Preliminary Notes on Mpd and Allied Forms of Dissociative Disorder Not Otherwise Specified in Practicing Psychotherapists

Dissociative disorders, including multiple personality disorder and allied forms of dissociative disorder not othenuise specified, were encountered in 20 practicing psychotherapists. Detailed reportage is precluded by considerations of confidentiality. Selected topics with regard to their professional functioning, diagnosis, phenomenology, treatment, and prognosis will be discussed. Multiple personality disorder (MPD) and allied forms of dissociative disorder not otherwise specified (DDNOS) are increasingly appreciated to be relatively commonplace conditions. As more clinicians become sensitized to the dissociative disorders, and develop a higher index of suspicion for their subtle as well as their more overt manifestations, they are being discovered in patient groups with which severe dissociative psychopathologies are not traditionally associated. The first such patient group to be identified was children. Following upon the first modern reports by Fagan and McMahon (1984) andKIuft (1984a), a fledgling literature on this subject, recently reviewed by Peterson (1990), has developed. Adolescents with MPD were discussed by Bowman, Blix, and Coons, and by KIuft in 1985, and are the subject of two recent studies (Dell & Eisenhower, 1990; KIuft& Schultz, in press). MPDin the elderly was discussed by KIuft (1985, 1988a). Among the many other relatively novel and new groups in which these conditions are being appreciated are the pseudoretarded (Atlas, Fine, &KIuft, 1988), the blind (Ohberg, 1984), the deaf (Bowman, 1989), and those who function at a very high level (KIuft, 1986). On an informal basis, the existence ofMPD and DDNOS with features of MPD in mental health professionals is an increasingly appreciated phenomenon within the dissociative disordersfield. Significantnumbers ofcolleagueshave identified themselves to experiencedclinicians and scientific investigators within the field as suffering this sort of condition, often in conversation after the person to whom they reveal themselves has made a presentation they have attended, or by seeking consultation or treatment. I am informed by patients and colleagues who themselves are survivors of childhood trauma thatitis notuncommon for therapistswho are survivors ofchild abuse and are making presentations on dissociative disorders at meetings of"survivors' groups" or support groups to identify themselves as suffering the condition about which they are speaking; on occasions presenters at scientific meetings on dissociative disorders have done the same. Therefore, it seems timely to present some preliminary observations on this group of individuals. The published literature makes little reference to psychotherapists with dissociative disorders. A number of the dozen patients noted in my 1986 article on high-functioning MPD patients were, in fact, mental health professionals. However, in the interest of discretion, this was not discussed in the text of the article. In 1988(b) I described a psychologist who suffered fugues. I alluded to the difficulties of therapists who suffered dissociative disorders as a specific subgroup among psychotherapists overwhelmedby theirworkwith MPD patients (KIuft, 1989). I observed that "Counteridentification often compromises their therapeutic capacities; they may find themselves triggered by the patient's memories and difficulties. It can be very difficult for such therapists, who may continue to heal themselves in others, to be objective about their difficulties withMPD patients. Theyoften have knowinglyorunconsciously gambled heavily upon their ability to achieve vicarious mastery bytheirtreatmentofothers" (1989a, pp. 245-246). Itisimportant to note that this was a discussion of overwhelmed therapists, and should not be understood to characterize all therapists who suffer dissociative disorders. In anotheraccount, I described my encounters with several impaired psychiatry residents and graduate students in psychiatry who suffered dissociative disorders (1990). The current communication is based on experience with 20 practicing psychotherapists who suffered MPD or DDNOS with features of MPD. It does not include mental health professionals seen for psychogenic fugue, psychogenic amnesia, depersonalization disorder, and DDNOS without features