10 symptoms of split personality, or what Billy Milligan's multiple minds are hiding

Dissociative identity disorder is a complex, mysterious, but very interesting phenomenon. Scientists are still trying to understand its essence, conducting massive research, studying “accessible” personalities. In cinema, the disorder has become a platform for the scripts of a large number of films that intrigue the viewer almost until the end of the film. And indeed, each subpersonality of a “crowded” personality is like a separate character in one scenario.

Periods of study of dissociative identity disorder. Historical reference

The history of the study of dissociative identity disorder (or, more correctly, dissociative identity disorder) is saturated with the spirit of romanticism, combined with silent delight and popularization of this phenomenon in wide circles.
So, perhaps, the first mentions of a kind of splitting, division of personality can be found in ancient rock paintings, when a shaman, carrying out his mystical ritual, reincarnates into a wolf, bird or other animal.

It may seem absurd to consider such symbolism as a kind of split personality, but it should be remembered that rock art dates back to the birth of the second human signaling system. And that is why the image of a shaman reincarnated as an animal is a powerful breakthrough in the consciousness of an ancient person in an attempt to understand the issue of duality or splitting of personality.

The first mention of split personality in medical scientific works dates back to the 16th century. The famous Swiss physician and philosopher Paracelsus mentions a woman who claimed that someone was constantly stealing her money. As it turned out later, she stole the money herself, but in a different state of consciousness, which she did not remember.

Further, the phenomenon of split consciousness begins to gain popularity not only in scientific, but also in ordinary circles. From the 1700s to the 1880s, due to the widespread dissemination of Mesmer's theory of individual magnetism, the phenomenon of dual personality was considered from these positions.

It was believed that split personality was the result of “personal magnetism,” a certain hypnotic influence that a particular person possessed. In other words, split personality was perceived as a kind of hypnotic state that a person could enter independently or under the influence of a hypnotist. While in such a state, the person spoke and behaved like some other person.

Beginning in the 1880s, ideas about split personality gradually began to change. The famous French doctor and psychologist Pierre Janet noted that in some people it is possible for a complex of ideas to split off from consciousness and for such a complex to exist as a kind of independent unit. P. Janet called this condition “dissociation,” which translated from Latin means “to be separated from society.”

At the end of the 19th century, the published book “Variations of Personality” by Bourru and Bourreau was a great success. The book described the story of a guy who had 6 personalities in his mind, each of which had its own “package” of memories and even contractions of certain muscle groups; each person acted independently of each other and did not know about each other’s existence.

Further references to multiple personalities that can coexist in one person are brief and fragmentary. Scientific minds of the late 18th and early 19th centuries closely observed and described those rare conditions that they interpreted as split personality. Stengel's statement in 1943 that the condition of multiple personalities no longer occurs...

Nevertheless, in the second half of the 20th century, the issue of multiple personalities became wildly popular in the widest circles of society. The book and film adaptation of “The Three Faces of Eve”, Flora Schreiber’s sensational bestseller “Sibyl” at that time, instantly gave the phenomenon of split personality a touch of tragic romanticism. And finally, Daniel Keyes’s 1981 documentary book about the guy Billy Milligan, in whom 24 personalities coexisted, became a kind of triumph in popularizing this phenomenon.

The phenomenon has ceased to be a phenomenon, it has lost its scientific character, medical harmony and consistency of thought, turning into a beautiful and romantic saga that makes the reader/viewer sigh at the events of the book or film and even envy the main characters...

Photo: https://www.sciencedebate2008.com/persons-of-william-stanley-milligan/

Such a frantic popularization of the phenomenon of multiple personalities today poses a completely logical and logical question to us: what is multiple personality actually? What is split personality and what are the main causes and symptoms of this condition?

Classification

Despite the fact that multiple personality disorder is included in the ICD (code F44.81), in a number of countries doctors deny the existence of this disease. There are blind spots, riddles, questions and secrets in this issue. All researchers argue about the reality or falsity of the disease. How does a person have multiple personalities? Perhaps this is just a fantasy, and not a disease? Indeed, there are individuals who react this way to unpleasant events in their lives. Perhaps this is the activation of personalities of previous incarnations, who have their own experience, characteristics of consciousness and their own history?

Since this problem is dealt with by psychoanalysts, psychologists, and psychotherapists who are not experts in psychopathology, it is difficult to draw statistical conclusions from their descriptions. There are only 350 case reports with a diagnosis according to ICD-10 F.44.81. It is impossible to deny the possibility of this phenomenon being suggested by psychologists and psychotherapists and of their cultivation of this phenomenon.

The topic often appears in feature films, but almost all cases of split personality described are related to crimes, forensic psychiatric examinations and escaping punishment. In forensic psychiatric practice, this is most often a simulation. Films about multiple personality disorder: “The Three Faces of Eve”, “Duplicate” (2018, USA), “Black Swan” (2010, USA), “Mrs. Hyde” (France 2017), “Me, Myself and Irene” (2000, USA), “Dark Mirror” (2018, USA), “Frankie and Alice” (2009, Canada), “Hide and Seek” (2005, USA), “Split” (2016, USA). Examples of split personality are shown to us in fiction and documentary works - books by Trudy Chase “When the Rabbit Howls”, Flora Schreiber “Sibyl”, Anastasia Novykh “AllatRa”, Crabtree “Multiple Man”, Daniel Keyes “The Multiple Minds of Billy Milligan” and “The Mysterious Case of Billy Milligan."

The last two are documentary: the real patient Billy Milligan tells the author about his subpersonalities in an interview, the author’s conversations with the doctors who examined and treated this patient are recorded. Disintegrated Billy's adaptive capabilities increased, despite the fact that there were internal conflicts and struggle between individual subpersonalities. Integrated Billy lost significantly in general adaptive abilities. The Billy Milligan case set a precedent for exoneration of criminal liability for those who committed a crime due to multiple personality disorder. This fact clearly demonstrates the attitude that it is more profitable to be a split personality than to be a holistic one.

In the West, this disorder is not considered a disease, but is considered as a variant of the norm. If the state of multiple personality is not uncomfortable for a person and does not cause social consequences, then it cannot be treated, and many patients refuse to integrate subpersonalities into a single whole and do not seek help.

Videos from psychologists and psychiatrists will be more useful: “Split Personality” by Veronika Stepanova, “Dissociative Identity Disorder” by Evgeniy Chibikov. At the same time, many psychiatrists admit that in all their practical activities they have never encountered such patients. Still, it is believed that with multiple personality there is a predisposition to this from birth and the ability to self-hypnosis. Most often, a child is emotionally abandoned, and he finds an imaginary friend and mentally turns into him (a horse, a spider-man) - a defense mechanism against loneliness is triggered (now there are two of us, and we are not bored or scared). Severe psychological trauma in childhood (usually of a sexual nature) contributes to the emergence of alternative personalities - saviors, guardian angels, or evil and aggressive ones.

People with a split personality are sometimes critical of themselves and describe their condition as follows: “I see another personality, but it takes over me, it sucks me in, and I cannot control this process.” These selves are different and have different qualities, inclinations and abilities. A person with a split personality often goes on social networks and these subpersonalities “write” under different names and describe pictures from their lives. They have different gender, age, nationality, writing style and presentation of thoughts.

Many psychiatrists are not inclined to identify this disorder as an independent nosology and consider it as a manifestation of a hysterical disorder. To raise a hysterical child, you need to create an idol out of him; he is allowed everything, he is surrounded by attention, but as an adult he does not receive such attention and does everything to attract him to himself. According to many authors, hysterical psychosis is a psychogenically caused, functional disorder, and not an organic one.

Hysterical (dissociative) psychoses are heterogeneous in clinical manifestations. Hysterical psychoses include: hysterical twilight stupefaction , puerilism , pseudodementia , personality regression syndrome , hysterical stupor . Depending on the severity, the picture of psychosis can combine various hysterical disorders, or some hysterical manifestations can be successively transformed into others. These psychogenic reactions are formed against the background of situations of loss (death of relatives, breakup of relationships) and are interpreted as a “repression reaction” of mental trauma.

Puerilism, considered as hysterical psychosis, is manifested by a hysterical narrowing of consciousness and childish behavior in adults. Childish speech, movements, behavior, and emotional reactions are typical. Patients lisp, speak in childish intonations, play with dolls, run in small steps, pout their lips in response to insult or stomp their feet, and promise to “behave well.” In general, there is a return of psychological functioning to the childhood level caused by mental disorders (stress, schizophrenia).

This disorder can be a temporary phenomenon (with stress) or persistent and irreversible (intellectual regression in schizophrenia in adults). Unlike foolishness in schizophrenia, symptoms in puerilism are more changeable, varied and have a strong emotional overtones. Symptoms of puerilism are combined with other hysterical manifestations.

Modern ideas about the phenomenon of multiple personality

First of all, it is worth understanding what the term “dissociation” means. Indeed, since the time of Pierre Janet (who introduced this concept into use), the term has firmly taken root to name states that indicate the presence of multiple personalities in the human psyche.

The modern International Classification of Diseases, 10th revision (ICD-10), considers the condition of multiple personality as “dissociative identity disorder” (or “dissociative identity disorder”). In ICD-10, this diagnosis is coded F44.8 (other dissociative (conversion) disorders). As you can see, modern psychiatry equates the concepts of “dissociative” and “conversion”.

According to modern concepts, dissociative identity disorder is understood as a special condition in which certain elements of the human psyche (memory, thinking, attention, etc.) are split and separated, which creates the impression that several personalities live simultaneously in one person. Moreover, each person can have his own gender, age, memories, etc.

It should be understood that with dissociative disorder, each person has his own gender, age, level of education, characteristics of thinking, i.e. changes concern the mental component of the individual. At the same time, the theory of changes in physical parameters for each individual (its own blood type, its own level of hemoglobin, cholesterol, etc.) looks absurd and illogical!

Doubling, splitting of thinking, separate memories, one's own muscle contractions - all these terms raise a completely logical question in us: is this not schizophrenia at all? With his typical schism (splitting) of thinking, with his mental automatisms, in which a person feels that his thoughts, actions, words are controlled by someone else, but not by him?

The rub is that schizis in schizophrenia is so typical for an experienced psychiatrist. A person suffering from schizophrenia remembers his actions and understands that someone is directing his actions or thoughts, while with a split personality, each personality may be unaware of each other’s existence. Separate worlds are built here, which may not intersect with each other.

According to modern concepts, the overall prevalence of dissociative disorders ranges from 0.5% to 5%. However, it is important to understand that this includes the entire spectrum of dissociative disorders as such. The most common among them are dissociative amnesia, dissociative fugue, dissociative disorders of movement or sensation, and Ganser syndrome.

Today, many psychiatrists argue whether the existence of multiple personality is possible in precisely the context in which it appears to us in books or on the big screen. Many go back to 1943 and Stengel's claim that multiple personalities no longer exist.

However, as can be seen from the initial stages of the history of the study of multiple personality, each case of this phenomenon is so rare that it has its own documentary description. At the very least, many experienced psychiatrists will not be able to boast of acquaintance with the modern “Billy Milligan”.

Based on DRL

Another Oscar-winning masterpiece directed by the legendary Alfred Hitchcock is Psycho. The plot tells the story of a young man, Norman Bates, the owner of a hotel, where a girl ends up after stealing 40 thousand dollars from her boss and running away because of it.

Norman says he lives with his tyrannical mother, whom he loves very much. The man is fascinated by Marion, but his parent does not like the guest, which is expressed in the “screaming” arguments heard from the hotel windows.

While Marion was taking a shower, a woman with a knife (her face is hidden on screen) burst in and killed her. Norman, seeing what happened, wrapped the girl in a shower curtain and drowned her in the swamp along with her car and things.

Worried about Marion, her sister and a detective go looking for her. They end up at the Bates Hotel. In a conversation with Norman, the detective senses something is wrong. The detective decides to visit the hotel secretly. Here he is attacked by a killer who resembles a woman from behind and kills him with a knife.

Then sister Marion and her fiancé Sam go on a search on their own. The local sheriff told them that Norman's mother died 10 years ago. In the Bates house, the couple finds a woman's room with a wardrobe and cosmetics. It seems that someone lives in it. Sister Marion goes down to the basement and sees her mother's mummy sitting, turned towards the wall. At this time, Norman, dressed in his mother's clothes and holding a knife, attacks her, but Sam saves her.

Bates was arrested, but the psychiatrist rendered his verdict: split personality. Norman, jealous of his mother and her husband, poisoned them both. Although before this it was believed that it was the mother who poisoned first her husband, and then herself. Unable to bear the separation, the son took the corpse out of the coffin, placed it in the basement and began to talk to his mother. His personality was split. And the mother, now in the form of an Alter personality, began to dominate Norman. She was especially irritated by the young beautiful girls whom she killed.

The guy was sent to a psychiatric hospital, where he often talked to himself in a motherly voice. Her personality remained dominant.

These are just a few cinematic examples, there are actually many more, as this topic can make some pretty interesting narratives. In fact, the life of patients cannot be called exciting.

Causes of split personality

For what reasons can dissociative disorder occur? What could underlie its formation?

Let us return again to the definition of the concept “dissociation” - the separation of any mental processes. Thus, the foundation for the emergence of dissociative disorders (in their widest form) is the ability of the human psyche to escape from painful, difficult-to-bear events and experiences.

In other words, dissociation is a defense mechanism with which we can detach ourselves from an unpleasant event, imagine that this event is happening not to us, but to someone else, to some other person...

Photo: https://pixabay.com/illustrations/face-dialogue-child-talk-psyche-2670529/

The main feature of a person prone to the development of dissociative disorders is his ability to form a psychological defense mechanism such as withdrawal and avoidance of a difficult situation. The increased suggestibility of the individual also plays a major role here.

Thus, the following conditions may be the main reasons for the development of dissociative disorder.

1. Severe stressful situations.
2. Mental trauma that can stretch from childhood.
3. Physical or psychological violence against a person, etc.

Any psychotraumatic situation can provoke the development of a dissociative disorder in an individual prone to dissociation.

A number of psychiatrists, analyzing dissociative disorder in its broad sense, come to the conclusion that a traumatic situation is not always the cause of such a disorder. It is often impossible to identify the reason why dissociation occurs. It is quite possible that, in addition to external causes, there are also some internal (endogenous) factors that contribute to the occurrence of dissociation.

Mild to moderate degrees of dissociation can occur in a number of situations.

1. Lack of night sleep.
2. Passion for a book or movie.
3. Minor accidents.
4. Exposure to nitrous oxide, etc.

Doris Fisher

When doctors talked about Doris Fisher, they meant her five personalities. Real Doris, Lethargic Doris, Sickly Doris, Margarita and Sleeping Margarita. In general, a kind of kinder surprise or even a nesting doll. Margarita was considered the coolest “matryoshka”. She constantly did nasty things, but blamed it on the Real Doris. It was Margarita who tore pages out of books, stained her clothes with mud and could deliberately cut herself with a knife. But only the Real Doris felt guilt, resentment and pain. Psychiatrists tried for a long time to cure the poor thing, but nothing worked. Medicines, therapy, hypnosis - all in vain. Then the doctors decided to take one last chance and invited... a medium. After his visit, all the “extra people” disappeared, and only Doris the Real remained alive. After this, trust in official medicine.

Clinical manifestations of dissociative disorder

Core symptom of dissociative identity disorder

An important and, undoubtedly, main symptom of dissociative identity disorder is the presence of multiple personalities in an individual. At one fine moment, a kind of “switching” of one personality to another occurs; and now it seems that before us is a completely different person, with his own mental abilities, with his own principles, special intonations in speech and unique behavioral characteristics.

As a rule, each person also has his own baggage of memories, inaccessible to another person.

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Dissociative disorder should not be viewed as the actual coexistence of several personalities in one person. A person’s personality is unified, but in the case of dissociative identity disorder it consists of several more or less independent phenomenological units.

Other symptoms

The phenomenon of multiple personality can often be accompanied by a number of symptoms affecting all components of the psyche:

• mood disorders from depression to agitation and agitation;
• sudden mood changes;
• anxiety;
• suicidal thoughts and tendencies;
• phobias of various types, panic attacks;
• sleep disorders;
• behavioral disorders, sexual preferences;
• eating disorders;
• in rare cases, the occurrence of hallucinations in one or more analyzers.

The range of additional symptoms is wide and varied. Only competent collection of anamnestic data and a thorough study of a cross-section of a person’s personality can separate the wheat from the chaff and distinguish dissociative identity disorder from diseases such as schizophrenia, bipolar affective disorder, etc.

Shirley Mason

For a long time, the American Shirley Mason existed not on her own, but in as many as four forms. All of Shirley's personalities were independent and completely different from each other. They differed in intelligence, age and character. The most aggressive and harmful person was the one who called herself Sally. During hypnosis sessions, Sally was capricious, refused to obey, and acted out. Only flattery and persuasion managed to convince Sally to leave her mistress’s body and leave the others alone. Left without Sally, Shirley Mason's three personalities quickly calmed down and united into a single whole.

Diagnostic criteria. Differential diagnosis

As mentioned above, modern psychiatry considers dissociative identity disorder under F44.8. – other dissociative (conversion) disorders. A big advantage of ICD-10 is the presence of certain criteria on the basis of which one or another diagnosis can be made.

The phenomenon of multiple personality also has such criteria. These include the following manifestations.

• The existence in the individual’s psyche of two or more different personalities, one of which exists at any given moment in time.
• Each personality has its own mental abilities, way of thinking and behavioral characteristics. A situation is possible in which one of the personalities completely determines a person’s behavior.
• There are certain memory impairments when a person cannot remember some information - most often that which relates to another person, and to those events that happened to him under the “supremacy” of another person.
• An important diagnostic criterion is the fact that the presence of all of the above symptoms should not be due to the influence of alcohol or other psychoactive substances.

According to ICD-10, category F44 in its broadest sense includes dissociative (conversion) disorders that fall under the category of neurotic disorders. The presence of a hysteroid radical in the individual’s psyche plays a very important and, perhaps, integral role in the occurrence of dissociative disorders. Without it there is no conversion (dissociation).

It is very important to distinguish dissociative identity disorder from other mental illnesses that have completely different development mechanisms and arise for other reasons. After all, as you know, the lion's share of success in the treatment of any disease is a correctly made diagnosis.

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Many symptoms of dissociative identity disorder can lead a researcher (doctor) to believe that a person has the following diseases.

• Schizophrenia. “Divination” in schizophrenia is characterized by the fact that a person’s actions and thoughts are controlled by someone from the outside. This symptom is called mental automatism. In this case, the individual’s memory does not suffer, while with dissociation the person does not remember the events that another person committed.
• Bipolar affective disorder and other mood disorders. A distinctive feature of dissociative identity disorder is the presence of the main symptom - multiple personalities. Having identified this symptom, we will see that mood disorders are only secondary; they can be a consequence (not at all obligatory!) of a traumatic situation.
• Organic disorders (anxiety, depression and a number of others). The main feature of any organic disorder is the presence of a physical cause causing this disorder. Such causes may be traumatic brain injury, chronic cerebral ischemia, brain tumors, etc. With dissociative identity disorder, we are dealing with the consequences of a powerful traumatic situation, i.e. with psychological spectrum causes.

The differential diagnosis of the phenomenon of multiple personalities can, in fact, be carried out with any mental illness. However, you should remember that one symptom that fundamentally distinguishes it from any other disease. This important difference lies in the name of this phenomenon - the phenomenon of multiple personality. What is important is the proven (based on the above criteria) presence of two or more personalities in an individual.

Symptoms

There can be many signs of dissociative identity disorder. Scientists have systematized all forms of manifestation of the disease and identified key symptoms. Among them:

• Dissociative fugue, or dissociative flight reaction. In this state, a person looks healthy, but he develops features that are unusual for him. He may suddenly leave or leave work, answer to different names, and look lost. As a rule, this passes quickly, but minor memory lapses are possible.
• Dissociative amnesia. Usually, memory disappears for individual events that traumatize the psyche. The person understands this and tries to remember something, but he fails. At the same time, he assimilates new information well.
• Dissociative identity disorder. This is a form of direct split personality, when it splits into several persons, each of which has its own name, character and even nationality. The main personality does not control the transition from one character to another. Subsequently, a person cannot remember what he did and how he ended up in this or that place.
• Depersonalization disorder. The patient feels as if he is observing his body from the outside. The perception of the world changes, it becomes colorless. The feeling in time and space is lost. A person suffers from anxiety and depression. These signs are similar to the symptoms of some forms of schizophrenia.
• Trance. In this state, the patient does not respond to external stimuli. Children tend to behave this way in response to violence or as a result of trauma.
• Ganser's syndrome (speech). A person deliberately gives incorrect answers to the simplest questions, feigns a serious mental illness, performs actions in the reverse order, for example, lights a match with the wrong side. The syndrome is often detected in male criminals. In such situations, it is difficult to determine whether a person is really sick or is trying to pretend to be sick. After recovery from the attack, amnesia sets in.

Any of these signs is a reason to consult a psychotherapist. If this is not done, the disease will progress, which is often accompanied by:

• suicide attempts;
• severe headaches;
• self-harm;
• problems with eating;
• drug addiction and alcoholism;
• deviant behavior, etc.

There are other possible consequences that the patient may not remember. If you believe the biography of Billy Milligan, then sexual crimes, that is, violence against women, were committed by a lesbian girl (one of his personalities) who sought physical intimacy with girls.

Treatment of split personality

Everyone knows that the best treatment is one that is aimed at eliminating the cause of the disease. Since split personality often has a psychological basis, the main method of treating dissociative identity disorder is the use of various psychotherapeutic techniques.

Psychotherapy

Perhaps the most difficult method of treating mental illness is psychotherapy. What is important here is not only the successful use of various techniques, but also the personality of the psychotherapist - his charisma, his ability to persuade, change the patient’s views and worldview, and free the person from the heavy burden of his psychological problems.

Psychotherapy for dissociative identity disorder includes the following main areas:

• identifying a traumatic situation is a long, complex process that requires a lot of patience from both the patient and the psychotherapist;
• acceptance of a traumatic situation;
• formation of a rational response in a patient in a particular stressful situation. In other words, a new way of responding is formed, different from avoiding the problem (and it is precisely the mechanism of avoiding the problem that underlies dissociation);
• The formation of a single personality in a patient is a responsible, lengthy process, reminiscent of the slow but gradual construction of a building made of bricks.

Among the areas of psychotherapy for the treatment of split personality, you can use:

• cognitive psychotherapy;
• clinical hypnosis;
• psychodynamic therapy, etc.

Drug treatment

It is important to understand that there is no universal pill that can be taken to restore a holistic, unified personality and recover from dissociative identity disorder. The use of pharmacological arsenal is only symptomatic and is aimed at correcting existing disorders.

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Thus, for affective disorders in the form of low mood and suicidal tendencies, various groups of antidepressants are used. The presence of mood swings in an individual from depression to manic euphoria entails the prescription of mood stabilizers - drugs that normalize mood. Dominant anxiety justifies the use of tranquilizers, etc.

About schizophrenia

Schizophrenia is an endogenous polymorphic mental illness that affects thinking. It does not lead to a split personality. Even if the patient considers himself Napoleon, no split occurs. In this case, we are talking about the disintegration of personal characteristics, but within the framework of one identity. As a result, a person can completely lose touch with reality and remain inside his own fantasies.

The causes of schizophrenia are unknown. Like most mental disorders, it is genetically determined. It can be triggered by various factors, including psychological trauma, as with split personality.

Schizophrenia manifests itself in different ways and develops some form in about 1 in 100 people.

The symptoms of psychopathology depend on the phase. When the psyche is active, symptoms of an attack or exacerbation are observed:

• Delusional ideas (delusions of grandeur, delusions of jealousy, invention, reformism, etc.).
• Hallucinations (often voices, but can be visual, tactile or even olfactory).
• Catatonic syndrome (excitement, in which a person makes strange, similar movements; or stupor, when the patient freezes for a long time in an unnatural position).

In the negative phase, the patient suffers from apathy, depression, lack of will and other symptoms that indicate the passivity of the mental apparatus.

These signs can also be observed in people with split personality. However, delusions and hallucinations are extremely rare. Catatonia is also not typical for this disorder.

Treatment of schizophrenia is carried out using psychotherapeutic methods and medications. Among the latter are various types of antipsychotic drugs. Some of them increase dopamine levels, while others, on the contrary, decrease them. This allows you to cope with depression or delusions and hallucinations, respectively.

Forecast of split personality

Talking about the prognosis for dissociative identity disorder is quite difficult for several reasons.

• Split personality is a complex and multifaceted phenomenon, which, in addition to the main symptom, may be accompanied by variations in other symptoms. The prognosis of split personality depends on the severity of these symptoms. In severe cases, rapid splitting of mental functions and a progressive increase in the number of personalities are possible.
• Another reason is the negligible number of documented cases of split personality, and therefore there are difficulties in determining the further prognosis of this condition.