Adolescent Multiple Personality Disorder: A Preliminary Study of Eleven Cases PA UL F . DELL, PH.D. ,
AND
.J AMES W . EISEN HOWE R, L. C. S .W .
Abstract. T he diagnostic features and trea tment histor ies of II adolescents with multiple person a lity d isor der (MPD) are presen ted . Clinical evaluation revealed that the maj ority of these adole sce nts manifested ex tre me ly variable schoo l perform ance , disrup tive behavior, trances, amnesias. mood swings, sharp c hanges in perso nal ity , apparent lying , voices heard in the head, and depression . All had a history of childhoo d traum a: Sex ual abuse (73%) , physical abuse (73%), and emo tional abuse (82%). Seve nty-three percent had a parent with a d iagnosab le dissociative disorder ; 36% of the mothers had MP D. These ado lesce nts had a mean number of 24 . 1 alter per son alities and appear to have become multiple at a mean age of 3 years, I month . All patients had angry protector alters , dep ressed alters , scare d alters , and child alter s. Fifty-four percent of these cases have integrated dur ing treatment or are pro gressing toward integration . The rema ining eases dropped out of therapy. J. Am . /vcad. Child /vdolesc, Psychiatry, 1990 , 29, 3:359- 366. Key Words: mult iple personality disorder , dissociation, traum a, adolescent, psychotherapy. Over the past decad e , there has been an acce lerating proliferation of clinica l research on adult patients with multiple personality disord er (M PD) . Yet , desp ite a research and cl inical conse nsus that MP D is a childhood onset disorder (American Psychi atric Associa tion, 1987) , there have been rather few pub lished report s of MPD in childhoo d or ado lescence . At presen t, the literatur e on childhood M PD co nsists of a total of 10 case s of MP D (Despine , 1840 ; Fagan and MeM ahon , 1984 ; Kluft , 1984a , 1986b; Weiss et al., 1985; Malcnbaum and Russell , 1987; Riley and Mead, 1988), and an add itional three cases of " ineipient multiple personality in children " (Fagan and McM ahon , 1984). T he literatu re on adolescent MPD co nsists of five cas e studies (A lexander, 1956; Gruenwald , 1971 ; Horton and Miller, 1972 ; Fagan and Mc Ma hon, 1984 ; Bowman et al. , 1985) and a brief overview of 16 teenage cases in Kluft ' s ( 1985b) land mark paper on the natur al history of MPD .
however , this tactic of ada ptation (i.e., coping with trau ma via splitting it off' into different "selves") may be repea ted as often as the individual rinds it necessary or helpful in dealin g with repeated incid en ts of fear, pain , or abuse . Alter perso nalities have two basic fun ct ion s: ( I) to sequester trau matic affect , sensa tion, and memory so that the host personal ity is protected from such ma terial , and (2) to help cope with the env iro nment (both external and internal) . As a consequece of those functions , each alter has " its ow n relatively enduring pattern of perceivin g , relating to , and thinking about the enviro nme nt and one's sc lf" (A me ric an Psychi atric Association, 1987 , p . 1( 6). Crite rion A for MPD in the DSlvl-l/I-R requ ires that two or more such dist inct personalities or personality states be present. T he second (and only add itional) criterion in DSM -Il/-R is that " At least two of these personalities or person ality sta tes recu rrentl y take full control of the person ' s beh avior " (p . 1( 6). Although MPD was pre viously considered to be rare , rece nt research on the c linica l phenomenology of MPD (Kluft , 1985b; Putnam et al ., J 986; Coons, 1988 ; Ross et al, 1989b; Schultz et al. , 1989; Ross ct a!., in press) strongly sugg ests that MPD is not so much rare as it is well -hidden . Because MPD is characteristically an adaptation to a chro nically dangero us and abusive chi ldhood environmen t, there arc exce llent reaso ns why these patients and their alters keep a low profile and delib erately try to hide their " switches " and periods of amne sia .
Brief Overview of Multiple Personality Disorder MPD is a severe dissociati ve disorder characterized by disturbances in both ident ity and me mory (Nerniah , 1981). It is best understood as a posttraum atic condition (Putn am , 1985; Kluft, 1984b; Spiegel , 1984; Braun and Sachs , 1985; Klu ft , 1988a; Putnam, 1989). T hat is , MPD is the adaptive , dissocia tive resp onse of a young child's mind to the fea r and pain of overwhelming trauma-most co mmo nly abu se (Putnam ct al. , 1986; Coo ns, 1988; Ross et al . , 1989b; Schultz et al. , 1989; Ross et aI., in press). Once begun,
Subjects and Method Subjects The suhjec ts of this st udy are the II adolescents see n by the authors over the past 4 years , who were d iagnosed as M PD , and who were the n followed in therapy . Eight of the II were specificall y referred by the previous ther apist (or, in one case, by the patien t' s MPD mo the r) for ev aluation of possible dissociative symptoms. The remaining three were ge neral refer rals for psych oth erapy .
1\("("('l' t('t! .1
AND
.J AMES W . EISEN HOWE R, L. C. S .W .
Abstract. T he diagnostic features and trea tment histor ies of II adolescents with multiple person a lity d isor der (MPD) are presen ted . Clinical evaluation revealed that the maj ority of these adole sce nts manifested ex tre me ly variable schoo l perform ance , disrup tive behavior, trances, amnesias. mood swings, sharp c hanges in perso nal ity , apparent lying , voices heard in the head, and depression . All had a history of childhoo d traum a: Sex ual abuse (73%) , physical abuse (73%), and emo tional abuse (82%). Seve nty-three percent had a parent with a d iagnosab le dissociative disorder ; 36% of the mothers had MP D. These ado lesce nts had a mean number of 24 . 1 alter per son alities and appear to have become multiple at a mean age of 3 years, I month . All patients had angry protector alters , dep ressed alters , scare d alters , and child alter s. Fifty-four percent of these cases have integrated dur ing treatment or are pro gressing toward integration . The rema ining eases dropped out of therapy. J. Am . /vcad. Child /vdolesc, Psychiatry, 1990 , 29, 3:359- 366. Key Words: mult iple personality disorder , dissociation, traum a, adolescent, psychotherapy. Over the past decad e , there has been an acce lerating proliferation of clinica l research on adult patients with multiple personality disord er (M PD) . Yet , desp ite a research and cl inical conse nsus that MP D is a childhood onset disorder (American Psychi atric Associa tion, 1987) , there have been rather few pub lished report s of MPD in childhoo d or ado lescence . At presen t, the literatur e on childhood M PD co nsists of a total of 10 case s of MP D (Despine , 1840 ; Fagan and MeM ahon , 1984 ; Kluft , 1984a , 1986b; Weiss et al., 1985; Malcnbaum and Russell , 1987; Riley and Mead, 1988), and an add itional three cases of " ineipient multiple personality in children " (Fagan and McM ahon , 1984). T he literatu re on adolescent MPD co nsists of five cas e studies (A lexander, 1956; Gruenwald , 1971 ; Horton and Miller, 1972 ; Fagan and Mc Ma hon, 1984 ; Bowman et al. , 1985) and a brief overview of 16 teenage cases in Kluft ' s ( 1985b) land mark paper on the natur al history of MPD .
however , this tactic of ada ptation (i.e., coping with trau ma via splitting it off' into different "selves") may be repea ted as often as the individual rinds it necessary or helpful in dealin g with repeated incid en ts of fear, pain , or abuse . Alter perso nalities have two basic fun ct ion s: ( I) to sequester trau matic affect , sensa tion, and memory so that the host personal ity is protected from such ma terial , and (2) to help cope with the env iro nment (both external and internal) . As a consequece of those functions , each alter has " its ow n relatively enduring pattern of perceivin g , relating to , and thinking about the enviro nme nt and one's sc lf" (A me ric an Psychi atric Association, 1987 , p . 1( 6). Crite rion A for MPD in the DSlvl-l/I-R requ ires that two or more such dist inct personalities or personality states be present. T he second (and only add itional) criterion in DSM -Il/-R is that " At least two of these personalities or person ality sta tes recu rrentl y take full control of the person ' s beh avior " (p . 1( 6). Although MPD was pre viously considered to be rare , rece nt research on the c linica l phenomenology of MPD (Kluft , 1985b; Putnam et al ., J 986; Coons, 1988 ; Ross et al, 1989b; Schultz et al. , 1989; Ross ct a!., in press) strongly sugg ests that MPD is not so much rare as it is well -hidden . Because MPD is characteristically an adaptation to a chro nically dangero us and abusive chi ldhood environmen t, there arc exce llent reaso ns why these patients and their alters keep a low profile and delib erately try to hide their " switches " and periods of amne sia .
Brief Overview of Multiple Personality Disorder MPD is a severe dissociati ve disorder characterized by disturbances in both ident ity and me mory (Nerniah , 1981). It is best understood as a posttraum atic condition (Putn am , 1985; Kluft, 1984b; Spiegel , 1984; Braun and Sachs , 1985; Klu ft , 1988a; Putnam, 1989). T hat is , MPD is the adaptive , dissocia tive resp onse of a young child's mind to the fea r and pain of overwhelming trauma-most co mmo nly abu se (Putnam ct al. , 1986; Coo ns, 1988; Ross et al . , 1989b; Schultz et al. , 1989; Ross et aI., in press). Once begun,
Subjects and Method Subjects The suhjec ts of this st udy are the II adolescents see n by the authors over the past 4 years , who were d iagnosed as M PD , and who were the n followed in therapy . Eight of the II were specificall y referred by the previous ther apist (or, in one case, by the patien t' s MPD mo the r) for ev aluation of possible dissociative symptoms. The remaining three were ge neral refer rals for psych oth erapy .
1\("("('l' t('t! .1
