Multiple Personality Disorder as a Mental Problem - Essay Example

? Multiple Personality Disorder Multiple Personality Disorder Multiple personality disorder is a mental problem characterized by the existence of two or more different and relatively enduring personality states known as alters, that control a person’s behavior alternately. This is normally accompanied by the impairment in memory. For instance, victims forget crucial information that cannot be explained by normal forgetfulness. There is no definitive test for the presence of the Multi Personality Disorder in the human body. Its presence is confirmed by the help of health interviews that identifies signs and symptoms. Close analysis of the disorder proves that the ailment is a product of the internalized oppression and not the existence of multiple personalities. Recent research indicates that the condition is diagnosed more in females than males. This research paper is a theoretical exploration of the multiple personality disorder with emphasis on dissociation and etiological theories, diagnosis and treatment. The occurrence of the disorder can be explained by two main theoretical branches that focus on dissociation and etiology of the disorder. Dissociation theories represent the idea of a divided self and form the foundation for the existence of the disorder (McClure, Chap 2). One of the theories that extrapolate on dissociation includes Psychoanalytic Theory. It was developed by Joseph Breuer and Sigmund in their interpretation of the hysteria case they once handled. They characterized hysteria as a disease with three distinct states of consciousness. The second theory is the Jungian Theory. The proprietor of the theory, Jung, focused on a central and benign role of dissociation as fundamental to the process of the psyche. Other dissociative theories include Behavioral State Theory, Hypnosis Theory and State Dependent Learning Theory. Theories focus on the etiology of the disorder include Ego State Theory, Kluft's Four-Factor Theory, Double-Bind Theory, 3-P Factor Theory, Braun’s BASK Theory and the attachment theory. According to the Ego-State theory, personality is the product of the clustering of emotions and perceptions into ego states to create organized behavior and experience states bound together by a common principle (McClure, Chap 2). The theory argues that mind is poly psychic i.e. characterized by many processes and systems throughout life. The processes of differentiation and integration during development can be a source of internal conflict and source of dissociation. This is because putting concepts together during integration can lead to emergent of more complex concepts. Dissociation through differentiation occur when the process becomes excessive and the victim experiences complexity when coping. The theory also suggests that the primary personality eliminates pain through displacing it into other personality states. This leads to accumulation of pain that causes conflict and dissociation. One ego state acquires ego energy and becomes the dominant self while the others become less dominant. The dominant ego is the one referred to as the primary self although behavioral and environmental conditions can interchange the norm. The theory portends that every person has a covert ego that can be accessed through hypnosis. However, the covert ego of multiple personality disorder patients is turned into overt ego. Another theory that focuses on etiology of the Multiple Personality disorder is Kluft's Four-Factor Theory. The theory was proposed by Kluft through focus on four etiological factors necessary for the development of the multiple personality disorder. These factors include: possession of the capacity to dissociate; experiencing adverse traumatic experience that requires the intervention of the dissociative state of the body defense mechanism; presence of an alternate personality or varying ego state within self; and the failure of the society to minimize the disorder’s effects in children. Closely related to Kluft's Four-Factor Theory is Braun’s BASK Theory. The BASK elements proposed by Braun include behavior, affect, sensation and knowledge. Disruption of any of these elements may lead to multiple personality disorder. The theory argues that awareness negates any conflicts that may emanate from conflict of any of the processes with dissociation resulting from pathological extremes. The Double-Bind Theory suggests that the primary mechanism that causes multiple personality disorder is the contradiction caused by primary injunctions of the parent. For instance, parents may brutalize their parents while convincing them that are doing it out of love. This makes the child to develop dissociative tendencies in a bid to retaliate the parental attention through a combination of fear and pain leading to mixed feelings. The child combines the resistance and attention into one being leading to dissociation. Instead of blaming the parent, the 3-P Factor Theory centers its arguments on predisposition, precipitation and perpetuation. Predisposition represents the genetic influence on dissociation, and the prolonged and repeated childhood trauma. Precipitation is characterized by the defense mechanism applied by the body inform of dissociation as a counter strategy to the extremes of traumatic experience. Continued abuse and traumatic experiences among the patients leads to enhanced dissociation that ensures the continuation of the personalities. The final etiological theory is Attachment Theory that identifies the causes of the disorder as abandonment and assault. Abuse interrupts the developmental function of forming emotional attachments with other people, making people feel insecure. The feeling of insecurity makes the child develop dissociation as a form of defense mechanism. Dissociation is based on the alternating personal states between assault and abandonment. Most of the children experiencing abuse form emotional attachments to their abusers prevent them from forming future trustworthy relationships. Most of their future attachments are characterized by anxiety and fear due to the lack of trust. Based on the causes proposed by the theories, the prominent risk factor is a child’s exposure to childhood trauma (Moskowitz, 2004, p. 21-46). The common response among victims of child abuse is to avoid the memories. Multiple Personality Disorder may be the result if this reaction becomes extreme. The condition is not heritable although shared environmental conditions may have considerable impacts on the prevalence of the condition. Presence of a family member with the disorder may be a risk factor as this increase the vulnerability of other family members. However, this does not translate into the condition being genetic. The presence of the disorder is portrayed through various ways. The obvious symptom is memory lapse; to the extent of forgetting crucial life events such as birthdays (Elzinga, Phaf, Ardon and van Dyck, 2003). Victims experience blackouts making them end up in places that they cannot recall how they accessed them. Patients may sometimes possess things that they cannot recall how they acquired them. Most of them can hear voices inside their heads that are not their own. Victims may fail to respond to their names, as they consider them unfamiliar. They may even fail to recognize their images in the mirror. These symptoms make the victims feel unreal. The diagnostic criterion is denoted by the presence of two or more different identities or personality states (Gleaves, May and Cardena, 2001, p. 577-608) Each personality has its own distinct, persistent pattern of perception, relation and thinking about him or herself and the surrounding environment. A minimum of two identities should repeatedly and alternately take control of the person’s behavior. The victim experiences extensive and unusual memory loss that causes inability to recall crucial personal information. This cannot be explained by ordinary forgetfulness. The ailment is not a result of any medical interventions. The condition is not a product of direct physiological effects of substances such as alcohol intoxication. Additionally, the condition is not caused by fantasy play or imaginary playmates in children. Analysis of the disease involves the exploration of the patient’s past. This ensures that the current behavior is not related to another condition that the victim may have suffered during their childhood. The disorder occurs in various forms. One of the forms includes Depersonalization Disorder which makes the victims feel detached from their surroundings or themselves. Dissociative Amnesia form represents the memory problems emanating from a traumatic experience. Dissociative Fugue is a state of dissociation from the familiar surroundings and forgetfulness of the past. The disorder may also occur in periods of mental illness that cannot be classified as one of the specified forms. Multiple personality disorders normally occur in collaboration with other emotional conditions such Borderline Personality Disorder (BPD) and Post-Traumatic Stress Disorders (PTSD) (Steinberg, Barry, Sholomskas and Hall, 2005, p. 237–249). Diagnosis of multiple personality disorder is normally difficult because there are many other conditions that exhibit such symptoms. Such conditions include somatization disorder, psychogenic fugue and schizophrenia. The difficulty in the diagnosis of the condition has been exploited by criminals to get legal favor from the courts. The most conclusive way to confirm that a person is suffering from the condition is the use of a structured interview. Successful diagnosis will pave way for treatment that involves psychotherapy, hypnosis or Eye Movement Desensitization and Reprocessing (EMDR). Psychotherapy is the prominent treatment for Multiple Personality Disorder. The measure involves assisting victims to strengthen relationships with other people through prevention of confrontations. Psychotherapy sessions help patients to experience feelings they have not felt so comfortable expressing in the past. The process is carried-out systematically to prevent patients from being overwhelmed by anxiety or the trauma that characterized these feelings in the past. Victims are also guided on the ways in which they make the personalities coexist and function together. Methods of avoiding lapses and other negative effects are also identified during psychotherapy. The patient is then taught how to apply them in curtailing the prevalence to the disease. Psychotherapy can also be applied in ensuring reintegration of the personalities existing within an individual. However, the process requires care and extra caution. This ensures that patients do not feel as if psychotherapists are eliminating part of their personality states. Resistance from the patient will lead to the failure of psychotherapy. Eye Movement Desensitization and Reprocessing (EMDR) combines the traumatic memories with the patient’s own resources. The process has been applied for assisting in information processing and eventual healing. Hypnosis is applied to assist the victims learn more about their personality and the measures they can apply in regaining control of their emotional states and reasoning capabilities (McDonagh et al, 2005). Hypnosis helps the victim to deal with the different personalities as they interchange. The communication and behavioral attitudes of each personality state is monitored and identified, and the patient is taught how to control and recognize them. Medications minimize the adverse effects of conditions such as anxiety, anger and depression. The medication used should not make the patients feel as if they are being controlled in any way as such a feeling would enhance the trauma. Medications can only be exercised under strict prescription to avoid making the patient feel controlled, which can multiply their trauma. Some of the methods applied in medication include individual therapy, antidepressants and anxiolytics. In addition to the use of the stated medication, Carbamazapine can be used to treat electroencephalograph conditions, nightmares can be minimized through the use of Prazosin and Naltrexone for the treatment of self-injuries (Gleaves, May and Cardena, 2001, p. 577-608). The studies involving pharmacotherapy for Multiple Personality Disorder is scarce although research has been enhanced on diazepam and Perospirone. This is because they have portrayed promising treatment results. Perospirone is suitable for minimizing anxiety and hallucinatory problems. The anxiety-reduction property of Diazepam may be useful for memory retrieval when the condition is characterized by the enhanced memory lapse. Effective treatment of the disorder requires an integrated treatment plan. According to studies by International Society for the Study of Trauma and Dissociation (2011), the complicated nature of the condition and lack of relevant information on medication indicates that treatment requires an integrative approach. This includes review of the symptoms, psychotherapy and hypnosis, and medication i.e. the phase approach. The use of medication in minimizing the anxiety and trauma as well as use of the phase approach assists in eliminating the distressing symptoms, flexibility and the continual evaluation progress. Inflexibility in the use of one approach may compromise the effectiveness of the other methods as most of the co-morbid factors may require to be handled separately. Social support is eminent in the treatment process. All sources of support should be established to aid in the healing process once the patients attain stability. Such measures include behavior or group therapy (Gabbard, 2007, p. 92-93). Some of the advantages of the group therapy include reduction of isolation related to the diagnosis of the condition, chance to intermingle with other members of the heterogeneous groups and the replacement of the childhood isolation and secrecy that are caused by abuse tendencies. Group therapy provides patients with the opportunity to intermingle with other patients with similar problems and get encouraged. Other measures included in the integrative treatment plan include safety, symptom reduction and stabilization; handling the affected memories directly; rehabilitation and identity integration. If not well treated, the victims of this condition might resume their earlier dangerous habits. This is in an attempt to deal with the effects of victimization. They are also vulnerable to attempted suicides and violent behaviors as a way of forgetting their traumatic conditions. Normally, patients exhibit poor social interaction capabilities and low productivity in most of their activities. Prevention is the most effective strategy in avoiding the negative impacts of the disorder. Prevention of this disorder involves minimizing the exposure to the prominent cause i.e. traumatic experiences. Prevention can also involve assisting the victims and the affected to remember and adopt the behaviors they used to exhibit during their normal state of health (Korol, 2008, p. 249- 267: Ross and Haley, 2004). Epidemiological information is crucial in application of the preventive strategies. The systematic data relating to the prevalence of the condition is scarce. According to Sadock and Sadock, (2008, p. 299-300), the condition is prevalent in young adults and declines with maturity. Higher rates of this condition are noted in the psychiatric patients. It is more prevalent in young females than males. However, the assumption may be biased because most of the male cases may be confused with criminal tendencies ending up in jails rather than hospitals. The bias is confirmed by the rate of prevalence in children that is almost the same in both sexes. According to Maldonado and Spiegel, (2008), the rate of prevalence reached its peak in the 20th century where 40, 000 cases were diagnosed. This changed to less than 200 cases before the end of 1970. However, the beginning of the 1980 portrayed a sharp rise in the number of these cases. The complexity of the disease also increased with the number of alters rising from one to 13 in a victim. The sharp rise is blamed to the ignorance due to professional skepticism and the increased capability of the medical fraternity to identify the disorder. Recommendations Further investigative research is required on the nature of the multiple personality disorder. The area of focus should be on risk factors and the effect of genetic or environmental factors. More research is also necessary to identify the most effective medications. Research on the effect of cultural practices on the disorder should also be enhanced to assist families with such victims in devising efficient ways to deal with the situation. Conclusion Multiple personality disorder is a mental problem characterized by the existence of two or more different and relatively enduring personality states known as alters. They control an individual’s behavior alternately. The theoretical analysis of Multiple Personality Disorder involves the focus on both dissociation and etiological theories. Dissociation theories include psychoanalytic theory, Jungian theory, behavioral-state theory, hypnosis theory and state-dependent learning theory. The etiological theories include attachment theory, 3-P Factor theory, Braun’s BASK theory, the double-bind theory, Kluft's four-factor theory and ego-state theory. The most prominent risk factor is childhood trauma. The diagnostic criterion is denoted by the presence of different identities or personality states. The prominent symptom related to the condition is frequent memory lapse. Treatment involves psychotherapy, hypnosis or Eye Movement Desensitization and Reprocessing (EMDR). Some of the methods applied in medication include individual therapy, and use of antidepressants and anxiolytics. An integrative treatment plan is necessary for effective treatment of the condition. References Elzinga, B., Phaf, R., Ardon, A., & van Dyck, R. (2003). Directed forgetting between, but not within, dissociative personality states. Journal of Abnormal Psychology, 112(2), 237–243. Gabbard, G. O. (2007). Gabbard's treatments of psychiatric disorders (4th ed., pp. 92-95). Washington, DC: American Psychiatric Pub. Gleaves, D., May, M., & Cardena, E. (2001). An examination of the diagnostic validity of dissociative identity disorder. Clinical Psychological Review, 21(4), 577-608. International Society for the Study of Trauma and Dissociation (2011). Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation 12(2). 115-187 Korol, S. (2008). Familial and Social Support as Protective Factors against the Development of Dissociative Identity Disorder [Abstract].Journal of Trauma & Dissociation, 9(2), 249- 267. Maldonado, J. R., & Spiegel, D. (2008). "Dissociative disorders — Dissociative identity disorder (Multiple personality disorder)". In Hales RE; Yudofsky SC; Gabbard GO; with foreword by Alan F. Schatzberg. The American Psychiatric Publishing textbook of psychiatry (5th Ed.). Washington, DC: American Psychiatric Pub. 681–710. McClure, R. (n.d). 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