Dissociative Identity Disorder used to be known as Multiple Personality Disorder. At that time, amnesia was not a required criterion for the diagnosis, meaning that any system could potentially wind up diagnosed with MPD if seen by a psychiatrist (assuming that their plurality was detected at all- diagnosis rates for DID are fairly low, and old articles for MPD often note that there was a small window of diagnosability).
The shift from MPD to DID raises an interesting question about diagnostic labels. There are systems who were diagnosed with MPD who did not qualify for a DID diagnosis. Some of these people may have been diagnosed with Otherwise Specified or Unspecified Dissociative Disorders instead, but some of them may not have received a diagnosis at all after the change. Are these people still plural? Does psychiatry get to decide what someone’s reality is, or can plurality exist independently from the psychiatric framework? And if plurality does exist as an independent phenomenon, then what defines plurality?
I’d encourage thinking about it for yourself and forming your own ideas, particularly if you identify as a plural group- that said, see Labels are Words.
Writing on MPD
Much of the writing on MPD can be a window into different ways that medicalized plural systems existed at the time, and many of these presentations likely still exist now. They may not qualify for a DID diagnosis in all cases, but they can happen.
There is no one, universal way for a mind to function. Two different systems will develop in their own ways in response to the unique environments they were exposed to in their lives, and they will function differently as a result. Remembering this makes it much easier to work with your own system instead of trying to work with the stereotype of someone else’s system.
Kluft on MPD Presentations, 1991
The natural history of multiple personality disorder involves most individuals’ making very different presentations over the course of their patient careers (…) most patients who satisfy DSM-III criteria for multiple personality disorder at some points in time do not satisfy such criteria at others. (…) Approximately 20% of MPD patients spend the majority of their adult lives in an overtly MPD adaptation. Of these, approximately only 6% make a consistent and florid attention-seeking appearance on an ongoing basis at certain periods in the course of their patient careers; the remaining 14% are overtly MPD on an ongoing basis for long periods, but they do not call attention to themselves and try to pass with their condition remaining covert.
In terms of the patient’s needs, the personalities need only be as distinct, public, and elaborate as becomes necessary in the handling of stressful situations.
Another dimension is the alters’ pattern of cooperation. If it is high the alters may share contemporary memory, try to pass for one another, and come out smoothly in tandem to deal with problem areas. Neither amnesia nor overt differences may be readily apparent.
Another aspect of overtness is the manner in which the alters learn to influence one another. If they do so by inner dialog, no overt signs of MPD may be observed.
Kluft’s List of Non-Classical Presentations, 1991
Latent MPD describes patients whose alters are generally inactive but are triggered to emerge infrequently by intercurrent stressors, many of which are analagous to, symbolic of, or trigger memories of childhood trauma. For example, some MPD patients only become overt when their own children reach the ages at which they had been traumatized, or when their abusers become ill or die.
Posttraumatic MPD is clandestine until the patient experiences an overwhelming contemporary event. Object loss, rape, combat, witnessing of violence, betrayal, and head trauma sufficient to cause organic amnesia are not uncommon precipitants. Often a review of childhood events reveals a history suggestive of childhood MPD gone dormant.
Extremely Complex or Polyfragmented MPD occurs when there is a wide variety of alter personalities and their comings and going are so frequent and/or ephemeral that it is hard to discern the outline of the MPD behind the rapidly fluctuating and switching manifestations. Ironically, the patient has become so multiple that the multiplicity disguises itself and rarely takes a classic form.
Epochal or Sequential MPD occurs when switches are rare - the newly emergent alter simply takes over for a long period, and the others go dormant. Because of the length of the dominant periods and the shock of other alters when they return, the author has referred to this as the “Rip Van Winkle” form of MPD.
Isomorphic MPD is not uncommon, and many patients spend considerable time in this adaptation. Here a group of very similar alters are largely in control, and/or the alters try to pass as one. The only overt manifestation may be an uneveness of memory and skills, a fluctating level of function, and inconsistency that is striking in view of the patient’s apparent strengths (e.g., “she’s quite bright, but what an airhead!”).
Possessioniform MPD occurs when the alter that is most evident or the sole manifestation presents itself as a demon or devil. Its importance resides in the readiness with which such manifestations can be mistaken for psychotic conditions. Cultural dimensions are quite important.
Private MPD occurs when the alters are aware of one another, and the isomorphic presentation is consciously adapted to pass as one. Once such patients relax their guard, however, the alters usually are not isomorphic.
In Secret MPD, the alters, although classic, never emerge except when the host is alone, and unlike the private form, the host is unaware of the alters. Cases that bridge private MPD and secret MPD are more common than either pure form - here the alters that know one another present as unified except when alone, but there are other alters unknown to that cooperative system.
Another form is Ostensible Imaginary Companionship MPD which occurs when the patient is found to have an apparent adult version of imaginary companionship with an ego-syntonic entity that is co-conscious and copresent and engages in friendly and supportive dialog with an otherwise socially constricted host. Examination reveals, however, that this entity does assume executive control, and that (usually) other entities are present as well.
Puppeteering or Passive-Influence Dominated MPD forms occur when the host is dominated by alters that rarely emerge. If the host is unaware of what is transpiring, he or she feels him or herself the hapless victim of influences that force behavior in ways not willed or chosen. If the host is aware, he or she may express him or herself in ways that confuse the interviewer, i.e., “I am Jane, but I am Sarah (the alter dominating Jane’s behavior from behind the scenes) now.”
Phenocopy MPD is the most important of the covert forms. It occurs when the final common vector of the alter’s influences create phenomena that are similar to the manifestations of other mental disorders. Alters in conflict insist on their thoughts, and cancelling out one another’s actions may mimic obsessive compulsive disorder. Alters’ harassment of one another may lead to a decompensated hallucinated presentation resembling an acute schizophrenic episode. Etc.
Switch Dominated is a not infrequent presentation. In this form, the switch process is occuring so frequently and/or rapidly that it rather than amnesia or the clear emergence of alters dominates. The patient appears bewildered, confused, and forgetful. This is most common in the extremely complex MPD patient with large numbers of alters.
Ad Hoc MPD is a very rare form in which a single helper alter that rarely emerges persists and creates a series of short-lived alters that function briefly and cease to exist. The helper may speak to the host inwardly to advise on how to frustrate inquiries.
Modular MPD is also quite uncommon but most instructive, occuring when usually autonomous ego functions become personified and split and when personalities are reconfigured from their base elements when mobilized. More standard alters may or may not be present. Such patients have an “MPD feel” about them, but once one has talked to an apparent alter one may appreciate its vagueness and may never encounter it in exactly the same way again. Here the dissociative process has become far more extreme than in personality formation per se. There are clear analogies between this form of dissociative defense and computer functioning, and it may well be that this form will be seen with increasing frequency in the future.
Kluft, 1991, Clinical Presentations of Multiple Personality Disorder
Polyfragmentation
Some folk have (systems) that aren’t groups of headmates/people, but are groups of tiny mental pockets that merge, grow, shift — so these may be ad hoc DID or modular DID systems, for example. They “whip up a persona” to deal with a situation and subside into a more depersonalized mass after. Some of these systems do have discrete parts or people within the system. Ad hoc has at least one headmate controlling the process of assembling personas to handle situations. Modular is more unconscious.
The Crisses, Polyfragmented System Notes