The psychological organization of multiple personality disordered patients as revealed in psychological testing.

Résumé

The reader familiar with the borderline literature may see a correspondence between certain of our MPD/DD Rorschach results and typical borderline characteristics. Most notably, both groups reason and view others in unusual but not psychotic ways and demonstrate certain difficulties in affect integration. On the other hand, the MPD/DD group exhibits many attributes that contradict predictions one would make from a borderline perspective, and which support Kluft's assertion that the majority of these patients have a more complex and structured personality system. Rather than holding oversimplified attitudes, they are attuned to the subtleties of experience. Their generally introversive personality style reflects a capacity for internalization, for ideational organization of anxiety, for taking analytic distance from themselves, and for viewing and relating to others in a complex and empathetic fashion. To return to our metaphor of the explorer, we can conclude that the borderline personality concept gives us too broad and blurred a view of the MPD/DD terrain. It lacks the level of specificity needed to describe the test phenomena that appear on these MPD/DD Rorschachs. The special test instructions, behavior ratings of extra-test dissociative phenomena, and the posttest process questions enable us to see that although at gross level certain vulnerabilities resemble borderline characteristics, the processes underlying these phenomena are quite distinct. Moreover, unexpected areas of strength and maturity also exist. These findings suggest that we are not viewing a developmental arrest, but rather, are seeing the signs of what developmental psychologists call a "strange" development i.e., an atypical developmental pathway created by unusual interactions with the world. It may well be that much of the difficulty in establishing the validity of BPD test criteria has been due to the unwitting inclusion of DD patients within these studies. If so, the distinction between borderline and dissociative test characteristics will lead to more accurate and refined studies of both groups. The concept of PTSD has been a particularly useful dimension for elucidating MPD test phenomena. As we further investigate commonalities and differences within the MPD/DD continuum, it will be interesting to examine in what way the severity of these patients' PTSD relates to their personality characteristics, symptom patterns, and treatment response. The strength of psychological assessment has long been its ability to describe the organization of psychological processes to gain a detailed knowledge of the individual. As such, in the hands of well-trained clinicians, psychological assessment has been one of the most powerful tools for predicting long-term treatment outcome.(ABSTRACT TRUNCATED AT 400 WORDS)