contd. from

Parents debilitated by trauma disorders share common family difficulties with other parents who have mental illnesses. These parents may be emotionally unavailable to their children, may neglect them, and may be unable to model responsible adult behavior. Often in such families, young children become "parentified," taking on the nurturing parental role, caring for younger children and for the disabled parent, as well.

The vast majority (as many as 98 to 99%) of individuals who develop DID(MPD) have documented histories of repetitive, overwhelming, and often life-threatening trauma at a sensitive developmental stage of childhood (usually before the age of nine), and they may possess an inherited biological predisposition for dissociation. In our culture the most frequent precursor to DID(MPD) is extreme physical, emotional, and sexual abuse in childhood, but survivors of other kinds of trauma in childhood (such as natural disasters, invasive medical procedures, war, and torture) have also reacted by developing DID(MPD).

Survivors of extreme trauma may also have additional parenting problems different from those of people with other psychiatric disabilities. For example, although a minority admit to being abusive, adults who grew up in violent, abusive families typically have no experience with parenting behavior other than that which is violent and abusive. All parents live vicariously, to some extent, through the experiences and activities of their children. Unfortunately, it is not unusual for a dissociative parent to functionally decompensate when their own children reach the age at which he or she was traumatized. Even if the parent does not become functionally impaired, the child's age, appearance, and behavior may act as a "trigger," reminding the parent of his or her own childhood abuse and subconsciously causing the parent to respond in a non-nurturing way.

People often ask whether individuals diagnosed with MPD actually have more than one personality. The answer is yes, and no. One reason for the name change from Multiple Personality Disorder to Dissociative Identity Disorder is that "multiple personalities" is a somewhat misleading term. A person diagnosed with DID(MPD) perceives having within her two or more entities, or personality states, each with its own independent way of relating, perceiving, thinking and remembering about herself and her life. These entities previously were often called "personalities," even though the term did not accurately reflect the common definition of the word. Other terms often used by therapists and survivors to describe these entities are: "alternate personalities", "alters," "parts," "states of consciousness," "ego states," and "identities." It is important to keep in mind that although these alternate personality states may appear to be very different, they are all manifestations of a single person.

The fluctuations of alternate personality states may be a particular problem for the children of parents with DID(MPD). Most parents who have dissociative disorders perceive themselves as "good" mothers or fathers, and most have nurturing parental alters. A minority, however, are frankly abusive or deliberately hurtful: children may be injured when they are misperceived as someone else, or when an aggressive alter becomes hostile. More commonly, dissociative parents may elope for periods of time, fail to protect their children, and model inappropriate and non-nurturing behavior.

Even in the best of cases, the children are often so attuned to the changes in the dissociative parent's alters that they accommodate their own behavior accordingly. For example, children may learn to promote parental dissociation, encouraging permissive personalities to allow questionable activities, or using periods of parental amnesia to cover misbehavior. In many families with a dissociative parent, the inconsistencies of values, disciplinary codes, memory of daily routines, etc. can severely compromise the safety of the children and the level of function within the family.

One complex aspect of the mental health picture in regard to children with a dissociative disorder is the recently recognized phenomenon of secondary traumatic stress. Children can be vicariously traumatized by living with a dissociative parent who may be self-destructive or prone to flashbacks of trauma experiences. In addition, trauma survivors often find themselves in circumstances that are revictimizing, and their children may also be victimized in these situations. For example, it is not uncommon for people with histories of childhood victimization to connect with partners who are abusive, patterns which increase the risk to children and step-children.

The recently published standards of practice guidelines of the International Society for the Study of Dissociation suggests that the children of dissociative parents also be evaluated by a professional familiar with the indicators for dissociative disorders and child abuse. These are children who are at risk for a wide variety of psychiatric disabilities due to the instability in these families, risk of exposure to violence, and possible genetic factors. There is some evidence for a biological predisposition to dissociation. Because children of dissociative parents may have been left with extended family members who may be abusive, careful history taking regarding childcare arrangements is essential. Case studies of children of dissociative parents suggest that even without extreme abuse histories, these children may rely on fantasy and dissociative defenses for coping. Fortunately, if dissociative disorders are diagnosed in children, treatment tends to be quick and successful.

Psychoeducation for children, to familiarize them with their parent's problems, is an important intervention. Parents may have involved children too much, or conversely withheld information from them. Children need to learn to regard the parent's dissociative behavior as a manifestation of an illness, rather than something to be imitated or manipulated. Many children in dissociative households have been places in parent-like roles in the family to take care of parents who may regress. Family therapy to reestablish appropriate boundaries is important. Individual therapy for the child should focus on ambivalent feelings about the parents, and deal with traumatic exposure to family violence or witnessing of parental suicide attempts. Other therapeutic interventions might include confirmation of a child's perception of their parent's changeability and inconsistency; reality-orientation; and crisis intervention (focusing on fears, ambivalence, confusion over a parent's bizarre behavior, and guilt over wished-for removal of the parent).

Dissociative disorders are highly responsive to individual psychotherapy, or "talk therapy," as well as medications, hypnotherapy, and adjunctive therapies such as art or movement therapy. In fact, DID(MPD) may be the psychiatric condition that carries the best prognosis, if proper treatment is undertaken and completed. The course of treatment is long-term, intensive, and invariably painful, as it generally involves remembering and reclaiming the dissociated traumatic experiences. Nevertheless, individuals with DID(MPD) have been successfully treated by therapists of all professional backgrounds working in a variety of settings.

Sometimes DID(MPD) parents involved in custody disputes are portrayed by their partners as "hopelessly mentally ill" and their utilization of therapy is portrayed as a weakness rather than as a strength. In legal proceedings it is extremely important to evaluated each case bases on its own merits, using experts as necessary. Many DID(MPD) patients are excellent parents who have made commitments not to recreate the patterns of abuse that existed in their families of origin. After a proper course of treatment specifically for dissociative disorders, it is possible that even people who have had periods of compromised parenting can be successful and nurturing parents.

References 

International Society for the Study of Dissociation, Guidelines for Treating Dissociative Identity Disorder (Multiple Personality Disorder) in Adults, Chicago, IL: ISSD, 1994

Kluft, R., Clinical Perspectives on Multiple Personality Disorder, Washington, D.C.:American Psychiatric Press, 1993.

Putnam, F.W., Diagnosis and Treatment of Multiple Personality Disorder, New York, NY: Guilford Press, 1989.

General Reading about Dissociative Disorders

Cohen, Giller, and W., Multiple Personality Disorder from the Inside Out, Lutherville, MD: Sidran Press, 1991.

Rivera, M., Multiple Personality Disorder: An Outcome of Child Abuse, Toronto, ON: Education/Dissociation, 1991.

Speigel, D., Dissociative Disorders: A Clinical Review, Lutherville, MD: Sidran Press, 1993.

For Children of Parents with Dissociative Disorders

Boat, B. and Peterson, G., Multiple Personality Disorder (MPD) Explained for Kids, Chapel Hill, NC: The Childhood Trust, 1991.

Sessions, D., My Mom is Different, Lutherville, MD: Sidran Press, 1994.

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Reviewed: 04/2006