Continuum of Disease


Dynamics of Dissociation

The Personality System

Making the Diagnosis

Common Presentations of MPD



Nursing Implication

Cast Studies



Post Examination

Case Studies


            Marrion, a 28 year old woman, was admitted to the hospital by her outpatient therapist who felt at a loss of how to deal with Marion’s newly diagnosed multiple Personality Disorder.  She had a psychiatric history that began when she was 19 years old.  She had been hospitalized twice, both times for suicidal impulses.  She had been previously diagnosed with borderline personality disorder.  She had also been in therapy with several different psychiatric professionals.

            Marrion presented as a frightened, withholding, depleted and extremely depressed person.  The name on her insurance identification card was Mary Anne.  Marrion stated that Mary Anne had not been seen for many years, that she was incapable of managing “everyone.”  Marrion was the only person able to keep everything in control, managing work, a husband and day to day living.  However, doing this was taking its toll on Marrion.  She was exhausted from hr constant vigilance over conflicting alters and the pressure of memories about to emerge, which Marrion was terrified to bring up.

            Once settled into the unit, Marrion seemed to almost immediately relinquish control.  A child alter, Mimi, was often seen at rambunctious play.  Mimi’s facial expressions and movements were markedly different from those of the depleted Marrion.  Mimi appeared refreshed, happy, open to everyone, and would run and skip and jump her way around the hospital grounds.

            Other alters began to emerge in time.  There was Kate, a venerable child alter, who would approach nursing staff at night asking when her mommy was coming home.  This alter would also run outside at night and hide in the bushes while she awaited mommy’s return.  The patient, Mary Anne, had a history of abuse by her father, which included the escape of her mother one night through a window, never to be seen again until the patient reached college age.

            An alter, called the Light Watcher, would sit at a window at night, appearing quite morose, and almost evil or dangerous in her appearance of blank inwardness, or calculating muteness.  This alter’s purpose was not completely understood.  But it was apparent her actions also had to do with watching for mother to come home by watching the lights of cars as they would pass by on the street.  This alter was viewed as dangerous and unpredictable by Marrion.

            Mimi was allowed and encouraged to be out for long periods of time to provide necessary respite for Marrion.  Marrion would appear more rested and relieved after Mimi had been out to play.  Kate needed to be protected at night from becoming lost or harmed outside.  She was comforted and asked to go to a safe place inside and to let Marrion help her to feel taken care of.  The Light Watcher was counted down into a safe place as soon as possible upon appearance and asked to make its issues known to the therapist.  The therapist was successful in calling up this alter in psychotherapy sessions and working through its evil fascination with revenge and pain.  The birth personality, Mary Anne, was never seen during the hospital stay.

By this time in treatment Marrion had made many gains into co-consciousness and communication among her alters.  She was also feeling much more rested as she allowed her alters to come out and express themselves, and as she safely worked through memories in the safe and supportive environment of the hospital.

CASE  #2

            Bonnie was admitted to the hospital for depression and suicidal ideation.  She was also diagnosed with bulimia.  Bonnie had never before been hospitalized, but admitted to feeling depressed most of her life.  She stated she often felt suicidal, but her purge behavior somehow gave her a sense of relief, for which she was quite ashamed.  Up to this point she had been working with a therapist around her eating disorder issues, which were a source of great frustration, depression, and negative feelings about herself.  Neither she nor her therapist felt she was progressing in therapy.  She seemed to be very blocked.  Though there was sometimes a hint of child abuse, Bonnie tended to focus on contemporary problems such as relationships, work and her self-image.  She was quite adept at steering clear of childhood issues, beyond a rudimentary history of her family of origin.

            Bonnie’s negative self-image led her to feel like cutting her wrists.  She had made some superficial cuts with a butter knife and it was at this point her therapist felt it necessary to hospital her for protection.

            In the hospital, still, it was very difficult to access any material with which to begin work.  She continued her bulimic behavior of purging after almost every meal.  Her feelings about herself became increasingly more derogatory and she required suicide precautions daily.  Finally, it was decided to attempt hypnosis with amytal.

            Under hypnosis, a child alter named Shoshana reluctantly came forward.  She admitted to feeling extremely frightened.  Having to see or eat meat made her vomit because she was forced to eat raw animal flesh as part of cult rituals as a child.  She was terrified she would be killed as a result of sharing this information.

            In another hypnotic session, the persecutor alter who threatened Bonnie’s life if she divulged any information about the past, was finally accessed and worked with in regards to the destructive behavior.

            After approximately six weeks Bonnie was able to control the suicidal impulses to the point of continuing productive therapy.  She gained some control over her bulimic behavior by changing her eating habits to vegetarian.  Though frightened, she experienced a sense of relief over the diagnosis of Multiple Personality Disorder because she finally had a point at which to begin appropriate treatment.

            Bonnie’s hospital stay was approximately eight weeks.  Once she could control the suicidal impulses and trust her inpatient therapist with the traumatic material, she was discharged and continued working with that therapist on an outpatient basis.

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