Systemic treatment of multiple personality: response to a chronic disorder

Article Abstract:

Multiple personality disorder (MPD) seems to be a consequence of severe childhood trauma, especially sexual abuse. With this disorder, the patient expresses a number of distinct personalities, some of which may not even be aware of the existence of the others. Most theories presume that personality fragmentation involves a series of steps and serves a defensive purpose. First, the traumatized child dissociates or splits off unbearable feelings or thoughts from consciousness. Since normal defensive capacities become overwhelmed by the degree of trauma, the child splits into fragments of personality. If repeatedly forced to endure the trauma (as in continuing abuse), the splitting process goes on until each fragment develops into a separate personality. Traditional treatment of MPD entails establishing trust between the 'host' (the personality who initiates therapy) and the therapist. Then, the various personalities or 'alters' venture out to meet and interact with the therapist. Treatment proceeds towards increasing inter-awareness and cooperation between the host and alters, which requires the unravelling and understanding of the original trauma. Integration of host and alters into a cohesive personality is usually the endpoint of therapy. Since many alters view integration as a form of death in which their uniqueness is given up and their existence as a separate entity is ended, an alternative treatment approach based on the theoretical concept of family systems dynamics is presented. The premise of this therapy is that the system of personalities rather than one dominating personality drives behavior. Therapy addresses the behavior of all alters in a democratic decision-making system in which all personalities act for the good of the whole system. Facilitating coexistence creates a supportive environment in which alters become aware of each other's views, strengths, weaknesses and feelings. Co-consciousness prevails, so that an active personality remains aware of the consciousness of all the alters without becoming domineering. Problems related to coexistence (e.g., sexuality, taste, employment, etc.) are outlined within a problem-solving framework. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Multiple personality

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Paranoid personality disorder: a synthesis of developmental, dynamic, and descriptive features

Article Abstract:

A profile of the paranoid personality disorder has been provided which takes into account the numerous facets of this condition. This disorder has been well-established and is included in the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R). Paranoia may manifest itself in other disorders as a symptom of a psychosis or schizophrenia. A variety of aspects of the disorder have been collected and synthesized to create a comprehensive survey of paranoid personality disorder. A historical summary of descriptive studies is presented, along with various psychoanalytic views. The criteria listed in the DSM-III-R are discussed, along with differential diagnoses. Six key areas of psychosocial functioning are listed; behaviors associated with this profile may be 'overt' or 'covert'. These six features are self-concept, interpersonal relations, social adaptation, ethics, standards and ideals, love and sexuality, and cognitive style. The self-concept of the overt paranoid type characteristically reflects arrogance, overconfidence, and an intimidating manner, as compared with those with a covert type of self-image, who are usually timid, frightened, and are characterized by feelings of inferiority. Both extremes may be symptomatic of the paranoid personality disorder. The paranoid personality disorder is usually easily distinguished from paranoid schizophrenia, in which a serious break with reality occurs, which is accompanied by delusional behavior or ideas. Other personality disorders that may seem similar, but are distinct, include phobic, compulsive, narcissistic, and antisocial personality disorders. Discrepancies in the patient's perceptions of the outer and inner world are a primary distinguishing feature common to all who suffer from the disorder. These individuals are demanding, arrogant, and mistrustful of the outside world, while internally self-doubting, fearful, and timid. In assessing the symptoms of those who suffer from paranoid personality disorder, these considerations are important and provide a better approach to diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Identification and classification, Paranoid disorders, Paranoia, Paranoid personality disorder

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Relationship between hypochondriasis and obsessive-compulsive personality disorder: close relatives separated by nosological schemes?

Article Abstract:

There has been much conjecture regarding a possible association between hypochondria and obsessive-compulsive personality disorder. Although hypochondria has not been formally linked with any specific personality pattern, an association between these two conditions has been previously observed and the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) has listed hypochondria as a possible complication of obsessive-compulsive personality disorder and states that ''obsessive-compulsive personality traits are frequently observed'' in hypochondriacs. Other disorders which may overlap with these two conditions are narcissism and depression. This paper further explores the relationship between hypochondria and obsessive-compulsive personality disorder. There exist several common characteristics, which are discussed. Among these are past experience of insecurity and vulnerability with the perception of excessive threat to oneself; mistrust of oneself and of others; a strong need for control with a subsequent search for security; low tolerance and fear of the unknown, along with a specific thought pattern developed to maintain control. The repetitive nature of both disorders as a result of an excessive need for control is a common and pronounced characteristic of both obsessive-compulsive personality disorder and hypochondria. These two conditions may be perceived as varying degrees of expression of similar patterns of coping, where the sense of self and body takes on an excessive degree of importance. It is pointed out that either condition may exist separately from the other and one does not necessarily precede the other, but mechanisms, common origins, and shared characteristics of these two conditions are evident. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Hypochondria, Hypochondriasis, Compulsive personality disorder

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