I recently read Kluft’s paper on polyfragmentation in DID (previously referred to as polyfragmented MPD or complex MPD). It was REALLY interesting! The paper is rather old, from 1988. Back then, “complex MPD” was thought of as having anything over 26+ alters, lol. The term “polyfragmented” (originating from Braun) has always been associated with 100+ alters, however.
26 patients were interviewed for this paper. The number of alters in each system varied from 26 to over 4,500. Despite the amount of alters, Kluft states that “unless they were in the midst of an intense therapeutic process it was unusual for more than one to six of their alters, in addition to the host, to play major ongoing roles in their interpersonal lives at any particular point in time. When this occurred, usually the patient became dysfunctional.” He states that the more alters a patient has, the more likely it is that certain alters will appear less frequently or openly. This reflects my experience with being polyfragmented so I thought it was pretty interesting!
Despite having so many parts, the author explains that these patients were all difficult to diagnose (even the ones who were self-diagnosed). Five of the interviewed patients who were diagnosed by Kluft were in his practice for months to years before DID was suspected. The others referred to him who could have their treatment documented all averaged over 10 years within the mental health system before DID was even suspected.
Here are some of the reasons why it was so difficult to diagnose them:
Previous therapists did not believe them.
They deliberately withheld information or provided disinformation.
Despite having massive amounts of alters, many of them only had a small number of alters handling most of their activities, so they were no more obvious than smaller systems.
They experience order effect, which means alters are not the same all the time and their appearance may not be crisp and clear. (”Alter A may be somewhat different when it has been preceded by alter B than when it follows alter C.”)
- TW for abuse, ritual abuse, & incest -
100% of the patients interviewed had experienced “longstanding severe abuse” (of any kind). Kluft states “As children they had been so bombarded with outrages that they had not been able to develop a cohesive and comprehensive system of alters within which their further traumata could be managed. Instead, new alters were formed frequently on an ad hoc basis, and many persisted, some becoming major, some highly specialized, and some fairly inactive.” 81% were abused well into adolescent and adulthood. Several were still being abused even after establishing their own families, and 19% were still being abused even after receiving their MPD diagnosis and beginning treatment.
92% had experienced inc-st, 58% experienced vicious torment that even the professionals considered “unusual” in terms of working with DID patients, 35% had experienced r-tual abuse, and 35% experienced abusers exploiting or encouraging the creation of alters.
73% of the patients had weak non-dissociative coping skills and seemed to heavily rely on dissociation as a coping mechanism. As a result, 96% of the patients reported splitting a new alter when facing new stress. 65% had experiences where they split multiple alters at once. 42% developed new alters in response to minor stressors and inconveniences, or whenever they felt cornered.
69% experienced a highly elaborated inner world. A select few had even split alters for no other reason than to fill roles in their inner world.
19% of the patients experienced having groups of alters based on fictional characters or stories. Sometimes these alters were already pre-existing and had reshaped themselves to parallel the creative work. Kluft states that most DID patients have introject alters of real people, but 15% of the interviewed patients had massive amounts.
It was interesting to read a lot of this. There are several other things mentioned in the paper if you want to read it yourself! (Link is below the read more.)
