The author has interviewed and reviewed the cases of over 100 patients with a suspected diagnosis of multiple personality disorder (MPD). He finds it clinically useful to think of a continuum of character pathology in which dissociative and defensive altered states predominate. At one end of this continuum is MPD, which he considers a lower-level dissociative character. He redefines dissociation as a defensive altered state, due to autohypnosis, which augments repression or splitting. Depending on the degree of integration of the ego, it may result in a broad range of disturbances of alertness, awareness, memory, and identity. Four vignettes are presented which illustrate a transient hypnoid state, "characterological" dissociation in an upper-level dissociative character, and two cases of MPD, including one emerging in analysis.
“How didst thou make division of Thyself?”—William Shakespeare, Twelfth Night
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