Denial and Dissimulation: Patients Usually Reject the Diagnosis of Multiple Personality and Disclaim the Evidence and Behavior on Which It is Based

With most psychological conditions, the person knows that they have it. They may or may not know what it’s called, but they know, and acknowledge, that they have the symptoms.

For example, a person with panic disorder may or may not know that they have “panic disorder,” but they know that they have panic attacks. For a psychiatrist to say, “Well, you may not know that you experience panic attacks, but I know that you do, unconsciously,” would be ridiculous.

Indeed, there is no diagnosis in the psychiatric diagnostic manual (DSM-5) that involves a psychoanalytic interpretation. And this has been true since 1980 (DSM-3), when psychoanalytic terms and concepts were deleted from the manual.

Unlike other diagnoses in the manual, the person with multiple personality usually doesn’t know that they have it. The reason is that the “patient”—the host personality—usually has amnesia for any period of time during which an alternate personality (alter) has come “out.”

But, even if the host doesn’t know that the person has multiple personality, don’t the alters know? Yes, they do have self-awareness. But, no, they don’t see it as multiple personality. To them, they are other people. (They are alters, not other people, but I’m telling you how they see it.)

Moreover, the alters don’t want either the host or any meddling outsider (like a psychiatrist) to know about them, so they usually come out incognito (answering to the regular name, even though, secretly, they may have their own name).

So how is the diagnosis made? Clues such as puzzling behavioral inconsistencies and memory gaps—the host may know that he or she has a history of memory gaps—will alert the clinician to recognize when an alter does come out. And when the alter is “caught” being out, the alter will often acknowledge who they are and provide information that can be corroborated.

How can you recognize that you are speaking to an alter? To give one clinical example, a patient once came to see me for her usual appointment, and immediately expressed outrage about the antidepressant medication that I had been prescribing for some months. She angrily insisted that I discontinue it. This surprised me, because at past appointments she had always praised the medicine and wanted to continue it.

When I remarked on her inexplicable inconsistency, the alter knew that she had been “outed.” And she explained that when the host personality took this medicine, it became very hard for the alter to come out. So the alter would sometimes hide the medicine.

Which reminded me that the patient—the host—had occasionally complained that her medicine would, mysteriously, get misplaced.

Thus, the diagnosis of multiple personality is based on overt behavior, and not on psychoanalytic interpretation. But the “patient” (host personality) will usually deny the diagnosis, and disclaim the behavior upon which the diagnosis was based, since, after all, the host doesn't remember it; and, moreover, the host doesn’t like the whole idea.

Indeed, if, prematurely, you try to prove to the host that they have multiple personality—e.g., by telling the host about a specific item that is hidden in a specific drawer at home, which the alter had told me about—then when they go home and are shocked to find that very item in that very drawer, they may drop out of treatment.