The first documented case of dissociative identity disorder (DID) was in 1584. Though not labeled such at the time, Jeanne Fery recorded her exorcism in detail (with additional details provided in the records of her exorcists), preserving documentation of symptoms that exactly match those that are found in individuals with DID today. She had multiple alters, each with their own name, identity, and identifying features and had alters that would today be described as an ISH, persecutory protectors, and child alters. Her alters were associated with actions that ranged from helping her to heal to self harm and disordered eating, were audible inside her head, and could take control of her body to allow for various actions, conversion features, and changes in knowledge and skills. The alters resulted from childhood physical and possibly sexual abuse. Jeanne Fery was actually called ”the most perfect case” of “dédoublement de la personnalité,” the most perfect case of DID, by Bourneville, the man who reissued a book about her life in 1886 (van der Hart, Lierens, Goodwin, 1996)1.
Following Jeanne Fery in 1623 was Sister Benedetta, a woman who was supposedly possessed by three angelic boys who would beat her to cause chronic pain. When they took control of her body, each would speak with a different dialect and tone of voice while using different facial expressions. Benedetta had amnesia for some of their actions, including a sexual relationship that they had initiated. Like Jeanne Fery, Sister Benedetta suffered from self harm and disordered eating. Her parents had also shown signs of dissociation and had been rumored to be possessed, and one of the “angels” was frozen at age 9, the same age at which Sister Benedetta's father had died, her symptoms had become uncontrollable, and she had been sent to the convent (van der Hart, Lierens, Goodwin, 1996)1.
DID has a history of being mistaken for possession. After such a view was no longer acceptable, those with DID were seen as hysterics. Hysteria was seen as primarily dissociative in nature and could involve disturbances of memory, consciousness, affect, identity, and body functions (van der Hart, Lierens, Goodwin, 1996)1, the same symptoms today associated with dissociative disorders and particularly with dissociative identity disorder.
The first person to be officially diagnosed with multiple personality disorder (instead of double personality disorder as had eventually come into use in France) was Louis Auguste Vivet in 1882. Louis was physically abused and neglected as a child and had frequent “attacks of hysteria.” One such attack occurred when he was 17 and bitten by a snake. He lost use of his legs for almost one year, and when the use returned after a 50 hour attack, he didn’t remember any of the physicians who had been treating him in an asylum for the last month or any of his fellow patients. His manner, morals, and appetite were different as well. Following additional attacks, the next year, his character would change from impulsive and dangerous to calm and gentle. In 1884, he had another attack that left him gentle of manner but unable to walk, and yet another attack returned the use of his legs but left him quarrelsome and inclined to steal as he had done as a child in order to survive. Amnesia for intervals spanning episodes was noted. By 1888, he had been recorded as having 10 personality states, each of which were different in character, memory, and somatic symptoms. In 1885, integration of the youngest alters began (Faure, Kersten, Koopman, & Van der Hart, 1997)2.
Interestingly, the earliest reports by Louis’s treating physicians acknowledged only two of his eventually discovered alters as having presented while he was first hospitalized, though later examination of the hospital reports clearly indicated the presence of at least three alters. It is thought that Louis’s case was forced to fit the mold of double personality disorder for as long as possible. The same had happened to Azam’s patient Felida X. Though Azam recognized that Felida had three personalities, he publically recognized only two in order to make her case fit the only diagnosis he could give it (Faure, Kersten, Koopman, & Van der Hart, 1997)2.
There’s always been a history of professionals attempting to diagnose DID as another more prominent disorder of the time, even if to do so was to willingly ignore information. Even after DID became a valid diagnosis, it was still often mistaken for other disorders. In 1918, it was first acknowledged in the predecessor of the DSM under Hysterical Psychoneuroses, a subgroup of Psychoneuroses and Neuroses that included alternate states of consciousness acting on normally unknown desires, amnesia, and sensory and motor disturbances (“Statistical Manual for the use of Institutions for the Insane,” 1918)3; this again placed DID under a hysteria label. Additionally, in 1910, Bleuler had introduced the term schizophrenia, and in 1927, the reported number of cases for this disorder rose dramatically, matched by a decrease in the diagnose of DID. One reason for this is that the original description of schizophrenia actually included multiple personalities! Many of those diagnosed and treated as having schizophrenia should have been diagnosed as having DID, but because schizophrenia was the more popular diagnosis, that was what was officially recognized (Rosenbaum, 1980).4
It wasn’t until Ferenczi’s “Confusion of Tongues” paper in 1932/1949 that dissociation and subsequent splitting of the personality were explicitly linked to childhood abuse. However, at the time, any theory involving the subconscious mind was unpopular, and few paid attention to what Ferenczi had discovered. As well, the schizophrenia diagnosis still included and dominated over the DID diagnosis at this time. It wasn’t until shell shock was noted in soldiers and then recognized as posttraumatic stress disorder (PTSD) in abused women and children that attention finally returned to dissociation. (Howell, 2011).5 After this point, it was specific case studies that brought attention to the disorder, starting with that of Clara Norton Fowler (“Christine Beauchamp,” 1898-1904) and followed by that of Chris Sizemore (Eve).
1 Van der Hart, O., Lierens, R., & Goodwin, J. (1996). Jeanne Fery: A sixteen century case of Dissociative Identity Disorder. The Journal of Psychohistory, 24(1).
2 Faure, H., Kersten, J., Koopman, D., & Van der Hart, O. (1997). The 19th century DID case of Louis Vivet: New findings and re-evaluation. Dissociation, 2(2).
3 Statistical Manual for the use of Institutions for the Insane. (1918). In Statistical manual for the use of institutions for the insane. New York: American medico-psychological association/National committee for mental hygiene.
4 Rosenbaum M. (1980). The role of the term schizophrenia in the decline of diagnoses of multiple personality [Abstract]. Archives of General Psychiatry, 37(12), 1383-5. DOI: 10.1001/archpsyc.1980.01780250069008
5 Howell, E. (2011). The Dynamic Unconscious and the Dissociative Structure of the Mind. In Understanding and treating dissociative identity disorder: A relational approach. New York: Routledge.
Also referred to as multiple personality disorder, a condition in which a person's identity dissociates, or fragments, creating additional, distinct identities that exist independently of each other within the same person.
Persons suffering from dissociative identity disorder (DID) adopt one or more distinct identities which co-exist within one individual. Each personality is distinct from the other in specific ways. For instance, tone of voice and mannerisms will be distinct, as well as posture, vocabulary, and everything else we normally think of as marking a personality. There are cases in which a person will have as many as 100 or more identities, while some people only exhibit the presence of one or two. In either case, the criteria for diagnosis are the same. This disorder was, until the publication of DSMIV, referred to as multiple personality disorder. This name was abandoned for a variety of reasons, one having to do with psychiatric explicitness (it was thought that the name should reflect the dissociative aspect of the disorder).
The DSM-IV lists four criteria for diagnosing someone with dissociative identity disorder. The first being the presence of two or more distinct "identities or personality states." At least two personalities must take control of the person's identity regularly. The person must exhibit aspects of amnesia—that is, he or she forgets routine personal information. And, finally, the condition must not have been caused by "direct physiological effects," such as drug abuse or head trauma.
Persons suffering from DID usually have a main personality that psychiatrists refer to as the "host." This is generally not the person's original personality, but is rather developed along the way. It is usually this personality that seeks psychiatric help. Psychiatrists refer to the other personalities as "alters" and the phase of transition between alters as the "switch." The number of alters in any given case can vary widely and can even vary across gender. That is, men can have female alters and women can have male alters. The physical changes that occur in a switch between alters is one of the most baffling aspects of dissociative identity disorder. People assume whole new physical postures and voices and vocabularies. One study conducted in 1986 found that in 37 percent of patients, alters even demonstrated different handedness from the host.
Statistically, sufferers of DID have an average of 15 identities. The disorder is far more common among females than males (as high as 9-to-1), and the usual age of onset is in early childhood, generally by the age of four. Once established, the disorder will last a lifetime if not treated. New identities can accumulate over time as the person faces new types of situations. For instance, as a sufferer confronts sexuality in adolescence, an identity may emerge that deals exclusively with this aspect of life. There are no reliable figures as to the prevalence of this disorder, although it has begun to be reported with increased frequency over the last several years. People with DID tend to have other severe disorders as well, such as depression, substance abuse, borderline personality disorder and eating disorders, among others.
In nearly every case of DID, horrific instances of physical or sexual child abuse—even torture—was present (one study of 100 DID patients found that 97 had suffered child abuse). It is believed that young children, faced with a routine of torture and neglect, create a fantasy world in order to escape the brutality. In this way, DID is similar to post-traumatic stress disorder, and recent thinking in psychiatry has suggested that the two disorders may be linked; some are even beginning to view DID as a severe subtype of post-traumatic stress disorder.
Treatment of dissociative identity disorder is a long and difficult process, and success (the complete integration of identity) is rare. A 1990 study found that of 20 patients studied, only five were successfully treated. Current treatment method involves having DID patients recall the memories of their childhoods. Because these childhood memories are often subconscious, treatment often includes hypnosis to help the patient remember. There is a danger here, however, as sometimes the recovered memories are so traumatic for the patient that they cause more harm.
TWO FAMOUS CASES
The stories of two women with multiple personality disorders have been told both in books and films. A woman with 22 personalities was recounted in 1957 in a major motion picture staring Joanne Woodward and in a book by Corbett Thigpen, both titled the Three Faces of Eve. Twenty years later, in 1977, Caroline Sizemore, the 22nd personality to emerge in "Eve," described her experiences in a book titled I'm Eve. Although the woman known as "Eve" developed a total of 22 personalities, only three could exist at any one time—for a new one to emerge, an existing personality would "die."
The story of Sybil (a pseudonym) was published in 1973 by Flora Rheta Schreiber, who worked closely for a decade with Sybil and her New York psychiatrist Dr. Cornelia B. Wilbur. Sybil's sixteen distinct personalities emerged over a period of 40 years.
Both stories reveal fascinating insights—and raise thought-provoking questions—about the unconscious mind, the interrelationship between remembering and forgetting, and the meaning of personality development. The separate and distinct personalities manifested in these two cases feature unique physical traits and vocational interests. In the study of this disorder, scientists have been able to monitor unique patterns of brainwave activity for the unique multiple personalities.
There is considerable controversy about the nature, and even the existence, of dissociative identity disorder. One cause for the skepticism is the alarming increase in reports of the disorder over the last several decades. Eugene Levitt, a psychologist at the Indiana University School of Medicine, noted in an article published in Insight on the News (1993) that "In 1952 there was no listing for [DID] in the DSM, and there were only a handful of cases in the country. In 1980, the disorder [then known as multiple personality disorder] got its official listing in the DSM, and suddenly thousands of cases are springing up everywhere." Another area of contention is in the whole notion of suppressed memories, a crucial component in DID. Many experts dealing with memory say that it is nearly impossible for anyone to remember things that happened before the age three, the age when much of the abuse supposedly occurred to DID sufferers.
Regardless of the controversy, people diagnosed with this disorder are clearly suffering from some profound disorder. As Helen Friedman, a clinical psychologist in St. Louis told Insight on the News, "When you see it, it's just not fake."
Arbetter, Sandra. "Multiple Personality Disorder: Someone Else Lives Inside of Me." Current Health (2 November 1992): 17.
Mesic, Penelope. "Presence of Minds." Chicago (September 1992): 100.
Sileo, Chi Chi. "Multiple Personalities: The Experts Are Split." Insight on the News (25 October 1993): 18. Sizemore, Chris Costner. I'm Eve. Garden City, NY: Doubleday, 1977.
Sybil [video recording].
Thigpen, Corbett H. The Three Faces of Eve. New York: Popular Library, 1957.
The Three Faces of Eve [videorecording]. Beverly Hills, CA: Fox Video, 1993. Produced and directed from his screenplay by Nunnally Johnson. Originally released as motion picture in 1957.
"When the Body Remembers." Psychology Today (April 1994): 9.