ANGELES, JAN ROBBY M.

GRADE 10-PETER

What is Personality disorders? are a group of mental disturbances defined by the fourth
edition, text revision (2000) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as
"enduring pattern[s] of inner experience and behavior" that are sufficiently rigid and deep-seated to bring
a person into repeated conflicts with his or her social and occupational environment. DSM-IV specifies
that these dysfunctional patterns must be regarded as nonconforming or deviant by the person's culture,
and cause significant emotional pain and/or difficulties in relationships and occupational performance. In
addition, the patient usually sees the disorder as being consistent with his or her self-image (ego-
syntonic) and may blame others for his or her social, educational, or work-related problems.

Case

A 42 year old single female presented to the emergency ward complaining of restlessness,
depression and inability to concentrate. She was disheveled and agitated, with blunted incongruous
affect, thought disorder and auditory hallucinations. She claimed to be unable to remember details of
her childhood and that both her parents were alcoholics. She had done well in school until age 16,
when she began abusing drugs and alcohol. She worked steadily for several years, until she was
limited by her substance abuse and frequent hospitalizations and was then supported by a disability
pension. She had several short-lived unstable relationships with men and reported having been raped
four times. At age 17 she accidentally cut herself, noticed no pain and began cutting herself
repeatedly. She was hospitalized in her early 20s and was treated with phenothiazines for about four
years; she was subsequently hospitalized because of suicide attempts and "behaving strangely." She
met the DSM-III-R criteria for schizophrenia. A differential diagnosis of a personality disorder with
schizophreniform episodes was also considered. A second psychiatric opinion supported this
assessment.

The patient was convinced that she had MPD; this was first suggested to her by a friend because of
her intermittently childish manner, mood swings and poor recall of childhood events. She read several
books on MPD and demanded hypnosis and intensive psychotherapy. After several consultations,
she was diagnosed as having MPD by one therapist (with a special interest MPD), and "probable
dissociative disorder" by a second therapist. The diagnosis of MPD appeared to be based on the
patient’s psychopathology and history and not on the observation of a second, distinct personality.
Her psychotic symptoms improved with neuroleptics. The patient, however, refused to even consider
the diagnosis of schizophrenia, stating she preferred a diagnosis of MPD since it was "treatable."