Multiple personality disorder is almost always caused by persistent trauma, or past trauma such as early childhood sexual or physical abuse. When trauma occurs over a long period of time, the affected person may begin to cope by completely disassociating from the events that cause the trauma. This can lead to “alters,” separate personalities within the same person who either are aware of, or are unaware of the abuse. Alters can be childlike, strong, male, or female, and often emerge as a coping device.
Psychiatrists make the distinction between a person having several personalities, and believing they have several personalities. In general, multiple personality disorder is the belief on the part of the patient that several personalities seem to exist within the self.
One of the main characteristics of multiple personality disorder is that people seem to “lose” time. They seem unaware that time has passed; yet someone observing them may see them acting in many different ways. The afflicted however, tends to have no idea what has occurred. This generally central personality seems most likely to dissociate if the person is exposed to situations which can evoke earlier traumas, or if the person is still enmeshed in a traumatic situation.
Other symptoms of multiple personality disorder include depression, confusion, suicidal thoughts, phobias, differing levels of ability to function “normally,” anxiety, and self-medication, such as alcoholism or drug abuse. Additionally, those with multiple personality disorder may hurt themselves such as in cutting the skin, may have a high degree of panic or panic attacks, may have eating disorders or be prone to headaches.
As portrayed in films, multiple personality disorder seems to consist of a number of very distinct personalities, which is usually not the case in reality. Rather, those with multiple personality disorder may pass from greater awareness to less, without putting on a different accent or assuming a completely separate identity. Multiple personality disorder that results in crimes, as presented in several television series and with great effect in the Richard Gere film Primal Fear rarely exists.
The primary treatment for multiple personality disorder is therapy, which may include play therapy, hypnosis, art therapy, and/or talk therapy. Medication is usually not preferred because of the likelihood of overdose, and because the dissociative state is not chemically induced. The goal is to get alters in communication with each other, so that the person does not continue to dissociate from reality. A secondary goal is to be sure the person is removed from any ongoing traumatic situations, such as removing a child from an abusive home. When the person has reintegrated different personalities, there may still be need for treatment, possibly drug therapy to treat underlying psychological conditions like chronic depression or schizophrenia. However, while the person is still “losing time,” drug treatment may be completely ineffective because the person may not remember to take the medication or may accidentally overdose.
