Jefferson Journal of Psychiatry


Historically, the diagnosis of Multiple Personality Disorder (MPD) has generated curiosity, fascination, skepticism, and disbelief. From the first reported cases in the early nineteenth century, controversy has abounded about the plausibility of the many dramatic manifestations of the illness, its pathogenesis, and appropriate approaches to its treatment (I). From the midst of scientific controversy and debate, a more refined conceptualization of the illness is being developed, particularly since the recent inclusion of the diagnosis in DSM-III (2). Noteworthy among these advances are the theories of pathogenesis described by Kluft (3), and Braun and Sachs (4) which emphasize a prerequisite biological dissociative potential in combination with extreme environmental stress, and Speigel's (5) formulation framing MPD as a post -traumatic stress disorder. Despite these advances, many long rejected and scientifically invalid notions about the illness continue to play a part in the clinical assessment and treatment of MPD. Misinformation has led to delays in accurate diagnosis. A recent study has shown that the average length of time to reach the diagnosis of MPD is 6.8 years (6), with preliminary diagnoses ranging from schizophrenia to borderline personality disorder. The use of hypnosis as an adjunct in both diagnosis and treatment of multiple personality disorder has further complicated the picture, inspiring questions about the role of suggestion and the possibility of an iatrogenic etiology. One assumption has been that MPD is the unfortunate creation of an overzealous psychiatrist engaged in a folie a deux with a highly suggestible patient. These questions and concerns have clear effects on the treatment and management of patients diagnosed with MPD as well as with the other DSM-III Dissociative Disorders.

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