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So You Want To Talk About Multiple Personalities?

I’ve gotten a few requests over my blogging time to talk about multiple personality disorder. I’ve (half) jokingly told friends that this post would garner me a great deal of upset commenters but here it is. 

Important Note: My opinions on the scientific validity of this disorder DO NOT reflect any belief that identified ‘multiples’ or sufferers of DID aren’t suffering, don’t deserve to be treated, or should be in any way, shape or form ridiculed, belittled, or treated poorly. Full stop.

So, I totally spoiled it with the disclaimer, but here it goes.

I don’t think Dissociative Identity Disorder/Multiple Personality Disorder is scientifically valid as a diagnosis.

…and since this is a fairly prevalent feeling in the psych community, I’m less worried about the Internet is Forever ™ problem.

Sybil: a book, a movie, and a tale of really unethical psychology.

DID?

While there’s some reports of people exhibiting something like multiple personalities as early as the 17th century, but the diagnosis didn’t take off in popularity until the 20th century. It’s entry into pop culture is strongly linked to Sybil, a book about one (real) woman who appeared to have sixteen personalities. It was a popular book, run in newspapers, and cited as one of the main factors in the sudden upswing of DID/MPD diagnoses. Sybil and her therapist are no longer alive, but much  criticism surrounds it. (See below)

DID/MPD was called Hysterical Neurosis, Dissociative type in the second iteration of the DSM. By DSM III it was Multiple Personality Disorder, and DSM IV made both significant changes to the criteria and the name, creating Dissociative Identity Disorder (DID).  However, because of the prevalence of MPD in current literature/horror movies/culture, I’ll use DID/MPD.

In general, DID/MPD is characterized as having multiple distinct personalities or identities (this is the second required criteria for diagnosis). These are called ‘alters’. Usually, though not always, there’s a central personality that’s often treated as the “real” one. That identity is usually depressed or anxious.

 

So. Sybil.

Sybil is the pseudonym for Shirely Mason, the client of psychoanalyst Cornelia Wilbur.  Mason didn’t come to her therapist because she had DID/MPD–her presenting problems were anxiety and memory loss. Then, after seeing Wilbur, suddenly, BAM, she had sixteen personalities.

Do I sound suspicious? I am.

Though the client files are sealed, multiple analyses of the taped sessions have said that Wilbur herself encouraged Mason to develop alters…and offered her money for talking about her different personalities. How did those personalities appear? Wilbur, who gave many drugs to her clients (including some very highly addictive psychotropics), gave Mason sodium thiopental and heard her mention other identities under the drug’s influence.

Sketchy? Most definitely. If that wasn’t damning enough, Mason wrote later that she had made the alters up.

Relevant reading: Remnants: The Last Stand of the Satanic Ritual Abuse Movement.

Who gets diagnosed? Who is diagnosing?

Of course, Sybil/Shirely Mason being a the result of unethical practice doesn’t negate that multiple personalities could exist. So what else do we know?

Those with DID/MPD diagnoses are often reported as having severe trauma in childhood. Data on this isn’t actually very clear, because many of the psychologists to originally diagnose MPD/DID believed in repressed memories and used really unscientific techniques to ‘retrieve’ them (This was around the time of the satanic abuse cases). Current research doesn’t support the idea of this sort of trauma repression.

DID/MPD patients also score very highly in measures of ‘hypnotizabilty’–a specific measure of being suggestible…and anywhere between ‘many’ and ‘most’ practitioners who diagnose DID/MPD use hypnosis to determine if their clients have multiple personalities. Hypnosis: not a methodologically sound form of diagnosis.

And those practitioners? They’re a specific subset of  psychologists, and they appear to get a statistically improbable number of clients who turn out to have DID/MPD. Of course, this could be a result of skeptic practitioners under diagnosing, right? Absolutely.

However as many as 70% of those with MPD/DID diagnoses appear to have borderline personality disorder (BPD). That’s high enough to suggest something more than simple co-occurence, which has lead to suggestions that professionals are using the idea of multiple personalities to explain the impulsivity and rapid emotional changes of BPD. Further, when the diagnosis of schizophrenia was introduced, there was a sudden crossover from those with MPD/DID to schizophrenia. Is it possible that those who believe in the DID/MPD diagnosis are just more likely to categorize BPD or schizophrenia as multiple personalities?

Relevant Reading: Dissociative Identity Disorder: A Controversial Diagnosis

The North America Problem. Is this a cultural diagnosis?

North America has the highest rates of DID/MPD diagnoses in the world. It’s also the place where multiple personalities are most familiar to the population at large. While this doesn’t mean the diagnosis is invalid, it casts, shall we say…aspersions. Secondly, when DID/MPD became a popular diagnosis in the 80’s, we also saw a sudden increase in the average number of alters, from 2-3 to an average of approximately 15. Hmmm.

Memory crossover in alters.

We’ve learned a lot about memory in the years since MPD/DID gained traction.We know, for instance, that repeated exposure to neutral (or even nonsense) words will result in faster recognition of those words.

(This can be tested by giving participants a series of possible categories for nonsense words and letting them learn by trial-and-error which word matches which category. For instance, in Trial One, James may match word Njdhsuf to Category A. When the result is NO, he is unlikely to try Category A for word Njdhsuf in Trial Two. By Trial Three, he may know that word Njdhsuf goes with Category C. If he is retested a short time later, James will sort the familiar nonsense words into their correct categories at higher rate than random chance, even if he feels as though he is guessing.)

Those diagnosed with DID/MPD report distinct personalities and identities, almost always reporting autobiographical amnesia (alters report knowing nothing of other alters or of what was done when the client was in a different identity) between personalities, one. So in a test like the one described above or similar, you would expect to see that if James is one identity, when he became an alternate identity, he would show no memory of the nonsense words, and sort them into correct categories at rates that resembled random chance. That’s not been shown to happen*. (This study also showed that indirect measures of behavior and ERP–which could be grossly oversimplified as how your neurons fire–found recognition in one identity of neutral words learned in different identity.) This study tested emotionally loaded words and found the same.

Okay, so what about autobiographical information? Though patients may have a central organizing identity, most report their personalities know nothing of other personalities. Objective tests have utterly failed to validate this. Though I strongly encourage reading this entire study about autobiographical memory in those with MPD/DID, here’s some relevant sections  [bolding is mine]:

Consistent with previous studies, transfer between identities on the memory task occurred even for negative material, despite patients reporting amnesia for this material, learned in another identity state. Transfer across amnesic barriers in DID also occurs for conditioned emotional information. Testing DID participants, Huntjens et al. administered an evaluative conditioning procedure that confers a positive or negative connotation on neutral words. In a subsequent affective priming procedure, participants displayed transfer of this newly acquired emotional valence to the amnesic identity (i.e., transfer of emotional material between identities).

Our findings are consistent with the results of other studies involving objective laboratory tasks indicating intact inter-identity memory functioning in dissociative identity disorder. In most studies, researchers test memory within the same experimental session shortly after learning. In contrast, we tested memory after a 2-week delay, thus increasing the ecological validity of our study. However, the results do conflict with the reports of amnesia between identities, suggesting that the subjectively experienced absence of autobiographical knowledge about other identities is quite self-convincing.

These findings become particularly important in cases like these**.

So what about people who appear to be multiples***?

I don’t have a great answer to this. Right now, therapy for DID/MPD seems to focus on integration: bringing all facets together into a single identity. There’s some pushback from self-identified multiples on this idea, many of whom feel that they’re not sick or broken, and that therapy treats them as such. I don’t really disagree, if they feel that they’re coping well. Forcing someone into therapy rarely goes well, and except in instances of danger to self or others, I’m all about the hands-off approach.

In the long term? I think we need to remove Dissociative Identity Disorder from the DSM. Like other diagnoses (*cough* Transvestic Fetishism *cough*) it seems to be the theory of a small contingent of scientists with little support in the community. When this dies as a cultural meme, I believe we’ll see a similar decrease in diagnostic popularity and even symptomology.. (We’re also seeing a sharp decline in scientific interest.)

——–

A great deal of the links and understanding that were required for this blog would not have been possible without Ed Cara, who you can find on twitter and blogging at The Heresy Club.

*Upon reflection this isn’t quite accurate. A few case studies have suggested autobiographical amnesia. However, I’m going to go with the majority of evidence found in studies that used controls (and simulators–people pretending to have amnesia) and larger pools of participants.

**Though DID/MPD has been a staple of the horror genre and several sensational trials, please don’t make the mistake of thinking DID/MPD is linked to being violent.

***This seems to be the preferred term in my reading of multiples’ writings (another popular term is ‘systems’). I’ll take correction and change this if I’m wrong.

Comments

  1. Shannon Kish says

    Interesting points that you bring up. Have you read “Sybil Exposed?”

    As a Social Worker, I am not sure what I believe at this point about DID. I used to fully embrace it and accept it, but as I have learned more about it I have become a bit more skeptical about it. Thanks for your thoughts!

  2. castlewood victims says

    The false accusations of childhood abuse that go hand in hand with a misdiagnosis of DID like a nuclear bomb going off in a family. Most individuals and families that suffer with this misdiagnosis suffer in silence and shame. The practitioners continue to diagnosis with little regard to the damage that they cause and without facing any consequences legally or ethically. We represent a group of individuals that have been harmed by one such practitioner named Mark Schwartz at a facility called the Castlewood Treatment Center. Currently there are four lawsuits against him and Castlewood. There are countless more without cause to sue because the statute of limitations is only 2 years and many do not come to their senses and recant before that time runs out. For many, our only hope is to tell our story in hopes of preventing others from falling victim to this heinous epidemic. Thank you for taking the time to shine some light on this difficult subject.

  3. lactosefermenter says

    Hi Kate.

    This is a fascinating subject. Thanks for writing about it. I’m wondering, if DID is no longer recognized as a real diagnosis by the majority of psychological workers, why do you think it continues to hang on through successive editions of the DSM? Does it persist due to a small but vocal minority, simple inertia…?

    Thanks again and keep up the good work

  4. Kate Donovan says

    I think it’s a twofold thing. One, there’s still a small but vocal minority. Two, the gap between editions of the DSM is very large. Many of the things we know about DID right now aren’t the things we knew when the last edition happened.

  5. erikabutler says

    I don’t really have much of an opinion either way on this particular dissociative disorder, I do wonder how valid the memory tests are for disproving it. I know that in amnesia, implicit memory is often still intact, while it’s explicit memory that is compromised. Perhaps in DID/MPD, implicit memory would still be intact throughout the different personalities, while it’s explicit memory that would be compromised?

    I wonder, though, what you think of the dissociative disorders as a whole, especially depersonalization disorder?

  6. Kate Donovan says

    You make a good point about the memory issue. However, Criteria B of the diagnosis says that the personalities must be entirely distinct (not fragments of each other). While I suppose I’d be willing to concede that “distinct” could mean transfer of implicit memories, the ways in which the diagnosis needs to be changed to reflect that are important.

  7. Robert B. says

    I thought I was going to be an upset commenter…

    But your objections all seem to be to the diagnosis proper and the supposed science that supposedly backs it up. I’ve read up on that, and you’re right – abusive and bad science and entirely sketchy. My experience is so unlike the diagnosis that it took me years to realize that it was supposed to be talking about me. (No amnesia, no abuse, fairly good mutual awareness, communication, and cooperation between identities.) Just keep in mind – continue to keep in mind, I should say, because it’s clear that you have – that just because science has studied something badly doesn’t mean it doesn’t exist (even if its most famous examples were fraudulent), just as debunking alchemy didn’t make chemistry not exist. It just means that most of what we know about it is likely to be wrong.

    Your terminology is fine, by the way. “Multiple” is generally used as you used it, to distinguish people like me/us from people with only one identity per brain (sometimes called “singlets”). “System” is used more to identify one particular group of, um, internally cohabiting folks rather than another, in a context where it’s already clear you’re talking about multiples. “Alter” is widely (though not universally) disliked, because it carries connotations of some really bad treatment models, but since you used it in the context of slamming those models I have no issue there.

    And THANK YOU for what you said about the sensational media treatments, ugh. That shit is horrible. “Violent” is only one of the stupid stereotypes it propagates.

  8. says

    Seems to me like the combination of pop-culture and poor diagnosis unfairly stigmatizes coping mechanisms. Like…if I’m in distress and have few/no people that can help, I sort of…um…I guess ‘externalize’ my good sense as someone else in my head, and go on autopilot to converse with that and calm down somewhat. Unfortunately it often helps for me to actually, y’know, converse. Back and forth. Audibly. With myself, or at least with my own good sense. And it’s obviously not dissociative, because I know full well that I created these figures (and they know it too, which makes for fun conversation).

    And it really, really doesn’t help when I can’t have the verbal conversations I need, because there’s other people around and I might raise someone’s hackles by “talking to myself” =/

  9. Robert B. says

    It’s even more fun when only half the conversation is out loud. Answering questions – or laughing at jokes – that other people didn’t hear will really raise some eyebrows.

  10. hoary puccoon says

    I wonder if the idea of “a personal relationship with God” (or Jesus or the Virgin Mary) is in some way related to this issue. Is the deity an incipient multiple personality?

    I also wonder how this relates to “theory of mind.” Humans, to function normally, must be able to have some idea of how other humans are acting and reacting. In some way, we have to recreate other people’s minds in our own. That normal process might be part of the multiple personality phenomenon.

    Just a couple of random thoughts I had, reading this.

  11. says

    I find myself agreeing with Robert B (#5) on DID. I have almost developed a knee jerk reaction to people saying that Dissociative Identity Disorder doesn’t exist, but my problem is more along the lines of people saying DID/MPD doesn’t exist therefore there is nothing wrong with the people that have been diagnosed as such.

    I have no problems with the idea that there are misdiagnoses out there. Perhaps many people with the DID/MPD diagnosis don’t actually have DID/MPD. I can easily see how people could diagnoses with a disorder that is more culturally popular; but can that, along with the other explanations, explain all the people diagnosed with DID/MPD?

    Perhaps some people were just flat out mistaken as castlewood victims (#2) says. I see no reason to disagree with this. Perhaps some people suffer from other diagnosis like Borderline Personality Disorder BPD instead of DID/MPD. Perhaps some of them suffer from schizophrenia instead of DID/MPD. Yet after all these groups of people are subtracted from the DID/MPD group, isn’t there still people left?

    I can easily see how the popularity of the DID/MPD diagnosis could plummet, as it should if people are being misdiagnosed. I am more concerned about the people that would be left behind if psychiatrists and psychologists decide that this isn’t a valid diagnosis. Since the research doesn’t seem to eliminate the necessity for the DID/MPD diagnosis at this time, might there still be people that validly need the diagnosis and treatment offered by DID/MPD instead of one or more of the other diagnoses?

  12. Kate Donovan says

    I completely agree that it’s silly to say that people diagnosed with DID/MPD are perfectly fine. That runs counter to all available evidence.

    However.
    I’m not talking about misdiagnoses of DID/MPD. I’m talking about a diagnosis that’s handed out by only a few doctors, that grew out of belief in repressed memories and a lack of understanding about the brain, that is considered deeply unscientific by the majority of the psych community. Mainl, I disagree with your claim that the research doesn’t eliminate the necessity for the DID/MPD diagnosis. Besides, I’m hardly arguing for the removal of all the other Dissociative Disorders–just the idea of individual personalities in one brain.

  13. timanthony says

    The fact that the commenters so far all have different names, writing styles and perspectives, leads me to the inevitable conclusion that they are all actually the same person.

  14. says

    I wonder if different people aren’t using different meanings for the diagnosis of MPD?

    Certainly, the brain can product contrary impulses or voices; I always made the assumption (based on a childhood friend, admittedly) that what MPD was – aside from the obviously false cases – was a conflation of metaphorical masks used for interacting with the world with these conflicting desires and voices. Not that MPD ever was anything like phantom hand (although superficially similar).

    One of the reasons I find the arguments against it unpersuasive is because many require the same logic that denies that other rare combinations – or something not so rare like transsexualism – don’t exist because there’s more cases where it’s known about more. That just seems a bad piece of logic. And personally hurtful to those trying to deal with their own peculiarities.

  15. says

    I think I understand, and I think I see where we begin to disagree on this. I have seen several individuals that have received the DID/MPD diagnosis. Each one was diagnosed by a different doctor working at different facilities. While I don’t know the case history of all of them, I am sure that at least some of them didn’t receive the hypnosis/repressed memory techniques that seem to be the target of so many people’s disagreement.

    I didn’t think I was making a claim that the research doesn’t eliminate the necessity for the DID/MPD diagnosis. I am not familiar with the latest research and I think it is at least possible that the DID/MPD diagnosis could be replaced with other, better diagnoses. What I wonder about is if, once everyone that can be removed from the DID/MPD group is removed from the DID/MPD group, would there still be patients left?

    It seems obvious to me that, given the spike in DID/MPD diagnoses, there was either a great leap forward in diagnosing people with DID/MPD or that there were plenty of mistakes made. Given the retreat of the diagnosis of DID/MPD, I would assume that latter was actually the case. Still, even if there was a surge of false diagnoses from a smattering of doctors, I don’t think that will adequately account for all the people currently diagnosed with DID/MPD.

  16. Latrodectus says

    Okay, I feel a need to comment something, though honestly not quite sure what. I am a self-identified multiple, but not a MPD/DID patient. That is, I have multiple personalities, but not in the way that I would be officially classified as a MPD-person. I feel it’s not a disorder, but rather a way someone’s mind is organised. Never been abused, zero amnesia, quite a fluid co-consciousness. No depression, or at least nothing that lasts long enough to be depression, but occasional slips into anxiety that partly has to do with the feeling of not being the person/people who want to be in charge at the moment. Also, the personalities aren’t very starkly distinct from one another. I guess it makes sense, with the shared memories and consciousness.

    So, the problem isn’t the multiple personalities but the feeling of being out of control of switches. There is no desire to be unified into one and the idea that I should is quite offensive. I’ll mention that it started in early teens, and was sort of a choice in some way, to “branch” into several instead of continue to be one.

    I agree that the scientific evidence is sketchy, but the fact that something may not really exist *in a certain form* doesn’t mean it doesn’t exist in some other.

    I’m sorry if I appear twitchy, but the discourse around the subject (usually by other people than the “patients” themselves) tends to upset me. It sounds like either ” so you must have suffered from abuse? Are you potentially dangerous?” or “I don’t think it’s real and oh, so you don’t even meet the criteria, maybe you should stop pretending, you just want to feel special”.

  17. Latrodectus says

    Hey Robert, in case you see this, can you recommend multiple communities where one could get in touch with others? Most websites I’ve seen are pretty old and inactive – kind of supporting the idea that this is just a fad or something.

  18. says

    Seeing as this post was virtually a slickly produced commercial for my writing, I figured I should weigh in.

    Two things.

    One: The main (scientific) problem with DID/MPD to me is that so little of its foundations were/have ever been verified as true by others whose interests aren’t directly based on the condition existing as is. To this day, MPD experts like Richard Kluft and Bennett Braun are cited in DID-supportive (the few that are still conducted) research papers. These are doctors who were either stripped of their medical license or forced into million dollar settlements by former MPD patients who alleged gross ethical misconduct. I can’t imagine that happening in almost any other field of science without outrage. (Picture Andrew Wakefield getting a good citation in a policy paper on vaccines). When those not connected to the small DID community have looked at the assumptions of DID as endorsed by the people who diagnose it, they inevitably come up lacking. On top of this is the still-accepted connection of DID to ritual abuse by many in the DID community. Past conferences of the major body of DID experts, the International Society for the Study of Trauma and Dissociation, still feature talks on ritualistic abuse cases. I wanna say, as far back as 2012.

    Two:Despite all this, it doesn’t mean DID is ‘fake’. People express distress in a multitude of ways, often unconsciously yet culturally informed. That some people can come to experience life through distinct personalities they also believe are amnesiac from one another is not a far stretch, especially when stories of a Sybil or a Tyler Durden exist in the popular imagination. But, and this is the big but, there is little evidence that people unconsciously repress early childhood memories of trauma (usually sexual) that later cause the formation of disparate personalities. We (probably) don’t work that way. There is plenty of evidence therapists have unethically fostered false memories and the belief of DID in their patients though. The trauma model of DID that exists now is not rooted in an ounce of science, and until that changes, it shouldn’t be treated as such.

  19. Robert B. says

    We’re not active there anymore, but this Livejournal community is where we did our internet multiple socializing. It’s much more active than it looks – nearly all the posts are members-only, due to some trolling a while back. Membership is open to everyone, though psych professionals or students are asked to disclose that when they join.

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