When a person has many personalities. Divergence of opinion. The Multiple Minds of Billy Milligan

Psychological illnesses are among the most difficult, they often respond poorly to treatment and in some cases remain with a person forever. Split personality or dissociative syndrome belongs to such a group of diseases, has similar symptoms to schizophrenia, identity disorders become signs of this pathology. The condition has its own characteristics, which are not known to everyone, so there is a misinterpretation of this disease.

What is split personality

This is a mental phenomenon, which is expressed in the presence of two or more personalities in a patient, who replace each other with a certain periodicity or exist simultaneously. Patients who are faced with this problem, doctors diagnose "dissociation of personality", which is as close as possible to a split personality. This is a general description of the pathology, there are subspecies of this condition, which are characterized by certain features.

Dissociative disorder - concept and manifestation factors

This is a whole group of disorders psychological type, which have characteristic features violations of psychological functions that are characteristic of a person. Dissociative identity disorder affects memory, awareness of the personality factor, behavior. All affected functions. As a rule, they are integrated and are part of the psyche, but when dissociated, some streams separate from consciousness, gaining a certain independence. This may appear in the following moments:

• loss of identity;
• loss of access to certain memories;
• emergence of a new "I".

Behavioral Features

A patient with this diagnosis will have an extremely unbalanced character, will often lose touch with reality, and will not always be aware of what is happening around him. The dual personality is characterized by large and short memory lapses. To typical manifestations Pathologies include the following symptoms:

• frequent and severe sweating;
• insomnia;
• severe headaches;
• impaired ability to think logically;
• inability to recognize one's condition;
• mood mobility, a person first enjoys life, laughs, and after a few minutes he will sit in a corner and cry;
• conflicting feelings about everything around you.

Reasons

Mental disorders of this type can manifest themselves in several forms: mild, moderate, complex. Psychologists have developed a special test that helps to identify the signs and causes that caused a split personality. There are also common factors that provoked the disease:

• the influence of other family members who have their own dissociative type disorders;
• hereditary predisposition;
• childhood memories of mental or sexual abuse;
• lack of support from loved ones in a situation of severe emotional stress.

Symptoms of the disease

Identity disorders in some cases have symptoms similar to other mental illnesses. You can suspect a split personality in the presence of a whole group of signs, which include the following options:

• patient's imbalance - a sharp change in mood, an inadequate reaction to what is happening around;
• the appearance of one or more new incarnations within oneself - a person calls himself different names, behavior is radically different (modest and aggressive personalities), does not remember what he did at the time of the dominance of the second "I".
• loss of connection with the environment - an inadequate reaction to reality, hallucinations;
• speech disorder - stuttering, long pauses between words, slurred speech;
• memory impairment - short-term or extensive lapses;
• the ability to connect thoughts into a logical chain is lost;
• inconsistency, inconsistency of actions;
• sudden, noticeable mood swings;
• insomnia;
• profuse sweating;
• severe headaches.

auditory hallucinations

One of the common abnormalities in the disorder, which may be an independent symptom or one of several. Disturbances in the functioning of the human brain create false auditory signals that the patient perceives as speech that does not have a sound source sounds inside his head. Often these voices say what needs to be done, they can only be drowned out with medications.

Depersonalization and Derealization

This deviation is characterized by a constant or periodic feeling of alienation from one's own body, mental processes, as if a person is an outside observer of everything that happens. These sensations can be compared with those that many of the people experience in a dream, when there is a distortion of the sensation of temporal, spatial barriers, disproportion of the limbs. Derealization is a feeling of the unreality of the world around, some patients say that they are a robot, often accompanied by depressive, anxiety states.

Trance-like states

This form is characterized by a simultaneous disorder of consciousness and a decrease in the ability to adequately and modernly respond to stimuli from the outside world. The trance state can be observed in mediums who use it to séances and for pilots who perform long flights at high speed and with monotonous movements, monotonous impressions (sky and clouds).

In children, this condition manifests itself as a result of physical trauma, violence. The peculiarity of this form lies in the possession, which is found in some regions and cultures. For example, amok - in Malays, this condition is manifested by a sudden fit of rage, followed by amnesia. A man runs and destroys everything that comes his way, he continues until he cripple himself or die. The Eskimos call the same condition piblokto: the patient tears off his clothes, screams, imitates the sounds of animals, after which amnesia sets in.

Change in self-perception

The patient fully or partially experiences alienation from his own body, on the mental side it can be expressed by a feeling of observation from the side of himself. The state of derealization is very similar, in which mental, temporary barriers are broken and a person loses a sense of the reality of what is happening around. A person may experience false feelings of hunger, anxiety, the size of his own body.

In children

Toddlers are also prone to splitting personalities, it happens in a somewhat peculiar way. The child will still respond to the name given by the parents, but at the same time there will be signs of the presence of other "Selves", which partially capture his consciousness. The following manifestations of pathology are characteristic for children:

• different manner of speaking;
• amnesia;
• food habits are constantly changing;
• amnesia;
• mood lability;
• self-talk;
• glassy look and aggressiveness;
• inability to explain their actions.

How to recognize dissociative identity disorder

This condition can only be diagnosed by a specialist who evaluates the patient according to certain criteria. The main task is to exclude herpes infection and tumor processes in the brain, epilepsy, schizophrenia, amnesia due to physical or psychological trauma, mental fatigue. A doctor is able to recognize a mental illness by the following signs:

• the patient shows signs of two or more personalities who have an individual relationship to the world as a whole and certain situations;
• a person is unable to remember important personal information;
• the disorder occurs not under the influence of drugs, alcohol, toxic substances.

Criteria for the splitting of consciousness

There are a number of common symptoms that indicate the development of this form of pathology. These symptoms include memory lapses, events that cannot be logically explained and indicate the development of another personality, alienation from one's own body, derealization and depersonalization. All this happens when many personalities coexist in one person. Be sure the doctor takes an anamnesis, talks with the alter ego, and monitors the patient's behavior. The following factors are indicated in the handbook as criteria for determining the splitting of consciousness:

• in a person there are several alter egos that have their own attitude to the outside world, thinking, perception;
• capture of consciousness by another person, behavior change;
• the patient cannot remember important information about himself, which is difficult to explain by simple forgetfulness;
• all of the above symptoms did not become a consequence of the drug, alcohol intoxication, exposure to toxic substances, other diseases (complex seizures of epilepsy).

Differential Analysis

This concept means the exclusion of other pathological conditions that can cause symptoms similar to the manifestation of a splitting of consciousness. If studies show signs the following pathologies, then the diagnosis is not confirmed:

• delirium;
• infectious diseases (herpes);
• brain tumors that affect temporal lobe;
• schizophrenia;
• amnestic syndrome;
• disorders resulting from the use of psychoactive substances;
• mental fatigue;
• temporal epilepsy;
• dementia;
• bipolar disorder;
• somatoform disorders;
• post-traumatic amnesia;
• simulation of the considered state.

How to exclude the diagnosis of "organic brain damage"

This is one of the mandatory stages of differential analysis, because the pathology has many similar symptoms. A person is sent for verification based on the result of the anamnesis collected by the doctor. A neurologist conducts a study, which will give a direction for conducting following tests:

• computed tomography - helps to obtain information about functional state brain, allows you to detect structural changes;
• neurosonography - used to detect neoplasms in the brain, helps to examine the cerebrospinal fluid spaces;
• rheoencephalogram - examination of the vessels of the brain;
• ultrasound examination of the brain cavities;
• MRI - is performed to detect structural changes in brain tissues, nerve fibers, blood vessels, the stage of pathology, the degree of damage.

How to treat a split personality

The process of patient therapy is usually complex and lengthy. In most cases, follow-up is required for the rest of a person's life. You can get a positive and desired result from the treatment only with the right medication. Drugs, dosages should be prescribed exclusively by a doctor on the basis of studies and analyzes. Modern treatment regimens include the following types of drugs:

• antidepressants;
• tranquilizers;
• neuroleptics.

In addition to medications, other methods of therapy are used, which are aimed at solving the problems of splitting consciousness. Not all of them have a quick effect, but are part of complex treatment:

• electroconvulsive therapy;
• psychotherapy, which can only be carried out by doctors who have completed specialized additional practice after graduating from a medical institute;
• hypnosis is allowed;
• part of the responsibility for treatment lies on the shoulders of others, they should not talk to a person as if they are sick.

Psychotherapeutic treatment

Dissociative disorder requires psychotherapeutic therapy. It should be carried out by specialists who have experience in this field and have passed extra education. This direction is used to achieve two main goals:

• relief of symptoms;
• reintegration of all human alter egos into one fully functioning identity.

To achieve these goals, two main methods are used:

1. Cognitive psychotherapy. The doctor's work is aimed at correcting stereotypes of thinking, inappropriate thoughts with the help of structured learning persuasion, behavior training, mental state, experiment.
2. Family psychotherapy. It consists in working with the family to optimize their interaction with the person in order to reduce the dysfunctional impact on all members.

Electroconvulsive therapy

For the first time, the method of treatment was applied in the 30s of the 20th century, then the doctrine of schizophrenia was actively developing. The rationale for this treatment was the idea that the brain could not generate localized bursts of electrical potentials, so they had to be created artificially to achieve remission. The procedure is as follows:

1. Two electrodes were attached to the patient's head.
2. A voltage of 70-120 V was applied through them.
3. The device started up the current for a fraction of a second, which was enough to affect the human brain.
4. The manipulation was carried out 2-3 times a week for 2-3 months.

As a therapy for schizophrenia, this method has not taken root, but in the field of multiple split consciousness therapy it can be used. For the body, the degree of risk from the technique is reduced due to constant monitoring by doctors, anesthesia, and muscle relaxation. This helps to avoid all the unpleasant sensations that might arise when creating nerve impulses in the substance of the brain.

Application of hypnosis

People who experience multiple splits in consciousness are not always aware of the presence of other alter egos. Clinical hypnosis helps to achieve integration for the patient, to alleviate the manifestations of the disease, which contributes to changing the character of the patient. This direction is very different from conventional treatments, because the hypnotic state itself can provoke the appearance of a multiple personality. The practice is aimed at achieving the following goals:

• ego strengthening;
• relief of symptoms;
• reduced anxiety;
• creation of rapport (contact with the conducting hypnosis).

How to treat multiple personality syndrome

The basis of therapy is medication, which is aimed at alleviating symptoms, restoring the full functioning of a person as a person. A course is selected, dosage only by a doctor, a severe form of bifurcation requires more strong drugs than easy. Three groups of medicines are used for this:

• neuroleptics;
• antidepressants;
• tranquilizers.

Antipsychotics

This group of drugs is used to treat schizophrenia, but with the development of a split personality, they can also be prescribed to eliminate a manic state, delusional disorders. The following options can be assigned:

1. Haloperedol. This is a pharmaceutical name, so this medicinal substance can be part of various medicines. It is used to suppress delusional, manic states. Contraindicated in patients with disorders of the central nervous system, angina pectoris, dysfunction of the liver, kidneys, epilepsy, active alcoholism.
2. Azaleptin. It has a powerful effect and belongs to the group of atypical antipsychotics. Used more to suppress feelings of anxiety, strong arousal, has a strong hypnotic effect.
3. Sonapax. It is used for the same purposes as the above means: suppression of feelings of anxiety, manic state, delusional ideas.

Antidepressant

Often a split personality occurs due to a psychogenic reaction to the loss of a loved one, in a child this often occurs against the background of a lack of attention from parents and this does not manifest itself in early childhood, but in adulthood it leads to psychiatry. Dissociative experience is manifested as a result of a long depressed state, severe stress. For the treatment of such causes, the doctor prescribes a course of antidepressants to eliminate all symptoms of depression, apathy for planning one's future. Of the drugs prescribed:

• Prozac;
• Porgal;
• fluoxetine.

tranquilizers

These drugs are strictly forbidden to use independently without a doctor's prescription. These potent drugs can cause significant harm to health and aggravate the patient's situation. The doctor, after a general examination, may prescribe these drugs to achieve an anxiolytic effect. You can not take tranquilizers with a tendency to suicide or prolonged depression. In medical practice, personality disorder is usually treated with Clonazepam.

Video

- a mental disorder in which in one person there are two or more personalities with their own character, memories, temperament, features of interaction with the outside world. The age, nationality and gender of subpersonalities may vary. It is assumed that the cause of the development of split personality disorder is severe psychological trauma in childhood. The diagnosis is established on the basis of the anamnesis, conversations and observations of the patient. Treatment - psychotherapy, assistance in establishing cooperation between subpersonalities, pharmacotherapy of concomitant disorders (anxiety, depression).

General information

Split personality disorder (multiple personality, dissociative identity disorder) is a rare mental disorder in which several personalities coexist in one person. This disorder is well known to the general public from films and books (Sybil, Fight Club, Me, Myself and Irene, The Multiple Minds of Billy Milligan), but until recently, many experts doubted the existence of split personality disorder. Dissociative Identity Disorder is now officially recognized and included in the latest edition. International Classification Diseases (ICD-10).

It is assumed that split personality disorder is more common in English-speaking countries, but the reasons for this phenomenon have not yet been clarified. From 1980 (from the moment the pathology was included in the reference book of mental disorders) until the end of the 20th century, according to various sources, this diagnosis was made to 20-40 thousand people. Some psychiatrists still consider split personality disorder to be an extremely rare disease and consider multiple cases of this diagnosis as overdiagnosis or the result of iatrogenesis (careless impact of the words or actions of the doctor on the patient's psyche). The treatment of split personality disorder is carried out by specialists in the field of psychiatry.

Causes of split personality disorder

The reasons for the development of a multiple personality are not precisely clarified, however, research data show that this pathology arises as a result of the action of biological factors, which are superimposed by repetitive severe psychological trauma. In 98-99% of patients suffering from split personality disorder, unbearable shocks are detected in childhood, often posing a threat to life. Multiple personality disorder can also be triggered by constant neglect, rejection, and emotional pressure in the absence of direct sexual or physical abuse.

Psychiatrists view split personality disorder as a kind of defense mechanism that allows you to completely separate from traumatic events, splitting memories, and then forcing them into an alternative personality or personalities. The critical period is the age of development of feelings (up to 9 years). With the occurrence of severe psychological shocks at an older age, a split personality disorder develops very rarely.

Some experts claim that about 3% of patients who are hospitalized in psychiatric departments suffer from a split personality disorder, but this information has not yet been officially confirmed. According to another unconfirmed opinion of some psychologists and psychiatrists, a split personality disorder occurs 9 times more often in women than in men. At the same time, experts do not exclude that such a ratio of sick men and women may be due to the difficulties in diagnosing the disorder in the stronger sex.

Manifestations of split personality disorder

The main manifestation of split personality disorder is the presence of multiple alter egos. Usually, at the initial stages of treatment, the psychiatrist manages to identify 2-4 subpersonalities in the patient. Subsequently, the number of discovered alter egos can increase to 10-15 or more. There have been cases of split personality disorder in which one patient had more than 100 alter egos. Each personality has its own character, attitudes, attitudes, abilities, knowledge (for example, one personality may speak a language unknown to other alter egos), memories and life history.

Gender, age, nationality, and the origin of the alter ego in multiple personality disorder can vary. A small white Ohio girl, a young Texan, and a middle-aged black Hispanic may coexist in the same patient. Each person has his own gestures, his own manner of speech, his own way of conducting a dialogue and his own ways of expressing emotional reactions. Moreover, some researchers argue that in the transition from one personality to another, even some physiological indicators(pulse and blood pressure).

Strictly speaking, in split personality disorder, not full-fledged alter egos are formed, but fragments of personalities that have arisen to respond to a traumatic situation. One personality may primarily perform the function of a protector, the other may reflect the weak, childish, emotional part of the patient, unable to cope with external circumstances, etc. Usually, among the many alter egos of a patient suffering from a split personality disorder, a host personality stands out, identifying himself with the present name of the patient and most important facts his biography (place and time of birth, real parents, place of study, profession).

As a rule, the alter egos of patients with split personality disorder are unaware of the existence of each other. The transition from one personality to another is carried out suddenly, against the background of some external impulse (usually psychological or physical stress varying degrees intensity). During the period of dominance of one alter ego, the rest are “inactive” (as if they do not exist) and do not retain any memories of the events taking place.

Because of this, a patient suffering from a split personality disorder cannot remember some events, including significant ones (for example, he does not know about the sale of an apartment or car). A patient with a split personality disorder finds himself in some places, not understanding how he got there, discovers other people's things, finds documents and notes written in someone else's handwriting, communicates with strangers who behave like acquaintances, etc. Sometimes individuals are aware of each other's existence and are in a state of conflict.

People with multiple personality disorder often experience headaches, mood swings, and sleep disturbances. Patients may suffer from nightmares or insomnia, and some develop somnambulism. Patients with split personality disorder have increased anxiety, panic attacks are possible when immersed in traumatic memories or getting into similar situations. Often, signs of obsessive-compulsive disorder (obsessions, compulsions, ritual behavior) are revealed.

Typical symptoms of split personality disorder are derealization and depersonalization - it seems to patients that they are watching their actions from the side and cannot control their behavior. Possible trance states, the feeling of "curvature" of space and time. Some patients with multiple personality disorder have varying degrees of psychotic symptoms (eg, hallucinations). Against the background of constant psychological distress, depression develops, suicidal thoughts, intentions and actions arise.

In a number of cases, with a split personality disorder, a tendency to self-persecution, self-destructive behavior, and direct violence against oneself and others is revealed. Some patients with multiple personality disorder, without moving from one alter ego to another, “find themselves” behind dangerous or deliberately harmful actions: gross violation of traffic rules, driving at high speed, stealing from friends or superiors, senseless conflicts that turn into assault, etc. At the same time, patients with a split personality disorder condemn such behavior and say that consciously (freely or even under pressure) they wouldn't do that. There is an increased risk of developing alcoholism and drug addiction.

Diagnosis of split personality disorder

Symptoms that make it possible to suspect a split personality disorder are memory lapses, the presence of inexplicable events that suggest the participation of another person (other people's notes, other people's stories about actions that the patient did, but which he does not remember, "unfamiliar acquaintances"), depersonalization, derealization and alteration of identity (discovering oneself while committing unacceptable or disgusting acts). The diagnosis of split personality disorder is based on the history, conversations with various alter egos, and observation of the patient's behavior.

As diagnostic criteria for split personality disorder, the DSM-4 manual of mental disorders indicates:

• The presence in one person of two or more alter egos, having their own stable perception, thinking, attitude towards themselves and the outside world.
• "Transition" of the control of the patient's behavior from one person to another.
• The inability to recall important information about oneself and one's life on a scale that cannot be explained by ordinary forgetfulness.
• The listed symptoms are not caused by the action of alcohol, drugs and are not the result of another disease (for example, complex partial seizures in epilepsy).

Treatment and prognosis for split personality disorder

The main objectives of therapy for split personality disorder are to eliminate or reduce the intensity of "general" symptoms (anxiety, depersonalization, insomnia, etc.), ensure patient safety and reunite different alter egos. Psychiatrists consider psychotherapy as the main treatment for split personality disorder. Various psychotherapeutic methods can be used: clinical hypnosis, family therapy, cognitive therapy, psychodynamic therapy. in the correction of split personality disorder is ineffective, medications are used only to treat comorbid disorders and facilitate access to repressed memories.

The best result of the treatment of split personality disorder is to overcome childhood trauma, eliminate internal conflicts that cause protective split personality, and form a single whole identity. However, even with prolonged work, the psychiatrist is not always able to achieve the reunification of various personalities. In such cases, the elimination of conflicts and the establishment of productive cooperation between various alter egos is considered as a satisfactory result. Treatment is long, the average duration of regular continuous therapy for split personality disorder is 6-8 years or more.

Have you ever thought that maybe you don't know someone very well? That sometimes he seems completely different, alien, unfamiliar, as if he had been replaced? As if several completely different people live in his body?

Dissociative identity disorder (DID), also known as multiple personality disorder (MPD), multiplicity, split personality… what it is?In this article, psychologist Yulia Koneva will tell you everything about split personality disorder, what are its causes, signs, symptoms and manifestations, and you will also learn real stories from the lives of people with this disorder.

Split personality: 23 souls in one body

"Personalities" may vary mental faculties, nationality, temperament, worldview, gender and age

Reasons for the development of DID

How does multiple personality arise? The etiology of a split personality is not yet fully understood, but the available data speak in favor of the psychological nature of the disease.

arises due to the mechanism of dissociation, under the influence of which thoughts or specific memories of ordinary human consciousness are divided into parts. Divided thoughts expelled into the subconscious mind spontaneously emerge in consciousness due to triggers (triggers), which can be events and objects present in the environment during the traumatic event.

Split personality, like other dissociative disorders, is psychogenic in nature. Its occurrence is associated with a whole range of factors. The trigger mechanism can sometimes be an acute stressful situation with which a person is unable to cope on his own. The multiple personality for him serves as protection from traumatic experiences. Many dissociative disorders develop in people who, in principle, are able to dissociate, to separate their perceptions and memories from the stream of consciousness. This ability, combined with the ability to enter a trance state, is a factor in the development of dissociative identity disorder.

The causes of a split personality often lie in childhood and are associated with traumatic events, the inability to defend against negative experiences and the lack of love and care towards the child from his parents. Research by North American scientists found that 98% of people with multiple personalities were abused as children(85% have documentary evidence of this fact). Thus, these studies have shown that a key factor provoking a split personality is violence in childhood. In other situations, a large role in the development of dissociative identity disorder is played by early loss of a loved one, a complex illness or other acute stressful situation. In some cultures, war or a global catastrophe can become a key factor.

For multiple personality disorder to occur, a combination of:

• Intolerable or strong and frequent stress.
• Ability to dissociate (a person must be able to separate from consciousness their own perception, memories or identity).
• Manifestations in the process individual development defense mechanisms of the psyche.
• Traumatic experience in childhood with a lack of care and attention in relation to the affected child. A similar picture arises when the child is not sufficiently protected from subsequent negative experiences.

A unified identity (the integrity of the self-concept) does not arise at birth, it develops in children through a variety of experiences. Critical situations create an obstacle to the development of the child, and as a result, many parts that should be integrated into a relatively unified identity remain isolated.

A long-term study by Ogawa et al. shows that lack of access to a mother at two years of age is also a predisposing factor for dissociation.

The ability to generate multiple personalities does not appear in all children who have experienced abuse, loss or other serious injury. Patients suffering from dissociative identity disorder are characterized by the ability to easily enter a trance state. It is the combination of this ability with the ability to dissociate that is considered a contributing factor to the development of the disorder.

Do you suspect depression in yourself or someone close to you? Find out with the help of innovative whether there are anxiety symptoms which may indicate depression. Get a detailed report with recommendations in less than 30-40 minutes.

Symptoms and signs

Dissociative identity disorder (DID) is the modern name for a disorder that is known to the general public as multiple personality disorder or split personality disorder. This is the most severe disorder of the group of dissociative mental disorders, which is manifested by the majority of known dissociative symptoms.

To major dissociative symptoms include:

1. Dissociative (psychogenic) amnesia in which sudden memory loss is caused by a traumatic situation or stress, and the assimilation of new information and consciousness is not impaired (often observed in people who have experienced military operations or disaster). Memory loss is recognized by the patient. Psychogenic amnesia is more common in young women.
2. Dissociative fugue or dissociative (psychogenic) flight reaction. It manifests itself in the sudden departure of the patient from the workplace or from home. In many cases, the fugue is accompanied by an affectively narrowed consciousness and a subsequent partial or total loss memory without awareness of the presence of this amnesia (a person may consider himself a different person, as a result of having a stressful experience, behave differently than before the fugue, or not be aware of what is happening around him).
3. Dissociative identity disorder, as a result of which a person identifies himself with several personalities, each of which dominates him with a different time interval. The dominant personality determines the views of a person, his behavior, etc. as if this personality is the only one, and the patient himself, during the period of dominance of one of the personalities, does not know about the existence of other personalities and does not remember the original personality. Switching usually occurs suddenly.
4. Depersonalization disorder, in which a person periodically or constantly experiences alienation of his own body or mental processes, watching himself as if from the side. There may be distorted sensations of space and time, the unreality of the surrounding world, the disproportion of the limbs.
5. Ganser syndrome("prison psychosis"), which is expressed in the deliberate demonstration of somatic or mental disorders. Appears as a result of an internal need to look sick without the goal of gaining. The behavior that is observed in this syndrome resembles the behavior of patients with schizophrenia. The syndrome includes passing words (a simple question is answered inappropriately, but within the limits of the question), episodes of extravagant behavior, inadequacy of emotions, decreased temperature and pain sensitivity, amnesia in relation to episodes of the syndrome.
6. dissociative disorder, which manifests itself in the form of a trance. Manifested in a reduced response to external stimuli. Split personality is not the only condition in which trance is observed. The trance state is observed with the monotony of movement (pilots, drivers), mediums, etc., but in children this state usually occurs after trauma or physical abuse.

Dissociation can also be observed as a result of a long and intense violent suggestion (processing the consciousness of hostages, various sects).

Signs of a split personality also include:

• Derealization, in which the world seems unreal or distant, but there is no depersonalization (there is no violation of self-perception).
• dissociative coma, which is characterized by loss of consciousness, a sharp weakening or lack of response to external stimuli, extinction of reflexes, changes in vascular tone, impaired pulse and thermoregulation. Stupor (complete immobility and lack of speech (mutism), weakened reactions to irritation) or loss of consciousness not associated with somato-neurological disease is also possible.
• emotional lability(severe mood swings).

Anxiety or depression, suicide attempts, panic attacks, phobias, or nutrition are possible. Sometimes patients experience hallucinations. These symptoms are not directly associated with a split personality, as they may be a consequence of the psychological trauma that caused the disorder.

Diagnostics

Dissociative identity disorder is diagnosed when the following criteria are met:

• The absence of alcohol, drug intoxication, the influence of other toxic substances and diseases. Lack of explicit simulation or fantasizing.
• A person has obvious memory problemsthat have nothing to do with simple forgetfulness.
• The presence of several distinguishable "I"-states with stable models of perception of the world, different attitudes to the surrounding reality and worldview.
• presence, by at least, two of the distinguishable identities capable of influencing the patient's behavior. Dissociative identity disorder (split or split personality, multiple personality disorder, multiple personality syndrome, organic dissociative personality disorder) is a rare mental disorder in which personal identity is lost and it seems that there are several different personalities (ego states) in one body .

Dissociative identity disorder is diagnosed based on four criteria:

1. The patient must have minimum two(possibly more) personal states. Each of these individuals must have individual features, character, their own worldview and thinking, they perceive reality differently and differ in behavior in critical situations.
2. These personalities control the person's behavior in turn.
3. The patient has memory lapses, he does not remember important episodes of his life (wedding, childbirth, attended a course at the university, etc.). They appear in the form of phrases “I can’t remember,” but usually the patient attributes this phenomenon to memory problems.
4. The resulting dissociative identity disorder is not associated with acute or chronic alcohol, drug or infectious intoxication.

Split personality needs to be distinguished from role-playing games and fantasies.

Since dissociative symptoms develop even with extremely pronounced manifestations post-traumatic stress disorder, as well as disorders associated with the appearance of pain in the area of ​​some organs as a result of an actual mental conflict, a split personality must be distinguished from these disorders.

The patient has a "basic" main personality, which is the owner of the real name, and which usually unaware of the presence of other personalities in his body, therefore, if the patient is suspected of having a chronic dissociative disorder, the psychotherapist should examine:

• certain aspects of the patient's past;
• current mental status of the patient.

How is the disorder diagnosed? Interview questions are grouped by topic:

• Amnesia. It is desirable that the patient give examples of "time gaps", since microdissociative episodes under certain conditions occur in absolutely healthy people. In patients who suffer from chronic dissociation, time lag situations are common, amnesic circumstances are not associated with monotonous activity or extreme concentration of attention, and there is no secondary benefit (it is present, for example, when reading fascinating literature).

At the initial stage of communication with a psychiatrist, patients do not always admit that they experience such episodes, although every patient has at least one personality who has experienced such failures. If the patient gave convincing examples of the presence of amnesia, it is important to exclude the possible connection of these situations with the use of drugs or alcohol (the presence of a connection does not exclude a split personality, but complicates the diagnosis).

Questions about the presence in the wardrobe (or on herself) of the patient of things that she did not choose help to clarify the situation with time gaps. For men, such “unexpected” items can be vehicles, tools, weapons. These experiences can involve people (strangers claim to know the patient) and relationships (deeds and words that the patient knows about from the stories of loved ones). If a strangers, addressing the patient, used other names, they need to be clarified, since they may belong to other personalities of the patient.

• Depersonalization / Derealization. This symptom is most common in dissociative identity disorder, but it is also common in schizophrenia, psychotic episodes, depression, or temporal lobe epilepsy. Transient depersonalization is also seen in adolescence and at moments of near-death experience in a situation of severe trauma, so you need to remember about the differential diagnosis.

The patient needs to be clarified whether he is familiar with the state in which he observes himself as stranger, watching a "movie" about himself. Such experiences are characteristic of half of patients with a split personality, and usually the main, basic personality of the patient is the observer. When describing these experiences, patients note that at these moments they feel a loss of control over their actions, they look at themselves from some external, located on the side or from above, a fixed point in space, they see what is happening as if from the depths. These experiences are accompanied by intense fright, and in people who do not suffer from multiple personality disorder and have had similar experiences as a result of near-death experiences, this condition is accompanied by a feeling of detachment and peace.

There may also be a feeling of the unreality of someone or something in the surrounding reality, the perception of oneself as dead or mechanical, etc. Since such a perception manifests itself in psychotic depression, schizophrenia, phobias, etc., a wider differential diagnosis is needed.

• Life experience. Clinical practice shows that in people suffering from split personality, certain life situations are repeated much more often than in people without this disorder.

Childhood abuse is a key factor in the development of DID

Usually, patients with multiple personality disorder are accused of pathological deceit (especially in childhood and adolescence), denial of actions or behavior that other people have observed. The patients themselves are convinced that they are telling the truth. Fixing such examples will be useful at the stage of therapy, as it will help to explain incidents that are incomprehensible to the main personality.

Patients with a split personality are very sensitive to insincerity, suffer from extensive amnesia, covering certain periods of childhood (the chronological sequence of school years helps to establish this). Normally, a person is able to consistently tell about his life, restoring in his memory year after year. People with multiple personalities often experience wild fluctuations in school performance, as well as significant gaps in the chain of memories.

Often, in response to external stimuli, a flashback state occurs, in which memories and images, nightmares and dream-like memories involuntarily invade consciousness. The flashback causes intense anxiety and denial ( defensive reaction main person).

There are also obsessive images associated with the primary trauma and uncertainty about the reality of some of the memories.

Also characteristic is the manifestation of certain knowledge or skills that surprise the patient, because he does not remember when he acquired them (sudden loss is also possible).

• The main symptoms of K. Schneider. Multiple personality patients may "hear" aggressive or supportive voices arguing in their head, commenting on the patient's thoughts and actions. Phenomena of passive influence can be observed (often this is automatic writing). By the time of diagnosis, the main personality often has experience of communicating with his alternating personalities, but interprets this communication as a conversation with himself.

When assessing the current mental status, attention is paid to:

• appearance (can change radically from session to session, up to sudden changes in habits);
• speech (timbre, vocabulary changes, etc.);
• motor skills (tics, convulsions, trembling of the eyelids, grimaces and reactions of the orienting reflex often accompany a change of personalities);
• thinking processes, which are often characterized by illogicality, inconsistency and the presence of strange associations;
• the presence or absence of hallucinations;
• intelligence, which as a whole remains intact (only in long-term memory is mosaic deficiency revealed);
• prudence (the degree of adequacy of judgments and behavior can change dramatically from adult to childish behavior).

Putnam F. "Diagnosis and treatment of multiple personality disorder"

Patients usually present with a marked learning disability based on past experience. EEG and MRI are also performed to exclude the presence of an organic brain lesion.

There are also other symptoms of a split personality:

• mood swings, depression;
• suicidal ideas and attempts;
• increased level of anxiety up to an anxiety disorder;
• sometimes there are dissociative disorders of a different nature;
• violation of appetite, diet;
• poor sleep, insomnia,;
• the presence of various phobias, panic disorders;
• a feeling of loss, confusion, sometimes derealization and depersonalization are manifested;
• children may have variability of tastes, conversations with themselves, talking in different manners.

Since schizophrenia and dissociative identity disorder have many similar symptoms, even hallucinations sometimes occur with a split personality, a person is sometimes misdiagnosed as schizophrenia, although dissociative identity disorder is of a completely different nature.

Psychological testing

MMPI test

The MMPI test (Minnesota Multiphasic Personality Inventory, MMPI) is a personality questionnaire created at the University of Minnesota (USA) by psychiatrist Stark Hatway and clinical psychologist John McKinley in 1947. This test is used in the diagnosis of personality.

In three studies, MMPI was performed on a sample of 15 or more patients with DID (Coons and Sterne, 1986; Solomon, 1983; Bliss, 1984b). All of these independent studies produced a number of consistent results. The MMPI profile of patients with DID is characterized by an increase in the F validity scale and in the Sc scale or the "schizophrenia" scale (Coons and Sterne, 1986; Solomon, 1983; Bliss, 1984b). Among the critical items on the schizophrenia scale, to which patients with DID often responded positively, was item 156: "I had periods when I did something and then did not know what I was doing," and item 251 : "I had periods when my actions were interrupted and I did not understand what was happening around" (Coons, Sterne, 1986; Solomon, 1983). Coons and Stern (Coons and Sterne, 1986) found in their study that 64% of patients on the first test and 86% of patients on the second test gave a positive response to item 156, with an average interval between two tests of 39 months. They also found that 64% of patients responded positively to item 251. In addition, it was noted that these patients were much less likely to respond positively to the critical psychotic items of the questionnaire, with the exception of the item describing auditory hallucinations.

An increase in the F score, which is often the formal basis for considering the entire MMPI profile invalid, was found in all three studies (Coons and Sterne, 1986; Solomon, 1983; Bliss, 1984b). Solomon (1983) interpreted high values ​​on this scale as a "call for help", he noted that this was due to suicidal tendencies in patients from his sample. In all three studies, the results of the application of MMPI to patients with DID indicate that the latter are polysymptomatic, in addition, it was suggested that many of the obtained profiles indicate the presence of borderline personality disorder.

Rorschach test

An even smaller number of patients with DID have been examined using the Rorschach test. Wagner and Heis (1974), in a study of the responses of patients with DID to the Rorschach test, noted two common features: (1) a large number of diverse movement responses and (2) labile and conflicting color responses. Wagner and colleagues (Wagner et al., 1983) supplemented these data obtained from four patients with DID. Danesino and colleagues (Danesino et al., 1979) and Piotrowsky (Piotrowsky, 1977) confirmed the first results of the Rorschach test by Wagner and Heis (Wagner and Heis, 1974) based on interpretations of the responses of two patients with DID. However, Lovitt and Lefkov (1985) objected to following the rules of interpretation followed by Wagner and his colleagues (Wagner et al., 1983), who used a different protocol for recording responses to the Rorschach test in a study of three patients with DID, as well as Exner's system for interpreting responses. Although the number of cases that were examined using these protocols was too small to allow generalizations, the authors offered their conclusions about the specificity of the Rorschach test in determining DID and other underlying dissociative pathology (Wagner et al., 1983; Wagner, 1978).

Physical condition research

Psychiatrists in their practice, especially in outpatient appointments, as a rule, do not systematically assess the patient's physical status. There are many reasons for this, and the decision to conduct a physical status study is the prerogative of therapists. However, there are several considerations regarding the importance of examining the patient's physical status, or at least their neurological status, in diagnosing DID.

The single most characteristic pathophysiological feature in DID is amnesia, which manifests itself as difficulty remembering. Differential Diagnosis memory functioning requires the exclusion of organic disorders such as concussion, tumor, cerebral hemorrhage, and organic dementia (for example, in Alzheimer's disease, Huntington's chorea or Parkinson's disease). In order to exclude the possibility of these diseases, a complete neurological examination is necessary.

Examination of the physical status can also help to identify signs of self-inflicted physical injuries by the patient, i.e. . Commonly targeted areas of self-harm in DID, often hidden from superficial observation, include the upper arms (hidden under long sleeves), the back, inner thighs, chest, and buttocks. As a rule, the marks of self-inflicted wounds are in the form of neat cuts made with a razor blade or broken glass. In this case, thin scars are visible, similar to lines from a pen or pencil. Often scars from repetitive cuts form on the skin a kind of figure that looks like Chinese characters or footprints. chicken feet. Another common form of self-harm is cigarette or match burns on the skin. These burns leave circular or dotted scars. If physical status assessment reveals signs of repeated self-harm, then there is good reason to suspect this patient dissociative disorder like DID or depersonalization syndrome.

Scars in patients with DID may also be related to childhood abuse. Sometimes patients with multiple personality cannot explain the appearance of scars associated with surgical operation- so we get one more fact that gives reason to assume that the patient has amnesia for important events in his personal life.

Meeting with alter personalities

How to behave if you are dealing with a person suffering from multiple personality disorder? The diagnosis of DID (or CML) can only be made if the clinician directly records the appearance of one or more alters and his observations confirm that at least one alter has characteristic features and takes control from time to time. behind the individual's behavior (American Psychiatric Association, 1980, 1987). A discussion of the individuality and independence inherent in alter personalities and distinguishing them from mood swings and "ego states" is given later in this chapter. How should a specialist behave at the first contact with the alter personality of his patient? F. Putnam talks about this in his book “Diagnostics and Treatment of Multiple Personality Disorders”. Let's consider in more detail.

From a review of NIMH publications and research data, it follows that in about half of all cases, the initiators of the first contact are one or more alter personalities who “come to the surface” and declare themselves as individuals whose identity differs from the main personality of the patient (Putnam et al ., 1986). Quite often, the alter personality begins contact with the therapist with a phone call or letter, presenting himself as a friend of the patient. Typically, until this event, the therapist does not suspect that his patient suffers from DID. Spontaneous manifestation of this symptom is possible immediately after the first meeting with the patient, either if he is in a state of crisis, or if the diagnosis of DID is confirmed.

Let us suppose that the patient admits to having some dissociative symptoms and says that at times he feels like a different person or that he has a different person, the other person being generally characterized as hostile, angry or depressed and suicidal. The clinician may then ask if it is possible for him to meet this part of the patient: "Can this part appear and speak to me?" After this question, patients with multiple personalities may have signs of distress. The main personalities of some patients know that they can prevent the appearance of undesirable personalities and do not want the therapist to try to establish contact with them. It often happens that the main personality, aware of the existence of other alter-personalities, competes with them for the attention of the therapist and is not interested in facilitating their acquaintance with the therapist. In various ways, the therapist can be made to understand that the appearance of this or that alter personality is impossible or undesirable.

Therapists who are not experienced with DID may experience great anxiety before the first appearance of alter personalities. “How should I behave if some alter personality really suddenly appears in front of me?” “What can happen in this case, are they dangerous?” “What if I’m wrong and there aren’t really any alter personalities? Won't my questions lead to the artificial emergence of such a person? Usually, these and other questions are especially acute for therapists who have suspected a multiple personality in their patient, but have not yet experienced a clear change in alter personalities in their patient.

Alter personalities

The best way to connect with potential alters is to contact them directly. In many cases it makes sense to ask the patient about their existence directly and try to establish direct contact with them.

However, in some circumstances, it is possible to use hypnosis or special drugs to facilitate contact with alter personalities.

Appeal to alleged alter personalities

If the therapist has good reason to believe that his patient is suffering from DID, but contact with the alter personality has not yet been made, then sooner or later there will come a point when, in order to establish it, the therapist will have to contact the alleged alter personalities directly. This step may be more difficult for the therapist than for the patient. In such a situation, the therapist may feel foolish, but this must be overcome. First of all, you need to determine to whom exactly to address your question. If the patient is indeed a multiple personality, then in most cases the personality with which the therapist identifies the patient is probably the main personality. The main person, as a rule, is the person who is represented in the treatment. Usually this person is depressed and oppressed by the circumstances of his life (this may be less true for men), this person actively avoids or denies evidence of the existence of other personalities. If the patient in the sessions is represented by a personality that is not the main one, then this personality is most likely aware of the plurality of the patient's personality and seeks to reveal it.

Usually the therapist will address the alter personality he knows best about. The therapist, asking about situations that may be associated with manifestations of dissociative symptoms in a given patient, can, along with positive answers, also receive a description of specific situations that can help him. Let's say that the patient told about how he lost his job several times due to outbursts of anger, which he could not remember anything about. Based on this information, the therapist can assume that if the episodes that the patient cannot remember were the onset of DID, then most likely there is a person who became active at these moments and acted with the affect of anger. The therapist can use the description of this person's actions and, based on them, address her in the following way: “I would like to speak directly with that part [aspect, point of view, side, etc.] of you that was active last Wednesday at your workplace and said all sorts of things to the boss.” The more direct the appeal to the alleged alter personality, the higher the chances of causing its appearance. Usually, addressing by a specific name is most effective, however, the use of attributes or functions of the person being addressed will also help to establish contact (for example, “something dark”, “someone angry”, “little girl”, “administrator”) . The tone in which the request for a meeting with another part of the personality is expressed should be inviting, but not demanding.

Usually, the appearance of an alter personality does not occur immediately after the therapist's first contact with it. As a rule, this request needs to be repeated several times. If nothing happens at the same time, then the therapist should pause in order to assess how the patient's actions have affected the patient. The therapist should carefully observe the appearance of signs of behavior that indicate a possible change in the patient's alter personalities. If a visible signs there are no switches, the therapist must determine whether his questions caused the patient a feeling of discomfort. For most non-DID patients, questions about the hypothetical structure of the personality system do not cause serious distress. They just pause or say something like, "I don't think there's anyone else here with us, doctor." On the other hand, in response to the therapist's insistence on making contact with the alter personality, patients with multiple personalities usually show signs of severe discomfort. This can be regarded as proof of the existence of alter personalities. Most likely at such moments they experience very strong distress. Some patients may enter a trance-like state where they are unresponsive to their surroundings.

If the patient shows signs of severe discomfort, the therapist may be tempted to withdraw his request. In this state, the patient can squeeze his head with his hands, he has grimaces of suffering, he begins to complain of headaches or pains in other parts of the body, and some other signs of somatic suffering caused by the therapist's request are possible. This discomfort is due to the fact that a certain struggle is unfolding inside the patient. Perhaps the main or some other alter personality belonging to the personality system is trying to prevent the appearance of this or that personality to which the request was directed; either two or more alters attempt to appear at the same time; or the personality system is trying to push the alter personality to which the request was addressed to the surface, but this personality resists, she does not want to “come to the surface” and meet with the therapist. However, each therapist in each case must determine for himself the degree of his persistence. Not all alters appear the first time they are encountered, and of course the patient may not have DID.

If the patient undergoes a dramatic transformation and then says, "Hi, my name is Marcy," then the therapist has overcome the first hurdle. If the patient reacts differently, then the therapist should stop and examine with the patient what happened to the latter when the therapist tried to establish contact with the alter personality. Patients with multiple personalities may report that after addressing their alleged alter personality, they seem to "gradually shrink", withdraw and withdraw, feel suffocated, feel very strong internal pressure, or feel as if a veil of fog has descended on them. Such patient testimonies are strong grounds for the suggestion of a dissociative pathology and indicate that the therapist should continue, perhaps in the next session, his attempts to make contact with the alter personality. In addition to trying to address those alter personalities that the therapist suspects exist from the examples given by the patient during the interview, one can try to establish contact with "some other" personality who may want to enter into communication with the therapist.

Do you want to improve memory, attention and other cognitive functions? Train your brain's core abilities with CogniFit! The program automatically identifies the most impaired cognitive functions and suggests a training regimen that is right for you! Train regularly 2-3 times a week for 15-20 minutes, and after a few months you should be able to see improvements.

If the patient does not show clear signs of strong feelings and denies any internal reaction to the therapist's request, then he may not have DID. However, it is possible that some strong alter personality or group of alter personalities is making an effort to hide the patient's multiple personality, and they may be able to do this for quite a long period of time. Most therapists experienced in the treatment of DID have experienced this on more than one occasion. Therefore, the therapist should not definitively rule out a diagnosis based on a single failed attempt to contact the alter personality. One way or another, the therapist should not be upset because he addressed his patient with this request. Patients who do not have DID tend to treat such questions as one of those routines that doctors usually do, like tapping patients on the knee with their little rubber hammers. Whereas patients with DID after such questions realize that the therapist is aware of the plurality of their personality and even wants to work with it. In general, the result of this intervention will be positive and it is quite possible that in response to it there will be a “spontaneous” appearance of an alter personality over the next few sessions. Sometimes a personal system just needs some time to get used to what was, perhaps, the first experience of addressing it as a kind of integrity and to decide on its answer.

If, however, the therapist fails to elicit an alter personality through direct appeal and the patient continues to show clear signs of frequent dissociative episodes, then hypnosis or drug-induced interviewing should be considered.

Ways to communicate with alter personalities

To the most simple options communication involves the emergence of an alter personality that introduces itself and calls itself by a specific name, after which it enters into a conversation with the therapist. Most likely, this development of relationships is the most common, and most patients with DID come to this sooner or later in therapy. However, at the very first stages of therapy, other ways of communication of alter personalities with the therapist are possible. They may approach the therapist indirectly, as if they were not "on the surface" (that is, they do not have direct control over the body). F. Putnam says that when he first came into contact with one patient's alter personality, she introduced herself as "Dead Mary" and communicated with him using the voice of the shocked and frightened main personality. First of all, Dead Mary spoke about her hatred that she feels towards the patient, and said that she dreams of "roasting her so that she turns into a firebrand"; later, when her actual appearance took place, she turned out to be much less vicious than her first lines would suggest. The main character's reaction to her first appearance was intense horror. The usual trained reaction of the therapist was to accept the statements of the emerging alter as an objective fact, to maintain a polite and interested conversation with Dead Mary. This approach has borne fruit, the dialogue has begun. Of course, the main goal for which contact is established with the alter parts of the patient is a productive dialogue.

Contact can also be made through internal dialogue. The patient may "hear" the alter personality as a kind of internal voice, which, as a rule, belongs to the "voices" that have sounded in the patient's head for many years. In this case, the patient transmits to the therapist the answers that he receives from the inner voice. Since the responses of the alter personality in this situation are controlled by another personality (usually the main personality), distortions of the transmitted messages are possible. Dialogues based on the transmission of answers from internal voices are, one way or another, rather uninformative. Perhaps this situation is caused by an insufficient degree of trust between the patient and the therapist to achieve more or less direct contact.

Another means of communication with the alter personality is automatic writing, that is, the patient's fixation in writing of the answers of the alter personality in the absence of volitional control on his part over this process. Milton Erickson published a case in which treatment was carried out using the automatic writing method (Erickson, Kubie, 1939). If the patient reports new entries in a diary he keeps regularly and states that he cannot remember how he made them, then the therapist may try to use automatic writing to establish a channel of communication with the author of these entries, provided that previous attempts to establish direct contact with this alter personality were unsuccessful. Automatic writing is time consuming and creates many problems, moreover, this method is not effective enough for long-term therapy. However, in the early stages, the therapist can gain access to the personality system through this method, which may be important in the later stages of treatment. Another way to establish contact with alter personalities with whom direct contact is impossible at this stage of therapy is the technique of ideomotor signaling. The greatest effect is achieved by combining this technique with hypnosis. The ideomotor signaling technique involves an agreement between the therapist and the patient to assign some signal (for example, raising the index finger of the right hand) to a certain value (for example, “yes”, “no”, or “stop”).

How to talk to alter personalities

Confirmation of the diagnosis

The therapist's contact with an entity whose identity is fundamentally different from the personal identity of the patient, which has become habitual for the therapist, is not a sufficient basis for confirming the diagnosis of DID. Further confirmation is needed that the alter personality, and other personalities that may follow it, are indeed independent, unique, relatively stable, and distinct from intermittent ego states. The task of the therapist is to determine as precisely as possible the extent to which the patient's alter-personalities are present in the external world, and in particular in therapy, and the role they have played in the patient's life in the past. The therapist must also assess the level of temporal stability of the alters. True alters are remarkably stable and resilient entities, whose "character" is independent of time and circumstance.

All currently known evidence suggests that the onset of DID is associated with a child's experience of extreme defenselessness during childhood or early adolescence. Over time, it is necessary to make efforts to find out the history of the emergence of certain alter-personalities of the patient, which first appeared under similar or other circumstances or earlier. In the case of other dissociative disorders, such as psychogenic fugue, the secondary identity usually lacks memories of independent activity before the fugue episode, since the emergence of a new personal identity is strictly due to the onset of the fugue.

Confirmation of the diagnosis of DID at the first stage of therapy may take some time, while the acceptance of the diagnosis by both the patient and the therapist may be followed by its rejection, etc. You need to be ready for this. Currently, there are no special methods for diagnosing DID. As a rule, data on the patient's response to the proposed treatment are needed to confirm the diagnosis. If there is a significant improvement in the condition of a given patient as a result of the use in his treatment of methods specially developed for the treatment of multiple personality, while other therapeutic approaches have been less effective, then the criterion of truth, so to speak, is practice.

Treatment for multiple personality disorder

Dissociative identity disorder is a disorder that requires the help of a psychotherapist experienced in treating dissociative disorders.

The main directions of treatment are:

• relief of symptoms;
• the reintegration of the various personalities that exist in a person into one well-functioning identity.

For treatment use:

• cognitive psychotherapy, which is aimed at changing stereotypes of thinking and inappropriate thoughts and beliefs by methods of structured learning, experiment, mental and behavioral training.
• family psychotherapy aimed at teaching the family how to interact in order to reduce the dysfunctional impact of the disorder on all family members.
• clinical hypnosis which helps patients achieve integration, relieves symptoms and promotes a change in the patient's character. Split personality needs to be treated with hypnosis with caution, as hypnosis can provoke the appearance of a multiple personality. Ellison, Cole, Brown, and Kluft, the multiple personality disorder specialists, describe cases of using hypnosis to relieve symptoms, strengthen the ego, reduce anxiety, and build rapport (contact with the hypnotist).

Relatively successfully, insight-oriented psychodynamic therapy is used, which helps to overcome the trauma received in childhood, reveals internal conflicts, determines a person's need for individual personalities and corrects certain protective mechanisms.

The treating therapist must treat all the patient's personalities with equal respect and not take any one side in the patient's internal conflict.

Drug treatment is aimed solely at eliminating symptoms (anxiety, depression, etc.), since there are no medications to eliminate personality splits.

With the help of a psychotherapist, patients quickly get rid of dissociative flight and dissociative amnesia, but sometimes amnesia becomes chronic form. Depersonalization and other symptoms of the disorder are usually chronic.

Generally all patients can be divided into groups:

• The first group is distinguished by the presence of predominantly dissociative symptoms and post-traumatic signs, the overall functionality is not impaired, and due to the treatment, they fully recover.
• The second group is characterized by a combination of dissociative symptoms and mood disorders, eating behavior, etc. Treatment is more difficult for patients to tolerate, it is less successful and longer.
• The third group, in addition to the presence of dissociative symptoms, is characterized by pronounced signs of other mental disorders, so long-term treatment is aimed not so much at achieving integration as at establishing control over symptoms.

First of all, a person who notices disturbing signs of a violation of self-identity should definitely contact a psychotherapist for help. If the patient does have a split personality, and not schizophrenia, intoxication, or another conversion disorder, then the main goal of treatment will be the integration of separate, distinguishable identities into one stable, well-adapted personality. And this can be done only under the supervision of a specialist using psychotherapy methods. This disease responds well to cognitive therapy, family therapy, and hypnosis. Medicines are used exclusively to relieve accompanying symptoms such as anxiety or depression. It is important in the process of treatment to help the patient overcome the consequences of psychological trauma, identify conflicts that provoked the separation of several identities and correct protective mental mechanisms. Not always the treatment of a split personality can help integrate different identities into one. However, ensuring the peaceful coexistence of different personalities is also quite a big success. In any case, you should trust the experts and tune in to a positive result.

Prevention of DID

Dissociative identity disorder is a mental illness, so there are no standard preventive measures for this disorder.

Since violence against children is considered the main cause of this disorder, many international organizations are currently working to identify and eliminate such violence.

As a prevention of dissociative disorder, it is necessary to timely contact a specialist if a child has psychological trauma or experienced severe stress.

Very little scientific literature provides information on dissociative identity disorder, however modern culture of a person constantly raises this issue in his works and fully shows the symptoms of this disease.

Notable cases of dissociative identity disorder

At the first sign of a violation of self-identity, you need to contact a psychotherapist

Louis Vive

One of the first recorded cases of a split personality belonged to the Frenchman Louis Vive. Born a prostitute on February 12, 1863, Vive was deprived of parental care. When he was eight years old, he became a criminal. He was arrested and lived in a correctional facility. When he was 17 years old, he was working in a vineyard, and a viper coiled around his left arm. Although the viper did not bite him, he was so terrified that he had convulsions and was paralyzed from the waist down. After being paralyzed, he was placed in a psychiatric hospital, but after a year he began to walk again. Vive now seemed like a completely different person. He didn't recognize any of the people in the asylum, he became more gloomy, and even his appetite changed. When he was 18 years old, he was released from the hospital, but not for long. Over the next few years, Vive constantly ended up in hospitals. During his stay there, between 1880 and 1881, he was diagnosed with a split personality. Using hypnosis and metal therapy (applying magnets and other metals to the body), the doctor discovered up to 10 different personalities, all with their own personalities and stories. However, after considering this case in recent years, some experts have concluded that he may have had only three personalities.

Judy Castelli

Raised in New York State, Judy Castelli suffered physical and sexual abuse and struggled with depression thereafter. A month after she entered college in 1967, she was sent home by the school psychiatrist. Over the next few years, Castelli struggled with voices in her head telling her to burn and cut herself. She practically crippled her face, almost lost sight in one eye, and one arm lost its ability to work. She was also hospitalized several times for suicide attempts. Each time she was diagnosed with chronic undifferentiated schizophrenia.

But unexpectedly, in the 1980s, she began to go to clubs and cafes and sing. She almost signed with one label but failed. However, she was able to find work and was the main number in one successful non-commercial show. She also began sculpting and making stained glass. Then, during a therapy session in 1994 with a therapist with whom she had been treated for more than a decade, she developed several personalities; at first there were seven. As the treatment continued, 44 personalities appeared. After she learned that she had a personality disorder, Castelli became an active supporter of movements associated with this disorder. She was a member of the New York Society for the Study of Multiple Personalities and Dissociation. She continues to work as an artist and teaches fine art for people with mental illness.

Robert Oxnam

Robert Oxnam is an eminent American scholar who has spent his entire life studying Chinese culture. He is a former college professor, former president of the Asiatic Society, and currently a private consultant on China-related issues. And although he has achieved a lot, Oxnam has to deal with his mental illness. In 1989, a psychiatrist diagnosed him with alcoholism. Everything changed after the sessions in March 1990, when Oxnam planned to stop therapy. On behalf of Oxnam, the doctor was approached by one of his personalities, an angry young guy named Tommy, who lived in the castle. After this session, Oxnam and his psychiatrist continued therapy and discovered that Oxnam actually had 11 separate personalities. After years of treatment, Oxnam and his psychiatrist reduced the number of personalities to just three. There is Robert, who is the main personality. Then Bobby, who was younger, a fun-loving, carefree guy who loves to roller-skate in Central Park. Another "Buddhist"-like personality is known as Wanda. Wanda used to be part of another personality known as the Witch. Oxnam has written a memoir about his life called A Split Mind: My Life with a Split Personality. The book was published in 2005.

Kim Noble

Born in the United Kingdom in 1960, Kim Noble said her parents were blue-collar workers who were unhappily married. She was physically abused from a young age, and then she suffered from many mental problems when she was a teenager. She tried several times to swallow pills, and was placed in a psychiatric hospital. After twenty years, her other personalities appeared, and they were incredibly destructive. Kim was a van driver, and one of her personalities, named Julia, took over her body and crashed the van into a pile of parked cars. She also somehow stumbled upon a gang of pedophiles. She went to the police with this information, and after she did, she began receiving anonymous threats. Then someone doused acid on her face and set fire to her house. She could not remember anything about these incidents. In 1995, Noble was diagnosed with dissociative identity disorder, and she still receives mental health care. She currently works as an artist, and while she doesn't know the exact number of personalities she has, she thinks it's somewhere around 100. She goes through four or five different personalities every day, but Patricia is dominant. Patricia is a calm, self-confident woman. Another notable person is Hailey, the one who was involved with pedophiles, which led to that acid attack and arson. Noble (on behalf of Patricia) and her daughter appeared on The Oprah Winfrey Show in 2010. She published a book about her life, All My Selves: How I Learned to Live with Many Personalities in My Body, in 2012.

Truddy Chase

Truddy Chase claims that when she was two years old in 1937, her stepfather physically and sexually abused her while her mother emotionally humiliated her for 12 years. When she became an adult, Chase experienced tremendous stress working as a real estate broker. She went to a psychiatrist and found that she had 92 different personalities that were significantly different from each other. The youngest was a girl about five or six years old, referred to as Lamb Chop. The other was Ying, an Irish poet and philosopher who was about 1,000 years old. None of the personalities acted against the other, and they all seemed to be aware of each other. She did not want to integrate all the personalities into one whole, because they went through a lot together. She referred to her personalities as "The Troops". Chase, along with his therapist, wrote the book When the Bunny Howls and it was published in 1987. It was made into a television mini-series in 1990. Chase also appeared in a highly emotional episode of The Oprah Winfrey Show in 1990. She died on March 10, 2010.

Trial of Mark Peterson

On June 11, 1990, 29-year-old Mark Peterson took an unknown 26-year-old woman out for coffee in Oshkosh, Wisconsin. They met two days later in a park, and as they walked, the woman stated, she began to show Peterson some of her 21 personalities. After they left the restaurant, Peterson asked her to have sex in his car and she accepted. However, a few days after this date, Peterson was arrested for sexual assault. Apparently, the two personalities disagreed. One of them was 20 years old, and she appeared during sex, while the other person, a six-year-old girl, just watched it. Peterson was charged and convicted of second-degree sexual assault because it is illegal to knowingly have sex with someone who is mentally ill and unable to consent. The verdict was overturned a month later, and prosecutors didn't want the woman to experience the stress of yet another trial. The number of her personalities rose to 46 between the incident in June and the trial in November. The Peterson case was never heard again in court.

Shirley Mason

Born January 25, 1923 in Dodge Center, Minnesota, Shirley Mason must have gone through a difficult childhood. Her mother, according to Mason, was practically a barbarian. During numerous acts of violence, she gave Shirley enemas and then filled her stomach with cold water. Beginning in 1965, Mason sought help for her mental problems, and in 1954, she began dating Dr. Cornelia Wilbur in Omaha. In 1955, Mason told Wilbur about strange episodes when she found herself in hotels in different cities, having no idea how she got there. She also went shopping and found herself standing in front of scattered groceries with no idea what she had done. Shortly after this confession, different personalities began to emerge during therapy. Mason's story of her horrific childhood and her split personality became the best-selling book, Cybil, and was made into a very popular television series of the same name starring Sally Fields. Although Sybil / Shirley Mason is one of the most known cases dissociative identity disorder, the public's judgment has been mixed. Many people believe that Mason was a mentally ill woman who adored her psychiatrist, who instilled in her the idea of ​​a split personality. Mason allegedly even admitted to making it all up in a letter she wrote to Dr. Wilbur in May 1958, but Wilbur told her that it was just her mind trying to convince her she wasn't sick. So Mason continued therapy. Over the years, 16 personalities emerged. In the television version of her life, Sybil lives happily ever after, but the real Mason is addicted to barbiturates and dependent on a therapist to pay her bills and give her money. Mason died on February 26, 1998 from breast cancer.

Chris Costner Sizemore

Chris Costner Sizemore remembers that her first personality disorder happened when she was about two years old. She saw the man pulled out of the ditch and she thought he was dead. During this shocking incident, she saw another little girl watching this. Unlike many other people diagnosed with multiple personality disorder, Sizemore did not suffer from child abuse and grew up in loving family. However, after witnessing that tragic event (and another bloody work injury later), Sizemore claims that she began to behave strangely, and her family members often noticed it too. She often got into trouble for things she did and didn't remember. Sizemore sought help after the birth of her first daughter, Taffy, when she was in her early twenties. One day, one of her personalities, known as "Eva Black", tried to suffocate a child, but "Eva White" was able to stop her. In the early 1950s, she began dating a therapist named Corbett H. Siegpen, who diagnosed her with a split personality. While she was being treated by Zigpen, she developed a third personality named Jane. Over the next 25 years, she worked with eight different psychiatrists, during which time she developed a total of 22 personalities. All these individuals were very different in behavior, and they were different in age, sex, and even weight. In July 1974, after four years therapy with Dr. Tony Cytos, all the personalities were combined, and she was left with only one. Sizemore's first doctor, Siegpen, and another doctor named Harvey M. Cleckley wrote a book about Sizemore's case called The Three Faces of Eve. It was made into a movie in 1957, and Joan Woodward won the Academy Award for Best Actress for playing three of Sizemore's personalities.

Juanita Maxwell

In 1979, 23-year-old Juanita Maxwell was working as a hotel maid in Fort Myers, Florida. In March of that year, 72-year-old hotel guest Ines Kelly was brutally murdered; she was beaten, bitten and strangled. Maxwell was arrested because she had blood on her shoes and scratches on her face. She claimed that she had no idea what had happened. While awaiting trial, Maxwell was examined by a psychiatrist, and when she went to court, she pleaded not guilty because she had multiple personalities. Except her self she had six more, and one of the dominant personalities, Wanda Weston, committed this murder. During the trial, the defense team, with the help of a social worker, were able to force Wanda to appear in court to testify. The judge thought the change was quite remarkable. Juanita was a quiet woman, while Wanda was noisy, flirtatious and loved violence. She laughed when she confessed to hitting a pensioner with a lamp because of a disagreement. The judge was convinced that either she really had multiple personalities, or she deserved an Academy Award for such a brilliant transformation. Maxwell was sent to a psychiatric hospital, where, she says, she did not receive proper treatment and was simply stuffed with tranquilizers. She was released, but in 1988 she was arrested again, this time for robbing two banks. She again claimed that Wanda did it; internal resistance was too strong, and Wanda again gained the upper hand. She did not want to contest the charge, and was released from prison after serving time.

Thanks for reading us! We will be grateful for questions and comments on the article.

Certified psychologist, candidate of economic sciences, accredited coach of ICF (International Coach Federation). Engaged in psychological practice since 2002, including as a child psychologist and psychologist of crisis situations. Specialization - victimology. Teaching experience since 2000.

Over the past twenty years, neuroscience has made quite a big leap forward, lifting the veil of the mystery of the brain structure of both humans and animals. If earlier we could only guess what is hidden in the skull of many representatives of the Earth’s population and how this “something” functions, now, especially with the development of MRI technologies, we are getting closer to the truth, and the explanation of the processes and characteristics of life is becoming ever clearer and clearer forms. And although there are still a certain number of mysteries of thinking and nervous activity to be revealed, the explanation of some paradoxes has already been crowned with success. Where some see mysticism and divine meanings, others prove that everything has a material, scientific justification.

Illustration: Anna Umerenko.

The thought process is born from the electrochemical interactions of neurons, the activity of axons and synapses - the cells of our nervous system. Such interactions give rise not only to thoughts and ideas, but also form a personality that is able to accumulate experience, knowledge, acquire skills and accumulate memories. If you do not delve into the features of the interaction of neurons, the functioning of the nervous system and the work of the brain (which you can read in detail and in an accessible form in the works of neurophysiologists and neuropsychologists Vileyanur Ramachandran, Oliver Sachs, Eliezer Sternberg), then the material justification for the existence of personality.

But how to explain those cases when several personalities “lived” in one body? For many years this was considered an inexplicable anomaly, and even now, when the connection between cognitive psychology and neuroscience is rather shaky, to find an exhaustive scientific explanation pretty hard. And it is unlikely that mankind would have been able to get away from religious dogmas, considering these cases as “the infusion of several spirits into the mortal body of a person,” if it were not for technical advances (for example, MRI) that made it possible to study the activity of individual areas of the brain.

What split personality looks like

One of the many cases of split personality syndrome was considered by the neuropsychologist Eliezer Sternberg in one of his works.

A single mother with an indefinite diagnosis of "congenital blindness" complained of memory gaps and could not explain the appearance of the words "I hate you" and "Abnormal" on her body after falling out of time, and also discovered new objects in her house that would never I did not buy, being in my right mind and memory. When the woman was admitted to the hospital, she did not know where her bruises and abrasions came from, and also could not remember where she had been the previous night. Her name was Evelyn, she was 35, and she had a very difficult childhood: her own mother mocked the girl, locked her in a closet, and when Evelyn was given to a foster family, her stepfather also abused the girl, and even harassed her.

When the number of falling out of time and the inability to account for what had happened to her since the “blackout”, and how long this “blackout” had generally lasted, assumed alarming proportions, Evelyn began to be examined by psychiatrists.

Eliezer J. Sternberg,

practicing physician, neurologist at Yale University New Haven Hospital

- Evelyn diagnosed with dissociative identity disorder-mental illness, which is also called a disorder in the form of a multiple personality or a split (splitting) personality. Inside Evelyn, it was as if several different people lived at once. Among them were a woman named Franny F. and her daughter, Cynthia, and an "ugly" ten-year-old girl, Sarah, with "thin red hair" brown eyes and freckles. And finally, Kimmy, an "angelic" four-year-old with blue eyes and short blonde hair.

The patient's behavior changed depending on which of the personalities came to the fore. Evelyn herself seemed smart, grown woman and was remarkably clear in expressing her thoughts. Turning into Kimmy, she suddenly began to babble in a childish voice, distort simple words, for example calling a purple shirt "foie". She said that the President-this is "her daddy", and admired the fact that kiwi-it is both a fruit and a bird. She boasted that her older brother was teaching her how to write her name.

When switching from one personality to another, not only the character, preferences, and in general the history of life, which the patient can tell, can change. Habits and handwriting can change (moreover, a right-handed person can become left-handed and vice versa), visual acuity can be different and even the level of physical fitness can vary.

In Evelyn's case, the blindness that doctors could not explain for so long suddenly practically disappeared when Evelyn lost her self and became Kimmy. The acuity of her vision was different and directly dependent on the personality that was activated at a particular moment. And the number of individuals increased over time.

Remember Billy Milligan, so famous for all the incredible number of personalities that have settled in his body - as many as 24! All of them also had the most different characters and abilities. So how can you explain this, if not mysticism?

Scientific Alter Ego

As a rule, those who have split personality syndrome have experienced very, very negative experiences in the past. Difficult childhood, psychological trauma, serious, mentally destructive events in life force our brain to somehow protect itself from adverse effects on the psyche and nervous system. It is necessary for our survival, and it is built into us by evolution.

If our nervous system had not developed defense mechanisms against stress and unpleasant memories, our species would hardly be viable. Psychological trauma can kill our desire to do anything at all, plunging us into depression and forcing us to stare aimlessly at one point. Our brains are wired to protect us from the destructive power of emotional trauma. The subconscious can take us away from bad memories, and dissociation works better than ever in this case.

This does not mean that everyone who encounters the slightest stress will have a split personality. But people with a fairly fragile nervous system who have been subjected to prolonged violence can experience this side effect protective mechanism.

How does the brain distance such people from traumatic memories? It fragments memory, blocking access to individual memories for the host personality. All subpersonalities develop from each other fragment of memories, filling in the resulting voids in consciousness (no one needs ownerless memories, this is a gap that the brain considers it necessary to fill). This is called fragmentation of consciousness.

Evidence for fragmentation of consciousness

Where did the idea of ​​fragmentation of consciousness in patients with dissociative personality disorder even come from? The same technical achievements that were mentioned at the beginning helped in this. Without a PET scanner (positron emission tomography), which allowed for neuroimaging studies, such a conclusion would hardly have been possible. Scientists examined the brains of split personality test subjects with a PET scanner while causing the patients to switch between their alter egos.

It turned out that when the alter ego switched, the areas of the amygdala, which is responsible for emotions, were sharply activated, but when the switch had already taken place, the brain activity in the subpersonalities was neutral, as in the host personality. This means that personalities create a kind of barrier from past experiences and emotional outbursts, protecting from traumatic experiences.

The study also revealed the activity of different parts of the hippocampus, which is the center of memory for life events. Depending on which of the personalities came to the fore, a certain zone of the hippocampus was activated. This is direct evidence that when the personality splits, fragmentation of consciousness and memories occurs. Each of the personalities has access only to a specific fragment of memory, so Evelyn could not remember in any way what happened to her at the moments of the "out". And the activity of other areas of the brain, to which the alter egos also had their own access, caused a difference in the quality of vision. Evelyn's blindness was purely neurological in nature and was due to problems with access to the visual cortex.

FROM Cognitive Psychology to Neuroscience

Explaining the nature of split personality is just one example of how neuroscience is moving forward, leaving no chance for mysticism and beliefs in the infusion of spirits or the transmigration of souls. There are still countless unexplored corners of our consciousness and features of the functioning of our brain, but today humanity is already moving far ahead, using technical installations for diagnostics and experiments.

Perhaps, over time, scientists will begin to explore the human psyche not through the “black box” method, trying to predict from external data what is happening inside cranium, but turn towards neurosciences that have the courage to look into the black box itself, making it less mysterious and leaving as little as possible dark and inexplicable in it.