Psych project: Multiple Personality Disorder (DID) By Daiana Kaplan Outline: Analysis of the case: I. Summary: Eve White began her therapy mainly because of severe and blinding headaches and blackouts. After many therapy appointments, Eve s therapists soon began to discover lapses in memory. To clear some of this memory loss her therapists used hypnosis which appeared to work at first. One of her memory lapses was about a letter she had wrote to her therapists that she had no memory of sending. The letter began in her usual handwriting but included a paragraph at the end in a form of handwriting completely undistinguishable from her own. When she was asked about the letter later on she claimed she remembered beginning a letter but had no recollection of actually sending it, believing instead that she had destroyed it. In this visit, Eve s personality began to completely differ from her usual persona and she claimed to have been hearing occasional imaginary voices. On one occasion, Eve White was telling her therapist of these voices and suddenly clasped both hands to the side of her head. When she eventually released her hands, she had transformed into a completely different personality: Eve Black. Below is a quick summary of some of the differences between Eve White and Eve Black. Eve White: Conventional, retiring, caring, seriousness, underlying distress. IQ of 110. Has a superior memory than Eve Black. Repressive, showed obsessive-compulsive traits, rigidity, introversive personality, able to be hypnotized. Unhostile to mother.
Eve Black: carefree, carried a much different physical presence (her manner, gestures and eye movements were all very different from Eve Whites). Childish/ daredevil air, erotically mischievous glances, extroversive personality, irresponsible, shallowly hedonistic desire for excitement and pleasure. IQ of 104. Healthier profile than Eve White. Unable to be hypnotized at first. Showed hostility to mother. Intolerant of Eve White s marriage. The therapists discovered that the way to call out Eve Black or Eve White at a certain time was through hypnosis. Eventually it became easier for them to call out the personalities without having to use hypnosis. The therapists discovered that when one personality was out the other personality had a black out / couldn t remember that time. Eve Black talked about her mischievous childhood and acts, acts that Eve White would later get punished for while remaining ignorant as to what had actually happened. Eve Black had little compassion for Eve White and was unwilling to cooperate in therapy. Soon, the therapists discovered another personality who referred to herself as Jane. When all three personalities were given electroencephalogram tests (EEG s) there were clear distinctions between the readings of Eve black and the other two personalities though Jane and Eve White were read as very similar. Jane was aware of both the Eve s personalities. By 1975 it was discovered that Eve had experienced a total of at least 22 personalities through her life.
Analysis of Case Part 2 II. Diagnosis and Analysis Common and distinctive symptoms of DID/ MPD: 1. Presence of two or more distinct identities or personality states (each with its own pattern of perceiving, relating to, and thinking about the environment and self). 2. At least two of these identities or personality states recurrently take control of the person s behavior. 3. Inability to recall important personal information 4. Restlessness, depression, inability to concentrate, disheveled, agitated. 5. Thought disorder and auditory hallucinations Where these symptoms appeared in Eve (numbers below correspond with numbers above) 1. Eve s two main identities were Eve White and Eve Black. Each of these personalities had completely different identities and ways of viewing the world. Eve White was much more prudent and responsible, while Eve Black was much more mischievous. 2. Eve s therapist pointed out that while Eve Black was out, Eve White would have a momentary blackout meaning that she could not remember anything that occurred during that time period. A great example of these blackouts is the letter she sent. Eve White remembered beginning the letter but had absolutely no recollection of finishing the letter. The ending of the letter included Eve Blacks handwriting signifying that Eve Black was in control during this time and Eve Whites memory lapse is due to the fact that her alter personality was in control instead. 3. The therapists noted that throughout her childhood Eve White was unable to remember important information as to why she would often get punished for things she couldn t remember doing. 4. Eve Black seemed to take on the agitated part of the personality, often refusing to help the psychologists. Eve White seemed to be the much more serene figure. 5. Eve White claimed to hear voices and sounds during many of her therapy sessions. As a method to surviving extreme stress, many children psychologically separate thoughts, feelings, memories, and traumatic experiences. This way, if a traumatic event occurs, the pain gets isolated to one are of the overall personality. In Eve s case, it seems that she has done something very similar. She separated different parts and memories in her life to different
parts/ personalities in her brain. The fragmentation of her personality was made in order to protect herself from things she couldn t bear/ past memories. Eve Black seemed to be the strong personality who would undertake these traumatic memories and shield Eve White from them. III. A look at the overall disorder: Causes The main cause of DID is thought to be extreme traumatic experiences or many stressful events throughout childhood By separating traumatic memories into completely separate areas of the brain, DID lets victims have a healthy overall level of functioning (because that way one traumatic event doesn t affect the entire person, it s isolated to only one part of the brain) The limbic system is crucial to the development of DID o Parts of the limbic system: amygdala, hippocampus, hypothalamus, thalamus, prefrontal cortex o regulates emotions and memory o Amygdala: senses and responds to fear and aggression, remembers details of experiences Details are then stored into the hippocampus which then converts them into long-term memory o MRI s show smaller sized amygdala s and hippocampus in DID victims = lower tolerance to fear and aggression and explains the amnesia and blackouts DID victims have Neurotransmitters and hormonal abnormalities: o Usual neurotransmitters that regulate stress are commonly affected in DID victims o Excessive amounts of cortisol, epinephrine and endogenous opioids can make the limbic system extremely reactive to any type of stress Memories from traumatic experiences are encoded in a unique way. o Emotional impact won t allow memories to be translated into words and symbols to be stored in the semantic memory o Instead, the experience gets stored in "somatosensory or iconic level" form which allows for vivid and accurate recalling of the memory later on. o Neuroimaging studies have shown that during the stimulation of traumatic memories, there is decreased activity in Broca's area of the brain (the part of the brain that deals with the translation of experience into words) o There is an increased activity in the right hemisphere areas, parts which are involved in the processing of emotional and visual information. When a person has DID they store these purely emotional and visual representations of their traumatic incidents into a whole separate identity.
o When a traumatic memory is triggered the person will revert to the emotional state they were in when they experienced the event o Therefore, they seem to have separate personalities whenever they revert to separate emotional states Summary of Causes: IV. 1. Why does it start? A persons/brains subconscious creates a defense system to traumatic events in order to preserve the overall health of the brain. This is done because due to his/her disease a DID victim has a much lower tolerance to stress and trauma. 2. Is it preventable? The issue with preventing DID is that the victim may not be aware of the onset of the disease because it is a subconscious act of the brain meaning that the victim has no power over it. 3. How does one s childhood contribute to the initiation or prevention of the disease? One s childhood is where many of the traumatic events occur that cause the brain to begin to separate and organize such memories. A stressful childhood may encourage the onset of the disease while a healthy childhood where a child may find other methods to dealing with the stress may prevent the disease. 4. How is the disease apparent in the brain? The brain in many DID patients becomes or is more sensitive to stress and uses split personalities as an alternative to deal with the stress. Also, memories are encoded in a special way that allows them to be encoded in a separate area of the brain and therefore allow them to be separated from the regularly encoded memories. Treatments: It has been shown that 60% of patients who undergo treatment maintain stable integration (stable integration= at least 3 months of having only one identity). Hypnotherapy and nonverbal therapy are commonly used to treat DID. o Hypnotherapy helps with memory retrieval, it calms, soothes and helps strengthen the ego. o Used to increase communication between the alters and between the alters and the therapist o Nonverbal treatment methods such as art and play therapy have also been proven useful to help treat DID Art is a freer expression of thoughts and feelings than verbal methods. The right side of the brain is more involved with creativity and the imagination where the left side is more concerned with language. Stimulating the right hemisphere (through art) might bring up "sensorimotor and iconic" memories more easily Medication is not always recommended for this disease because the multiple personalities may prevent consistency of treatment (i.e. one personality may be resistant to taking the medication). however some patients still do take medications
o There are no current medications that specifically treat DID Patients who suffer from DID often times suffer from other mental illnesses as well. Taking medications to relieve such other illnesses often times relieves some of the symptoms of DID as well. o Some drugs that doctors often prescribe to DID patients are: antidepressants, anti-anxiety medications or antipsychotic medications to help control the mental health symptoms associated with dissociative disorders Conclusion: Our brain seems to have a natural way of protecting itself, seemingly an extension of our survival instinct. DID is the brains natural way of making up for the victims low tolerance for stress. By keeping the trauma separate the brain is kicking in its survival instinct. Our brains and our bodies constantly work to help us survive, even when we aren t consciously forcing it to. Furthermore, stress and traumatic events are very important to control. It is important to have a healthy way of dealing with such stress in a conscious matter. Not dealing with a mental injury is just as bad as not dealing with a physical injury. If you let a broken leg heal on its own without any treatment it might heal incorrectly and give someone a limp for the rest of their lives. If you let a mental injury heal on its own without any treatment you might end up with some sort of mental illness.
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