Multiple Personality Disorder/Dissociative Identity Disorder/Borderline
Personality Disorder
?


?
Multiple personality disorder is not
schizophrenia.  Schizophrenics hear
voices from outside and their thoughts
do not always relate well to their
feelings.  Multiples hear voices from
inside of their own mind, sometimes from
other parts of themselves that may be
completely integrated with memory and
feelings, but just on a different track,
organized around more than one center.  
Just what is happening here is not for
sure.  It may be different in different
people.  So rather than calling it
"Multiple Personality," the psychiatric
community has chosen to emphasize the
dissociation.  Dissociative Identity is an
identity that does not always have one
clear center.

For some people with an identity
dissociation, it seems that they may have
put themselves in something like an
hypnotic trance in order to escape from
pain and experiences that they did not
want to deal with directly.  Like anything
having to do with hypnosis and
dissociation, this is controversial.  People
who are not good at dissociation often
do not want to believe that others are
good at it, they are sure it is an act, a put
on.  But some people seem to actually
live in a state of permanent dissociation
so that the memory and emotion and
personality they are operating with
change as they are with different people,
walk into a different room, pursue a
different goal.

The rise in report numbers of this kind of
thing is attributed to some kind of mass
hysteria.  And to some extent that may
be true.  If I am going to hide out in my
own head I may hide in what is available,
fact, fad, or fancy.
All of us experience that kind of thing now and then, but people with strongly
dissociative identities do it all the time and to such a degree that their memory
may shatter into a number of separate strands.  One subpersonality may be
gay and the other may be very anti-gay.  The anti-gay personality may have no
memory of ever going in a gay bar or doing something with someone of their
own sex.

This organism is protecting itself from self destruction by isolating the angry
parts from the fearful parts, the destructive parts, from the parts with the
resources and motivation to accomplish self destruction.

People with the borderline personality disorder may go through major mood
swings and phases and vacillate in their attitudes and opinions.  People with
dissociative identity may vacillate between independent personality centers with
their own separate strands of memory, that may merge or not merge with other
strands.  One personality center may be consistently compulsive, another
dependent, another narcissistic, another histrionic.  One may be very
responsible and careful with money and the other spend everything it can get.

Discussion of dissociative identity and multiple personality is difficult because of
the many different ways the topic has been handled in the last two hundred
years.  It has probably been confused with schizophrenia because both
multiples and schizophrenics can hear voices, as discussed above, but it has
also been much confused with borderline and histrionic personality disorder
because it tends to be most visible in persons who are basically fearful,
conformist, dependent, compulsive, avoidant, and deal with their need to
escape, to be angry, to act out by generating histrionic and borderline
dissociative parts that are able to carry out these activities without disturbing
the original personality.  These histrionic and borderline dissociative parts put
on such a show that they catch the notice of the psychologist, or therapist that
describes them.  It is easy for some to claim that the dissociation was not what
it seems to be but just part of the histrionic show and borderline lack of
boundaries.

Part of the problem is its association with hypnosis, a phenomenon that is not
looked on with great favor by those psychologists that are pathologically left
cerebral hemisphere fact oriented types.  Hypnosis, dissociation, dissociative
identity threatens the ego of the elitist narcissistic psychotherapist that believes
himself to be all about reason, facts, and reality.  The notion of a dissociative
self, a real hypnotic state, threatens his own self concept as an independent
rational entity.  It is this male narcissism that may be the main reason
dissociation is rarely seen in males, who may escape into antisocial patterns
instead of borderline ones.  Much criminal behavior may be rooted in
dissociative patterns that are disguised as self serving addiction and acquisition.

The connection between the dissociation that supports criminal behavior,
addictive behavior, the black outs of alcoholics, and the dissociation traditionally
associated with the "hysterical" behavior of females is in great need of further
exploration. The Fourth Edition, of the Comprehensive Textbook of Psychiatry,
1985, (Edited by Harold I Kapan and Benjamin J. Sadock) had these interesting
items in a section written by John C. Nemiah, MD, (op. cit. pp. 942 - 957).

Nemiah discusses the work of the famous American psychologist William
James with the Rev. Ansel Bourne of Providence, Rhode Island.  James put
Bourne under hypnosis to explore a second personality and recorded some of
what he found in a famous textbook he published titled "The Principles of
Psychology."  There were a number of accounts of disorders of memory and
personality, of multiple personality, in the last part of the 19th century,
according to Dr. Nemiah.  A major study of dissociation was done in France by
Pierre Janet, under the supervision of Charcot at the Salpetriere, resulting in
L'Automatisme Pschologique and Etat Mental des Hysteriques.  Janet put
emphasis on the dissociation, but when Freud studied these issues, it was the
amnesia that interested him, and the notion of repression.  As a result the
whole issue was buried in dogma and theory and finally forgotten until the later
20th century.  Now hysteria in females was no longer seen as a weakness of
the mind.  The fact that there may have been severe abuse in childhood, that
rather than over dramatization, hysteria, the real problem could be deep injury,
deep stress damaging personal integration at its roots, this has returned the
subject of the multiple person back to center stage.


Jerrold S. Maxmen and Nicholas G. Ward, in Essential Psychopathology and Its
Treatment, Second Edition, W.W. Norton, 1995, pp. 313 -315, provide an
excellent summary, to paraphrase: There are more than one different distinct
personal egos, that take over at different times.  Each may have its own name,
its own memory, behavior, emotions, work history, mental problems and
physical problems, differing results on psychological tests.  There are cases
where the tested cerebral blood flow and electrical potentials may be different,
per op. cit. above.  The average number of these complex personalities is 8 to
13, but there may be 50.

The changes, transitions, are usually "sudden," they often appear when
unexpected and can be "spooky" to watch, but occur in response to stress.  
The personality switching in seems to take over body and soul, per Maxmen
and Ward.  Dress, speech, facial expression can change radically.  The primary
personality is usually unaware of these secondaries, but the secondaries are
aware of the primary and may communicate with other secondaries, they may
help and protect each other, and do things while other personalities observe.  
The secondaries are "extreme caricatures" of the primary, per Maxmen and
Ward.  Thus, this very shy and conventional ego type may give way to a
devilish whore, taking on different ages, sexes, even races from the primary.

Multiples are not easy to detect, nor do they come in for multiple problems,
requests for treatment for depression are more common.  Perhaps because
the primary personality is more likely to take on the depression.  Since the
secondaries are often more manic, they may not seek treatment because they
are the parts having fun, and these are the only parts with a clue about what is
really going on.  The multiple parts are revealed through memory problems and
time problems, items purchased that the primary does not remember buying.  
Depression, substance abuse, suicide attempts, psychotic episodes, phobias,
hypochondria, voices of other personalities talking are common problems,
according to the op. cit. above.

For treatment Maxmen and Ward report the following (see page 318, op. cit.):
These clients can overwhelm the therapist since secondary personalities may
come out while treatment is in progress.  These can be "hostile, seductive, and
manipulative; some will bait the primary identity, try blocking alliances with the
therapist, or act out by drug-taking and wrist-slashing."  Maxmen and Ward
state "All resist recalling traumatic events."  Note that multiples can be very
suggestible and questions can induce responses that cause the split off parts to
act out the suggestions of the therapist.

One therapist treated multiple as a form of Borderline Personality Disorder and
ignored the multiples with good results and some fusion of the personalities
(see op. cit. p. 319).  Maxmen and Ward suggest the following therapy for
Borderline Personality Disorder: "a narrow path between giving support without
rescuing and encouraging independence without signalling abandonment."  
"empathic and supportive statements should be combined," "a lot of structure
and consistency is also important."  The patient may be encourage to explore
"unconscious wishes and fantasies," to do "reality-testing," and in developing
consistent patterns that provide controls against impulsive self destructive acts.

According to the op. cit. above (p. 317) 70% of multiples have been give a
diagnosis of Borderline Personality Disoder: "emotional liability, low
self-esteem, impulsivity, substance abuse, chronic boredom, identity confusion,
temper tantrums, manipulative interpersonal relations, and suicide attempts" are
characteristic of both Borderline Personality and Dissociative Identity (op. cit. p.
317).

Cognitive behavioral interventions that "integrate adaptive coping skills with
intense affective reactions and cognitively fusing opposites," can show success
over a period of "years," per the op. cit. above.

One hypothesis to explain the above may be problems with the reward system.
Interactions with the young child and the mother generally establish reward
expectations for interactions with others. The child develops consistent
expectations and responses.  Problems with inherited tendencies and with the
environment can damage the stability of these patterns.

Neurological systems that are overloaded on dopamine and underloaded on
serotonin and gaba will generated uncontrolled expectations and lack off
boundaries and limits on those expectations.  When these systems are placed
under stress from the amygdala in response to strong fear, anger, sexual
overstimulation, the normal system, and its associated memories may shatter,
break, and separate reward seeking streams of behavior and memory may
diverge.

Poorly rewarded primary personalities may be left behind as secondary
personalities diverge in search of new systems of reward.  Generally each new
break will be more reward, more escape focused than the last.
Thus, the memory loss, the feeling of being high that accompany various forms
of alcoholism, drug addiction, and sex and love addiction, are reward system
problem generated dissociation not totally unlike other forms of dissociation.  
Thus, the borderline personality, the addictive process, the addictive family
system, the dissociative identity are interacting complexes of human experience
rooted in dysfunction that disturbs normally behaviors by placing too much
emphasis on continual reward (dopamine imbalance) and too little emphasis on
satisfaction.

The dissociated personality, the dissociated family, the dissociated society are
all similar.  Reward spills over and runs out. Pleasure and reward are not used
in a thrifty, loving, or an effective way and each becomes confused with anger,
acting out, punishment, and finally self punishment.  As pleasure blends into
pain, the dissociated personality becomes like a tree with a top blasted by wind
and lightning.  It can either grow into something beautiful, by carefully trimming
itself, loving itself as a gardener carefully tends his prize specimen.  Or it can
allow itself to grow like a sprawling weed, shoots feeding off the main trunk and
drawing energy away, without a clear leading shoot, without a clear top, lost in
the undergrowth, and addict powerless over the latest glass of pleasure.

The latest work with dissociation and brain function shows major differences in
dissociatives in the way the brain processes emotions and ego states. There is
evidence that the dissociative ego is really attempting to put a wall between
itself and memories that it does not want to integrate.  At some point the
amygdala, the structure at the edge of the cerebrum that processes emotional
states like anger, fear, and sexual arousal, was overloaded.  Put under so
much stress that normal connections with the hippocampus, and temporal lobe
areas of the brain responsible for generating a standard time line of personal
memories, these connections broke, time lines shattered.  The continuous
strand of reward directed personality was disrupted because the security of the
person became more significant than reward achievement.

Thus, the dissociated personality is a personality shattered by its protective
response to reward disruption, by extreme threats to the security of the
organism.

Research indicates that children subjected to stress generate glucocorticoid
reactions that cause deterioration in the area of the hippocampus and
associated temporal lobes and amygdala, regions responsible for personal
memory and emotional memory.  The results of this damage may be multiple
personality symptoms, dissociation symptoms that support the borderline
personality disorder and attention deficit hyperactivity disorders.  Sensitivity to
stress may be a product of the genes for unusually dopamine and gaba
chemistry that seem to characterize the nervous systems of addicts and
alcoholics.

Genetic propensity and environmental stress seem to interact.  In some cases,
there may be deterioration of the corpus callosum, a structure that connects the
hemispheres of the cerebrum, the personal memory coordinating hippocampus,
and associated temporal lobe and limbic areas, and the emotion coordinating
amygdala.  The nerve pathways that might connect separate bundles of anger,
fear, sexual response, anxiety response appear to break down.  Some of this
breakdown may be self reinforcing.  Habitual personality patterns may fail to
integrate and the neural pathways that facilitate integration may begin to fail
also.

Since some of these problems appear to involve the muscle movement
coordinating, striated bodies, basal ganglia and cerebellum, physical exercise
and body awareness, mindfulness meditation, breathing exercises, yoga, ti-chi,
etc., should be helpful in overcoming the dissociation.  Mindfulness meditation
appears to strengthen the insula, bridging sensation and action and emotion.  
Using pathways such as these, it may be possible to counter some of the
disintegration associated with the effects of post traumatic stress and
associated personality dissociation.

So what is happening here, what is going on?  Stress generated by trauma has
caused a cascade of chemical releases in the brain that have caused the decay
of neural systems that would normally integrate complex emotional responses.  
Instead the brain is left with a series of primitive emotional systems with
isolated streams of memory.  Apparently the identity module organizing
functions in the frontal lobes responsible for planning the person's packaging of
it's self image have found new brain structures that can be recruited to develop
personality new systems.  These systems can replace those damaged by the
neural destruction.

Perhaps, the neural destruction caused by the shrinkage of the amygdala and
hippocampus forces the identity organizer in the frontal lobes to recruit a set of
false front personalities that can disguise the emotional damage the abuse has
caused.  The job of these false front personalities is to look normal, to prevent
the traumatized victim from looking like a victim and thus becoming a target for
more abuse by appearing weak and different.

First the identity organizer recruits a set of false fronts.  Then it recruits a set of
abuser clones that carry on abusive actions themselves so that the victim can
substitute the more powerful role of victimizer for the weaker role of victim.  
Finally the identity organizer recruits a set of helper personalities to help clean
up the mess caused by the victimizers.

A nobody personality with no gender and no emotional and sexual agenda may
appear as stage manager to control the mythology of the larger system.  
Subsidiary stage managers may appear to set guidelines for the helper
personalities and help them control the personality system.  Personalities may
be recruited to carry the anger, the fear, to play the clown and keep up the
myth of happiness and good fortune where that is necessary to prevent
destructive behaviors from overwhelming the order of the total system.

What is happening?  Have sub persons, alters, taken over the tracks of the
switching areas of the basal ganglia, the striated bodies of the lower cerebrum?
One dissociated person claims to be able to think more clearly when he
integrates.