Dealing with alters: a pragmatic clinical perspective.

Temple University School of Medicine, Philadelphia, PA, USA.
Psychiatric Clinics of North America (Impact Factor: 2.13). 04/2006; 29(1):281-304, xii. DOI: 10.1016/j.psc.2005.10.010
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    ABSTRACT: Patients with dissociative identity disorder (DID) are often diagnosed with borderline personality disorder (BPD) and misdiagnosed with psychotic illnesses. This study is designed to determine whether the Rorschach protocols of 67 patients with DID differ from those of 40 patients with BPD and 43 patients with psychotic disorder (PSD) in variables reflecting capacity for working alliance, complexity of experience, and ability to reason despite traumatic flooding. As theoretically and clinically predicted, the DID group could be distinguished from the PSD sample by the DID group's significantly higher level of traumatic associations alongside their more logical reasoning (e.g., Trauma Content Index [TCI], WSUM6). In comparison to the BPD group who, by definition, were also likely to dissociate and struggle with other trauma based symp-toms, the DID sample showed greater social interest (Sum H), self-reflective capacity (FD; Form Dimension), ability to perceive more accurately and think more logically (X-, WSUM6). The authors discuss the treatment applications of these findings and make suggestions for further research. Dissociative identity disordered (DID), bor-derline personality disordered (BPD), and psy-chotic spectrum disordered (PSD) inpatients are often difficult to distinguish from a symptom perspective alone (Dell, 1998; Ellason, Ross, & Fuchs, 1996; Horevitz & Braun, 1984; Ross, Miller, Reagor, Bjornson Fraser, Anderson, 1990; Yargic, Sar, Tutkun, & Alyanak, 1998). These patient groups offer different clinical challenges and, especially in a time-limited in-patient setting, efficient decision-making based on accurate diagnoses is crucial to outcome. People with DID typically receive three to four prior diagnoses, often in the psychotic and per-sonality disordered dimensions (typically BPD), prior to being appropriately diagnosed and treated (Ross, Norton, & Wozney, 1989; Put-nam, Guroff, Silberman, Barban, & Post, 1986). Their long road to diagnosis is understandable, not only because diagnosing and treating disso-ciative disorders is a relatively new area, but because from a behavioral and symptomatic standpoint these three disorders can appear in-distinguishable. For example, both patients with BPD and DID show major fluctuations in self-image and affective presentation, and both have high rates of self-harm and suicidality (e.g.,
    Psychological Trauma Theory Research Practice and Policy 01/2009; DOI:10.1037/a0016561 · 0.89 Impact Factor
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    ABSTRACT: The current state of the data concerned with psychopharmacologic interventions for multiple personality disorder (MPD) is reviewed. Common sense guidelines are provided for drug treatment of MPD. An overview is given for use of medications for specific symptoms commonly found in MPD patients, such as affective, posttraumatic stress disorder, and sleep disorder symptoms.
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