Maggie's Farm

I have considerable agreement. Early in my career, a psychiatrist and a psychologist I greatly respected were discussing at lunch whether either of them had ever seen a MPD that was not therapist-induced. They could not come up with even one between them. We all have some trouble integrating the various parts of our personality together, and those who have had neglectful or traumatic childhoods have a more difficult time. But increasing the fragmentation by encouraging it, giving portions a name, and interpreting for the patient is damaging.

As another psychiatrist said, the said part of MPD is that the pieces add up to less than one. I have not seen anyone come in with a claim of MPD in over a decade. Our standard practice is is to defer discussion of said personalities by admitting sadly that much of our staff has little expertise with the condition, and the patient will do better if she can designate one personality to speak for the others while she is with us. This encourages integration and gets us out of pointless arguments.

Dissociative Identity Disorder was a bit of an escape move diagnostically, but it has the advantage of describing along a continuum and giving an alternative explanation other than full personalities. It is rather fuzzy around the edges, and we discourage its use in favor of the more measurable PTSD symptoms. I think this whole cluster, which is strongly associated with Borderline, Histrionic, and some other PD/O's with continue to evolve diagnostically as we find more brain-measurables.

MPD diagnosis also had a strong regional component around here. The closer one got to a certain famous and august private psych hospital, the more multiples one would find. This remains pronounced enough that if I even hear of someone having the diagnosis I guess - with remarkable accuracy - that they are over forty and come from the SW portion of NH. Quite a coincidence, eh?