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Inpatient Treatment of Dissociative Disorders

  • Walter C. Young
  • Linda J. Young

Abstract

The past two decades have seen an explosion in the diagnosis of severe dissociative disorders, including dissociative identity disorder (DID), formerly multiple personality disorder (MPD), and a variety of other related syndromes lacking the clinical specificity of dissociative identity disorder (Barkin, Braun, & Kluft, 1986; Bliss, 1986; Bliss & Jeppsen, 1985; Braun, 1986; Coons, Bowman, & Milstein, 1988; Kluft, 1984a,b, 1991a,b; Quimby, Andrei, & Putnam, 1993; Greaves, 1980, 1993; Putnam, 1986; Putnam, Guroff, Silberman, Barban, & Post, 1986; Ross, 1989, 1991; Ross, Norton, & Wozney, 1989). Fortunately, the Diagnostic and Statistical Manual for Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association, 1994) has renamed multiple personality disorder to dissociative identity disorder (DID), which will more accurately represent dissociative conditions as belonging to a continuum of trauma-related syndromes that disrupt normal identity formation using prominent dissociative defenses. This renaming will go a long way to end confusion that MPD is a bizarre condition in which many persons exist in a single mind and will shift clinical focus to a more traditional psychological framework where the disorder of identity reflects a dissociative elaboration that owes its complexity to early and prolonged child abuse (Coons et al., 1988; Putnam, 1985, 1989; Putnam et al., 1986; Kluft, 1984a, 1990, 1991a,b; Ross, 1989; Ross et al., 1989; Spiegel, 1984).

Keywords

False Memory Inpatient Treatment Psychiatric Clinic Traumatic Memory Dissociative Condition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Adams, K. (1990). Journal to the self 22 paths to personal growth. New York: Warner Books.Google Scholar
  2. Adams, K. (1993). The way of the journal . A journal therapy workbook for healing. Lutherville, MD: Sidran Press.Google Scholar
  3. American Medical Association (1985). Report of the American Medical Association Council on Scientific Affairs: Scientific status of refreshing recollection by the use of hypnosis. Journal of the American Medical Association, 253, 1918–1923.CrossRefGoogle Scholar
  4. American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.Google Scholar
  5. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders ( 4th ed. ). Washington, DC: Author.Google Scholar
  6. Barach, P. M. (1994). International Society for the Study of Dissociation (ISSD) guidelines for treating dissociative identity disorder (multiple personality disorder) in adults from standards of committee. Google Scholar
  7. Barkin, R., Braun, B. G., and Kluft, R. P. (1986). The dilemma of drug therapy for multiple personality disorder. In B. G. Braun (Ed.), Treatment of multiple personality disorder (pp. 107–132 ). Washington, DC: American Psychiatric Press.Google Scholar
  8. Benjamin, L., and Benjamin, R. (1992). An overview of family treatment in dissociative disorders. Dissociation, 5, 236–241.Google Scholar
  9. Bliss, E. L. (1986). Multiple personality, allied disorders and hypnosis. New York: Oxford University Press.Google Scholar
  10. Bliss, E L, and Jeppsen, E. A. (1985). Prevalence of multiple personality among inpatients and outpatients. American Journal of Psychiatry, 142, 250–251.PubMedGoogle Scholar
  11. Board of Trustees, American Psychiatric Association (1993). Statement on memories of sexual abuse. Washington, DC: Author.Google Scholar
  12. Braun, G. G. (1984). Uses of hypnosis with multiple personality disorder. Psychiatric Annals, 14, 34–40.Google Scholar
  13. Braun, B. G. (1985). The transgenerational incidence of dissociation and multiple personality disorder: A preliminary report. In R. P. Kluft (Ed.), Childhood antecedents of multiple personality (pp. 127–150 ). Washington, DC: American Psychiatric Press.Google Scholar
  14. Braun, B. G. (1986). Issues in the psychotherapy of multiple personality disorder. In B. G. Braun (Ed.), Treatment of multiple personality disorder (pp. 1–28 ). Washington, DC: American Psychiatric Press.Google Scholar
  15. Braun, B. G. (1990). Unusual medication regimens in the treatment of dissociative disorder patients. Part I: Noradrenergic agents. Dissociation, 3, 144–150.Google Scholar
  16. Braun, B. G. (1993). Aids to the treatment of multiple personality disorder on a general psychiatric inpatient unit. In R. P. Kluft, C. G. Fine (Eds.), Clinical perspectives on multiple personality disorder (pp. 155–178). Washington, DC: American Psychiatric Press.Google Scholar
  17. Briere, J., and Conte, J. (1993). Self-reported amnesia for abuse in adults molested as children. Journal of Traumatic Stress, 6, 21–31.CrossRefGoogle Scholar
  18. Brown, D. (1995). Pseudomemories: The standard of science and the standard of care in trauma treatment. American Journal of Clinical Hypnosis, 37, 1–24.PubMedCrossRefGoogle Scholar
  19. Caul, D. (1984). Group and video tape techniques for multiple personality disorder. Psychiatric Annals, 14, 46–50.Google Scholar
  20. Cohen, L. M., Bergoff, J. N., and Elias, M. R. (Eds.). (1995). Dissociative identity disorder: Theoretical and treatment controversies. Northvale, NJ: Aronson.Google Scholar
  21. Cohen, B. M., and Cox, C. T. (1989). Breaking the code: Identification of multiplicity through art productions. Dissociation, 2, 132–137.Google Scholar
  22. Colligan, M. J., Pennebaker, J. W, and Murphy, L. R. (1982). Mass psychogenic illness: A social psychological analysis. Hills Dale, NJ: Erlbaum.Google Scholar
  23. Coons, P. M. (1994a). Confirmation of child abuse in child and adolescent cases of multiple personality disorder and dissociative disorder not otherwise specified. Journal of Nervous and Mental Diseases, 182, 461–464.CrossRefGoogle Scholar
  24. Coons, P. M. (1994b). Report of Satanic ritual abuse: Further implications about pseudomemories. Perceptual and Motor Skills, 78, 1376–1378.PubMedCrossRefGoogle Scholar
  25. Coons, R M., Bowman, E. S., and Milstein, V. (1988). Multiple personality disorder: A clinical investigation of 50 cases. Journal of Nervous and Mental Disease, 176, 519–527.PubMedCrossRefGoogle Scholar
  26. Fine, C. G. (1988). Thoughts on the cognitive perceptual substrates of multiple personality disorder. Dissociation, 1, 5–10.Google Scholar
  27. Fine, C. G. (1991). Treatment stabilization and crisis prevention: Pacing the therapy of the multiple personality disorder patient. Psychiatric Clinics of North America, 14, 661–675.PubMedGoogle Scholar
  28. Frankel, F. H., and Perry, C. W. (Eds.) (1994). Special issue: Hypnosis and delayed recall: Part I. International Journal of Clinical and Experimental Hypnosis, 42.Google Scholar
  29. Frankel, E. H., and Perry, C. W. (Eds.) (1994). Special issue: Hypnosis and delayed recall: Part R. International Journal of Clinical and Experimental Hypnosis, 43.Google Scholar
  30. Frischholz, E. (Ed.) (1994). American Journal of Clinical Hypnosis, 36. Google Scholar
  31. Ganaway, G. K. (1989). Historical versus narrative truth: Clarifying the role of exogenous trauma in the etiology of MPD and its variants. Dissociation, 2, 205–220.Google Scholar
  32. Garry, M., and Loftus, E. (1994). Pseudomemories without hypnosis. International Journal of Clinical and Experimental Hypnosis, 42, 363–378.PubMedCrossRefGoogle Scholar
  33. Gelinas, D. J. (1995). Dissociative identity disorders and the trauma paradigm. In L. M. Cohen, J. N. Bergoff, M. R. Elias (Eds.) Dissociative identity disorder: Theoretical and treatment controversies (pp. 175–222 ). Northvale, NJ: Aronson.Google Scholar
  34. Greaves, G. B. (1980). Multiple personality: 165 years after Mary Reynolds. Journal of Nervous and Mental Disease, 168, 577–596.PubMedCrossRefGoogle Scholar
  35. Greaves, G. B. (1992). Alternative hypotheses regarding claims of Satanic cults: A critical analysis.“ In D. K. Sakheim and S. E Devine (Eds.) Out of darkness: Exploring Satanism and ritual abuse. New York: Lexington Books.Google Scholar
  36. Greaves, G. B. (1993). A history of multiple personality disorder. In R. P. Kluft and C. G. Fine (Eds.), Clinical perspectives on multiple personality disorder (pp. 335–380 ). Washington, DC: American Psychiatric Press.Google Scholar
  37. Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.Google Scholar
  38. Horowitz, M. J. (1986). Stress response syndromes. Northvail, NJ: Jason Aronson.Google Scholar
  39. Kihlstrom, J. F. (1994). Hypnosis, delayed recall, and the principles of memory. International Journal of Clinical and Experimental Hypnosis, 42, 337–345.PubMedCrossRefGoogle Scholar
  40. Klein, H., Mann, D. R., and Goodwin, J. M. (1994). Obstacles to the recognition of sexual abuse and dissociative disorders in child and adolescent males. Dissociation, 7, 138–144.Google Scholar
  41. Kluft, R. P. (1982). Varieties of hypnotic intervention in the treatment of multiple personality. American Journal of Clinical Hypnosis, 24, 230–240.PubMedCrossRefGoogle Scholar
  42. Kluft, R. P. (1983). Hypnotherapeutic crisis intervention in multiple personality. American Journal of Clinical Hypnosis, 26, 73–83.PubMedCrossRefGoogle Scholar
  43. Kluft, R. P. (1984a). Aspects of the treatment of multiple personality disorder. Psychiatric Annals, 14, 51–55.Google Scholar
  44. Kluft, R. P. (1984b). Treatment of multiple personality: A study of 33 cases. Psychiatric Clinics of North America, 7, 9–29.PubMedGoogle Scholar
  45. Kluft, R. P. (1989). Playing for time: Temporizing techniques in the treatment of multiple personality disorder. American Journal of Clinical Hypnosis, 32, 90–98.PubMedCrossRefGoogle Scholar
  46. Kluft, R. P. (1990). Incest and subsequent revictimization: The case of therapist-patient sexual exploitation, with a description of the sitting duck syndrome. In R. P. Kluft (Ed.), Incest-related syndromes of adult psychopathology (pp. 263–287 ). Washington, DC: American Psychiatric Press.Google Scholar
  47. Kluft, R. P. (1991a). Multiple personality disorder. In A. Tasman and S. M. Goldfinger (Eds.), American Psychiatric Press annual review of psychiatry (Vol. 10, pp. 161–188 ). Washington, DC: American Psychiatric Press.Google Scholar
  48. Kluft, R. P. (1991b). Hospital treatment of multiple personality disorder: An overview. Psychiatric Clinics of North America, 14, 695–719.PubMedGoogle Scholar
  49. Kluft, R. P. (1994). Editorial. Ruminations on metamorphoses. Dissociation, 7, 138–144.Google Scholar
  50. Kluft, R. P. (1995). Current controversies surrounding dissociative identity disorder. In L. M. Cohen, J. N. Bergoff, and M. R. Elfin (Eds.), Dissociative identity disorder: Theoretical and treatment controversies (pp. 347–378 ). Northvale, NJ: Aronson.Google Scholar
  51. Koss, M. P, Trompe, S. and Tharan, M. (1995). Traumatic memories: Empirical foundations, forensic and clinical implications. Clinical Psychology: Science and Practice, 2, 111–132.CrossRefGoogle Scholar
  52. Kroll, J. (1993). PTSD/borderlines in therapy: Finding the balance. New York: Norton.Google Scholar
  53. Lanning, K. V. (1992). A law enforcement perspective on allegations of ritual abuse. In D. K. Sakheim and S. E Devine (Eds.), Out of Darkness: Exploring Satanism and Ritual Abuse (pp. 109–146 ). New York: Lexington Books.Google Scholar
  54. Loewenstein, R. J. (1991). Rational psychopharmacology in the treatment of multiple personality disorder. Psychiatric Clinics of North America, 14, 721–740.PubMedGoogle Scholar
  55. Loewenstein, R. J., Hornstein, N., and Farber, B. (1988). Open trial of clonazepam in the treatment of post-traumatic stress symptoms in MPD. Dissociation, 1, 3–12.Google Scholar
  56. Loftus, E. (1993). Reality of repressed memories. American Psychologist, 48, 518–537.PubMedCrossRefGoogle Scholar
  57. Loftus, E. (1995). The myth of repressed memory: False memories and allegations of sexual abuse. New York: St. Martin’s Press.Google Scholar
  58. Lynn, E J. and Nash, M. R. (1995). Truth in memory: Ramifications for psychotherapy and hypnotherapy. American Journal of Clinical Hypnosis, 36, 194–208.CrossRefGoogle Scholar
  59. Markush, R. E. (1973). Mental epidemics-A review of the old to prepare for the new. Public Health Reviews, 2, 353–442.Google Scholar
  60. Mersky, H. (1995). The manufacture of personalities: The production of multiple personality disorder. In L. M. Cohen, J. N. Bergoff, and M. R. Elfin (Eds.), Dissociative identity disorder . Theoretical and treatment controversies (pp. 3–32 ). Northvale, NJ: Aronson.Google Scholar
  61. Mills, A., and Cohen, B. M. (1993). Facilitating the identification of multiple personality disorder through art: The diagnostic drawing series. In E. Kluft (Ed.), Expressive and functional therapies in the treatment of multiple personality disorder (pp. 39–66 ). Springfield, IL: Charles C. Thomas.Google Scholar
  62. Mulhern, S. (1991). Embodied alternative identities: Bearing witness to a world that might have been. Psychiatric Clinics of North America, 14, 769–786.PubMedGoogle Scholar
  63. Mulhern, S. (1994). Satanism, ritual abuse and multiple personality disorder: A sociohistorical perspective. International Journal of Clinical and Experimental Hypnosis, 42, 265–288.PubMedCrossRefGoogle Scholar
  64. Nash, M. R. (1994). Memory distortion and sexual trauma: The problem of false negatives and false positives. International Journal of Clinical and Experimental Hypnosis, 42, 346–361.PubMedCrossRefGoogle Scholar
  65. Orne, M. T. (1979). The use and misuse of hypnosis in court. International Journal of Clinical and Experimental Hypnosis, 27, 311–341.PubMedCrossRefGoogle Scholar
  66. Pettinati, H. M. (Ed.). (1988). Hypnosis and memory. New York: Guilford Press.Google Scholar
  67. Powers, F. M. (1991). Fantasy-proneness, amnesia, and the UFO abduction phenomena. Dissociation, 4, 46–54.Google Scholar
  68. Putnam, F. W. (1985). Dissociation as a response to extreme trauma. In R. P. Kluft (Ed.), Childhood antecedents of multiple personality disorder (pp. 65–97 ). Washington, DC: American Psychiatric Press.Google Scholar
  69. Putnam, F. W. (1986). The treatment of multiple personality: State of the art. In B. G. Braun (Ed.), Treatment of multiple personality disorder (pp. 175–198 ). Washington, DC: American Psychiatric Press.Google Scholar
  70. Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. New York: Guilford Press.Google Scholar
  71. Putnam, E. W. (1991). The satanic ritual abuse controversy. Child Abuse and Neglect, 15, 175–179.PubMedCrossRefGoogle Scholar
  72. Putnam, E W, Guroff, J. J., Silberman, E. K., Barban, L. S., and Post, R. N. (1986). The clinical phenomenology of multiple personality disorder: A review of 100 recent cases. Journal of Clinical Psychiatry, 47, 285–293.Google Scholar
  73. Quimby, L. G., Andrei, A., and Putnam, E. W. (1993). The deinstitutionalization of patients with chronic multiple personality disorder. In R. P. Kluft and C. G. Fine (Eds.), Clinical perspectives on multiple personality disorder (pp. 201–226 ). Washington, DC: American Psychiatric Press.Google Scholar
  74. Richardson, J. T, Best, J., and Bromley, D. G. (1991). The satanism scare. New York: Aldine de Gruyer.Google Scholar
  75. Ross, C. A. (1989). Multiple personality disorder: Diagnosis, clinical features and treatment. New York: John Wiley.Google Scholar
  76. Ross, C. A. (1995). The validity and reliability of dissociative identity disorder. In L. M. Cohen, J. N. Bergoff, and M. R. Elfin (Eds.), Dissociative identity disorder: Theoretical and treatment controversies (pp. 65–86 ). Northvale, NJ: Aronson.Google Scholar
  77. Ross, C. A. (1991). Epidemiology of multiple personality disorder and dissociation. Psychiatric Clinics of North America, 14, 503–518.PubMedGoogle Scholar
  78. Ross, C. A., Norton, G. R., and Wozney, K. (1989). Multiple personality disorder: An analysis of 236 cases. Canadian Journal of Psychiatry, 34, 413–418.Google Scholar
  79. Sachs, R. G. (1986). The adjunctive role of social support systems in the treatment of multiple personality disorder. In E. G. Braun (Ed.), Treatment of multiple personality disorder (pp. 157–174 ). Washington, DC: American Psychiatric Press.Google Scholar
  80. Sachs, R. G. (1990). The sandtray technique in the treatment of patients with dissociative disorders: Recommendations for occupational therapists. American Journal of Occupational Therapy, 44, 1045–1047.PubMedCrossRefGoogle Scholar
  81. Sachs, R. G., Frischoltz, E. J., and Wood, J. I. (1988). Marital and family therapy in the treatment of multiple personality disorder. Journal of Marital and Family Therapy, 14, 249–259.CrossRefGoogle Scholar
  82. Sakheim, D., and Devine, S. (1992). Out of darkness-Exploring satanism and ritual abuse. New York: Lexington Books.Google Scholar
  83. Sakheim, D. K., Hess, E. P, and Chivas, A. (1986). General principles for short-term inpatient work with multiple personality disorder. Psychotherapy, 25, 117–124.CrossRefGoogle Scholar
  84. Simpson, M. A. (1995). Gullible’s travels, or the importance of being multiple. In L. M. Cohen, J. M. Bergoff, and M. R. Elin (Eds.), Dissociative identity disorder: Theoretical and treatment controversies (pp. 87–134 ). Northvale, NJ: Aronson.Google Scholar
  85. Spanos, N. P, Burgess, C. A. and Burgess, M. F. (1994). Past-life identities, UFO abductions, and satanic ritual abuse: The social construction of memories. International Journal of Clinical and Experimental Hypnosis, 42, 433–436.Google Scholar
  86. Spence, D. P. (1994). Narrative truth and putative child abuse. International Journal of Clinical and Experimental Hypnosis, 42, 289–303.PubMedCrossRefGoogle Scholar
  87. Spiegel, D. (1984). Multiple personality as a post-traumatic stress disorder. Psychiatric Clinics of North America, 7, 101–110.PubMedGoogle Scholar
  88. Terr, L. (1990). Too scared to cry: Psychic trauma in childhood. New York: Harper and RowGoogle Scholar
  89. Terr, L. (1994). Unchained memories: True stories of traumatic memories, lost and found. New York: Basic Books.Google Scholar
  90. Benschoten, S. C. (1990). Multiple personality disorder and satanic ritual abuse: The issue of credibility. Dissociation, 3, 22–30.Google Scholar
  91. Kolk, B. A. (1987). Psychological trauma. Washington, DC: American Psychiatric Press.Google Scholar
  92. Kolk, B. A. (1989). The compulsion to repeat the trauma: Re-enactment, revictimization and masochism. Psychiatric Clinics of North America, 12, 389–411.PubMedGoogle Scholar
  93. Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry, 1, 253–265.PubMedCrossRefGoogle Scholar
  94. Victor, J. S. (1993). Satanic panic: The creation of a contemporary legend. Chicago: Open Court.Google Scholar
  95. Watzlawick, P. (1984). The invented reality. How do we know what we believe we know? Contributions to constructivism. New York: Norton.Google Scholar
  96. Williams, L. M. (in press). Adult memories of childhood abuse: Preliminary findings from a longitudinal study. The Advisor. Google Scholar
  97. Wilson, S. C. and Barber, T X. (1993). Fantasy-prone personality: Implications for understanding imagery, hypnosis and parapsychological phenomena. In H. A. Sheik (Ed.), Imagery: Current Theory, Research, and Application (pp. 340–387 ). New York: John Wiley.Google Scholar
  98. Yapko, M. D. (1994). Suggestibility and repressed memories of abuse: A survey of psychotherapists’ beliefs. American Journal of Clinical Hypnosis, 36, 163–171.PubMedCrossRefGoogle Scholar
  99. Young, W. C. (1988a). Observations on fantasy in the formation of multiple personality disorder. Dissociation, 1, 13–20.Google Scholar
  100. Young, W. C. (1988b). Psychodynamics and dissociation: All that switches is not split. Dissociation, 1, 33–38.Google Scholar
  101. Young, W. C. (1992). Recognition and treatment of survivors reporting ritual abuse. In D. Sakheim and S. Devine (Eds.), Out of darkness—Exploring satanism and ritual abuse (pp. 249–278 ). New York: Lexington Books.Google Scholar
  102. Young, W. C., Sachs, R. G., Braun, B. G., and Watkins, R. T (1991a). Patients reporting ritual abuse in childhood: A clinical syndrome. International Journal of Child Abuse and Neglect, 15, 181–189.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Walter C. Young
    • 1
  • Linda J. Young
    • 1
  1. 1.Del Amo HospitalNational Treatment Center for Traumatic and Dissociative DisordersTorranceUSA

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