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Various forms of dissociative disorders have been the focus of the misdiagnosis and incomplete treatment
of TRS (Trauma Reenactment Syndrome) clients. In the late nineteenth century, Freud’s
treatment  of women who were survivors of childhood sexual abuse
and other doctors’ hypnosis work with dissociative manifestations
of early trauma represented the medical establishment’s
view that women with dissociative behaviors and communications
were to be diagnosed as suffering from hysteria. While this was
an improvement over seeing these women as possessed by demons,
it still unduly stigmatized the victim of childhood trauma. Until
recently, dissociative episodes were likely to result in diagnoses
such as schizophrenia, manic-depression, or other forms of major
mental illness. Now that childhood trauma has been understood
to stimulate dissociative patterns in children that last into
adult life, there has been significant development in the mental
health field. The trauma researcher and psychiatrist Bessel van
der Kolk has developed a new diagnostic category to assess the
various types of dissociation related to early trauma not specified
as part of other diagnoses. While this is a hopeful step toward
more precisely understanding and describing the effects of trauma
on dissociative phenomena, there is still much mystery and confusion
in this area of diagnosis and treatment.
Multiple Personality Disorder (MPD), also referred
to as Dissociative Identity Disorder, an extreme form of dissociation,
has become enormously interesting to clinicians and the public
over the past few years. Many women whose behavior seems relatively
normal yet who are strangely withdrawn, isolated, or difficult
to relate to are now being diagnosed as suffering from this disorder.
The MPD client has several distinct personalities, or alters,
as a result of dissociative patterns developed during trauma experiences
in childhood. These parts of herself are split off from each other
and have separate, fully developed personae. One personality may
be a child; another may be an adult woman very different from
the woman as she is known to the world; another may be a male
alter; and so on. The alters do not necessarily communicate with
each other. The primary task of healing is generally assumed to
be the integration of these various parts of the self into a more
unified and better functioning whole self, or at least improvement
in coordination of the various selves.
Women with this disorder are being
seen in therapy far more frequently today than in years past.
The discovery that MPD seems more prevalent than professionals
had assumed seems directly linked to the recent evidence that
child sexual abuse is more widespread and more damaging than had
been thought. There is increasing pressure to believe the mental
health professionals who say that Multiple Personality Disorder
is a relatively common response to severe abuse.
Treatment of MPD is still evolving and there is
no “usual” protocol for working with this disorder.
It is generally accepted that rather lengthy individual psychotherapy
is necessary. The therapist and client work together to bring
forth as many of the personalities as possible, getting acquainted
with each part of the fragmented self. They then begin the work
of integrating the alters, so that the client can have a more
cohesive self and manage her life more effectively. Not much is
yet known about how medications or support groups may work to
aid the psychotherapy treatment.
MPD women can include Trauma Reenactment
Syndrome among their problems. They are likely to engage
in self-destructive behaviors, ranging from self-mutilation to
addictions and eating disorders. They are slightly more complicated
than other TRS women in how they communicate, however, because
only some alters seem to be responsible for the self-destructive
behavior. Theoretically, this factor could make treatment much
easier, because the particular part of the self that does the
damage to the body has already been split off and identified.
One could work directly with this alter on the self-harming patterns
and then either persuade the alter to stop the behavior or integrate
the alter with the parts of the self where there is more capacity
for self-protection. In practice, however, this is not easy. The
destructive alters are more accountable for the self-harmful behavior
than the Abuser—Victim—Nonprotecting Bystander fragments
of the Triadic Self, but they are not easy to communicate with
or to neutralize. The non-MPD TRS woman may be less aware of the
conflict within herself than the MPD woman. However, once she
develops an understanding of how the Triadic Self operates, she
generally has an easier time developing a Protective Presence
to stop the Abuser’s self-harm.
A positive factor in connecting the MPD diagnosis
with TRS is that the problem of dissociation resulting from childhood
trauma takes center stage. All those who work with, or are in
any form of relationship with, the TRS woman need to become familiar
with the centrality of dissociation and fragmentation. The problems
of the fragmented self for TRS women are on a continuum. MPD is
at one end of the continuum; at the other end is the Triadic Self,
a less severe form of fragmentation. The attention being given
to MPD should make the road smoother for a better understanding
of all TRS women and their problems with fragmentation and dissociation.
The preoccupation with MPD can get in the way, however; because
they are distracted by the novelty and drama of MPD clients, clinicians
and other experts may lose sight of the fragmentation problems
presented by other trauma victims. Professionals may also exaggerate
the simpler triadic version of fragmentation so that it becomes
a false MPD diagnosis.
- Miller, Dusty; Women who Hurt Themselves: A Book of Hope and
Understanding; Basic Books: Massachusetts; 1994
Personal
Reflection Exercise #7
The preceding section contained information about self-injury
behavior in Multiple Personality Disorder. Write three case study
examples regarding how you might use the content of this section
in your practice.
Online Continuing Education QUESTION
21
According to the author, what is a positive factor in connecting
MPD with Trauma Reenactment Syndrome? Record the letter of the
correct answer the .
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