Dissociation : Vol. 1, No. 2, p. 027-033 : Diagnosis Of Covert And Subtle Forms Of Multiple Personality Disorder Through Dissociative Signs
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There are different forms of multiple personality disorder (MPD) that vary on a dissociative continuum from subtle forms in which the alters are not very distinct or elaborated and often influence each other without assuming full control, to patients with fully developed AIPD, whose alters are distinct, elaborated, assume full control, and emerge covertly. Most MPD patients present covertly, and some patients with covert presentations will later show overt classic symptoms, while those with subtle forms will often remain mild and subdued. Most MPD patients hide or disguise their condition, while their alters express their thoughts and feelings through subtle dissociative signs that occur when the alters influence each other, partly emerge, or subtly shift. These signs consist of frequent, sometimes sudden, fluctuations in affects, thoughts and behaviors, transferences, developmental levels, and psychiatric symptoms, and marked discrepancies in memories, viewpoint, and attitudes, which may indicate the possible presence of alters and of MPD or Dissociative Disorder Not Otherwise Specified : variants of MPD. The case of a subtle form of MPD is presented which illustrates some of the subtle signs of dissociation and other dissociative symptoms often seen in these patients.