Psychiatric Times.
No. 11
A Patient with Dissociative Identity Disorder 'Switches' in the Emergency Room
By Rený J. Muller, Ph.D. |
November 1, 1998
Dr. Muller works for the Crisis Intervention Service at Union Memorial Hospital in Baltimore, Md. His books include The Marginal Self: An Existential Inquiry into Narcissism (1987), Alembics: Baltimore Sketches, Etc. (1992) and Anatomy of a Splitting Borderline: Description and Analysis of a Case History (1994). His most recent book, Beyond Marginality: Constructing a Self in the Twilight of Western Culture, has just been published by Praeger.
Many mental health care professionals who believe in the DID diagnosis insist the main personality (for this patient, Nadine) is a borderline personality. Taken as one person and one identity, Nadine does come off as thoroughly borderline. Indeed, some who do not acknowledge the validity of the DID diagnosis claim that DID patients are really just severe borderlines. But clearly, even borderline patients who are very labile do not have emotions and behaviors that coalesce around strikingly different identities to the extent of many patients diagnosed with DID, including Nadine.
If someone with DID can ultimately be considered borderline, he or she must be seen as a very different kind of borderline-perhaps one with hysterical features severe enough to warrant the diagnosis of hystrionic personality disorder.
In the attempts to distinguish one mental disorder from another, a point is sometimes reached when the notion of diagnostic specificity itself is pushed to the limit. This may be the time to quit trying to fit a patient's symptoms to one set of diagnostic criteria or another so that the more fundamental question of why a patient's life is being lived as it is-i.e., the meaning of the pathological behavior-can be asked more directly and concretely.
References
American Psychiatric Association (1994), Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C.: American Psychiatric Association.
McHugh PR (1995), Witches, multiple personalities and other psychiatric artifacts. Nat Med 1(2):110-114.
McHugh PR (1992), Psychiatric misadventures. American Scholar 61(4):497-510.
McHugh PR, Putnam FW (1995), Resolved: multiple personality disorder is an individually and socially created artifact. J Am Acad Child Adolesc Psychiatry 34(7):957-962; discussion, 962-963.
Merskey H (1992), The manufacture of personalities. The production of multiple personality disorder. Br J Psychiatry 160:327-340. See comments.
Putnam FW (1989), Diagnosis and Treatment of Multiple Personality Disorder. New York: Guilford Press.
Ross CA (1989), Multiple Personality Disorder: Diagnosis, Clinical Features and Treatment. New York: John Wiley & Sons.
Thigpen CH, Cleckley HM (1957), The Three Faces of Eve. New York: McGraw-Hill.
