However, we find it pretty unnerving to look back at this text and realize that at one time this was the only type of information on multiplicity available on line. Of particular note are Kluft's interrogation techniques. Multiples and abuse survivors alike, in bulletin boards and later on the internet, took it seriously, passed it around, and apparently felt that this kind of behavior on the part of therapists was justified.
This was originally provided by the Love Galaxy, Home of VBBS Health Net, which offered many files on multiple personality and health issues. PRODIGY(R) interactive personal service 11/21/92 9:27 PM SUPPORT GROUPS TOPIC: SEXUAL ABUSE TIME: 11/20 2:56 PM TO: ALL FROM: CALLIE GOBLE (TDMK17A) SUBJECT: MPD REPRINTS Diagnostic Signs of MPD DISSOCIATIVE INTERVIEWING: 60% of multiples will not do or say anything that suggests MPD unless subjected to a detailed, subtle, and sophisticated dissociative inquiry. Never accept "No" for an answer. Denial, forgetting and minimization produce many false "no's" to questions regarding dissociative experiences. If you have any reason to suspect MPD, keep the issue open in your mind despite the patient's initial "No's" to crucial diagnostic questions. Said differently, it often takes several or even a good many therapy sessions before sufficient information is acquired to strengthen (and finally confirm) a diagnosis of MPD. AMNESIA: Virtually all multiples have periods of amnesia (losses of time) but (i) may deny them (ii) may be genuinely unaware of them. Remember 80% of multiples have no knowledge that other personalities exist. Finally, some multiple confabulate. They report made up memories which cover their amnestic lapses - - and they believe these confabulations. Losses of time, blackouts, Called a "liar" as a child, blamed for things he "did not do", finding that the rest of the class seemed to have been taught something that the patient had not been taught. Discovery of items among one's possessions that cannot be accounted for parents or friends report behavior or events which the patient does not recall Does not recall a large chunk of childhood; Zero memory for one or more years. For example, "I don't remember anything before age 8." CO-PRESENCE PHENOMENA: (Schneiderian first rank symptoms) are often an important guide to diagnosing MPD. These symptoms are accidental or deliberate impingements, by alters inside, on the personality who is "out": Voices arguing: usually about the patient Voices commenting on one's actions: typically, a helper or persecutor Influences playing on the body: often, somatic memory of abuse/trauma Thought withdrawal: going blank, often in mid sentence Thought insertion: alien or surprising thoughts are imposed or "happen" "Made" feelings: surges of feeling out of the blue that are not owned. "Made" impulses: strong impulses to action that are not felt to be one's own. "Made" violational acts: feels controlled, "I watched myself do it" MOOD SHIFTS: Most of the time, MPD looks like mood shifts rather than personality changes. "Moody" -- sudden mood swings observed or reported by patient or others Brought to you without permission by: THE TEACHER & Nikki 10/22 09:48 pm "MEMORY" PROBLEMS: Many forms of apparent forgetting that are actually the result of activity of alter personalities. Little forgettings (e.g. lighting a cigarette while another is still burning in the ashtray; going to bring in the mail or newspaper when he/she has already brought it in) Peculiar forgettings (e.g. learning school material and then TOTALLY forgetting it the next day.) NOTE: This is an extremely common MPD experience. Makes written notes to him or herself because he/she too often forgets what he/she has done or needs to do Headaches that do not respond to pain relievers Spontaneous trance states Staring as if in thought Like watching a movie and may talk to self Dissociative experiences May admit to fearing that he or she is going crazy Visual hallucinations, visions Unexplained pain or other conversion symptoms Marked differences in manner, voice, language, or dress Changes of handwriting Says he or she wants to know "why" he/she did something (e.g. an episode of acting out) Does not like mirrors. Avoids going to the dentist NOTE: The more of the above items that characterize the patient, the more likely it is that she/he is multiple. Early in the diagnostic process, a patient who is multiple, may score positive on only 3 or 4 items. Generally, this score will increase with time as the patients' dissociative process becomes increasingly visible. Some patients, however, will have a score of 10 or more right from the beginning. In any event, diagnosis ultimately depends on establishing unmistakable contact with one or more alter personalities. As Rick Kluft is fond of saying, "The opera ain't over until the fat lady sings". Of course this is brought to you without permission courtesy of: THE TEACHER & Nikki @ 10/22 09:42 pm Part 1 of 4. General MPD Info MPD Education....Multiple personality disorder is about pain. Nothing else. Just pain - physical pain, emotional pain, total helplessness, terror, traumatic humiliation, and overwhelming rage. MPD is the desperate and creative solution of the traumatized child. It is a crude, powerful and wonderful means of survival for children who are repeatedly terrified, abused or trapped in inescapable pain. MPD arises in childhood, mostly ages 3-9. There is juvenile diabetes and there is adult onset diabetes, but there is no adult onset MPD. Only children have sufficient flexibility (and vulnerability) to respond to trauma by breaking their still coalescing self into different, dissociated parts. It used to be thought that MPD was an exotic form of hysteria, an elaborate means of escaping responsibility for dealing with life. It is not; it is usually an effort to "escape" from child abuse. It is often thought that MPD is a sham: a bizarre form of play acting that is perpetrated by manipulative, attention-seeking individuals. It is not; MPD is a "disorder of hiddenness" wherein 80-90% of MPD patients do not have a clue that they are multiple. Most know that there is something wrong with them; many fear that they are crazy - but few know that they are multiple. It is sometimes thought that MPD is the last refuge of a criminal, a deceptive effort to provide an insanity defense so that the criminal can evade responsibility for his or her crimes. Far from it, most multiples don't know that they are multiple. Moreover, once the diagnosis is made, the typical MPD patient consumes months denying the diagnosis and insisting that the therapist has a very vivid imagination. A recent study of convicted criminals (felons, murderers, etc.) who were diagnosed after being imprisoned, found that none of them wished to make use of their diagnosis in order to seek a new trial or to ameliorate their existing sentence. Finally, MPD is frequently misunderstood by the question, "Isn't MPD just an exaggeration of the different parts of our personality; aren't we all really multiple?" This is an enticing question. Yes, we all have different parts to our personalities. No, MPD is not "just an exaggeration" of these parts. Why? At least 6 reasons: 1) Because we all don't have dissociative disorder; 2) Because we all do not have amnesia for what we are doing when a different part of our personality comes to the fore; 3) We all don't suffer from severe and chronic child abuse or trauma; 4) Because the raison d'etre of the different sides of out personality is not to hide from ourselves information or feelings about trauma; 5) Because we all do not have high hypnotizability; and 6) Because we all do not develop post-traumatic stress disorder when we begin to pay attention to our parts. How many parts are there? The typical female multiple has about 19 alter personalities; male multiples tend to have less than half of that. The number of alters is explained by 3 factors: a) the severity of the trauma, b) the chronicity of the trauma, and c) the degree of vulnerability of the child. Thus, a male multiple who was sexually abused a half dozen times by a distant relative from ages 7-10 is going to have far fewer alters than a female multiple who was severely physically, sexually, and emotionally abused by both parents from infancy to age 16. The latter patient, in fact, could easily wind up with 30-50+ alters. How could a person have so many different personalities? How would you tell the difference among them? The answers to these questions require a clarification of several points. First, MPD is a misleading term; Dissociated Self Disorder would probably be better. There is but one self that is dissociated into multiple parts. MPD tends to be understood (incorrectly) to mean multiple self disorder; in fact, there is only one self - however, divided or dissociated it may be. Second, there are usually only 3-6 alters who are particularly active (i.e., assuming full executive control) on any given day. The rest of the alters are relatively quiet (or even dormant for long periods of time). Third, THERE IS NO REQUIREMENT THAT DIFFERENT PERSONALITIES BE VISIBLY DIFFERENT TO AN OBSERVER. It is only necessary that each alter fulfill the basic function of an alter personality; to protect the host personality from the knowledge and experience of trauma. This task is accomplished by means of dissociative barriers or walls of amnesia. Thus, a multiple could conceivably have dozens of alters that look just the same, but who nevertheless serve the function of walling off the trauma from the host (and dispersing it among different alters). Nikki & The Researcher 10/23 08:12 pm The answers to the above questions can now be more easily understood in light of the basic task of an alter personality. If the raison d'etre of alters is to sequester trauma from the host so that she or he is able to continue to function without becoming overwhelmed, then as many alters will be produced as are necessary. Accordingly, when an alter becomes overwhelmed, additional alters may be produced to help contain the trauma. It is not required that these new alters look different, nor is it necessary that they all be active at one time; it is only necessary that they do their job (of controlling the trauma). The typical alters that are found in a person with MPD include 1) a depressed, depleted host, 2) a strong, angry, protector, 3) a scared and hurt child, 4) a helper, 5) an embittered internal persecutor who blames and persecutes one or more of the alters for the abuse that has been suffered. While there may be other types of alters in any given MPD individual, most of them will be variations on the themes of these 5 alters. How common is MPD? Although all data are not in, the best estimate of the prevalence of MPD is that it approximates that of schizophrenia (about 1% of the general population). This estimate would translate into at least 2,000,000 cases in the U.S. alone. Why so many? Because MPD is directly linked to the prevalence of child abuse. And, unfortunately, child abuse is all too common. How impaired is a person with MPD? The range of impairment across different persons with MPD is best analogized to that of alcoholism. Impairment due to alcoholism ranges from skid row bums to high- functioning senators, congressmen, and corporate executives. Impairment also varies in any given alcoholic from one period of time to another (as function of binges, patterns of drinking, life stresses, and so on). It is much the same with MPD. There are some multiples who are chronic, state hospital mental patients, others who undergo recurrent hospitalization due to self-destructive behavior, and many more who raise children, hold jobs and may even be high- functioning professionals such as lawyers, physicians, or psychotherapists. There are 3 major factors that account for whether a multiple is low-functioning or high-functioning; personality traits, post- traumatic stress disorder, and experiences of criticism or rejection. Despite having many "personalities", every multiple, as a whole, has a personality (just like the rest of us). Thus, to the extent that a multiple has counterproductive traits (i.e. irresponsibility, rampant denial and avoidance, strong narcissism, entitlement, masochism, addiction to interpersonal control, psychopathy, etc) then that person will be impaired in his or her functioning as a competent and responsible adult. The character traits of multiple not only typify how they deal with daily life, but ALSO HOW ALTERS DEAL WITH ONE ANOTHER. Lower functioning multiples may have alters who are struggling with one another for dominance, competing for attention, stealing from one another, refusing to take responsibility for the mess that they just made, grabbing control whenever they want (no matter what it interrupts -job, relationships, child care, financial solvency, etc) and so on. Such negative character traits are the single biggest determinant of frequent crises or chronic dysfunctionality; they are also unquestionably the largest hindrance to the therapeutic treatment of MPD. The 2nd major factor that affects daily functioning in persons with MPD is post-traumatic stress disorder (PTSD) (flashbacks, intrusive memories, nightmares). Individuals with MPD also tend to have PTSD. To the extent that a person is troubled with recurrent, intrusive re-experiencing (visual, auditory, or somatic) of trauma, he or she may also have depression,loss of concentration, suicidality, substance abuse, panic attacks, self-mutilation, etc. An upsurge in PTSD symptoms (i.e., flashbacks about a significant trauma) is one of the 2 most common causes of sudden crises, decline in functioning, or psychiatric hospitalization for a multiple. The 2nd most common cause of sudden crisis in persons with MPD (and the 3rd major factor that affects their daily functioning) is an experience of rejection or emotional abuse and rejection as children. As a consequence, most alters are highly (and often catastrophically) reactive to current life experiences that are reminiscent of parental criticism or rejection. Such current life experiences trigger crippling emotional flashbacks and intensely negative thoughts to self-loathing, hopelessness, and perhaps even self-injury or suicidality. For many observers, MPD is a fascinating, exotic, and weird phenomenon. For the patient, it is confusing, unpleasant, sometimes terrifying, and always a source of the unexpected. The treatment of MPD is excruciatingly uncomfortable for the patient. The disassociated trauma and memory must be faced, experienced, metabolized, and integrated into the patients view of him- or herself. Similarly, the nature of one's parents, one's life, and the day to day world must be re-thought. As each alter personality metabolizes his or her trauma, then that alter can yield its separateness and reintegrate (because that alter is no longer needed to contain undigested trauma). Recovery from MPD and childhood trauma is a long and arduous process of mourning during which fear, hurt, rage, and shame must all be digested. Recovery usually takes about 5 years. This appears to be one of three notes on therapy posted by Nikki, Researcher and Teacher about therapeutic vs spontaneous abreactions. Facts about Spontaneous & Therapeutic Abreactions: 1. Trauma and Dissociation - During a traumatic experience some people automatically enter an altered state of consciousness that protects them from the full impact of the trauma. When this occurs, PART OR ALL of the traumatic experience is stored in a dissociated compartment of the mind. 2. Encapsulated Raw Trauma- Such dissociated compartments contain RAW UNDIGESTED TRAUMA that is now "on hold". Unfortunately, such encapsulated trauma cannot be kept on hold indefinitely. 3. Flashbacks and Spontaneous Abreactions- The encapsulated trauma will develop leaks (flashbacks) from time to time. If a flashback intensifies beyond a certain point, a spontaneous abreaction may take place. In an abreaction, the compartment breaks wide open, the person is flooded with the raw trauma, and he or she begins to VIVIDLY RELIVE the trauma. 4. Temporary Loss of Contact with the Here-And-Now. When a person abreacts (relives the trauma), he/she may APPEAR to be psychotic due to losing contact with here-and-now reality. That is, the person becomes totally immersed in reliving the there-and-then reality of the trauma. As a result,the person may seem crazy because, (for example) he/she may suddenly tuck into a ball with flailing arms and scream "No, Daddy! No, Daddy!" This is NOT psychosis, it is a dissociated reliving of trauma. 5. Renewed Dissociation of the Trauma. A spontaneous abreaction of dissociated trauma can be just as overwhelming as was the original traumatic experience. Consequently, the person who is inundated with a spontaneous abreaction cannot handle the trauma this time either. He/she will try to force the undigested trauma back into its compartment as soon as possible - usually in a matter of minutes to an hour or so, but will probably continue to be troubled by intrusive flashbacks. In other words, SPONTANEOUS ABREACTIONS USUALLY DO NOT LEAD TO ANY PROGRESS IN DIGESTING THE TRAUMA. 6. Therapeutic Abreactions. Because the encapsulated material is overwhelming (i.e., traumatic) the person can digest it only if it is somehow rendered non-overwhelming. Abreactions that are not overwhelm- ing -are- therapeutic, because the person is now able to METABOLIZE the trauma. 7. CAREFULLY PLANNED ABREACTIONS. The key to facilitating safe therapeutic abreactions are careful planning, pacing and titrating. A carefully planned abreaction for a person with MPD has at least 8 components. i) The patient knows (and KNOWS that he/she knows) a variety of basic hypnotic skills that provide control, containment, and dosed release of the traumatic material. ii) The patient has an explicit, clear understanding (IN ADVANCE) of each step in the abreaction - including how he/she will be left at the end of the session. iii) The basic details of the trauma are known BEFORE initiating the abreaction. iv) All alters who are part of this trauma are known in advance of the abreaction. v) The trauma is released A PIECE AT A TIME (e.g., visual overview, fear, body sensations, anger, shame, grief) in ONE ALTER AT A TIME. vi) Adequate time is reserved for the abreactive work to be done in the session AND for winding down and preliminary cognitive processing of the trauma. vii) At the end of the session, either unfinished trauma is locked away again or unabreacted alters are put hypnotically to sleep until the next session. viii) Adequate time is allocated in the NEXT SESSION for more cognitive processing of the meaning and implications of the trauma that is being metabolized. 8. ABREACTIVE WORK WITH MULTIPLES. In general, abreactive work should not begin until months of teaching, stabilization and establishing the therapeutic alliance across many alters has taken place. An abreaction may (and, often should) be spread out over several sessions - broken down into logical chunks that allow session-sized pieces of abreactive work to be done. Depending on the complexity of the case, therapy may involve dozens, or even hundreds of abreactions. As the therapy progresses, and the patient learns the ins and outs of abreactions and the broad parameters of his/her trauma history, he/she will often be able to speed up, condense, or even group abreactions in order to move faster. The impetus for such accelerated abreactive work should come from the PATIENT, not the therapist. 9. HYPNOSIS, DISSOCIATION and ABREACTION. Hypnotic phenomena, dissociative phenomena, and abreactive phenomena are intimately intertwined with one another. An informed approach to treating MPD requires a rich understanding of all three. Accordingly, a clinician who seeks to treat MPD must be prepared to seek whatever training, continuing education, consultation or supervision that might be necessary. [I'm not certain if this next item is part of a series] Note 2 of 3: MPD EDUCATION*FACTS ABOUT DISSOCATION & MPD 1. Dissociation is a normal psychophysiological ability that allows people to protect themselves when faced with trauma. 2. Dissociation occurs spontaneously in the midst of trauma and gives the individual partial protection by BLOCKING PART OF THE PAIN, TERROR, AND AWARENESS of what is happening. 3. This blocked pain, terror, and awareness of trauma creates "compartments" in the mind that hold the still undigested trauma. Blockage of awareness causes AMNESIA for part or all of the trauma. When these trauma compartments "leak", the person has FLASHBACKS, NIGHTMARES, and PANIC ATTACKS. (i.e., PTSD) 4. Dissociative ability is a normal, inherited talent that differs from person to person. Approximately 10-15% of individuals have superb dissociative ability; probably it is only this group that has the capacity to develop multiple personality disorder. 5. Multiple personality disorder is a survival tactic. It is the creative attempt of highly traumatized children to protect themselves from trauma and abuse: "It isn't happening to ME". When children dissociate (block) trauma, their "compartments" of trauma become separate personalities. 6. Only children have sufficient flexibility (and vulnerability) to adapt to trauma by means of creating alter personalities. ALL MPD begins in childhood; adults do not have the capacity to adapt to trauma by forming alter personalities. (The exception is that adults, who became MPD in childhood, CAN continue to make more alters during adulthood. 7. Because of the frequency of child abuse, about one person out of 100 (HA!-says I) has MPD (or another closely related severe dissociative disorder. 8. The most common symptoms of MPD are sudden mood swings, episodes of depression, lack of memory for much of childhood, periods of amnesia or time loss, headaches, nightmares, and hearing voices. Other symptoms may include, flashbacks, self-injuring behaviors, shame, guilt, self-hatred, panic attacks, wanting to die, and feeling crazy. Some people with MPD have all of them symptoms, others have only some. 9. MPD IS NOT SCHIZOPHRENIA. Most people think that schizophrenia means split personality. Actually, this is totally incorrect. Split personality is MPD - not schizophrenia. Schizophrenia is a chronic psychosis due to a biochemical/genetic disorder of the brain. Schizophrenics do not have other personalities, schizophrenia is not caused by trauma, and does not involve amnesia and flashbacks. 10. A person who is multiple will REMAIN multiple until successfully treated. 11. About 90% of multiples are totally unaware that they are Multiple. 12. The SYMPTOMS of MPS wax and wane. A person who is multiple may appear to be fine for years and then suddenly begins to have strong symptoms - usually due to flashbacks of past trauma. 13. The typical personalities in a person who is multiple include: 1) a depressed host personality; 2) a scared or hurt child; 3) a strong, angry protector; 4) an internal caretaker of the child alters; 5) an envious protector who is angry at the host. 14. MPD may appear to be exotic or strange, but when seen in context, MPD "makes sense". It is an ADAPTATION to a TOXIC ENVIRONMENT. In an environment of danger and abuse, it makes good sense to be multiple. 15. Each of the alter personalities protects the host by holding one or more compartments of undigested trauma. HOLDING TRAUMA IS THE BASIC AND MOST IMPORTANT FUNCTION OF EACH AND EVERY ALTER PERSONALITY. 16. Recovery from MPD is a process of releasing the old hurt and completing the process of mourning. Successful digestion and full understanding of the old hurt and trauma puts an end to the nightmares, flashbacks, and panic attacks. It also allows the various alter personalities to REUNITE with one another. Nikki & The Researcher & The Teacher Note 1 of 7 - MPD Education Series # 4 [this series of notes is more technical than the others] Etiology of Multiple Personality -From Abuse to Alter Personalities- Researchers have yet to fully understand the causes of multiple personality, but preliminary findings suggest that no single factor engenders the syndrome and no single intrapsychic pattern is common to all cases. Instead, according to Dr. Richard Kluft, "There appear to be both biological and environmental factors which interact with developmental and psychodynamic processes in each patient with MPD. The uniqueness of this interaction in each individual case leads to the wide diversity of the condition's manifestations, structures and treatment outcomes." Kluft has developed a "four-factor theory of the etiology of MPD which reflects this conclusion. The four factors he deems necessary for the development of multiplicity are: 1. A biological capacity for dissociation. 2. A history of trauma or abuse. 3. Specific psychological structures or contents that can be used in the creation of alternate personalities. 4. A lack of adequate nurturing or opportunities to recover from abuse. Kluft's model was well-received by his colleagues at the 137th Annual Meeting of the American Psychiatric Association (APA) last spring in Los Angeles. It was published in a special issue of Psychiatric Clinics of North America (March, 1984) devoted exclusively to multiple personalities. Kluft hopes that the work he and others in the field have done to shape a broad picture of the etiology of MPD will contribute to the formation of testable hypotheses about the syndrome. Note 2 of 7 - MPD Education Series # 4 Defense Through Dissociation In Kluft's view, the first and most important factor in the etiology of MPD is a biological capacity for dissociation. Dissociation, according to him "is an unconscious defense mechanism which involves the segregating of mental or behavioral processes from the rest of one's psychic activity and any analogy with hypnotizability is probably not a capacity of all individuals. Instead, it is very highly developed and accessible in some - immediately so in others, and minimal in yet others." Psychologists say that dissociative mechanisms function in all of us, to some extent. The experience of dreams or spontaneous waking imagery, the "automatic" performance of "over learned" behaviors, and simple forms of state dependent learning are all instances of dissociation. Subpersonalities may also represent dissociative processes at work. Hypnosis and trance are considered dissociative states par excellence. By comparison with the norm, persons who develop multiple personality are dissociation-prone. Their response to the experience of extreme stress or abuse is to isolate the associated feelings and memories from conscious awareness, as memories are isolated from awareness in post-hypnotic amnesia (studies have found that nearly all multiples are highly hypnotizable). Dr Eugene Bliss of the University of Utah explained how the same mechanism might apply to multiple personality: - if hypnosis can cause the individual to forget experiences, feelings or even native language, why should he or she not be able to forget himself or herself. There is a rapid switch and the individual forgets herself or to describe it in a slightly different form, the individual goes into hypnosis, disappears and then is hidden in hypnosis like a host personality, while the (alter) personality emerges into the real world, no longer in hypnosis. Dissociation is the core mechanism in other psychopathological syndromes besides MPD. Psychogenic fugue, psychogenic amnesia and depersonalization disorder are among the dissociative disorders formally recognized by psychiatrists. Dissociation also plays a partial role in some kinds of phobia and anorexia nervosa. "In fact, many people may use dissociation as a defense, said Dr David Spiegel of Stanford University, School of Medicine, but they don't dissociate themselves, as multiples do". Only in MPD do dissociated processes and psychic contents form highly organized and autonomous personalities. This reflects the fact that there seems to be a critical period for the development of multiple personalities in children, prior to the development of a mature ego. Note 4 of 7- MPD Education Series #4 Abuse and Alter Personalities- Part II DISCLOSURE: The following information may be upsetting. Multiples have also been given frequent enemas or massive doses of cathartics because their caretakers believed they must be absolutely clean not only outside but within as well. Such physiological abuse has also included "home treatments" in which children were inappropriately given adult medications, which Wilbur said is common when a parent attempts to treat other abuses that have been inflicted on the child. "Who ever heard of an abusive parent take the child to the doctor?" she asked. Survey results suggest that the number of a multiple's alternate personalities is related to the number of different types of abuse she or he suffered as a child (super multiples have usually been severely abused well into adolescence, according to Kluft). Moreover, because of the multiples history of abuse, at least one personality will almost invariably be an angry, hostile, and possibly violent alter. The link between MPD and child abuse creates special problems both for detecting MPD in its early stages and for alleviating the conditions which foster it. Until recently, professionals tended to respond to reports of both child abuse and multiple personality with incredulity, disbelief, and misunderstanding. "While such responses may be an understandable attempt on their part to maintain a sane and manageable perspective on reality in the face of the awful evidence presented by abused children", Wilbur said at the APA meeting, "they amount to a shared negative hallucination". The problem with credibility may be particularly acute for child multiples. Since they are among the most severely abused individuals, they may also be experienced as the least credible. Incredulity and disbelief on the part of family and professional counselors, however, serve only to reinforce the child multiples use of dissociation as the best available defense against trauma, or the "only way out". "There should be a massive approach across the country toward the prevention of child abuse", Wilbur said. Research on multiple personality can help authorities and the public understand how important it is to control this terrible problem. Note 5 of 7 - MPD Educations - Series #4 The Puzzle of Psychogenesis Not all children who are abused become multiple personalities. What then are the other factors which place a child at risk for the development of MPD? Researchers have a few clues, but their data is primarily descriptive - the mechanisms of splitting are poorly understood. The third factor in Kluft's model of the etiology of MPD refers simply to all the psychological structures, ego contents and other unique shaping influences that a multiple can enlist in the creation of alter personalities. Taken together, these factors determine the particular characteristics of each alter, many of the relationships among them, and the ways in which they develop. Psychiatrists use the term "splitting" in several ways. Most generally, it simply refers to the creation of alter personalities. In psychoanalytic theories of MPD, however, the term has a more specialized meaning. There, splitting refers to a specific defense mechanism which functions very early in life and results in a distortion of ego development. It involves the polarization of emotional identifications so that the child fails to integrate experiences of "good" and "bad" in developing mental representations of the self and others. In the narcissistic or borderline personality disorders, splitting leads to uncertainty about identity, emotional instability, and problematic relationships. Some features of MPD support the psychoanalytic claim that ego splitting of this kind plays a role in its psychogenesis. At the APA meeting, for instance, Putnam noted that many multiples split off in pairs of personalities that seem to be emotional opposites. One personality might have a sweet pollyannish disposition, he said, while her complement is a "bad" or "horrid" child. Yet, some researchers also point out that other features of MPD argue against a strict theoretical interpretation involving splitting. Not all personalities in a multiple reflect the contradictory psychic organization that would be expected, and individual alter personalities may grow and reach more mature stages of psychological development than borderline or narcissistic patients do. Moreover, in some cases, a cohesive personality representing the whole self appears to exist in conjunction with all of the fragmentary alter personalities who represent split off parts of the self. This hidden personality may have a normal, integrated self structure and reflects a unity of personality that is totally lacking in the borderline or narcissistic disorders.In a paper prepared for the First International Conference on MP/DD States, Dr. Richard Kluft concluded that while "some limited support for the presence of "splitting" as a defense in individuals with MP exists...there is little evidence that the construct of "splitting" explains the actual formation or maintenance of alter personalities with unique memories and histories, nor does it explain the "switching" process between personalities." The Puzzle of Psychogenesis- Part II Just what comprises the "window of vulnerability" for MPD is thus still a puzzle for researchers. While they are amassing a growing body of clinical data regarding the creation of alter personalities and their subsequent intrapsychic organization, as yet, no theory unifies their findings. "There are a lot of competing theories", said Kluft. Clinical experience with multiples as well as survey results have shown that: -Some alter personalities may begin as imaginary playmates and develop gradually, while others have no identifiable precursors. -Some alters "live inside" for awhile before coming out and assuming control of the body, while others emerge full blown "on the spot" at just the moment they are needed. -The initial "split" usually occurs before the age of five. Once the first personality has been dissociated, alters may form at any time thereafter. -When an alter personality is formed, he or she may or may not deplete the parent personality of psychological resources. -Alters can be clustered or related to one another in terms of emotional or psychological similarities among them. -Splitting usually occurs along effective lines, and each alter tends to deal with a related set of conflicts and feelings. At the APA meeting Wilbur said, "In the analysis of the various alter personalities of a MP, we find individuals who deal with rage and hatred, individuals who deal with hypocrisy and dishonesty in others, alternates who deal with envy and jealousy in themselves and in others, and individuals who encapsulate intense affect and conflict of all kinds." Another way of putting this, according to Bliss, is that each alter is initially an invited guest, with specific functions for which he or she is responsible. In addition to alters who encapsulate emotions associated wth trauma, there may be personalities who are responsible for developing valuable skills or abilities, others who express conflictual impulses and needs such as sexuality or aggression, and personalities who assume control of the body in specific behavioral roles or social situations. Absence of Healing The final factor involved in the etiology of MPD is the lack of restorative experiences following abuse and dissociation. The incipient multiple never given a chance to heal adopts dissociation as a routine strategy for dealing with problems. Dissociative barriers are strengthened through reinforcement and elaboration, and alternate personalities assume an autonomous existence. Studies by Drs Bennett Braun and Charles Stern help to confirm the idea that multiples do not find the necessary succor or healing support in their environment. They have attempted to characterize the family of origin of the multiple, and the profile that emerges from their research is remarkably similar to that developed by other investigators studying families likely to include abused children. The family of origin of the multiple (often or typically): -Espouses rigid religious or mystical beliefs. -Presents a united front to the community, yet internally is riddled with conflict. -Is isolated from the community and uncooperative regarding intervention or assistance. -Includes at least one caretaker who exhibits severe pathology. -Subjects the child to contradictory communications from significant others during childhood. -Is polarized; one parent may be overadequate (the abuser), the other underadequate (the enabler) It is this combination of genetic, psychodynamic, developmental and environmental factors which perpetuates a tragic chain of abuse, dissociation and multiplicity. Edited from a note about kids with MPD FROM: LISA RICHARDSON (XDSH17B) A recent research study on a checklist used to screen for MPD in kids showed that a family history of MPD or Dissociative Disorder was not statistically significant in predicting MPD/DD in kids. The most predictive items were: traumatic history of sexual abuse, periodic intense depression, fearful regressive episodes and perplexing forgetfulness (Reagor, Kasten & Morelli, 1992). Symptoms of MPD\DD in kids which others describe include: in a daze, trance, 'another world'; answer to or use another name; big changes in personality and behavior; forgets or seems confused about very basic simple things; odd changes in physical skills; schoolwork goes from very good to bad (and I see kids who are inconsistent in what they can do in school--i.e. one day they read above average and the next day they can't read at all, etc); discipline has little or no effect; denial of behavior observed by others, extreme inconsistencies in abilities, likes, dislikes; intense angry outbursts; excessive daydreaming or sleepwalking; internal voices; imaginary playmates or companions (past age 6); amnesia. I would say that if you see some of these symptoms, perhaps you should have your child evaluated. If you are concerned, perhaps it would help you to rest easier to have it done, too. Please look for someone, though, who is familiar with working with children who have MPD/DD. I hope this helps. (Adapted note from Doris Bell) 0% PEARL 100% confidence of confidence TRUST -----------------------------O----------------------------- <-------- chain of confidence ------------> <=== the pearl can move either way ===> It helps to find a way to think about trust that allows you to make the adjustments in how MUCH you trust without needing to go into a tailspin about it. Now, say a total stranger does something thoughtful for us and we feel really good about it. It isn't wise to trust that person 100% because we FEEL good, because they are STILL a stranger to us. Or, say a trusted friend does something that makes us feel bad. It doesn't seem wise to move the pearl of trust to the 0% point, either. We know them, and have a lot of experience with them, and a long history of how they've treated us in the past. So, the trick of learning to trust wisely is to learn to move the pearl of trust only as far along the chain of confidence as is warranted by how much we know about the person we're dealing with, AND by the thing that happened that made us feel anxious, OR good. This gives us a SAFE way to determine how much trust to give at a particular point. Doris Editor's comment: I visualize the pearl as being VERY HEAVY, so that a single action has very little effect on it - like one nudge to a big boulder. A nice act by a stranger would have to be repeated lots of times to move it, and by that time the stranger has become a friend! Likewise, a friend who has been trustworthy for a long time would have to do a series of deliberate bad acts to move the pearl off the trust level they had attained over years. Note 3 of 7 - MPD Education- ~~~~~~~ Abuse and Alter Personalities ~~~~~~~~ The second factor in MPD is some set of traumatic experiences that overwhelm the individual's capacity to copewith them by any means other than dissociation. A growing and terrible body of evidence now shows that this is usually severe physical, sexual or psychological abuse by a parent or significant other in the the child's life. In a survey of 100 multiples, Dr Frank Putnam found that 97% of them had a childhood history of incest, torture, or other abuse. Psychiatrists now believe that as children, multiples created alternate personalities as a response to such experiences. Dr. Cornelia Wilbur of the University of Kentucky School of Medicine was the first contemporary psychiatrist to identify the role of abuse in the development of MPD in her pioneering psychoanalysis of Sybil Dorsett. Wilbur discovered that the severe and sustained abuse Sybil suffered at the hands of her mother had evoked intolerable feelings of rage, hatred, fear and pain that Sybil learned to cope with by blocking them out of awareness entirely, through dissociation. The feelings and memories that Sybil isolated from awareness, however, were the nucleus around which her alter personalities later formed though inner elaboration and through reinforcement by repeated abuse. "Normal at birth...Sybil had fought back until she was about 2 and a half, by which time the fight had been literally beaten out of her. She had sought rescue from without until, totally recognizing that this rescue would bedenied, she resorted to finding rescue within. First there was the rescue of creating a pretend world inhabited by a loving mother of fantasy, but being a multiple personality was the ultimate rescue. By dividing into different selves, defenses against not only an intolerable but also a dangerous reality, Sybil had found a modus operandi for survival. Wilbur discussed the nature and scope of the trauma that multiples suffer in a keynote address at the First International Conference on Multiple Personality/Dissociative States. The sexual abuse of multiples has included rape, incest, sodomy and fellatio, both heterosexual and homosexual, Wilbur said. Cases have been reported in which a child's caretaker(s) regularly invited other relatives or friends to participate in sexually exploiting him or her, and some multiples have been forced to witness the physical or sexual abuse of other children. Therapists have also treated multiples who were psychologically abused by being compelled to participate in murder, or who were exposed to multiple murders. Religious activity involving ritual murder - reportedly still widespread in this country - was said to be the context, in some cases, for this diabolical kind of abuse. Physical abuse of multiples has included burying, torture, and beatings. Neglect has included their being almost completely deprived of physical contact, or constantly having been fed inappropriate foods. If the latter practise is widespread, Wilbur noted, it suggests that nutrition may be an etiological factor in MPD, or may figure in some of the unusual psychosomatic irregularities in multiples.
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