Sunday, January 25, 2009

Multiple Personality Disorder Sketch

In my previous blog I introduced Annie, a 27 year old woman diagnosed with Multiple Personality disorder. She had nine alter personalities of which we were aware: three were adults, three were teenagers, and three were children. My aim is to clarify the similarities and differences between Multiple Personality Disorder and the internal parts that all of us have. In this blog I will introduce Annie's younger parts.

The teenagers are Tiffany at 17, and Julie and Sarah at 13. Seventeen year old Tiffany first appeared at age 15 when Annie was raped by a friend's drunken father at a sleepover. Tiffany hates men, but paradoxically she is also the part who will take executive control of Annie's body in order to seek out men on social occasions. She seduces men in order to demonstrate that she is in control of her sexuality and she can determine with whom she has sex. She is known to have left Annie to awaken in a strange man's bed wondering how she got there. The two 13 year olds, Julie and Sarah, appeared when Annie was 13 and her grandmother died. Julie reports that grandma was "the only one who loved her." The two 13-year-olds seem to represent aspects of the same painful experiences. Julie was devastated by the death of grandma, but everyone around her insisted that she get over it and keep smiling, when all she wanted to do was to die. She accommodated the demands upon her by becoming the one who always kept smiling, no matter what. Sarah carried the pain of loss and the desire to die. Recently, she has been active again with suicidal urges for Annie. Manager Sandra (an adult part) had kept her in lock-down mode through most of the years since she first tried to hang Annie at age 13. The three teenager parts are all capable of taking executive control, and when they do, Annie doesn't remember what happens. As noted above each teenager has her own function in the system. Tiffany controls sexuality; Julie is sociable and presents a happy face to the world; and Sarah dissociates Annie from her pain.

The younger parts are Polly, who presents herself as eight years old, Sam, who presents as seven, and Frannie, who says she is three. Evidently, none of these young parts take full executive control from Annie. Annie's first visualization of Frannie happened in the therapy room. She saw her as lying on the floor, rolled into a ball, the better to protect herself from her parents' beatings. She is stuck in her traumatic memories and has no knowledge of time passing or having passed. Sam first appeared as the escape artist who helped Frannie free herself from the ropes with which her mother tied her to a chair when she went out. Sam is dedicated to protecting Frannie, but has a broader role of protecting others, such as, for example, cautioning Annie not to talk to the therapist about her history lest she get into trouble. Eight year old Polly developed in response to the sexual abuse that began around age four and lasted through about age 10.

Annie's system appears to be fairly typical. There are parts of different ages, one of whom is male. Some of the parts take executive control of Annie's body leaving Annie with no memory for what happened during the takeover. Some parts rarely or never take executive control. The adult parts are aware of Annie's current life, but all the others are largely unaware of current events in Annie's world. All parts, even the little boy, present themselves as looking like Annie. In this they are probably atypical. In most systems it is common for internal parts to present in costumes that look nothing like the outside person.

Friday, January 23, 2009

Normal Parts vs Multiple Personality Disorder

Parts Psychology is a psychotherapy which aims to heal psychological problems through work with the naturally occurring internal self states that we all have. Those of us who not very dissociative (Multiple Personality Disorder has been renamed Dissociative Identity Disorder) are really not very different from people diagnosed with Multiple Personality Disorder. Here is some information about a case of MPD.

Annie is a 27 year old housewife and mother of two. Her score on the Dissociative Experiences Scale is 38.9, significantly above the frequent cutoff score of 30 that is used to identify potential cases of pathological dissociation. The average score in the general population is 10. Annie meets the criteria for Multiple Personality Disorder. When I first met her she was intermittently suicidal, raging, and paranoid that her children would be taken from her. Annie identifies nine parts, or alter personalities. Three of them present themselves as adult females, the same age as Annie at 27; three are teenagers; and three are children. The first adult is Sandra, the system's internal manager. She claims memories of neglect from the time before Annie was walking. There was no one, she said, who picked her up and held her close, except that mom would sometimes do so when dad was around. Sandra is the one who rages, especially when the younger parts are frightened or in pain. Another adult is Ysandra, the worker part, who is oriented to accomplishing tasks. When Annie worked as a waitress it was Ysandra who took orders without notes and effortlessly remembered what each customer wanted. The third adult is Andrea, a sweet and loving part who "gave her heart" (with permission from manager Sandra) to Annie's husband. Andrea seems to have developed in response to the most recent rape of Annie when she was 17. Only these three parts have full knowledge of Annie's present life. The others are to one degree or another locked in the experiences of earlier periods in Annie's life. When manager Sandra or other alters are in executive control, Annie has no memory for what transpires.

I'll say more about the specifics of Annie's case in a later blog. For now I just want to point out the similarities and differences between Annie's MPD and the normal self states that can be found in all of us. The first difference is that Annie is aware of her parts, although she did not know all nine of them. Most normal persons are unaware of any of their parts until they begin to do Parts Psychology. Actually, many MPD persons are also unaware of their own multiplicity. Annie's parts have specific roles that are fairly well defined. This is true also of people with normal parts, except that with MPD the roles tend to be more rigidly defined. Like persons diagnosed with MPD normal persons generally have parts with a range of ages from childhood to adulthood. Annie's parts were created during childhood traumas, and this is true also of normal persons, except that in general the traumas of normal persons are much less severe. For accuracy it might be better to use the expression "painful experiences" rather than "traumas" in characterizing the origins of normal parts. Like Annie normal persons can also have parts that are locked into the painful experiences of earlier times in their lives. Because they are somehow locked into earlier memories such parts do not have a full autobiographical knowledge of the person. Finally, when any of Annie's adult alters take full control of her, Annie is amnesic for what happens during that time. For normals, parts do not generally take full control of the person, but when they do there is usually no amnesia. There are a few exceptions to this. More later.

Sunday, January 11, 2009

Normal Parts Can Act Like MPD Alters

Working with the part-selves that are the unconscious underpinnings of our conscious behavior is often quite similar to working with the alter personalities of multiple personality disorder. That shouldn't be surprising. The difference between them is only a matter a degree, and sometimes that degree of difference is entirely absent. A few weeks ago I mentioned the man who was confronted by his wife over the presence of a love note from his girlfriend which his wife found underneath her keys on the kitchen counter. The man had no memory of having placed the note there. He did not want his wife to know about his girlfriend. A part of him, however, did. An investigation into the man's inner world discovered a part who wanted to anger the wife so that she would divorce the man. The part was in control of the man for only a brief time, just time enough to pull the note from the man's pocket and place it underneath the wife's keys. The man was tired and sleepy and this may have made it easier for the part to take the action. A single incident of subpersonality control with amnesia is not sufficient to warrant a diagnosis of multiple personality disorder. But the incident is exactly the sort of phenomenon that is commonplace with the dissociative disorder. It doesn't happen often among people without the disorder, but it is probably much more common than we generally acknowledge. Think of all the times when we or someone we know is accused of something they swear they didn't do. Or consider all the times husbands and wives accuse each other of saying things that they absolutely deny saying. Aside from the cases where one party is knowingly lying, or the other party is intentionally exaggerating the circumstances of an incident, my guess is that many of these incidents are due to a subpersonality briefly taking control of consciousness, taking action, and then quickly subsiding back into the nonconscious mind.

Sunday, January 4, 2009

Weight Loss and Parts Psychology

Losing weight and keeping off the excess weight is one of the most difficult tasks we set out to accomplish. We have plenty of reasons for losing weight. Diabetes rates are skyrocketing. There is a strong correlation between excess weight and heart problems as well as other life shortening conditions. Perhaps even more powerful is the American (and more generally Western) concepts of thinness and beauty. For women, especially, thinness translates directly into a greater sense of beauty. And unfortunately, the degree of thinness that is ideal for many segments of our society is probably also unhealthy. Weight loss programs are major components of a multi-billion dollar industry. But the result of most weight loss programs is usually only temporary. We lose it and then gain it back, often even more than we lost in the first place.

Can Parts Psychology help? Yes, but it is not a quick fix. The reasons for a person's excess weight are many, as are the reasons for our inability to lose weight permanently. And all the reasons are complicated by the simple truth that we must eat to live, and by a second truth that food tastes good. Eating is a pleasurable activity, just as is having sex. Parts Psychology can help by healing the childhood experiences that are hard to forget and for which eating can be a pleasurable escape. I recently completed work with a woman with a binge eating disorder. Healing the disorder meant healing her of the damaging treatment she received at the hands of others, especially the verbal abuse by her mother. The patient had a named binge eating part who agreed to the desensitization of her painful life experiences. However, she also had a raging part who had an interest in maintaining the binge eating disorder. So, we had to work with the raging part at the same time we worked with the bingeing part. But before we could heal the patient's rage we also had to work with an anxious part. There were three other internal parts who required work before we could bring to conclusion the work on the bingeing and the rage. It was complex work, requiring about eight months to complete. For Parts Psychology this is a long time, but still quite a bit less time than that required with conventional psychotherapy.

Eating Disorders and Parts Psychology

The recognized eating disorders include anorexia, bulimia, and binge eating disorder. One of the reasons for the lack of success of many eating disorders programs is that the programs spend too much time on the disorders themselves. The focus should be on a person's life history and the processing of traumatic and other painful experiences of childhood and adolescence. Unless a person is in fairly immediate physical danger from their disorder, let it alone until early experiences have been healed. Eating disorders represent defensive coping responses that will resist treatment for as long as the underlying issues are untreated. Typical issues include anxiety over early threats of parental loss, verbal and other abuse, and a history of having to adjust to lack of control in the early family situation. Parts Psychology can identify the particular subpersonalities who carry the disorders, but early work with them is likely to be unsuccessful unless the anxious, angry, and depressed parts who developed in response to the early family situation are brought into the treatment room. Therapists may see the problems with food as disorders, but for the parts who carry the problems, the so-called disorders generally represent somewhat pleasurable activities aimed at protecting the Self.