Which 7 diseases change your personality

Personality Multiplication? The so-called multiple personality or dissociative identity disorder

The topic of "multiple personality" has long since reached the media and is presented in a spectacular way: as if a person had two or even many personalities, of which one or the other stands out and neither knows about the other. Up to 60 "personalities" of a person are said to have been observed.
What is the truth about that? What is scientifically proven?


dissociation
What is meant by "dissociation" is not easy to describe: what actually belongs together falls apart; Something has gotten out of the overall experience, is no longer integrated, not fully capable of consciousness - this and similar are the descriptions. This is by no means a matter of "division" as is the case with schizophrenics; and dissociation has hardly anything to do with "splitting" borderline teaching.
What dissociation is will be explained using examples. One is pseudodementia (Ganser's syndrome), in which a person behaves as if he or she is demented, even though it is not the case. Dissociative lack of memory (psychogenic amnesia) and the so-called psychogenic twilight state, in which the patient is apparently not fully oriented, are similar. This can lead to running away or driving away, which is called dissociative fugue or poriomania.
These conspicuous behaviors are not "real" insofar as they are not dementia, amnesia or twilight in the sense of cerebral diseases. They look similar to these, but are psychological reactions that are close to the hysterical behavior and not, for example, brain diseases.
The dissociative syndromes mentioned are extremely rare. Clinical details will not be discussed here (8). The development is explained psychodynamically (here in brief): With massive affect pressure and an unbearable situation, the experience can be channeled, so to speak, on different paths, so that individual areas of thought content, affects and behaviors are demarcated and "the person affected becomes unbearable, as it were Situation enters into a different way of experiencing oneself... " (4).


Multiple personality?
In connection with dissociation, there is also the phenomenon of what was previously known as the multiple personality. Numerous works on this were published between around 1880 and 1910. The Beauchamt case, described by M. Prince (7), caused a sensation: "Miss Beauchamt is a person who has several personalities. She has at least three... For two or three years these three people have come and gone... Each pretends to be the real Miss B. ... each condemns the deeds and actions of the other ... " At the same time, fiction took on the subject. "Dr. Jekyll and Mr. Hyde" by R. L. Stevenson (1886) was best known and is still read today, but it is by no means an excellent account of the disorder.
But the multiple personality soon became quieter. It was hardly mentioned for decades until American psychiatry began to think about it again from around 1965. The process was repeated: first an extraordinary interest, spectacular descriptions, uncritical conclusions and theories - then gradually a more level-headed and more critical attitude to this phenomenon.
The term "multiple personality" has been replaced in the American psychiatric classification (DSM-IV 1994 [1]) by the more appropriate term: dissociative identity disorder. However, DSM-IV still describes the disorder in the traditional way: "Existence of two or more different identities or personality states, each with its own, relatively persistent pattern of perceiving the environment and oneself ... At least two of these identities. . repeatedly take control of the person's behavior. "
The international classification of the WHO (10) takes a more critical approach. It begins the definition with the following sentence: "This disorder is rare and the extent to which it is iatrogenic or culture-specific is controversial."


To the formation
In order to go into this more closely, the above explanation of the psychodynamic function of dissociation must first be linked. In the case of dissociative identity disorder, unbearable experiences are channeled in such a way that they appear to be represented by another personality, so to speak, and one's own ego is relieved. Experiences in psychotherapy speak for this. And it is certainly not a coincidence that the dramatic reports of numerous personalities of a person originate from inexperienced psychotherapies.
What the International Classification of the WHO means with culture-specific influences can already be seen from the above historical outline: There were times of increased and exaggerated interest in this phenomenon in connection with scientific-historical and professional-political factors. While very numerous and sensational reports were published in the USA, at the same time European psychiatrists saw these dissociative identity disorders only very rarely. It was not until the 1980s that the phenomenon was discussed more here, too, because it was apparently observed more often, significantly, in many cases by non-medical psychotherapists.
This is how the WHO's second warning in the International Classification should be understood: The extent of the phenomenon also depends on iatrogenic factors. If some patients change their style of behavior significantly during psychotherapy and let it switch back and forth repeatedly, the assumption of dissociation is reasonable. The behavior is reminiscent of the roles of an actor (hence the name histrionic = acting). Sometimes the therapist is too impressed by the role change, for example when he is not sufficiently trained or when there is a lack of supervision. If he goes into this too much, or if he shows scientific interest, the patient can in turn react by intensifying his behavior. Such undesirable developments in psychotherapy, which can be read from some publications, can be avoided by paying attention to the transference and countertransference processes (which is always required).
Increasingly dramatic childhood experiences, particularly ill-treatment and sexual abuse, have been used to explain the development of this disorder. Such traumatizations, which have also become the subject of great public interest and amateur discussion, must be viewed critically in terms of their pathogenetic significance, because they are cited for the development of very different psychological disorders. It is particularly important to question the reality of such patient statements, which are also accusations. Child sexual abuse is probably more common than has long been thought. It is also certain that not all later descriptions by the women who have meanwhile grown up are to be taken literally. Rather, we know that some later depictions of childhood experiences are products of an inner process and reflect fantasies, sometimes wishful fantasies. But these are also to be taken seriously from a psychotherapeutic point of view, because they represent an inner reality, even if they do not correspond to an actual occurrence and culpable behavior, for example of the father or the uncle. The distinction between real and "only" experienced processes is often very difficult, even for the experienced. It is therefore right to warn against accusing a "perpetrator", which is now also taken into account in the case law.


Critical assessment
In the meantime, a critical attitude is gaining ground (2, 5, 6): There is probably the phenomenon of dissociative identity disorder, but those dramatic intensifications are more artificial. It is not a disease, but at most a syndrome, or rather a mode of reaction that is psychodynamically understandable. The personality is not multiple, there are not several or numerous personalities in a person, but the person affected changes his behavior, he can assume different roles and perform them very convincingly. And, at least in the convincing representations, it is not a question of a multitude, but of two versions of the appearance of the personality (in the sense of a double life). The hypothesis of a regular connection with real sexual abuse in childhood cannot be maintained in this form.


Double life
But what is - realistically speaking - the core phenomenon? This should first clarify a clinical example:
A 35 year old man. He is a lawyer, works as a public prosecutor, is extremely successful and has been rated above average. One side of his life. The other: at the weekend he dresses as a rocker, drives to a big city, drinks a lot, spends nights in bars, gets involved in drug trafficking. He feels really comfortable in this way of life, as he reports later. He led this double life for a long time, although he was noticed by being drunk and once by an apartment fire; because of his good professional performance and his reputation in the office, the disciplinary proceedings were postponed several times until finally a psychiatric examination seemed inevitable.
Such a double life is not uncommon and was depicted again and again in fiction literature in the 19th and 20th centuries. The earliest and most impressive descriptions can be found in the romantic poet E. T. A. Hoffmann, for example in "Signor formica", "Ignaz Denner" and especially in "Das Fräulein von Scuderi" (written in 1820). This novella is the first crime story in literature and contains the earliest description of a double life in the sense of dissociation (8, 9). The goldsmith Cardillac is on the one hand a highly respected citizen in Paris who also works for the king, on the other hand he is a multiple murderer. It is noteworthy that the poet Hoffmann, who did not have a template for this material but invented it freely, suggests an understandable psychological explanation of this double life in the narrative of the processes.
What the psychiatrist knows and what the poet has described can be observed in many ways in everyday life: For example, women by day, prostitutes at night; or a man of honor by day, a criminal by night; also on the one hand loving householder, on the other hand despotic boss (or vice versa).


Inferences
Identity dissociations show a broad spectrum of manifestations. It ranges from healthy to sick, productive to destructive, harmless to criminal. Some states of illness and also some behavior patterns that are difficult to explain that one experiences in everyday life can be traced back to the fact that a conflictual personality shows and lives out its ambiguity in different behavior patterns or lifestyles.
It is important to recognize dissociation in this meaning and to initiate professional psychotherapy instead of dramatizing the phenomenon and bringing artificial excesses into the media as sensations.


How this article is cited:
Dt Ärztebl 1997; 94: A-1868-1870 [Issue 27]


literature
1. American Psychiatric Association: Diagnostic and statistic manual of mental disorder. Washington DC: Fourth Edition (DSM-IV); 1994.
2. Freeland A, Manchanda R, Chiu S et al .: Four cases of supposed multiple personality disorder. Evidence of unjustified diagnoses. Can J Psychiatry 1993; 38: 245-247.
3. Hitzig JE: From Hoffmann's life and estate. Berlin: Dümmler, 1823.
4. Hoffmann SO: The dissociation. New topicality for an old clinical concept. In: Kockott G, Möller HJ: Perspectives of psychiatry. Munich: Zuckschwert, 1994.
5. Merskey H: Multiple personality disorder and false memory syndrome. Br J Psychiatry 1995; 166: 281-283.
6. Pieper A: Multiple personality disorder. Br J Psychiatry 1994; 164: 600-612.
7. Prince M: The dissociation of a personality. Oxford: Univ Press, 1905.
8. Tölle R: Dissociative identity disorder (double life) in psychopathology and in poetry. Z Klin Psychol,
Psychiat, Psychother 1996; 44: 174-185.
9. Fool R: Psychiatry. 11th edition. Berlin, Heidelberg, New York: Springer, 1996.
10. World Health Organization: 10. Revision of the International Classification of Diseases: Mental and Behavioral Disorder. German edition: Dilling H et al. (Ed): International Classification of Mental Disorders. Bern: Huber, 1991.


Author's address
Prof. Dr. med. Rainer Tölle
University Psychiatry Clinic
Albert-Schweitzer-Strasse 11
48149 Munster