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Multiple personality disorder - symptoms and therapy
contents
- trauma
- symptoms
- Multiple personality and schizophrenia
- An invented disorder?
- The alienated self
- therapy
- Recognize multiple?
- Normal multiple?
Her memory has a lot in common with the hangover after an alcohol excess: only fragments of the experience are in the consciousness. The sufferers dissociate, and they seem like stepping away when they "walk".
Several personalities in one? Picture: alisseja - fotolia The part personalities have their own identities. Sophia, a victim, for example, knows an adult prostitute, a teacher and a 13-year-old girl. When she "transforms," her voice and attitude change, as do her opinions and interests. Their fears are different, as are their preferences - and even their knowledge of certain topics.
Sometimes she woke up naked in the shower, not knowing how she got there. Her last conscious memory was many hours ago. Then again, she occasionally worked as a prostitute, found herself on her sofa in her work clothes as a sex worker and with a full wallet, not knowing how she got there.
trauma
The multiple personality was long considered either charlatanry, invented disease or fascinating curiosity. Esoterics even saw spirits at work. Trauma research, on the other hand, recognized the behavior of multiple personalities as typical splits in traumatization.
The extent to which MPS represents a disease of its own, and whether the "participants" really act as autonomously as those affected and witnesses report is controversial in science. Not a few "multiple individuals" also suffer from borderline or post-traumatic stress syndrome.
These two disturbances not only characterize dissociation, but the people involved also construct realities that they themselves believe in or fantasize about in order to convey themselves in an encrypted way: for example, a war traumatized man invents incidents in which unknown persons attack him at night, defending himself and lies injured in bed in the morning - meanwhile, his acquaintances know that he actually staggers home drunk without meeting anyone.
Whether these constructions are deliberate lies, symbolic stories that translate a trauma or to what degree the person concerned believes them, can hardly be judged by outsiders.
This reservation also applies to the multiple personality. Sophia, for example, also fantasized with an ex-partner that they are both angels who would suffer on earth and have a special mission.
The limit of whether the Other I is consciously unconsciously invented in such multiple personality disorders in order to temporarily assume a different identity as a role play, or whether the unconscious builds its own pattern, which actually runs involuntarily, is difficult to draw and is not empirical studies sufficiently clarified.
But when it comes to the consequences of a trauma, it is at least clear what the partial personalities are for. Those who have a traumatic experience often divide the real experience from consciousness. The person concerned must continue to live in the traumatizing situation - be it that he remains a soldier in the war in the position, whether it is that she continues to live as an abused child with the raping father.
All traumatized individuals who share such experiences suffer in later life from not being able to integrate the experience: they panic when they recall a (harmless) trigger, they become aggressive towards innocent people, the similarities with the causer show the trauma (hairstyle, smell, first name, voice etc ...).
If it is true that the multiple personality is a disorder of its own, these divisions have become independent for those affected.
symptoms
People with this disorder find it difficult to cope in everyday life. They do not appear on dates because they "walk", their part personalities make deals that the "normal character" forgets, they lose much of their time and can not build a stringent life structure.
The diagnosis is not only controversial, it is also very embarrassing for many people affected. They lose a lot of time and energy by jumping from one state to another. In addition, they invest time in appearing normal to the outside world.
Their states are easily confused with other mental problems. First and foremost, they are chaotic; they can not bring their thoughts together; they can not concentrate and above all they can not keep what they promised before. All of this applies to people with attention deficits, borderline, and sometimes bipolar disorder.
In the case of multiple personalities, however, the supposed ability to do so lies in the fact that they are changing, and often none of the sub-individuals "pure" come to the fore. Those affected then act as if they have language disorders, they have "self-talk" when they are writing, their sentences abruptly break off, and they write with a different writing on a completely different topic.
Other symptoms overlap with various disorders, such as borderline or PTSD, which are also based on trauma: multiple suffer from flashbacks, in which the traumatic event reappears unfiltered, most have clinical depression. Their feelings break out like with borderline people, their behavior is compulsive, they have eating disorders such as anorexics and bulimia, and many of them expire in alcohol and other drugs.
Multiple personality and schizophrenia
People who are divided into several personalities, is popularly known as "schizophrenic". However, this does not correspond to the clinical picture: schizophrenics suffer from visual and auditory hallucinations. They hear voices, they think someone breaks into their flat, they think they are "bewitched", and they see invisible forces hidden from one another.
Even multiple personalities hear voices that drive them to action. In their main identity, those affected know that they are hallucinations. On the other hand, they forget what they did while they were in their own personalities.
Schizophrenics behave the other way around: they firmly believe in their hallucinations and consider mentally healthy people to be part of a conspiracy because they doubt that, for example, dark magicians send magic rays into the abdomen of those affected. But they usually remember what they do and experience.
People who suffer from the borderline symptom also move in a fragmented identity made up of personalities' splinters, and sometimes the diagnosis of borderline syndrome coincides with the (unsecured) diagnosis of multiple personality disorder, as in the case of Sophia.
However, there are also major differences between most borderline liners and the "classic" patterns of multiple personalities. It is true that borderliners are shifting from uncertainty about their identity, often their opinions, positions and self-images. While they also divide traumatized experiences, they are firmly convinced that they are a newly adopted role, and in them so many people haunt therapists that they feel a minority.
However, borderline does not primarily characterize a main personality with uncontrolled participants, but an inner emptiness and an as if behavior. They behave as if they were a pop star, a rebel, a femme fatale, something special, because they want to escape deep into their fear of being nothing.
In cases where this applies to multiple personalities, it would not be more or less autonomous part personalities, but a pathological theater to escape the inner emptiness. But this does not do justice to the very real dissociations that disturb the person concerned.
In fact, the dissociative identity disorder characterizes the fact that the patients can not remember essential experiences without simulating this loss of memory. Their normal identity is unaware of what the other identities are doing.
An invented disorder?
The dissociative identity disorder was already known in the 19th century; but until about 50 years ago, psychology was not particularly interested. In the 1970s, the "multipliers" became an issue - especially in the US. Thousands of people reportedly wandered around in certain patients, and therapists meticulously classified these hosts.
The dissociative identity disorder became a fashion diagnosis. In the midst of increasingly diagnosed multiple personalities, critical psychologists spoke up massively.
In some cases, the partial personalities came about through suggestive questions from the therapists, and the patients did not have such "other selves" before therapy.
For example, stagings in which "sufferers" assumed the identity of animals did not seem to be reminiscent of voodoo rituals in which believers believe that a god works in them or "new witches" claiming to recognize through trance. that they are the rebirth of a woman persecuted by the Inquisition.
Lawsuits in which criminals said they were in another person's act revealed that the perpetrators discovered the dissociative identity disorder in order to clear themselves of the guilt.
The "multiple personality" in these cases was nothing but deceit, perhaps linked to the repression of a person who did something bad, saying "that was not me," because his ethically conscious part would not do such a thing.
The critics felt confirmed by such scams. Even more: in many cases, examinations revealed that even the traumatic experiences of childhood were manipulated - often without the therapist's intention. Suggestions of the therapists, the ubiquity of the MPS in the media and the urge of the "sufferers" produced more and more and more exciting people.
Patients sued their allegedly abusive parents until the courts determined that there had never been any abuse; others took their therapists to court because they talked them into false memories.
In 1980, however, dissociative identity disorder was internationally recognized as a mental disorder.
The alienated self
The theatrical performances hid the true core: The "real" multiple personality disorder is not sensational, but associated with much suffering.
The term "dissociative identity disorder" refers to the fact that it is rarely about autonomously acting characters, but about alienation of aspects of their own biography. Thus, those affected hardly show up as Dr. med. Jekyll, whose dark side is doing evil acts on its own, complaining about not reconciling their different memories.
Fragments of their memory patterns appear without the patients knowing what has happened. Although these contents of consciousness rarely take the form of persons, they are stored without any connection to each other.
Also typical are multiple traumas that compulsively re-enact the sufferers and bring themselves into situations that repeat the trauma. Thus the dissociative identity disorder does not appear detached from other mental illnesses, but as a behavior of the traumatized.
So the multiple personality loses its magic - presumably because there are effective therapies for traumatized people today, and childhood abuse has been tabooed.
The stark self-portrayals of multiple personalities in the 1970s may have been an attempt to portray traumatic experiences as psychodrama.
The knowledge of today's trauma and memory research demystifies the dissociative identity disorder on the one hand, on the other hand, it turns the controversy between "invented phenomenon" and autonomously acting characters of the unconscious mind on its feet.
A person who experiences extreme stress switches emotions, and thus oneself, away from systematic thinking. It is a survival mechanism of the brain that allows the person to function in situations where his usual reactions make an action impossible.
An abuser, for example, would normally run away from his tormentor. A child dependent on an adult can not do that, so it splits off.
The multiple personality relativizes itself as a completely independent phenomenon also by the fact that in many cases the participants reflect participants of the trauma like helpless child, perpetrator and compensatory justice.
This corresponds exactly to the images that other traumatized people develop without perceiving these aspects of the separation as independent figures.
Concerned individuals who see hundreds of people at work are rarely, if ever, at all. Most probably, the therapists suggested that "storyline" to them suggestively, without possibly wanting it. Appeal and autosuggestion probably also played along.
However, the question between "real and fictitious disorder" dissolves even in such patients: our brain does not distinguish between experienced and invented, even those who only hear of traumatic situations without being there can develop the symptoms of a traumatized person.
Our memory is less a chronicle than a creative cluster that sets up "memories" to develop meaningful patterns. For a traumatized, going into different roles that are not integrated can be such a pattern.
therapy
The therapy of multiple personalities is complicated. It lasts a long time, and the underlying trauma does not heal like a broken leg.
The trauma therapy offers an approach to the help of those affected. Image: Photographee.eu - fotolia Psychologists of the 1970s presumably made the mistake of encouraging patients to act as part of their characters, thus advancing the split rather than dissolving it. Always new people were probably the result.
On the other hand, it is about making the person concerned familiar with the fact that his problem is not a "magical ability", but to relate the reaction to a trauma and the participants.
In the first step, the characters in the unconscious should get to know each other and then work together. In the second step, they should dissolve piece by piece - ideally, they merge into a being, that is, the person involved integrates them in his whole person.
But exactly on the other hand, many patients are reluctant. They have become so used to these different people that they fear losing themselves when they lose these other selves.
The trauma has often not been considered or found in the past with "multiple". Once the patient does not recall a traumatizing experience, the reason is usually that he repressed the trauma.
A rule of thumb could even be: The more sophisticated the sub-persons are and act, the greater the separation, the smaller the conscious memory of the real event. After all, dissociation means that different areas of experience separate - in terms of content. Certain information does not guide the brain.
There are many indications that multiple personality disorders take place, especially in repeated traumatizations: the child, traumatized by childhood abuse, unconsciously remembers situations that are reminiscent of the trauma and at the same time became acquainted with dissociation as a "way out". The dissociation is now easier and easier, the participants split up and share the suffering that would overwhelm the victim in their entirety.
At the same time, the person concerned with his "protectors" goes into role models of the real world that reflect the trauma - the abused girl seeks sexual partners who she detests or sells her body in sex work. Partials like the helpless child, the ice-cold whore or the tormentor can now act in a structure.
A dissociative disorder has its roots mainly in childhood traumas, because children dissociate far better than most adults.
The affected person must first get involved with the therapist. First, it is about a structure for everyday life, which work together. The head of the patient must be free from sequelae such as financial chaos or stressful acquaintances.
The therapist then takes the participants seriously. He does not throw the patient in the head "you only imagine this", but inquires into details such as age, preferences, nature and gender of the "other selves".
Then therapist and sufferer examine together in which relationship the individual alter egos stand. Know each other, he pursues one another, they protect themselves. Do they form relationships like "good friends", "mother and child", "big brother, little sister", are they rivals, perpetrators and victims or do they have no relation?
As in the dream work, the person affected slowly encounters the "evil" figures that work in him. They point to unresolved conflicts and often provide the key to dealing with the trauma.
The therapist thus includes the trauma, but only cautiously, by approximating the participant's actions to the traumatizing experience.
In the end, the affected person should accept the traumatizing memories and realize that he is the one who goes into the dissociations, but has more meaningful ways to live with the experience.
Depending on the severity of the trauma and other behavior of the person concerned, the treatment is more or less successful. Drug and alcohol abuse can exacerbate the split, alcohol addiction alone can lead to perceptions that resemble a dissociative disorder.
Recognize multiple?
Multiple individuals with weak symptoms often do not even know about their disorder. They do not know otherwise than to temporarily lose control of their multiplicity, and often think that the Alter Egos are completely normal, because after all, they live with it 24 hours a day.
Most sufferers have one main personality; Outsiders sometimes find their behavior funny, but they know nothing about the disruption. When multiple people notice, then often by accompanying phenomena: they run around aimlessly, they have unfounded fears, they seem like "stepped out", and many walk in their sleep.
They are often known as "chaotic" in their environment, their jobs and relationships are zigzagging, their emotions are leaps and bounds, and many others find it difficult to respect those affected.
Normal multiple?
All people dissociate. "Who am I, and if so, how many?" Asked the philosopher Richard David Precht. The character we occupy differs from ours as a husband, father, or lover, compared to friends I behave differently from strangers when I follow my hobby differently than when I sign a contract with the bank.
In contrast to the "multiply disturbed" we bring these different aspects of our personality together: we express aspects, but not sub-persons. We can separate, if necessary, and then put back together.
However, anyone who has been exposed to sexual abuse during childhood does not have this option.
While "normal neurotics" usually know that they play a role and as a (!) Person maintain their hobbies and aversions, the subdividies of the multiple personality usually have very different talents, interests, clothes or votes. From time to time they correspond to the characters of a short story and represent a specific facet: sadness, anger, hatred, naivety or confidentiality.
In contrast to the "normals", multiple personalities often have different handwriting, and even different illnesses.
But in their splits, the dissociative disorders reveal much about how our "normal" brain works and how we reconstruct our identity every day. (Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)
http://www.awmf.org/leitlinien/detail/ll/051-001.html
Bettina Overkamp: http://edoc.ub.uni-muenchen.de/archive/00004409/01/Overkamp_Bettina.pdf