LCEHWAILImDS, JAY PBEsUAycSGhEEi aARtrN,y S D1W5 D4ICI:1SAS2,O, EDCTeI cAAeTmLI.bOeNr 1 I9N9 7MURDERERS Objective Documentation of Child Abuse and Dissociation in 12 Murderers With Dissociative Identity Disorder Dorothy Otnow Lewis, M.D., Catherine A. Yeager, M.A., Yael Swica, B.A., Jonathan H. Pincus, M.D., and Melvin Lewis, M.B.B.S., F.R.C.Psych., D.C.H. Objective: The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder. Method: This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects’ family members and others. Handwriting samples were also examined. Data were analyzed qualitatively. Results: Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were docu- mented in 10 cases. Conclusions: This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it. (Am J Psychiatry 1997; 154:1703–1710) he diagnosis of dissociative identity disorder (for- symptoms nor the abuse engendering them have ever T merly called multiple personality disorder) is usu- been documented objectively in a group of dissociative ally not made until adulthood (1), long after the ex- identity disorder patients of any kind (children, adoles- treme maltreatment thought to engender the condition cents, adults, or murderers), both the diagnosis and its has passed. Therefore, although there is a consensus etiology in childhood maltreatment have met with criti- that the most common cause of the disorder is early, cism ranging from skepticism to scorn (8–15). ongoing, extreme physical and/or sexual abuse (2–6), The diagnosis in felons is doubly suspect. The pros- accounts of such abuse are usually provided retrospec- pect of facing the consequences of a serious offense tively by the patient and lack objective verification. As invites malingering (16, 17). Dinwiddie and col- Putnam (1) said, “In most reports, including the NIMH leagues (18) asserted that the disorder, especially in survey, there is no outside verification that any trauma forensic cases, could not be distinguished from malin- actively occurred.” gering. Orne and colleagues (19) suggested that the Coons (7) recently attempted to verify abuse histories most objective means of making the diagnosis in foren- in a group of 19 children and adolescents through in- sic cases was through interviews with family members terviews with families and “collateral reports from nu- and others who had observed the characteristic be- merous sources.” The extent to which abuse was docu- havioral changes in the individual before he or she mented in each case was unclear. Because neither the had committed a particular offense. To date, however, there have been no such systematic studies of groups of felons with dissociative identity disorder or, for that Received April 5, 1996; revisions received March 24 and July 7, matter, of any other series of adult patients with the 1997; accepted July 31, 1997. From the Department of Psychiatry, disorder. Carlisle (20) described 13 murderers suffer- Division of Child and Adolescent Psychiatry, New York University School of Medicine. Address reprint requests to Dr. Lewis, Depart- ing from multiple personality disorder but provided ment of Psychiatry, New York University School of Medicine, 550 few objective data to support the diagnosis or its etiol- First Avenue/New Bellevue 21 South 14, New York, NY 10016. ogy. Coons (21) collected information on a group of Am J Psychiatry 154:12, December 1997 1703 CHILD ABUSE AND DISSOCIATION IN MURDERERS TABLE 1. Child and Adult Symptoms and Signs of Dissociation and Sources of Confirmatory Data for 12 Murderers With Dissociative Identity Disorder Age Symptoms and Signs Symptoms and Signs Corroboration Subject Sex (years) in Childhood in Adulthood of Symptoms 1 M 40 Considered “possessed”; vivid Trances; vivid imaginary companions; voice Mother, sister, aunt; police imaginary companions; auditory changes/switches to foreign-sounding records; legal assistant’s hallucinations; dramatic language; different names/handwritings; notes; handwritten demeanor changes command hallucinations; amnesias; two documents and letters male personality states identified 2 M 32 Trances (“phasing out”) since age Trances; voice, accent, demeanor changes; Mother, brother, wife, 15 months; called “possessed”; different names/signatures; wrote different teacher, housemates; vivid imaginary companions; ages on forms; auditory hallucinations; am- handwritten documents auditory hallucinations; episodic nesias; three male personality states and letters shaking with eyes open; identified considered epileptic 3 M 41 Trances; fugue states; called Trances/“conscious blackouts”; voice and Wife, brother, sister, friends, “possessed”; vivid imaginary demeanor changes; regression to small neighbors, co-workers; companion; auditory child; legally changed name to that of most court records of legal name hallucinations; amnesias powerful alternate personality; different change to that of alternate signatures/handwritings; auditory personality; handwritten hallucinations; amnesias; three male documents and letters personality states identified 4 M 33 Trances (“glassy eyed”); fugues Trances/time loss; vivid imaginary com- Mother, father, brother, (age 8, found across town; age panions; voice and demeanor changes/ friends, cell mates; pros- 14, found in distant state); vivid dresses and sounds female; different ecution psychiatrist inter- imaginary companions; audi- clothing (sizes, sexes); different names/ viewed alternate person- tory, visual, and tactile hallucin- handwritings; auditory hallucinations; alities; trial transcripts; ations; amnesias; falling and shak- amnesias; two female and four male police audiotapes; hand- ing episodes; considered epileptic personality states identified written documents and letters 5 M 30 Fugues; vivid imaginary com- Trances (i.e., “astral projection”); fugues/ Mother, brother, aunt, uncle, panion; auditory hallucinations; time loss; voice and demeanor changes/ stepmother, stepfather, amnesias; wore girls’ panties dresses as a female; different names/sig- childhood friend; adult and and sanitary napkins natures/handwritings; different visual child psychiatric/psycho- acuities; auditory hallucinations; amnesias; logical records; school two female and four male personality records; handwritten states identified documents and letters 6 M 22 Trances; fugues; vivid imaginary Trances (i.e., “astral projection”); fugues/ Mother, siblings, cousin, companions; auditory and blackouts without alcohol; vivid imaginary schoolteacher, prison visual hallucinations; considered companions; voice and demeanor changes; psychiatrists; handwritten epileptic different names/signatures/handwritings; documents and letters different drawing styles; different visual acuities; auditory hallucinations; amnesias; one female and three male personality states identified 7 M 21 Trances; vivid imaginary com- Trances/blackouts without alcohol; fugues; Mother, father, panion; auditory hallucinations vivid imaginary companions; voice and de- grandmother, sister; meanor changes; different names/signa- handwritten documents tures/handwritings; auditory halluci- and letters nations; feels controlled from outside; amnesias; two female and five male personality states identified 8 M 46 Vivid imaginary companions; hos- Trances/blackouts without alcohol; voice Mother, ex-girlfriend, wife, pitalized for two episodes of and demeanor changes; regression to baby relatives hysterical paralysis (ages 9 and talk; different names; auditory hallucina- 10); talked to self as if to tions; amnesias; one female and two male someone else personality states identified 9 F 36 Vivid imaginary brother; auditory Time loss; voice and demeanor changes/ Parents, child, teenaged hallucinations dresses and sounds male; different names; accomplice, housemates; auditory hallucinations; amnesias; neurologist’s report diagnosed/treated for alleged psychomotor epilepsy (normal EEG); one other male personality state identified 10 M 43 Auditory hallucinations; Trances/dreamlike states; fugues/time loss; Mother, aunt, friends; amnesias; dizziness, falling vivid imaginary companions; voice and handwritten documents spells; considered epileptic demeanor changes; different names/signa- and letters tures/handwritings; refers to self in third person; command hallucinations/hears voices arguing; visual hallucinations;