Research has shown that multiple personality is most probably caused by severe childhood abuse, usually both physical and sexual. Psychotherapists who specialize in treating disorders caused by trauma hypothesize that the human mind or personality divides to cope with the terror of the trauma. It is as if one part of the mind handles the abuse to protect another part of the mind from the pain. This splitting of consciousness is a psychological defense called dissociation. Instead of memory, bodily sensation, emotions, and thoughts all being associated with an experience (which is the normal process of human experience), these aspects lose their association and seem to separate. A common example would be that a person who was sexually abused as a child loses the memory of those events and may have no recall of them until later in adulthood. In this case, the whole experience is dissociated. For example, in multiple personality, a so-called alternate personality ("alter" for short) named Ann experienced the abuse, while alter Jane, who deals with normal, everyday living, was not abused. Thus, Jane has no memories of abuse. A variation is that only certain aspects of the experience are dissociated, so that, for instance, the abused person has the memory that the sexual abuse happened but has no emotions regarding the pain and trauma of it. Freud coined the term "repression" to describe the process by which emotions that are too threatening to be admitted into consciousness are pushed into the unconscious.
Several well-researched psychological tests and structured interviews aid in diagnosing a client. For a formal diagnosis of DID, the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR (rev. 4th ed., 2000) states that the following four criteria must be present: two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self); at least two
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Chris Costner Sizemore, the subject of the book and film The Three Faces of Eve about multiple personality disorder. (AP/Wide World Photos)
of these identities or personality states recurrently take control of the person's behavior; there is an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness; and the disturbance is not due to the direct physiological effects of a substance (such as blackouts due to alcohol, drugs, or seizures).
The central paradox of multiple personality is that it is both real and not real at the same time. It is not real in that the mind or personality does not literally split. There is only one brain and one body. It is a creation of a person's imagination. At the same time, however, the person with DID experiences very real separations and is not faking them. The perceived separate parts must be dealt with as if they were separate, while teaching them the reality that they must live in the same body and jointly suffer the consequences of the actions of any one part.
Multiple personality goes unrecognized too often as a result of several reasons. First, it has only received considerable attention since the early 1980's. Second, it was wrongly thought to be extremely rare, so psychotherapists were previously taught that they would probably never see a case of it. Third, the trauma that causes DID produces so many symptoms, such as depression, anxiety, hearing voices, and mood changes, that it is wrongly diagnosed as schizophrenia, bipolar disorder, or something else. Fourth, there is skepticism about its validity as a true diagnosis.
Alters can be categorized in various ways. Some are victims who took most of the abuse. Some are persecutors who identified with the abuser and try to control other alters internally. Some are functioning alters who handle work or school. Alters may believe they are the opposite sex of the body and can see themselves as almost any age. Some may know a great deal about other alters. Others may only know of themselves and have no knowledge that others even exist.
Because at least some alters are usually dissociated from other alters, the person with DID will typically experience time loss when one alter has had control of the body and a different alter, who does not know what has happened previously, takes control. Dissociation is experienced in degrees. When it is present to a lesser degree, DID patients hear voices inside their heads. They are hearing alters talking. This may scare them when they first experience it, or it may be so normal for them that they mistake these voices for their own thoughts.
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