“The Body Keeps the Score” by Bessel A. van der Kolk, M.D.: Nonfiction bestseller on multiple personality in PTSD (Posttraumatic Stress Disorder)

“Dissociation is the essence of trauma” (1, p. 66). “…the problem with PTSD is dissociation…” (1, pp. 182-183). And as Dr. van der Kolk knows, multiple personality disorder, also known as “dissociative identity disorder,” is the premier dissociative disorder in the diagnostic manual (DSM-5).

Dr. van der Kolk does diagnose multiple personality when he sees it in its rare, atypical, overt, “classic” presentation: “It was early in my career, and I had been seeing Mary, a shy…young woman…for about three months in weekly psychotherapy…One day I opened the door to my waiting room and saw her standing there provocatively dressed in a miniskirt, her hair dyed flaming red, with a cup of coffee in one hand and a snarl on her face. ‘You must be Dr. van der Kolk,’ she said. ‘My name is Jane, and I came to warn you not to believe any of the lies that Mary has been telling you…’ Over the course of our session I met not only Jane but also a hurt little girl and an angry male adolescent. That was the beginning of a long and productive treatment. Mary was my first encounter with dissociative identity disorder (DID), which at that time was called multiple personality disorder…Exploring—even befriending—those parts is an important component of healing” (1, pp. 279-280).

But, judging by this book, he may fail to diagnose multiple personality in some other cases that he should have: “For example, one woman [in a study] described her plans for the day in a childlike, high-pitched voice, but a few minutes later, when she described stealing one hundred dollars from an open cash register, both the volume and pitch of her voice became so much lower that she sounded like an entirely different person. Alterations in emotional states were also reflected in the subjects’ handwriting. As participants changed topics, they might move from cursive to block letters and back to cursive; there were also variations in the slant of the letters and in the pressure of their pens. Such changes are called ‘switching’ in clinical practice, and we see them often in individuals with trauma histories…Switching manifests not only as remarkably different vocal patterns but also in different facial expressions and body movements. Some patients even appear to change their personal identity, from timid to forceful and aggressive or from anxiously compliant to starkly seductive. When they write about their deepest fears, their handwriting often becomes more childlike and primitive” (1, pp. 243-244).

Dr. van der Kolk may mistake a stabilizing technique for definitive treatment: “Lisa recalled dissociating when she was a little girl, but things got worse after puberty: ‘I started waking up with cuts, and people at school would know me by different names. I couldn’t have a steady boyfriend because I would date other guys when I was dissociated and then not remember. I was blacking out a lot and opening my eyes into some pretty strange situations.’ Like many severely traumatized people, Lisa could not recognize her self in a mirror [seen in multiple personality]. I had never heard of anyone describe so articulately what is was like to lack a continuous sense of self [the essence of multiple personality]. There was no one to confirm her reality…'They took me to the emergency room, but I couldn’t tell the doctor what I had done to cut myself—I didn’t have any memory of it. The ER doctor was convinced that dissociative identity disorder didn’t exist…” (1, pp. 319-320). Dr. van der Kolk does not name it that either, and is happy to report that Lisa was treated with neurofeedback. She improved, which only means that she was out of crisis, not that her multiple personality would not become overt again during the next crisis.

Comment

Multiple personality symptoms are usually hidden, and when you get rid of overt symptoms, you are just getting them back inside, where they usually are. Calming the personalities is only the initial, stabilization phase of therapy.

I still don’t think that most cases of PTSD are due to multiple personality. But after seeing Dr. van der Kolk’s authoritative, nonfiction book—which I was prompted to get by my having read James Hilton’s Random Harvest recently, and Pat Barker’s Regeneration Trilogy previously—I suspect that multiple personality may be more common than I thought among persons diagnosed with PTSD.

Fortunately, judging by my own clinical experience, and as reported by Dr. van der Kolk in the case that he did diagnose multiple personality, psychotherapy may be successful.

1. Bessel A. van der Kolk, M.D. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, Penguin Books, 2014.