It is occasionally true that people who are not genuine multiples can sometimes be subtly encouraged to adopt the belief that they are. We all tend to be one person in one situation and someone else in another, because of the conflicting demands placed upon us in our daily lives. When this conflict becomes extreme, some people might be inclined to conclude that they do indeed have multiple personalities, in order to lessen their guilt and gain notoriety and attention, particularly if they are encouraged in this belief by an unsophisticated therapist. Genuine multiples, however, may say things like, "I have to hide it, so that my family won't find out," and express suspicion of people who "flaunt" their diagnosis.
The DSM states states that many people who do qualify for a diagnosis of DID have an early history of severe physical abuse. In addition to the main personality, which is frequently passive, dependent, guilty, and depressed, there are two or more distinct identities or personality states, each one having its own history and identity. One alternate personality may be angry and aggressive, for example, while another one is highly controlling. Over half of all reported cases involve the presence of ten or more experienced personalities. There may be frequent lapses of memory for periods during which another personality is in control. Sometimes one personality may function as an executive, allocating time to the others. Differences between the personalities can include differences in age, gender, vocabulary, general knowledge, or prevailing mood.
When one of their childlike personalities is present, multiples may take a sudden interest in children's coloring books, and, like very young children, sometimes have difficulty staying within the lines of the pictures they are supposed to color. They may enjoy playing games which are more appropriate to children than to adults. Multiples may also be surprised to find themselves in possession of clothing, cosmetics, or foodstuffs which they have no recollection of purchasing and which their current personality may not even like. They may hear voices which can be just as clear as spoken speech -- but, unlike many schizophrenics, the voices are experienced as coming from within their head rather than from without.
People who qualify for a diagnosis of DID may also present with symptoms of substance abuse, borderline personality disorder, mood disorders, sleep disturbances, or other psychiatric diagnoses. They may suffer from various co-existing physical complaints, such as asthma, migraines, sleep disorders, digestive disorders, and irritable bowel syndrome. Their tendency to repeat earlier patterns of abuse renders them especially vulnerable to episodic or ongoing victimization -- by lovers, marriage partners, or even casual online acquaintances.
One client who is a genuine multiple has shown me printouts from a Web site operated for people diagnosed as having DID. Although there may be only ten to twenty people who actually belonged to this site, the actual number of members was over two hundred, because each personality was given a name and allowed to register and post entries separately, sometimes arguing or disagreeing with the other personalities with whom they shared a common physical body. She informed me that the site was very secretive, and operated like a cult. Its "members" were generally opposed to psychotherapy, because their separate personalities do not want to be integrated. Indeed, they were inclined to view any therapist who attempted such integration as a potential executioner! My client reports that she was blocked from membership because, in her efforts to collect information about this site, the administrators began to suspect that she was an "informant." The site was subsequently closed, and many of the former members organized a secret group on Facebook.
Popular literature has emphasized the fact that multiples are usually highly hypnotizable due to their great capacity for dissociation. However, because of their constant vigilance against potential sources of danger, some of their personalities may not be.
Psychotherapy with trauma survivors may proceed unevenly, because statements made by one personality may not be remembered by another one with different opinions concerning the previous trauma. This can sometimes lead to complications, with one personality defending, and another condemning, either the abuser or the therapist. Multiples with co-existing condiions such as borderline personality disorder may carry this idealization and devaluation to extremes, with a perpetual "battle going on inside their head" as to which one to defend or condemn at a given point in time.
After this basic level of security and safety has been attained, client and therapist can then collaborate in the construction of a therapeutic relationship which will increase feelings of confidence and self-esteem, overcome anxiety, depression, and despair, and bring forth an optimistic outlook on life which enables them change the narrative of their life story. (Levine, 1997; Naparstek, 2004; Rothschild, 2000; Scaer, 2007). These new methods of treatment by the world's leading trauma researchers and clinicians constitue ". . .a paradigm for understanding trauma's far-reaching psychological and physical consequences, without which, psychotherapeutic interventions remain extremely limited, and at times harmful to our clients."
The following video from PESI Seminars features some of the world's leading experts discussing how recent breakthroughts in the treatment of trauma, dissociation, and multiple personality are making it possible for clients who have gone years without improvement to finally begin to change.
The Walrus and the Carpenter - Lewis Carrol
Forward, S. (1997). Emotional blackmail: When the people in your life use fear, obligation, and guilt to manipulate you. New York: Harper-Collins.
Forward, S. & Buck, C. (2002). Toxic parents: Overcoming their hurtful legacy and reclaiming your life. New York: Bantam.
Levine, P.A. (1997). Waking the Tiger: Healing Trauma. Berkeley, CA: North Atlantic Books.
Naparstek, B. (2004). Invisible heroes: Survivors of trauma and how they heal. New York: Bantam.
Rothschild, B. (2000), The body remembers: The psychophysiology of trauma and treatment. New York: Norton. (Click on the link for a YouTube book review.)
Scaer, R. C. (2007) The body bears the burden: Trauma, dissociation, and disease. New York: Routledge.
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