An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder

Abstract

Chronic complex dissociative symptoms can be readily inquired about in the diagnostic interview leading to a clinical diagnosis of MPD in many cases. It is most useful to begin with inquiry about amnesia, autohypnotic, posttraumatic, pseudopsychotic, and passive-influence symptoms, and childhood abuse or traumatization. As this proceeds, overt dissociation is commonly noted including spontaneous trances, age-regression, blending or overlap of states, or frank switching. When this occurs, the interviewer can pursue more detailed information about the patient's experiences. Tracking these processes may readily lead to the clear appearance of an alter personality or will help make the patient sufficiently comfortable that he or she will allow the full emergence of an alter if this is directly requested. In other cases, however, methods such as use of ideomotor signals, formal induction of trance, and even barbiturate-facilitated interviews may be necessary to permit the full emergence of an alter. The symptom-cluster method is a useful clinical diagnostic tool to elicit dissociative symptoms for the diagnosis of MPD. Combined with diagnostic tools such as the DES, the DDIS, and the SCID-D, this method can help the clinician make the diagnosis of MPD in a far more expeditious and rigorous fashion. In addition, all psychiatric patients should be screened for a history of blackouts, time loss, trance experiences, childhood trauma, and PTSD symptoms. This will improve case finding to help clinicians begin to treat the single largest preventable cause of mental illness: the sequelae of childhood abuse, trauma, and family violence.