno>....':ille. IA 50138 oftm wednamlikethought(such asimagpy, symbols, crtativeimag ination, and personification) in the dream modt ojprocessing in Vol. III (2),94-101, 1990 which personalities an intenYly hallucinaUd, have delusions of Historical and Folk Techniques of Exorcism: expnlentiairtality, oflm a:pmmaamnesia, slwwinJnl.uenwtion. Applications to the Treatment of Dissociati,,-e Disorders ~ varying orienlations to tirnt', plaa, and pnsrm, and use par ArnhropologistsandpsychiahistshatxpoinUdoulsimilaritwbdwmJ alkl and analogical proassing. the traditional diagnosis ofpossession and presmt day diagnostic For reprints write: criteria Jar dissociative disorders. Ouer the centun-es, exorcism has Jean Franklin, M.D. btnl tIlL treaJment ojcJwiaJorsuch dis0n.hr3. In this article ClIristian 274 North Pleasant Street andJnui.sh exorcism praaices aredescribtd together with moW tech Amherst, MA 01002 niquesfrom other cultures. Common elementsJoond in traditional exarcis,ns indudL: l) use ojspeciailliagnostic techniques; 2) use of Vol. III (2),81-87,1990 incantations, scriptures and music; J) use ojritual obfrcts; 4) phys SeH·Mutilation Associated ~ith Dissociath-e Disorders ical intenJentions; 5) verbal confrontation ofthe possessing spirit; The incidena ojMlfmutilation is high aTlWng pat~ts with t!ating 6) aftncare; and 7) care to urukrstand and avert risks to tIlL DCOT disankrs, antisocial pmonaiit) disonkr, and bordnlint! personal,. cist. Familiarity with these techniques is useful when working with ity disorder. To dLtermint! Ihe incidence ojulfmutilation among patimu who alkgtlhat they are victims ojsadistic ritual abuse, ptJtienu with dWociatiVf! dis0n.hr3, lhe first one hundrtd consu'Il who may sedc exorcism from traditional sources, amcurrmtlJ with tivt: adult diss 58 ~---=------VOLUMES I· IV, 1988 - 1991 toms. For reprints write: For reprims write: Richard P. Kluft, M.D. Colin A. Ross, M.D., F,R.C.P.C. Dissociative Disorders Program Charter Hospilal of Dallas The InsLitule of Pennsylvania Hospital 6800 Preston Road III North 49th Streel Plano. TX 75024 Philadelphia, PA 19139 Vol.lll (2),107-112. 1990 Vol. III (3),127.134, 1990 A Preliminary Comparative Study of Drawings Produced Multiple Personality Disorder, Borderline Personality Under Hypnosis and in a Simulated State by Both Disorder, and Schizophrenia: A Comparative Study of Multiple Personality Disorder and Non-Multiple Clin.ical Features Pel"SOnality Disorder Adults Mulii/lkpmonality disorder(MPD) has al times been confused with In a pilot sludJ designed to tktennint! ifthere is a dilJerena in lhe bolh. schizophrenia (SCH1Z) andborderlinepersonali1y disorder(BPD). artworlr ofAfPD and non-MPD aduh.J whet ~lopmen1alstages In this study, 38patients with DMS-llI-R diagnosis ofMpt) (N-16), ofartistugrowth are compared, both. groups oJsubjeds werta.sY.Smi sauz (N-1I), or BPD (N-J J) were evaluated with a battery of under two conditj(J1ls. Each suJ1ed was asked 10 complete a set of strodumi interviews (SCJD, DDlS) and psychometric tests (MMPI, drawings while they wert putendjng /0 be cerlain agp (5, 9, 12, MCMI, DES) in order 10 define distinguishing features among the and 16), i.e., in a simuwted slate. A second set ofdrawings was thru diagnostic groups, MPD was differentiated.frvm SCHIZ on the completed while subjects were hypnotiud and age regressed to the great majority of test measures. MPD was not differentiated from same agp of5, 9, 12, and 16. A~Jar the simulated and hypnot BPD OIl MMPI or MeAtI, fntlthese groups differed in many clinical ically a~ rtgm-Md slal~ wm: seiLeud based on mrlier developmen fUllum, particularly measures ofseveril)' ofabuse and dissodalive till studi~ ofartwork. Each age seluud ~lsa differnll sta~ symptoms. ofartutic growth that can be identifiNt bJ cluJraamstics foond in For reprims ",Tite: the foon ofartwork ("otNt in the linUlr qualities, spatialorgani David Fink, M.D. zation, mid use ofd~tail within tM artwork). The Mmln Whitney Assoc. DirccLOr, Dissociative Disorders Program U test, wnt1t applud to scores representing developmental charac The Institute of Pennsylvania Hospital teristics in artwork frorll both the simulated and hypnotic states, I 11 Nortll 49th Slreet SMwffi, a difference aJ tI~ p<.OO6 level (significtlnt) and p<.OO2 Philadelphia, PA 19139 level (marginal), res(MctiVf!ly. Non-MPD subfrcts sromi higlll:r, in tM stagefour lhrough sta~ six range. AUYJ suhjtds' swres showtd Vol. III (3),135-143, 1990 grea1er diwrsil], with aU six stagd ofartistic growth bring r~ The Oinical Phenomenology of Males with Multiple senkd. This diversity in MPO SCOU$ suggests that a,t age regrnsiQn, Personality Disorder. A Report of 21 Cases ora phenomenon akin to it, occurs in MPD su,¥cts but is not afrpar l-V~ describe 21 mlJU patients meetingDSM-III-R and NIMH crite tnt in non·Mpf) subjects regardless ofinstructions to simulate or to ria for multipu personality disorder (MPD). They were compared follow a protocol instructing them to age regress hypnotically. with female patients in the NIMH data base on MPD and dissocia For reprinls write: tive disorders. Striking similarities between males andfemales were Nancy L. Fuhrman, M.Ed. found on most variahks. &th groups had extmsive childhood his 1118 Williamsburg Road toms ofsexual and physical abuse far excmiing 1M prevaJenas Lancaster, PA 17603 rqxmNtfor other diniall and non-dinical popuJa1ions. Thn"t were trnufs for males to have more alcoholism and antisocial beluJuior. Vol. III (2), 113-122, 1990 Generally, males had moresubtkclinicalpresentations thanfemaJes Preliminary Notes on Multiple Personality Disorder and a'nd reported fewer alter personalities. Implications ofthesefi'ndings Allied Fonns of Dissociative Disorder NOf Otherwise and the limitations ofthe present study are discussed. Specified in Practicing Psychotherapists For reprints write: DissodaJiVf! disorders, including mllltipu personality disorder and Richard]. Loewenstein, M.D. alliedfarms ofdissocintiuedisonJernot othnwisespedjied, lum'enroun Sheppard and Enoch Prall Hospital tertd in 20 practil:ing psydwtherapists. DdailM reportage is pre 6501 Nonh Charles Street duded l1J am.rideralions ofconfidentiality. SN€tLd topics wilh regard BaILimorc, MD 21285 to their professionalfunctioning, diagnosis, phenommolog;, tJ'"Mt ment, and prognosis will be discussed. 59 lHV\O(l\[[()\.\,,1 \ \" I \[~"h['l'l! Vol. ill (3), 144-150, 1990 Vol. rn (3), 154--159,1990 Unusual Medication Regimens in the Treatment Mental Unity, Altered States of Consciousness of Dissociative Disorder Patients: Part I: and Dissociation Noradrenergic Agents This wuxhl for understanding altertd slates ofamsciou..snD.J and Tht norodrnu:rgic agents proprarwlol, and tlJ a ksserexinlt, doni~ dissociation is based on the h)pothesis that normal amsciousness dim, are uwI in an ~men.tal setting to reduc~ switching and depends on an illusion. ofmentalunitygenerated by certain dynam anxi~ty in dis.rociative diMJrder patients, making tJwn !xUer can ic brain processes. When these processes an altn'ed and the illusioo didates fqr frsydwlhD-aP'J. TM ra1ionakfqr this non-FDA-aptmJvM ofmental unity is lost, tIlL individual experiences an aht:red state use ofthe drug! isfounb.d in tMJa1MS-wnge and Cannon·&rd ofamsciousne:ss in which normal consciou.sness is latent or Mdi.sso thd:nies oftmoti()n. It is h)pothLsiud further that the mechanisms ciated. " Mental organiUltionsformed during a'l alteretl state will, fnvPOsed l1J tM two theorns are reinfarcing ofone another via cla5- in tum, become dissociated when the altered state is terminaud and siCdI amditilming in tM frroducti(J1l and reinJoreemrnt ofchronic, mental unity ntuntS. In some aues, T«Unmt altered stales may sroer~anxidy rnpon.w. TMeffutoffrroPTanoJolond ckmidineCdn kad tlJ muilipk dissociated mrntal systems or states. Thnnpeutic mmplnnmt the tfJect ofbrnuxliaupines in these patients. In the resolution ofdissociation requires that the individual gain acms txpmmen.tal protot:ol dMcribtd, propranolol or clonidin~ is some to the memory, transwld the obligatory illusioo ofunity, and coo ti1Ms UMd at ultrahigh doys, with patients always untkrclose mLd salJUSly avow thetgo stateformLtl during the Iraumatic alJced state ical sufN:rui.siun. ofamsaousnLSS. For reprints write: For reprints write: Bennett G. Braun, M.D. Louis Tinnin, M.D. 9701 Knox Avenue, Suite 103 WVU DepartmentofBehmioral Medicineand Ps}'chiaU}' Skokie, IL 60076 Chesmut Ridge Hospilai 930 Chesmut Ridge Road Vol. HI (3), 151-153, 1990 MorganlOWll, WV 26505 The Dissociative Experiences Scale: Further Replication and Validation Vol. II] (3), 16().164, 1990 ThtPUrfl 60 mW)([\J10\ \,,1 \ \" I \1 ..,IlI~! VOLU~lES I-IV, 1988 -1991 , o/forbidden tksires by 011 aller, and 5) tJ~ ineuilahkfailure ojdis Jactitious disorder ojthe MunchallSen tJIM. sociative altnnpts to dispd psychic conJlia. These obsmJalionsfind For reprinLS wrile: corroboration in clinical maurial frraenud. Philip M. Coons, M.D. For reprints write: Larue D. Carter Memorial Hospital Emanuel E. Garcia, M.D. Ig15 WeSl 10th Street 2120 Race Street Indianapolis, IN 46202 Logan Square Philadelphia, PA 19103 Vol. III (4), 179-187, 1990 Adolescent Multiple Personality Disorder in the Vol. III (3), 167-173, 1990 Nineteenth and Early Twentieth Centuries Dissociation and Subsequent Vulnerability: Alth(fUgh modem literature refers to cases ofadolescmt MPD only A Preliminary Study since /956, six casts were reported betUJt:e1l /823 and 1926. This RLt:ttlt reports by D. Spiegd, E Putnam, and others derMnslratL article summarius the case reports oj thes~ patiems and compares that dis5oaol;qn is a common reJponse to JetJf:'fe trauma, snving to thnn. to r1Wdnn reports ofAlPD in adolesance. The tlJrly patitnts provide .rorru ckgree ojlUUte insulatioo against overwhelmingslre:s wereoUhr, were 50%Jrow.k, and had a maximum ofthrtl} rtport sors. Thisquitepn/imina']sttldynfl/orescertain oftheconsLqUences «i. personalities. While rome symptoms have r~ajned constant wer subsequent to the establishment ofdissociative defenses, and illus lime, the symptom profiles ojearly and nuxlern adouscent patients trates awl their successful employment is a lwo-edged sword, rtn are somewhat diffmmt. Early patients Jrequently switched person derillgthose w1wdeutlop an adaptation rel)'ingon dissociation wl alities upon awakeningfrom slNp, had dramol;c Jainting spells, nn-abk to rmlter than prot«ud against subYquent rtuiaimiUJtion. more oomplek mutual amnesias, more oonvtrsian symptoms, more Ofnghtem «mJuUy studw inm! viaims who had dnNloptd dis prominent ha:.ytranm, andlessthpression. Sexu.alabusewas rtport sociative disordm and had been sexually expWittd by /Mychothera «i. j'n two cases but authors were very retiant to discuss it and did /JiJts, 14 (78%) had been raped as adults. One hundred percent not recogniu it as an etiologic factor. Even though early authors were found to suffer orlgoing dissociative symptoms that disrupted were neurologically focused, rarely explored psychodynamics, and tMirsmseoJmastery and rAmtroioJthnnselvesand tMirlives. One oJJerni mostly physical tfflltments,jiw ojsix patients had symptom hundred permit demcnstra1td that tJu thfenrive ab/atitm ofmem remissions ojgrMter' than one ynJr. ory ofcrucial inJ(ff11Iation rrndmd thnn incapable oJ peruiuing For reprints write: and reading to act-ual danger situations appropriately. Nillety-two Elizabeth S. Bowman, M.D. percent became frozen or withdrawn under stress, and met situa Universily Hospital, N-604 tions best avoided by thdsive action unth passive compliance and 926 W. Michigan Street leanmi Mlplessmss. The samL peranlagt had suJJered a shatlering Indianapolis, IN 46202-5250 ofbaric life as.rumptions. In aU cases, traumati«J~induad du sociatiw def(ff11lation ofthe observing ego and debasement ofCOfj Vol. III (4), 188-194, 1990 nitivejunctioning had OCCU17'td, leading 10 a deconlextualization Educational Domains and Andragogica1 Approaches oftraumatic e>:/Jeriences. The outcome ofthese sequelae, which offer in Teaching Psychotherapists About Multiple lUUU protection, is a syndrome of chronic impairment which, in Personality Disorder sevr:u cases, prtdisposes those who suffer it to repetitiw reviclimiza Didactic efforts i" MUMting studetlts and co/.lMgues about multi tion. Thesefindings areduplicatni in a 14rpserUs currently under ple pmtmality disorder (MPD) oftm begin unth rather traditjqnal study. Thera/MUtic implications and useJul strategies an reviewed. attempts to conlKJ a hody ojdidactic know/nige. and assume that For reprints write: lhey prepare the studentleamer to begin his or her clinical worIc. In Richard P. K1uft, M.D. Jact, although such approaches are traditional and reasonably effec Dissociative Disorders Program live, they are perJorce limit«i.. Educators divide the goals oj«i.llca The Institule of Pennsylvania Hos~ital tion into thm domains: cognitive, attitudi"a.l, a.n instrummta.L III North 49th Street Also, adult learners tt:nd to absorb material best when it is oriented Philadelphia, PA 19139 toward problem-solving rather than the communi«Jtion oj in/or mation and abslract concepts. Therefore, teaching frrOJessi()nal stu Vol. III (4), 177-178, 1990 dents and graduate theraputs ideally should address the several Factitious Disorder (Munchausen Type) Involving domains and inclwk a la.rgt portio,t ofmaterial presented with the Allegations of Ritual Satanic Abuse: A Case Report several priruiples ojadult lnJrning born in mind. Thu presenta.c A ~r-old WQmtJrl was Iwspitaliud after IhTMtnling suicide. lion wiU lxgin with a review ojapproaches u.ud to educate thera She alleged that she had been the victim ojritual Satanic abuse. A pists aboutMPD, and thenJocus on t«hniques to bringabout learn careful evaluation including histury-taking, ditlicalobservation, ing with regard to the condition and its lreatment unlMn an requestJor collateral in/ormation, andpsychologicaltes/ing not only Jaikd to amuOOrate Ju:r story, but pointnJ insuad to a diagnosis of 61