Continuum of Disease


Dynamics of Dissociation

The Personality System

Making the Diagnosis

Common Presentations of MPD



Nursing Implication

Cast Studies



Post Examination


            The prognosis for most patients with MPD is quite optimistic if appropriate treatment is available,  (Kluft, 1989b)  Though the treatment is long, arduous, and continuous throughout a patient’s life, these patients are responsive to intense psychotherapeutic interventions and they do have the ability to live normal, healthy and productive lives.  The average length of time from initiation of therapy to stable integration is 21.6 months.  (Ross, 1990)

            Spontaneous remission cannot be expected in untreated MPD patients.  What happens instead of one alter may predominate, with infrequent overt or covert influences by others, particularly as the patient progresses into middle or old age.  (Kluft, 1989b)  Kluft followed over a dozen MPD patients who declined treatment and over two dozen who entered therapy where MPD was not addressed.  Two to eight years later all continued to have MPD.  However, of the patients who were appropriately treated for MPD, upon reassessment, these were noted to have made good progress in recovery.

            A phenomenon called “layering” sometimes occurs,.  This is the process by which groups of alters who have been suppressed begin to appear as the more predominant alters are integrated.  (Kluft, 1989b)  This could appear to be relapse, and would reinforce the importance of ongoing therapy even after it appears that integration has been achieved.

            Seventy-five percent of relapses appear to be the result of object loss, rejection, or the threat of such experiences.  (Kluft, 1989b)  If a patient continues therapy after integration and has developed a good support system, perhaps including an after-care group, he or she will better be able to deal with these crises as they occur, and possibly avoid the self-destructive behavior that leads to hospitalization.

Next Nursing Implications