EDITORIAL
THOUGHTS ON
CHILDHOOD
MPD
Richard P. Kluft, M.D.
A few weeks ago a rather unique visitor dropped into rev
office to sav hello. He looked sharp and lit in uniform, and
we threw one another friendly and mildly mocking salutes.
His was far crisper than mine. He was doing well. His world
was expanding and growing more exciting day by day. He
had plans and dreams, and felt that he had an excellent
chance to realize them. There was so much to say that we
barely had time to perform what is an obligatory ritual when
we meet, the administration of a recheck protocol to assess
his stale of integration. In 19'78 "Tommy," as he is known irr
the literature, then a sad and confused although bright and
delightful eight-year-old, became the index case of child-
hood multiple personality- disorder (MPD) in the twentieth
century, the first reported since Antoine Despine described
his work with the eleven-year-old girl he called "Estelle."
Tommy has now been integrated for n twelve years. He has
held his gains and built. liurther upon them.
Although I thought the identification and successful
treatment of Tommy was a significant event, the scientific
program committees and journal reviewers to whom 1 sub-
mitted abstracts and articles did not share my opinion.
Although I was able to mention Tommy' in passing in a 1979
presentation on another topic, six years passed before my
work on childhood multiple personality disorder appeared
in print, shortly after the publication of "Incipient Multiple
Personality in Children: Four Cases, " the classic paper by
Joen Fagan and Polly Paul McMahon (1984). Since then
there have been a handful of other reports, but the study of
childhood MPD and childhood dissociative disorders has
failed to develop significant momentum, and has remained
an area of peripheral interest in the field.
This is an unacceptable situation. MPD and allied disso-
ciative disorders in adults are the result of the failure to
identify and treat these conditions in children. The natural
history of MPD is now understood (Kluft, 1985). Thanks to
Tommy and mans' other youngsters and adolescents whom
it has been possible t.o study, we appreciate that MPD does
not begin as a full-blown phenomenon in the adults afflicted
with this condition. It develops early in life, and while in some
children it may emerge in classic form rather early, in others
it undergoes alengthy process of development and gradually
evol ves through several precursor stages before it assumes
the familiar adult form.
It appears that. children with MPD and allied dissociative
disorders can be treated far more rapidly than adults with
these conditions. This is the general consensus of the pub-
lished literature. Unfortunately the untimely death of David
Caul, M.D., deprived the field of an additional article that he
had planned to write, detailing his experience in treating
approximately fifteen youngsters with MPD. He also found
that such children responded quite rapidly to psychother-
apy.
When we consider the arduous and painful lives that
most adults with MPD have endured, the extensive treatment
that many MPD patients require to achieve recovery, and tlhe
many years of ineffective treatment that most of there have
received before they were diagnosed correctly, the socioeco-
nomic and public. health consequences of failing to detect
and treat MPD and allied dissociative disorders in children
become painfully apparent. Tommy integrated in tinder a
dozen sessions, and many other clinicians have succeeded iur
achieving similar results with their young patients. Exclud-
ing the most simple cases, the recovery of adults with MPI)
rarely is accomplished in less than several hundred hours of
treatment. Few adults with MPD have not suffered major life
disruptions due to their disorders, some of which have
inflicted serious and longstanding adverse consequences
upon them.
The study of childhood dissociative disorders should be
one of the highest priorities of the dissociative disorders
field. It represents an important opportunity for the applica-
tion of preventive psychiatry. The relatively low profile of this
area of concern deserves our attention, and must he cor-
rected. The modern study of MPD has largely been the
province of clinicians and scientific investigators whose pri-
mary expertise is with adults. Perhaps this explains in part
why the field has yet to turn its full attention to the plight of
youngsters with this and allied conditions. We must encour-
age our colleagues in child psychiatry and child psychology
to apply their clinical and investigative skills toward children
with dissociative disorders, and support with vigor research
and publication on childhood MPD and all varieties of
children's dissociative responses to trauma. It would he nice
to see classic adult MPD become in fact the rarity that it long
was thought to be.
Richard P. Kiufi:, M.D.
REFERENCES
Despine, A. {1840). De 1'ernploi du nragnetisme animal et des caax
mi taerales duns le trait-mea tdesmaladies novelises, su ividune observation
tres curieusede querison de nirnropathie.Paris: Germer, Ballierc. (Since
this source is quite rare, see Fine [1988}, which is not cited in the
text.)
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DISSOCIATION. Vol. No. L March1990
THOUGHTS ON CHILDHOOD MPD
Fagan. J., & McMahon, P.P. (1984). Incipient multiple personality
in children: Four cases. Jounal of Nervous and Menial Disease, 172,26-
36.
Fine, C.G. (1988) . The work of Antoine Despine: The first scientific
report on the diagnosis of a child with multiple personality disor-
der. American Journal of Clinical Hypnosis, 31, 33-39.
Kluft, R.P. (1984). Multiple personality in childhood. Psychiatric
Clinics of North America, 7, 121-134.
Kluft, R.P. (1985). The natural history of multiple personality
disorder. In R.P. Kluft (Ed.), Childhood an.tecedentsofmultiple person-
ality. Washington, DC: American Psychiatric Press.
Trauma Recovery
Newsletter
Complimentary sample available
Promoting the study and treatment of
trauma-related conditions.
Moshe S. Torem, M.D., Editor-in-Chief
Alan D. Gilbertson, Ph.D., Editor
For subscription information, and to find out
about proceedings and audio tapes of the
recent Regional Conference on Multiple
Personality/Dissociative States, held April 1990
in Akron, Ohio, contact Barbara Lohmier,
Department of Psychiatry, Akron General
Medical Center, 400 Wabash Avenue, Akron,
OH 44307. Or call Barbara at 216/384-6525.
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DISSOCIATION. Vol. III, No. I: March 1990