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Unsuspected multiple personality disorder: an uncommon source of protracted resistance, interruption, and failure in
1Institute of the Pennsylvania Hospital, Philadelphia 19139.
Abstract:
Multiple personality disorder (MPD) is being recognized with increasing frequency. A great imitator, it may be encountered among patients who appear to have a wide range of other diagnoses, and have been in treatment for years without the presence of MPD being discovered. Nine of 241 MPD patients interviewed by the author, 3.7%, had been accepted for psychoanalysis. In only one case had the diagnosis been appreciated by the analyst prior to his accepting the patient for analytic treatment. Four patients were profoundly resistant and or inaccessible to analysis for protracted periods. In one of these cases the diagnosis became clear and successful analysis was concluded, but three analyses ended unsuccessfully with the diagnosis still unknown. Two patients' analyses were interrupted due to abrupt regressive events initially perceived to indicate severe ego weakness incompatible with sustaining an analytic process, but later appreciated as signs of MPD. In three cases it appeared that the patients' being accepted for analysis triggered the emergence of the dissociative process, and either the patient or the analyst decided to pursue a different form of therapy. Unsuspected MPD appears to account for a small percentage of stalemates, failures, interruptions, and early flights from analysis.
Insights
Multiple personality disorder (MPD), now known as dissociative identity disorder, is often misdiagnosed. This study found that unsuspected MPD can lead to treatment failures in psychoanalysis.
Area of Science:
- Psychiatry
- Psychoanalysis
Background:
- Multiple personality disorder (MPD) is increasingly recognized.
- It can mimic other diagnoses, leading to delayed or missed detection in long-term treatment.
- MPD is a complex dissociative disorder requiring specific diagnostic approaches.
Observation:
- Of 241 MPD patients, 3.7% underwent psychoanalysis.
- In most cases, MPD was not identified by the psychoanalyst before treatment began.
- Several patients exhibited resistance or regressive events during analysis, later understood as MPD symptoms.
Findings:
- MPD was diagnosed pre-treatment in only one of nine analyzed patients.
- Three analyses were unsuccessful, and three were interrupted due to misinterpreting MPD symptoms.
- Psychoanalysis initiation sometimes triggered dissociative processes in MPD patients.
Implications:
- Unsuspected MPD contributes to psychoanalytic treatment failures, stalemates, and interruptions.
- Psychoanalysts should consider MPD in treatment-resistant or complex cases.
- Improved diagnostic awareness of MPD is crucial for effective psychotherapy.