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Interviews unmask multiple personalities.

Interviews unmask multiple personalities

In addressing the mysterious phenomenon of multiple personality, the psychiatric community assumes a split personality of its own. Some members hold fast to the traditional view that true multiple personality disorder (MPD) is extremely rare, and that the drastic increase in its diagnosis over the past decade largely reflects a U.S. fad fueled by movies such as "Sybil." Others see the disorder as a genuine affliction in need of greater recognition. Both sides agree, however, that MPD -- whether rare or rampant -- is all too often misdiagnosed.

Two recent studies -- one seeking a clearer picture of the disorder, the other assessing a new tool for recognizing it -- may help clinicians sharpen their diagnostic accuracy.

In the May AMERICAN JOURNAL OF PSYCHIATRY, researchers present the clinical profile emerging from what they describe as the first MPD study in which "a valid and reliable structured interview has been used by investigators at a number of different centers." Psychiatrist Colin Ross and his co-workers at the University of Winnipeg in Manitoba combined two standard interviews for use at clinics in Manitoba, Ontario, Utah and California. Interviews with the 102 patients identified as having MPD, 94 of whom were women, paint a detailed and coherent picture of the disorder.

Symptoms remained largely consistent from one clinic to the next. Ross reports, for example, that 90 percent of the patients believed another person existed inside them; 82 percent heard voices coming from within; 74 percent referred to themselves as "we" or "us." And the vast majority echoed a disturbing pattern noted in recent MPD studies: a personal history of intense suffering. More than 95 percent said they had experienced sexual or physical abuse as children; 92 percent had considered or attempted suicide.

At Yale University, psychiatrist Marlene Steinberg and her colleagues have developed what she calls a "more comprehensive" interview for identifying MPD. Two reviewers -- one conducting the interviews, the other studying them on videotape -- used the results to diagnose 48 individuals, including normal controls and people with MPD or closely related disorders. Both reviewers pinpointed virtually all of the MPD patients, Steinberg reports in the January AMERICAN JOURNAL OF PSYCHIATRY.

Skeptics argue that patients can fake MPD to gain attention, or that some clinicians are predisposed to diagnosing it. "The problem is that there are apparently some folks who love to find MPD because cases are very interesting to deal with and they require long-term psychotherapy," says Eugene Levitt, a psychologist at the Indiana University School of Medicine in Indianapolis.

Ross, Steinberg and others express the opposite concern. The traditional view of MPD, they say, may predispose some clinicians to mistakenly diagnose -- and treat -- these patients for other disorders such as schizophrenia or amnesia.

"Without the proper diagnosis," says Geri Anderson, a coauthor of the Canadian study, "the issues of their abuse and their dissociations never get addressed, and they can become chronic patients." When clinicians recognize the disorder, she says, "treatment is very long, very intense, very hard for both the therapists and the patients. But it's usually very successful."
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Author:Stolzenburg, William
Publication:Science News
Date:May 19, 1990
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