Maybe Sybil just needed a good night's sleep.
Multiple personality disorder is a rare and extreme form of what psychiatrists call "dissociative disorder," and it was popularized by the publication in the early 1970s of the novel "Sybil." Psychiatrists have long thought that dissociative disorder might be a person's natural response to extreme trauma, such as child sexual abuse, during which a victim might psychologically protect him or herself by "going away." A patient experiencing dissociation might describe feeling outside or separate from himself or from reality. Taking on an alter personality--or several--was thought to be a variant of that psychological strategy of self-protection.
But a new article on the subject suggests that multiple personalities and other forms of dissociation may not be a direct response to trauma but the result of an unholy trinity: sleep problems (which in some cases may follow trauma), a patient who is highly suggestible to begin with, and a psychotherapist plumbing for blocked memories. The article is set for publication in the journal Current Directions in Psychological Science.
We already know that there's an element of suggestibility to multiple-personality disorder. In the wake of Sybil's publication and the release of a movie by the same name, instances of multiple personality disorder shot up, and continue to spike after entertainment or media accounts of the disorder appear. Like the young women in Leroy, N.Y., who have recently reported an outbreak of Tourette syndrome-like symptoms, psychological contagion appears to play a role in the spread of dissociative disorder.
Disrupted sleep, however, may play the key catalyzing role, say the authors, from Emory University, State University of New York Binghamton and Maastricht University in the Netherlands. Among the pieces of evidence marshaled to make that case: that the cognitive effects of sleep deprivation and fragmented sleep are very similar to patients' typical descriptions of dissociation--moving through a dream-like state, experiencing one's own life from a distance, and confabulating people, places and experiences.
Also, improving sleep helps dispel these symptoms. Among a group of hospitalized psychiatric patients whose dissociative symptoms met the clinical definition for a diagnosis, half improved markedly after a program designed to assure sufficient high-quality sleep.
The authors suggest that sleep problems may first disturb a patient's cognitive patterns. Under such circumstances, patients who are suggestible to begin with might weave together things they've heard, seen or read about with personal experiences, further blurring reality and fantasy. If a treating psychotherapist encourages the exploration of past conflicts or traumatic memories, such a patient might respond with memories that are confabulated with fantasies, reality that is tinged with delusion and personalities that appear so distinct they are mistaken for "alters."
As psychiatrists continue to debate their definitions of mental disorders such as dissociative disorder, the authors say, they should consider the key role that sleep problems may play in this and other psychiatric conditions.