Covert multiple personality underlying eating disorders

Article Abstract:

Eating disorders are commonly seen among young adults and adolescents in this country, but there currently exist no comprehensive therapies for this type of disorder. This article has focused upon a subgroup of eating disorders, including bulimia and anorexia nervosa, which are symptomatic of an underlying multiple personality disorder. Although multiple personality disorder (MPD) has been thought to be rare, this condition may be more common than previously believed. One reason for the underrepresentation of this condition is the difficulty of diagnosing MPD. Five case histories are presented which illustrate patients in this subgroup. All five patients were initially examined for anorexia nervosa or bulimia and met the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) criteria for these conditions. After a thorough examination, it was apparent that the patients also met the DSM-III-R criteria for MPD. The underlying mechanism for the eating disorder for these individuals was dissociation and multiplicity. The ways in which MPD may be expressed by eating disorders are presented, along with information relevant for diagnosis and implications for therapy and patient prognosis. Some features that the clinicians should be alert to are self-punishing and masochistic behaviors, reenactment of unresolved past trauma, fear of oral impregnations (which, in at least one case that is described, was a result of childhood sexual abuse), and struggle for control among various alter personalities. Psychophysiological symptoms are generally not uncommon in patients with MPD. Pathological eating behavior has been observed with MPD previously, but this symptom may be more common than previously believed. The key to the development of the eating disorder in this subgroup of patients is dissociation. These patients do not usually respond to treatment directed at the eating disorder, and identification and treatment of the underlying multiplicity is needed before the symptoms will improve. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Causes of, Complications and side effects, Eating disorders, Dissociation (Psychology), Dissociative disorders, Multiple personality

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Brief psychotherapy of personality disorders

Article Abstract:

Research has shown that patients with acute episodes of a nonsevere nature do best in psychotherapy. Personality disorders, which tend to be pervasive, have therefore been assumed resistant to traditional psychotherapy. Brief psychotherapy, with its concentrated techniques, offers new hope in treating longstanding personality disorders. Two forms of brief psychotherapy were studied: short-term dynamic psychotherapy (STDP), and brief adaptational psychotherapy (BAP). There were 32 patients, with an average length of treatment of 37 weeks. Patients were selected on the basis of having pervasive personality characteristics that were interfering with their social interactions, and they were randomly assigned to either of the two study groups; a control group of 17 subjects on a waiting list for treatment was studied as well. Patients who were 'acting out' (for example, suicidal or homicidal) were excluded from the study. All patients were interviewed for data on social history and presenting complaints, and they completed the Social Adjustment Scale-SR (SAS-SR) and the Personality Diagnostic Questionnaire (PDQ). The test battery was repeated one month after the study ended. Both psychotherapy groups showed significant improvement on all measurements as compared with the controls. It is speculated that the nature of brief psychotherapy - the time limit, the focus on the interpersonal, and the importance of the patient-therapist relationship - may be a reason why short-term dynamic psychotherapy works in this traditionally resistant disorder. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Psychotherapy patients, Personality disorders, Brief psychotherapy

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