Clinician’s First Case of Multiple Personality: After 20 Hospitalizations, 12 Wrong Diagnoses, Patient Says She Is Someone Else and There Are Five Others. 

This blog is about the normal version of multiple personality, not about multiple personality disorder, but the following clinical vignette from another psychiatrist is relevant to my recent post about “the shaking woman,” since one of the patient’s symptoms is pseudoseizures.

“When this particular patient initially came to see me, she was a competent-appearing young woman who was working fairly successfully as a psychiatric nurse. The presenting personality did not reveal to me, nor did she even know, that in her off-duty hours another personality was working as a prostitute and using fair amounts of ‘speed’ and other illicit drugs. Nor did she reveal that in the 10 preceding years she had been hospitalized 20 times under 12 different psychiatric diagnoses and had been treated with eight antipsychotics, three tricyclic antidepressants, electroconvulsive therapy (ECT), lithium carbonate, three antianxiety drugs, four anticonvulsant drugs, and prolonged individual and group psychotherapy with five different therapists (four psychiatrists and one nurse practitioner). Five months later she was hospitalized and had an extensive evaluation for status epilepticus with atypical grand mal seizures (discovered one year later to be a manifestation of rage by one of her…alternate personalities).

“Following neurologic, metabolic, and endocrinologic evaluations in a general hospital, she was transferred to my service in a psychiatric hospital. Her behavior had become alternately: hostile and demanding; fearful, tearful, and shaking; or depressed and suicidal. Two months later she led us to suspect her correct diagnosis when she told a nurse she was really someone with a name different from the one we knew her by, and that there were five others as well. There is no telling how much longer she would have remained misdiagnosed if she had not revealed herself” (1, p. 243).

I don’t know anything about this woman except what is quoted above. But I would guess that subsequent treatment was difficult. For one thing, the patient is not described as claiming or acknowledging that she has multiple personality. Although she makes a candid statement which reveals that she has multiple personality—that she is not the person the doctors think she is, that she is another person with a different name, and that there are five others—this does not mean that she thinks she has, or would accept the diagnosis of, multiple personality.

The alternate personality who spoke up no doubt thinks of herself as a person in her own right. And when the woman later switched back to her regular, host personality (the personality who has the regular name that the doctors know her by), the host personality would have a memory gap for the time that the alternate personality was in control. And so the host personality would likely say that a diagnosis of multiple personality is far-fetched and preposterous.

Otherwise, the multiple personality would have been diagnosed by one of her many other doctors, and there would not have been 20 previous hospitalizations and 12 wrong diagnoses. Indeed, if someone were to confront the host personality—“You told the other doctor that you were a different person with a different name. It’s in the record”—the host personality might reply, “Well, if I did say that, I was lying!”

However, the vignette does say that, a year later, the woman’s pseudoseizures were discovered to be a manifestation of the rage of one of her alternate personalities, so I guess she didn’t flee treatment, and that she and her psychiatrist were able to work together.

1. Richard E. Hicks, MD. “Discussion: A Clinician’s Perspective,” Chapter 10, in Richard P. Kluft, MD, PhD, Editor, Childhood Antecedents of Multiple Personality. Washington DC, American Psychiatric Press, 1985.