Multiple personality in a case of functional psychosis

Multiple personality as a syndrome has been reemerging in the psychiatric literature since the 1970s. Its appearance during a psychotic condition, however, remains a diagnostic dilemma. The authors report an unusual case of multiple personality that has not been previously described in the literature. In contrast to most other multiple personalities, the patient's change from one personality to the other did not only occur with dramatic spontaneity, but would also occur in response to a specific perceptual cue which in this case consisted of a photograph of her children. The patient was a 39-year-old separated woman who has had numerous psychiatric admissions since 1972. She was treated for different diagnoses such as schizophrenia, manic depressive illness, and, more frequently, hysterical psychosis. On her admission in January 1981, for the first time, she presented symptoms of multiple personality. She was aggressive and grandiose and denied ever having known or seen the staff of the hospital who knew her well. She showed complete amnesia to her real identity. About 7 weeks after her admission, she dramatically changed into her real self and wondered why she was at the hospital. She was quite pleasant and cooperative, but denied any knowledge of her other personality. She then vacillated between the two distinctly different personalities for weeks. The photograph of her children was found to serve as an important perceptual stimulus which eventually led to the resolution of her multiple personality and maintenance of her real self with considerable improvement. During 2 years follow-up of this case, she never showed reappearance of multiple personality. However, she was admitted several times with peculiar, psychoticlike relapses. The authors discuss and elaborate on the clinical significance of her multiple personality and its relation to her other psychiatric disorders.