![]() Often there is a passive, depressed primary identity who cannot remember personal history as fully as can the other more hostile, protective, or controlling identities. People with dissociative identity disorder have two or more (on average, eight to fifteen) personalities or personality fragments that control their behavior at different times. In borderline personality disorder, there is one dramatically changeable personality with an intact memory, as opposed to several distinct personalities, each with an incomplete memory. This can be seen as a more severe form of borderline personality disorder. Hyde”), at least two seemingly separate people occupy the same body at different times, each with no knowledge of the other. In dissociative identity disorder, formerly called multiple personality disorder (the phenomenon behind Robert Louis Stevenson’s “Dr. By the 1980s, scientifically valid studies of the incidence and consequences of childhood sexual abuse were being published. During the 1970s, case reports of sexual abuse and incest appeared with increasing frequency in medical literature. Henry Kempe published The Battered Child Syndrome, and an avalanche of publicity led to the enactment of child abuse reporting laws. Physical abuse of children by their parents remained a hidden problem until 1962, when C. This theory has so swayed psychiatry for almost a century that it has largely blinded us to the frequency of real abuse in psychiatric patients’ childhoods and to the role of abuse in psychopathology. He evolved the more complex theory that “memories” of early sexual abuse were merely repressed childhood fantasies. Freud later retreated from this theory, though, refusing to believe that childhood abuse could be as prevalent as he had initially claimed. This hypothesis marked the birth of psychoanalysis. Furthermore, he claimed, based on his new analytical method, that their hysterical and neurotic symptoms could be traced directly to repressed memories of that early abuse. He was convinced that, as children, many of his patients had been sexually abused by their parents, older siblings, or other relatives. With The Etiology of Hysteria (1896), Sigmund Freud first introduced the topic of childhood sexual abuse in a scientific context. ![]() We are also beginning to understand how these abnormalities may account directly for the personality traits and other symptoms that patients manifest. We see specific kinds of brain abnormalities in psychiatric patients who were abused as children. Research on the effects of early maltreatment, including the work of my colleagues and myself at McLean Hospital in Belmont, Massachusetts, appears to tell a different story: that early maltreatment, even exclusively psychological abuse, has enduring negative effects on brain development. ![]()
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