Psychophysiologic Aspects of Multiple Personality Disorder A Review

Multiple personality disorder has been associated with marked psychophysiologic alterations ever since careful clinical observations have been made on this perplexing disorder. Physical symptoms known to be associated with multiple personality include headaches, conversion symptoms, changes in voice, seizure-like activity, unexplained pain or insensitivity to pain, alterations in handedness or handwriting style, palpitations, alterations in respiration, gastrointestinal disturbances including bulimia and anorexia, menstrual irregularities, sexual dysfunction, and dermatological conditions including unusual allergic responses and differential responses to medication. Early scientific studies on the galvanic skin response in multiple personality disorder were conducted by Prince in the eo.rly twentieth century. Since 1970 there has been a resurgence of interest in multiple personality disorder including sophisticated studies of physical symptoms, brain-wave activity, visual evoked potential, regional cerebral blood fWw, visual refraction, muscle activity, cardiac and respiratory activity, galvanic skin response, and the switch process. In addition to describing these studies, the etiology of multiple personality disorder and future directions in research will be dis.cussed. Marked psychophysiologic alterations are frequently described in patients with multiple personality disorder (MPD). The changes that occur across the alternate personalities are most notable. These changes have been reported almost from the beginning of the literature on MPD. For example, in 1811 Mary Reynolds, one of the earliest cases of multiple personality in the United States, suffered from blindness and deafness in her alter personality (Mitchell, 1888). In the French literature; Despine's patient, Estelle, appeared to suffer a paralysis (Despine, 1840). Dr. Morton Prince, a neurologist, was the first scientist to study MPD beyond merely providing a good clinical deSCription. He and a psychiatrist colleague, Dr. Frederick Peterson, were the first to study the galvanic skin response in MPD (Prince & Peterson, 1908). No further studies were undertaken until Morselli (1953) and Thigpen and Cleckley (1954) reported electroencephalographic differences between personalities in separate cases of MPD. Not until 1972 did Ludwig, Brandsma, Wilbur, Bendfeldt, and Jameson, perform a comprehensive scientific study of a patient with MPD. Their research included comprehensive electroencephalography, visual evoked responses, galvanic skin response, and numerous other psychophysiological tests. In 1984 Putnam observed that the psychophysiologic investigation of MPD was still in its infancy (1984a). Now, thanks to the efforts of Putnam and others, the scientific investigation of the various psyhophysiologic manifestations of MPD is enjoying a robust childhood. To date, studies have been conducted to investigate changes across personalities in virtually every organ system of the body. A variety of sophisticated techniques, including electroencephalography, visual evoked responses, galvanic skin responses, electromyography, regional cerebral blood flow, voice spectral analysis, brain electrical activity mapping, and electrocardiography have been used in the quest to better characterize and further understand MPD. This paper will attempt to summarize the major findings from these studies, offer observations upon its etiology, and suggest directions for future research. Major findings will be grouped below according to organ system. In an attempt to keep the reader abreast of the most current developments in this rapidly changing scientific field, the references cited include those which appear as abstracts in conference proceedings. Some of the studies cited here are admittedly anecdotal in nature and must await further rigorous replication before their findings may be regarded as established. In the interests of comprehensiveness, all scientific source material available to the author as of the time of this writing has been acknowledged. NEUROMUSCULAR SYSTEM Headaches One of the most common physical symptoms in MPD is severe headache. In studies reporting 20 (Coons and Milstein, 1986),70 (Bliss, 1984), and 100 (Putnam, Guroff, Silberman, Barban, & Post, 1986) MPD patients, headaches were reported to occur in 50-60 percent. Recently Packard and Brown (1986) described a 24-yearDr. Coons is Associate Professor of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana. Address reprint requests to: Philip M. Coons,M.D., Larue D. Carter Memorial Hospital, 1315 West 10th Street, Indianapolis, Indiana 46202 DISSOCIATION 1:1, March 1988 47 PSYCHOPHYSIOLOGIC ASPECTS .HII.Ill.111.11.i.i ........ ~i:m::m]][.I:.III.II.1:.iiI~Jmi!mj.i ... Ii ...... g.iIJ.;::: ...... ~ ...... ~ ..... Hm:m:ti.mi •• old woman whose seven personalities had a variety of headache types. Most headaches in MPD are tension, vascular, or a combination of both. These headaches usually are worse during personality changes.