Assessment of ego functioning in multiple personality disorder

The dissociative disorder known as multiple personality disorder (MPD) presents a diagnostic challenge to psychological assessment techniques. A case example is presented in which a new self-report, multifactorial measure of ego functioning discriminated distinct profiles for four personalities within one multiple personality organization. Interpretations of characteristics of the primary and secondary personalities based on the Bell Object Relations Reality Testing Inventory (BORRTI) are presented. The relationship between these findings and other approaches to psychological testing for dissociation and MPD are discussed. It is suggested that this approach will facilitate the clinical assessment of suspected MPD subjects and contribute to affording appropriate treatment to this population.     

Introject and Identity: Structural-Interpersonal Analysis and Psychological Assessment of Multiple Personality Disorder

Revisions of the diagnostic nomenclature have contributed to renewed interest in multiple personality disorder (MPD). Identity and self-organization in MPD are assessed using a sophisticated structural-interpersonal measurement system, Structural Analysis of Social Behavior (SASB). Two important features of the SASB model applied to MPD are the assessments of interpersonal perceptions of childhood initiators of abuse and of the introject or self-organization of host and secondary personalities. SASB findings from a clinical series of six cases of MPD are analyzed to illustrate the use of this assessment technique. Host personalities and abused secondary personalities differed in their identity and self-organization. Host personalities evidenced internalization of abuse dynamics related to selfdestructive trends. Secondary personalities, despite having experienced abuse, did not manifest such dynamics. Implications for understanding personality processes in MPD and for further research are discussed.     

Introject and identity: structural-interpersonal analysis and psychological assessment of multiple personality disorder.

Revisions of the diagnostic nomenclature have contributed to renewed interest in multiple personality disorder (MPD). Identity and self-organization in MPD are assessed using a sophisticated structural-interpersonal measurement system, Structural Analysis of Social Behavior (SASB). Two important features of the SASB model applied to MPD are the assessments of interpersonal perceptions of childhood initiators of abuse and of the introject or self-organization of host and secondary personalities. SASB findings from a clinical series of six cases of MPD are analyzed to illustrate the use of this assessment technique. Host personalities and abused secondary personalities differed in their identity and self-organization. Host personalities evidenced internalization of abuse dynamics related to self-destructive trends. Secondary personalities, despite having experienced abuse, did not manifest such dynamics. Implications for understanding personality processes in MPD and for further research are discussed.     

Memory and awareness in a patient with multiple personality disorder

We studied an individual with multiple personality disorder in whom each of several personalities claimed to have no direct awareness of the others and to be unable to consciously remember the experiences of other personalities. A broad selection of implicit and explicit memory tests was used to determine the extent to which one personality had access to knowledge acquired by another and the circumstances in which that knowledge would be expressed. The implicit assessment of memory was a necessary but not sufficient condition for demonstrating interpersonality access. The degree of compartmentalization of knowledge in this patient depended largely on whether the interpretation of presented information was likely to differ across personalities.     

One or Many? Commentary on Paper by Debra Rothschild

This discussion of Rothschild's case history of a multiple personality disorder (MPD) treatment situates the issue of integration versus multiple self states in terms of cultural values, psychoanalytic theory, and transference–countertransference experience of MPD patients and therapists. Views from autobiographies of multiple personalities are included, and some questions are raised about the relationship of “parts” to traumatic experience: When, and for whom, is integration a treatment goal? When is dissociation a characterological defense, and when do the parts each hold separate traumatic knowledge? How does this question bear on treatment—what gets integrated, the knowledge or the parts? Are termination and integration simultaneous? A recommendation is offered for a wider, more complex view of narrative and historicity in the understanding of narrative reconstruction. A concrete focus on veridicality can be a defense against the overwhelming nature of traumatic experience. A final view is offered which positions the author as more distant from integration as a goal than is Rothschild.     

Culture and Personality: Variability across Universal Motives as the Missing Link

What is the relation between culture and personality? I argue that to address this question, it is necessary to meet five criteria: (1) to identify universal principles of human functioning that underlie both culture and personality; (2) to treat those principles at different levels of analysis for culture and personality; (3) to define culture and personality in terms of those principles in a manner that maintains the integrity of these concepts; (4) to select specific psychological factors that, because of their survival value, are present in every culture and individual, although to varying degrees; and (5) to postulate how different cultures and personalities emerge from variability in the predominance of those specific psychological factors. I then propose that these criteria can be met by identifying specific human motives that are both universal and vary across individuals, situations, and groups. I propose a five‐step model that describes how cultures influence the personalities that emerge among its members, with particular emphasis on the human‐defining period of development between 3 and 6 years of age, and how those personalities in turn influence the culture (from effects of regulatory fit). As initial support for the model, evidence is reviewed for commonality among cultures in the existence of promotion, prevention, locomotion, and assessment motives; for variability across cultures in the predominance of these motives as modal personalities; and for universality in the relations between each motive and Big Five and self‐esteem trait characteristics. Combining the latter universal relations with the cultural variability in modal personalities yields cultural differences in manners of goal pursuit.     

Multiple personality disorder and the choice of self: Change factors in a brief therapy case

A person who identified herself as having a multiple personality disorder made remarkable changes after seven psychotherapeutic sessions and two batteries of tests, one on the alter. The case raises such problematic issues as the diagnosis of MPD, the unitary versus discrete theories and treatment of it, change factors in brief psychotherapy and for all psychotherapy, and the use of psychological tests.     

Conditional handedness: Handedness changes in multiple personality disordered subject reflect shift in hemispheric dominance

This study investigates whether the host personality (Pe) and the primary alterpersonality (Pa) of a woman with multiple personality disorder are controlled by the left and right hemispheres, respectively. Results support the hypothesis. Behavioral and preference measures indicate that Pe is strongly right handed and Pa is left handed. Verbal and musical dichotic tests show significantly greater accuracy for stimuli presented to the left ear for Pa and to the right ear for Pe. It is concluded that shifts in hemisphericity involve redistribution of attentional resources and callosal suppression. “Conditional handedness” is proposed as a handedness subtype, characterizing persons who alternate personalities and consistently display alternate hand preferences linked to specific personality characteristics.     

Dissociative disorders in Vietnam combat veterans

A group of Vietnam combat veterans were surveyed to determine the quantity and quality of their dissociative symptoms. The results suggest that the symptoms of post-traumatic stress disorder (PTSD) and dissociative disorders in this group of patients may be much more closely intertwined than we have heretofore considered. Those who suffer from PTSD have a continuum of severity of dissociative symptoms ranging from the frequent experience of a partially forgotten traumatic experience to the rare occurrence of a full blown case of multiple personality disorder (MPD). Most cases of MPD are related to trauma during childhood in environments fraught with extreme ambivalence and victimization, in association with abandonment and betrayal. However, the high frequency of dissociative symptoms and even occasional occurrences of MPD in Vietnam veterans suggests a similarity in the environmental factors associated with the Vietnam war.     

A Comparison of Three Rorschach Diagnostic Systems and Use of the Hand Test for Detecting Multiple Personality Disorder in Outpatients

Eleven individuals diagnosed with multiple personality disorder (MPD) on the basis of clinical observation by experienced therapists plus elevated scores on the Dissociative Experiences Scale (DES; Bernstein & Putnam. 1986) were administered the Rorschach Inkblo; Test and the Hand Test. Results from the sample (n = 11) and a matched control group (N = 22) were analyzed and discussed in accordance with previous Rorschach diagnostic systems. The Wagner Signs diagnosed 91% (n = 10) of the MPD cases in this outpatient sample, with no false positives. The Labott Signs were found to have no utility, and the Barach Signs, when they occurred, seemed to be diagnostic of MPD but yielded a high rate of false negatives. Hand Test results were analyzed and found to be possibly diagnostic of MPD. Tentative criteria were proposed for its use as an additional tool for diagnosing MPD.     

A Comparison of Rorschach Records of Three Multiple Personalities

Inter- and intra-protocol comparisons among the Rorschachs of three authenticated cases of multiple personality were presented. The original or primary personalities seemed reasonably complex but, as successive personalities emerged, a definite tendency toward simplification was noted. A theoretical explanation for this phenomenon was advanced.     

Autobiographical memory in a case of multiple personality disorder

Previous research on multiple personality disorder (MPD) has been concerned with between-personalities amnesia, and little attention has been paid to within-personality memory function. This study examined the autobiographical memory of a multiple personality patient, I.C., with cueing procedures that have proven useful in previous studies of normal and abnormal memory. Results indicated that I.C. was able to retrieve autobiographical episodes from the recent past, although her performance differed in several respects from that of matched controls. The study also revealed a striking deficit in I.C.'s autobiographical memory for childhood: She was unable to recall a single episode from prior to the age of 10 in response to various retrieval cues, whereas control subjects had no difficulty recalling numerous childhood episodes. This phenomenon of extended childhood amnesia has not been reported previously in studies of MPD.     

Understanding multiple personality with the Comprehensive Rorschach system

Exner's Comprehensive Rorschach system is utilized in studying a unique sample of patients--three multiple personalities. Each patient and a number of secondary personalities are tested. Several interpretative and technical aspects of Exner's system are clarified. All of the main personalities are ambient, extending Exner's conclusions regarding the implications of this style. The secondary personalities have personality structures which are remarkably different from those of the main personalities. Differences from previous studies are attributed to unique administrative features of the Comprehensive system.     

The Integration of Determinants and Content in Rorschach Interpretation

Millon has presented a grand and rich theory of personality disorder. Fundamental to this theory are three polarity dimensions (active-passive, pleasure-pain, and self-other) from which the personality disorders are said to be derived. This article reviews these polarity dimensions with respect to their conceptual relation with the personality disorder nomenclature, their assessment, and their empirical support.     

A conceptual model and case study for the psychological assessment of hysterical pseudo-seizures with the Rorschach

Conceptual models are being increasingly utilized to guide psychological assessment of complex clinical problems. In this article, I present a conceptual model to direct the assessment of personality processes involved in producing hysterical pseudo-seizures. Pathological personality processes present in hysterical reactions are outlined. Rorschach parameters that have been validated and that are therefore considered good indicators of the relevant personality processes are presented. A case study of a patient with both documented genuine and hysterical pseudo-seizures demonstrates use of the model. I offer a treatment plan that is related to the psychological structure of the patient. Use of this model may improve psychological consultation in medical settings.     

Convergent validity of alternative MMPI-2 personality disorder scales

The Morey, Waugh, and Blashfield (1985) MMPI (Hathaway et al., 1989) personality disorder scales provided a significant contribution to personality disorder research and assessment. However, the subsequent revisions to the MMPI and the multiple revisions to the diagnostic criteria sets that have since occurred may have justified comparable revisions to these scales. Somwaru and Ben-Porath (1995) selected a substantially different set of items from the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) to assess Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) personality disorder diagnostic criteria. In our study, we compared the convergent validity of these alternative MMPI-2 personality disorder scales with respect to 3 self-report measures of personality disorder symptomatology in a sample of 82 psychiatric outpatients. The results suggested that Somwaru and Ben-Porath's scales are as valid as the original Morey et al. scales and might be even more valid for the assessment of borderline, antisocial, and schizoid personality disorder symptomatology.     

Effects of Parental Psychological Control on Child’s School Life: Mobile Phone Dependency as Mediator

Ecological view of human development calls for an investigation of multiple contexts surrounding children. In South Korea, traditional Confucianism and recent technological advancements serve as influential social and cultural contexts that affect parent–child relations and child development. High levels of parental control and strong emphasis on academic achievement have long been distinctive features of Korean parenting practices, which are attributable to Confucian values. Additionally, Korean children’s mobile phone dependency (MPD) has become a growing concern, as South Korea developed as an IT powerhouse. Combined, these contexts resulted in high parental control of children’s mobile phone use, so that such electronic devices would not hinder learning and achievement. Effects of high parental control on children’s MPD and their school life, however, have yet to be discovered. We hypothesized, that, unlike parents’ intentions, psychological control is more likely to increase MPD and disrupt school life. To examine this research model, we made use of the first and third wave data from Korea Children and Youth Panel Survey. Participants were 2378 children (52.2 % boys) of the same age of 10 in the first wave. After multiple imputation for missing values, hierarchical logistic regression followed to examine the mediational model. The results verified the hypothesized model, showing significant adverse influence of psychological control on MPD, self-regulated learning and school adjustment. MPD fully mediated the effect of psychological control on self-regulations, while partially mediating the effects on school adjustment. Implications for Korean parents with regard to supporting children’s psychological autonomy was discussed.     

Seeing or smelling? Assessing personality on the basis of different stimuli

This study examines whether people can accurately assess personality on the basis of facial images and body odor and whether attractiveness influences these relationships. Three personality dimensions of target individuals – neuroticism, extraversion and dominance – were measured with the NEO Five-Factor Inventory, a one-item measure of dominance and the reports of close acquaintances. Naive observers assessed neuroticism and dominance at above-chance levels based on body odor, and they assessed extraversion (and in some cases, neuroticism) at above-chance levels based on either facial images alone or body odor and facial images presented together. The accuracy differed depending on the sex of the targets and the raters. In addition, facial and body odor attractiveness predicted the targets’ personalities and the assessments of their personalities. These results show that the accuracy of personality assessment changes when judges assess different types of stimuli.     

Personality disorders and response to outpatient treatment of chronic pain

As part of a comprehensive interdisciplinary evaluation conducted prior to participation in an outpatient chronic pain treatment program, the psychological status of 101 persons was assessed. The majority of participants was found to have a form of personality disorder, determined by conservative cutoff scores applied to their Millon Clinical Multiaxial Inventory (MCMI) profiles. DSM-III-R Cluster C disorders (i.e., Avoidant, Dependent, Obsessive-Compulsive, and Passive-Aggressive) were overrepresented in this sample. Subsequent analyses revealed that personality disorders were related to higher levels of self-reported distress and pain at both the beginning and the end of outpatient treatment. Differential responses to treatment were observed on self-report measures; however, few relations were found between personality disorder and physical therapist ratings of impairment and improvement. Implications for the assessment of personality disorders in outpatient pain treatment programs are discussed and appropriate intervention strategies are considered.