Continuum of Disease


Dynamics of Dissociation

The Personality System

Making the Diagnosis

Common Presentations of MPD



Nursing Implication

Cast Studies



Post Examination


Since the first exploration of the phenomenon of Multiple Personality Disorder some hundred years ago, the diagnosis has been the recipient of much confusion and skepticism,  Because its presentation can be so dramatic and the precipitating trauma so humanly unacceptable, it was passed off as the hysterical behavior of overwrought or spoiled women,  However, with the attention in recent years to the issue of child abuse, Multiple Personality Disorder has gained acceptance as a valid psychiatric diagnosis.  Once considered rare, the reported incidence has increased steadily since 1980.  It occurs in 1.2% of the general psychiatric population (Steele, 1989(, making it about as common as schizophrenia.

Dissociative Disorders (DD), specifically Multiple Personality Disorder (MPD), have received much attention in the past decade, though they are not new phenomena.  In fact, these disorders were among the first psychiatric conditions to be scientifically investigated by the nineteenth century pioneers of psychiatric medicine (Putnam, 1991).  However, in the twentieth century the work of such pioneers was largely set aside and forgotten as Freud  introduced his psychoanalytic model which substituted the idea of repression for dissociation in dynamic formulations.

MPD remains highly controversial among psychiatric professionals.  The reality of the disorder is often challenged.  Putnam feels “this distorts the scientific process and places an extra burden of proof on MPD that is not demanded of other psychiatric disorders.”  MPD and DD have met all the requirements expected of other psychiatric diagnoses, and Putnam maintains that “by this standard, MPD and the dissociative disorders are as “real” as any other psychiatric condition.”

However, the 1970’s and 1980’s saw renewed scientific interest in the disorder due to more objective case studies and more sophisticated investigations,  Also, awareness and acceptance in the past two decades of the prevalence and impact of child abuse, posttraumatic stress disorder and the importance of psychosocial stress as the underlying causes for dissociative disorder has led to their greater validation.

 Multiple Personality Disorder, once considered a rarity and a curiosity, is now being diagnosed with increasing frequency.  It is a difficult disorder to diagnose due to the multiple co-existing symptoms and disorders, and the secrecy which keeps its victims from seeking help.  Although the disorder wreaks havoc in the lives of its victims, they will generally do anything possible not to be found out.  The fear of appearing crazy or of sustaining punishment from the childhood abuser often keeps the MPD patient from disclosing information which would make diagnosis possible, lead to an appropriate course of treatment and eventual healing.

Despite the patient’s efforts to hide the traumatic past and conceal the chaotic internal life from others, the knowledgeable professional can see the signs and symptoms of MPD and learn to work effectively with them.

Nurses play an important role in the treatment of MPD patients in a hospital setting.  These patients can be particularly challenging to a nursing staff.  This course attempts to assist nurses in their work with MPD patients by providing information about the disorder and techniques to ensure that patient and staff receive what they need to proceed in this most arduous of treatment courses.

Next: Continuum of Dissociation