Written Response by: Vigneswaran Veeramuthu, MEd Psychology, BSc HRD,. Cert. Qualitative Criminology.

Questions: 1. Is Multiple Personality Disorder (MPD) the same as schizophrenia? No. Schizophrenia is mental disorder that is normally caused mostly by organic reasons especially in relation to the imbalance of specific neurotransmitters in the brain such as dopamine and serotonin. Whereas, MPD or now known as DID is disorder that is mostly related to extreme traumatic experiences mostly in early stages of childhood, insufficient childhood nurturing and innate ability to dissociate memories or experiences from consciousness. It is also believed by the proponents that it may have neurological / electrophysiological and neuropsychological roots. Having said that, patients who are suffering from DID can or may experience a wide range of symptoms such as depersonalization, derealisation, and auditory hallucination caused by alters (personalities) that can be misconstrued as schizophrenia. A lot of DID cases in the past have been diagnosed as schizophrenia.

2. What part of the brain does it affect and why? There is no specific area in the brain that one could point out and say this is the area that triggers DID. Having said that various studies show that there are distinct differences seen in various areas of the brain in DID patients. To quote a few, one study found through means of neuroimaging that DID patients have higher than normal levels of memory encoding and smaller normal parietal lobe which is located just behind frontal lobe (cerebral cortex). Another study found that DID patients show differing cerebral blood flood with different alters. They also seem to show smaller hippocampal and amyglada (temporal lobe) volumes which normally corroborates with patients who are exposed to traumatic stress like DID sufferers. 3. Is it something you are born with (hereditary) or do you develop it due to environmental factors? One twin study by Jang KL, Paris , Zweig-Frank H and Livesley WJ found hereditable factors in DID. But the reliability of this study is very much debatable as there were no real replication of this findings. I would personally take the stand that DID is triggered by complex interaction of extreme repetitive trauma and neurophysiologic entities of the individual. There are many studies that have be done that suggest that DID can also be developed iatrogenically where the patient develops these alters during therapy especially

those who are susceptible. This views though not welcomed by the proponents of DID, the questions raised are worth to be taken into consideration. 4. Do many people with MPD know that they have other personalities? The host may or may not be consciously aware of the existence of the other alters/ module/ personalities. However, the alters are more often than not, know the existence of the host or at least one of other alter. According to Silverman (2005), most people (those without DID) have one group containing their cognitive faculties, including recognition of the self, memory, intent, sensation, and consciousness allowing the person to develop one singular sense of continuous identity, and thus a single personality. This singular identity is not present in patients with DID; instead of having one singular identity, they experience many strands of the self where there is a breakdown of the cognitive faculties. In multiple personality or dissociative identity patients, several distinct states of mind or personalities reside in one body. These identities may or may not be aware of each other. In some cases the identities are aware of each other; this is referred to as "co-consciousness"-while one personality is in control, the others are in the background, in the back of the mind, aware of what the current personality is doing and seeing what the current personality sees (Brown, 2001). There are also possibilities when a memory is stored, it is claimed by the personality that was in control of the body at the time of the event; the other personalities would not refer to that event/memory as happening to themselves but instead to another personality. The awareness of other personalities and the system of memory claiming allows the multiple personalities to be unaware of the gaps in time allowing co-existence without question (Carter, 2003).

5. What might trigger a switch of personality in an MPD patient in their everyday environment? There are various reasons as to why the switch of personality is triggered in DID patients. It can be the environment in itself that consciously / unconsciously setting of the change of personality of the patient. The change of daily routines like illnesses, vacations, seminars, trips and etc can also cause the other alters to emerge sporadically. It can also be a case where the other alters/ personalities taking over when gaps of their episodic memory become distinct. 6. What is the most common number of personalities someone with MPD has?
There is a varying range of how many personalities may be present, ranging from 2 personalities to over 20 personalities within one shared body. In some extreme instances 169 (Merckelbach, 1998) alters have been recorded. Each of these personalities has its own sense of self and has its own habits of thought, emotions, and memory.

7. How long is each personality in control, on average? There are no standard answers for this but, it can range from few minutes, to hours and worst still days or weeks. But then again there no conclusive findings as to the duration of the

personality being in control. In some instances the alters can be in constant interaction with each other or the host through the auditory hearing in the mind of the DID patient 8. Does the host have a warning that their alter is about to take over? Not necessarily. 9. Is the dominant personality usually aware of everything that goes on, regardless of which personality experiences it? Yes, it is possible. These dominant personalities or alters according to some studies suggest that they can be very observant and manipulative. 10. How do you determine whether someone is really having MPD or is just faking it? DSM IV- TR have provided for some guidelines that need to followed before one is diagnosed as DID patient. The diagnostic criteria in DSM-IV (section 300.14) requires that an adult for a non-physical reason, be recurrently controlled by multiple discrete identities or personality states while also experiencing extensive memory lapses. In DSM 5, proposed diagnostic criteria are: 1. Disruption of identity characterized by two or more distinct personality states or an experience of possessions, as evidenced by discontinuities in sense of self, cognition, behaviour, affect, perceptions, and / or memories. This disruption may be reported by others or the patient 2. Inability to recall important personal information, for everyday events or traumatic events, that is inconsistent with ordinary forgetfulness 3. Causes clinically significant distress and impairment in social, occupational, or other important areas of functioning.
4. The disturbance is not a normal part of a broadly accepted cultural or religious

practice and is not due to direct physiological effects of a substance or a general medical condition such as complex partial seizures. For children, the symptoms should not be attributable to imaginary playmates or other fantasy play. So, for someone to be able to fake all these criteria would not be that easy . 11. As different personalities, do people with MPD frequently have different handwriting? Its possible. 12. Can alters be left handed if their hosts are right handed and vice versa? Yes. 13. What about cases where patients show different biological characteristics between host and alters?

As I have explained earlier, there are quite a significant number of cases where the patients have shown clear biological or the be more exact neurological differences between the host and alters. In one pertinent study by Tsai, Condie, Wu and Chang (1999), the alters showed a very clear distinctions between the alters, one had relatively normal hippocampal activity while the other had decreased hippocampal volume as the alters switched. This change was monitored through the use of fMRI. Some studies also showed change of EEG readings, change of pupil dilations and variance of skin conductance. But, arguably, these neurophysiologic studies have suffered from methodological flaws that make the findings insignificant/ generalization can be difficult. So the answer should be negative as of now until and when the methodological flaws are minimized, if not eliminated. 14. How common is this disorder in Malaysia? Though there are no statistics to be shown on the prevalence of this disorder in Malaysia, some recent extreme abnormal psychological manifestation like amok and dissociative trance disorder are being theoretically linked to DID 15. Do you know anyone who has experienced this disorder? No.