George Fraser

Schneiderian symptoms in multiple personality disorder and schizophrenia

We report structured interview data from a series of 102 cases of multiple personality disorder (MPD) diagnosed in four centers. Schneiderian first-rank symptoms of schizophrenia were equally common in all four centers. The average MPD patient had experienced 6.4 Schneiderian symptoms. When these 102 cases are combined with two previously reported series of MPD cases, an average of 4.9 Schneiderian symptoms in 368 cases of MPD is noted. This compares with an average of 1.3 symptoms acknowledged by 1,739 schizophrenics in 10 published series. Schneiderian symptoms are more characteristic of MPD than of schizophrenia.

Abuse histories in 102 cases of multiple personality disorder

The authors interviewed 102 individuals with clinical diagnoses of multiple personality disorder at four centres using the Dissociative Disorders Interview Schedule. The patients reported high rates of childhood trauma: 90.2% had been sexually abused, 82.4% physically abused, and 95.1% subjected to one or both forms of child abuse. Over 50% of subjects reported initial physical and sexual abuse before age five. The average duration of both types of abuse was ten years, and numerous different perpetrators were identified. Subjects were equally likely to be physically abused by their mothers or fathers. Sexual abusers were more often male than female, but a substantial amount of sexual abuse was perpetrated by mothers, female relatives, and other females. Multiple personality disorder appears to be a response to chronic trauma originating during a vulnerable period in childhood.

Book Review: Posttraumatic Stress Disorder: Advances in the Treatment of Posttraumatic Stress Disorder: Cognitive-Behavioral PerspectivesAdvances in the Treatment of Posttraumatic Stress Disorder: Cognitive-Behavioral PerspectivesTaylorSteven, editor. New York (NY): Springer Publication Company, Inc; 2004. 326 p. US

Aggression, happily, may find healthier outlets. For selected boys, group therapy offers the opportunity, among peers, to shed secrecy and, by slow degrees, to open to the group shameful recesses of their private worlds. Woods reports on the relief that boys feel as they gradually disburden themselves of their secrets. It is only then that their social development, previously retarded, can begin to move in the direction of social responsibility. An encouraging example, which becomes possible once the group has gained cohesion, occurs when each boy writes a letter or a poem in the voice of an abused child and then, conversely, writes a letter of apology to his victims. Creative tasks such as these are workable if the cotherapists—2 therapists being preferable to one—manage to diminish the power of their authority as the boys’ own authority increases. “The negotiation of power relations in a group,” Woods says, “is of crucial importance to the adolescent’s recovery of faith in a non-abusive world” (p 109).

48.95.

Because the dual diagnosis of posttraumatic stress disorder (PTSD) and substance abuse is rather common (according to this book the figures are 12% to 34% for women and 30% to 59% for men), I was pleased to discover a book that focuses on this specific area. The author notes, “most clinical programs treat PTSD and substance abuse, but rarely both. The majority of patients with PTSD and substance abuse do not receive PTSD-focused treatment.” The inspiration for the book is apparent from the observation, “Treatments that are effective for PTSD or substance abuse separately may not be advisable when the two disorders occur together.”