Unawareness and Denial of Pregnancy in Patients with Mpd

In female MPD patients, sexual intercourse and pregnancy are experiences of which only one or a few alter personalities may he aware. 7ien the host personality i.s is amneslir for these dissociated functions, severe complications may arise both for the affected woman and those around her. When the amnesia is lifted, the personalities involved may experience pregnancy and delivery as traumatic, and motherchild attachment may be severely hampered. This paper describes four case examples illustrating these complications. Two of them are classic 19th Century cases, Bellanger'.s (1854) Madame de B. and Azam s (1887) Felida X. The fact that in the 1854 case it was the treating physician who fathered the child dramatically illustrates Kluft's recent observations that these patients run the risk of sexual abuse 11 their psychotherapists and other health care professionals. The discussion section deals with.(1) Pierre Janet s views on unawareness and denial in MPD, as illustrated in sexual intercourse, pregnancy, and delivery; (2) the so-called partus stress rearlion, for which MPD patients with a childhood history of sexual abuse may beat risk; (3) trauma-induced psychotic reactions todelivery; (4) techniques for supporting patients with these issues; and (5) sexual abuse of MPD patients by therapists. Although not tnentioned as such in the D.SM-III-R (American Psychiatric Association, 1987), amnesia is a central characteristic of multiple personality disorder (MPD) (Putnam, 1989; Ross, 1989). The existence of amnesia for actions executed by dissociated parts of the personality can create difficulties and complications in the lives of MPD patients. One of the areas where this can be experienced most painfully is sexuality and pregnancy. Because of the frequent presence of sexual abuse in childhood and associated pregnancy fears, these areas are intrinsically problematic for many MPD patients. As reported in 19th Century case reports, amnesia for intercourse leading to pregnancy and the subsequent unawareness and denial of pregnancy constitute additional complications. Denial of pregnancy has been previously reported before in cross-cultural contexts and in incest victims (cf. Silverblatt & Goodwin, 1983), as well as in psychotic women (Miller, 1990). It is here described in women suffering from MPD, using both early literature reports and examples from the authors ' practice. We discuss how amnesia and pregnancy denial relate to each other. Special attention is given to the fact that the delivery itself can be traumatic for the MPD patient, and to techniques clinicians can use to help their pregnant MPD patients control symptoms during pregnancy, labor, and delivers'.