By Ralph B. Allison, M.D.
2162 Mountain View Dr.
Los Osos, CA 93402-3312
USA
Phone & Fax 805/528-7599
Email: R_Allison@compuserve.com
Published in Hypnos, 25(3):125-133, 1998
Key words: Dissociation, Imagination, Companions, Playmates, Identity
Word Count = 4,999
ABSTRACT In DSM-IV, Dissociative Identity Disorder (DID) replaced Multiple Personality Disorder (MPD). Review of both clinical and forensic cases over several decades supports a view that MPD is valid for a small group of patients who dissociated due to life-threatening trauma before age seven. DID is appropriate for a larger group who dissociated after age seven. Correct diagnosis of those who used Emotional Imagination to created Internalized Imaginary Companions (IIC's) needs to occur, especially in forensic cases.

Examples are provided of cases which are Pure MPD, Pure DID, Pure IIC's, IIC's followed by MPD, IIC's followed by DID, and MPD followed by IIC's. The DSM-IV criteria for DID are inadequate to differentiate IIC's from alter-personalities.

RALPH B. ALLISON, M.D. is a semi-retired psychiatrist, who now limits his practice to forensic cases. He directed the Santa Cruz County, California, Mental Health Service and had a private practice there for 12 years before moving to Davis, California.

There he was staff psychiatrist in the Yolo County, California, Mental Health Service for three years. He then moved to Los Osos, California, when he was employed as a psychiatrist for the California Men's Colony State Prison in San Luis Obispo for the next 13 years. He organized the first workshop on MPD for the American Psychiatric Association in 1978. In 1980, he co-authored "Minds In Many Pieces" about his work with patients with MPD in Santa Cruz. In 1997, an updated version of this book was published in Japanese. He is the author of numerous papers on dissociative disorders in clinical practice, courts and prison.

INTRODUCTION When DSM-IV replaced DSM-III-R in 1994, Dissociative Identity Disorder (DID) replaced Multiple Personality Disorder (MPD).

Having treated dissociated patients since 1972, I felt this failed to reflect the clinical reality clinicians faced. I was heartened by the fact that this change was not made in ICD-10-CM.

Since conducting a course at an annual meeting of the American Psychiatric Association on MPD in 1978, I had faced controversy regarding these patients. A common objection to the diagnosis was that each human is only endowed with one personality in the first place, so how could anyone have "multiple personalities?"

I had no answer to that question then, but many of my patients manifested alter-personalities. During treatment, some manifested an "Original Personality" which had control of the body before being severely traumatized in early childhood. I also had seen patients who created alter-personalities after age seven, and their Original Personalities usually maintained control of the body.

I saw jail inmates for evaluations who showed other "personalities."

While these men's "personalities" did harm to others, the criminals were not similar to my disabled MPD patients. I was not sure what the essential difference was, but I knew it existed.

Only later in my forensic practice a case showed me that crucial difference. A murder defendant's sister testified her brother had created, at age seven, an imaginary playmate who was a bully, after their father shot their mother in front of them. This hostile product of his imagination shot to death a cab driver 18 years later (Allison, 1989).

Now I had an alternative explanation as to why the criminals were dissimilar to my suffering patients. The criminals used as "hit-men" Internalized Imaginary Companions (IIC's), not alter-personalities. They used Emotional Imagination instead of Dissociation.

I could now differentiate subgroups with this insight. Dissociation is a life saving mental mechanism which very highly hypnotizable abused patients used to stay alive, by creating alter- personalities.

Emotional Imagination is a ubiquitous ability which all but the demented can use to create Imaginary Companions, both internal and external. Dissociation is the separation of certain aspects of the personality into two or more parts, while imagination is the creation of new images and features which never existed before.

Two of my integrated MPD expatients, 13 and 20 years later, described how they had made IIC's in addition to alter-personalities.

They described moving their IIC's in and out of their bodies.

Since they had voluntarily created these entities, they controlled where they placed them.

Only those patients who had dissociated due to life-threatening trauma before age seven manifested Inner Self Helpers (ISH) (Allison, 1980). They were disabled and needed structured hypnotherapy with age revivification. They were the ones who demonstrated Original Personalities who abdicated control of the body because of the original trauma. I felt this select group, small as it was, deserved the diagnostic label of MPD.

A larger group of dissociators showed no ISH, no absence of Original Personalities, and only a few alter-personalities each.

Each alter-personality was created after the age of seven during a crisis which was not necessarily life-threatening. But it had been of such type and magnitude they were too immature to cope with it successfully. They created one alter-personality to deal with each problem. Since the label DID had been invented, I decided to apply it to this other group of patients.

The criminals I had evaluated had used IIC's to commit violent crimes. They were not dissociators. Since each had made his IIC voluntarily as a "hit-man," and since each could destroy it voluntarily, I did not assign any degree of legal irresponsibility.

I also had some mixed cases, with evidence of both dissociated alter-personalities and IIC's. These were the most confusing patients to understand, as they had one or two real alter- personalities, with most of their "personalities" being IIC's.

Below are examples of these groups. Each patient with MPD or DID illustrates a subcategory of patients who dissociate as a preferred mental mechanism of defense. In addition, they can now be differentiated from those who prefer to live in a world of fantasy, using Emotional Imagination to fulfill their wishes of how their world ought to be.

ILLUSTRATIVE CASES PURE MULTIPLE PERSONALITY DISORDER "Christina Peters"(Peters & Schwarz, 1978) was a case of pure MPD. My criteria for MPD include four factors, the first three of which must always be present. The fourth is valid if there are siblings. These criteria are followed by quotes from Christina's autobiography to indicate how she met them.

The first criterion is that the patient must be in the top 4 per cent of the population in hypnotizability, in Grade V by the Stanford or Harvard scales. This criterion must be met first, or the others will not apply. All patients whom I now know to have had MPD met this criterion. Only those who are Grade V hypnotizable can dissociate the two parts of the mind, the Rational Soul and the Irrational Soul, as Plato called them in about 300 BC (Stone, 1997). The terms I use are Essence and Original Personality. The ISH is a job description, i.e., Disaster Control Officer, for the Essence, when dissociated from its Original Personality. The present "accepted wisdom" is that childhood trauma is the essential factor needed to bring about dissociated alter-personalities. However, my finding is that only those children who have the "psychic fragility" associated with Grade V hypnotizability are able to dissociate to the degree needed to produce alter-personalities adequate to operate the body for extended periods of time.

The most significant therapeutic benefit Grade V hypnotizability provides the patient is the ability to age revivify. The patient appears to be the little child who experienced the abuse. This is beyond age regression, which only requires detailed remembering of past events. These patients relive the event as if it is happening in the office. Evidence of High Hypnotizability In 1977 (Allison, 1977), I wrote about Christina: "There is another patient, Mrs. D, age 30, whom I saw for several years because of multiple personality and a very heavy drinking and barbiturate abuse [sic]. I had seen her first, a year before treatment started, in jail for the purpose of preparing a legal report, since she had been caught writing bad checks. She claims that I hypnotized her lightly during that interview, but I do not recall doing so. During therapy, she told me that that hypnotic induction, for history clarification only, had been the point where she had begun to lose the tenuous control she had over her very negative alter-personalities, and her life had really gone to pieces after that."

In her autobiography, she wrote on page 171: "Dr. Brewster helped Linda to a chair. He ran some preliminary tests, such as an eye-roll test, to see if she was likely to be a good subject for hypnosis. When he satisfied himself that she was he said, "Close your eyes, Mrs. Peters. . . ."

The second criterion is that the first trauma causing dissociation is life threatening and occurs before the age of seven. This information may not be available during the intake interview but will be discovered during therapy. Evidence of Life Threatening Abuse Before the Age of Seven She writes on page 11: "Today I am Christina, a whole individual in my early thirties, with a normal range of emotions, whose life, though far from perfect, is totally within my control.

Yet just a few months ago I was five years old the same age I was when I disappeared into the 'room' inside my mind to hide while my alter-personalities ruled my body for almost thirty years."

On pages 17-18, she continues: "He [my father] reached for me, grabbing my panties and ripping them down. He held me so I couldn't move, his large hand clutching my neck and the upper part of my chest, his other hand guiding his penis toward my body.

"There was a scream somewhere in the distance. At first it seemed to be coming from my throat. I felt the vibrations of my vocal cords and the rising pitch of sound emerging from my lips. I twisted my body but to no avail. The sound grew louder as the penis was pushed against me.

"Then there was the pain, the searing of flesh as the penis was thrust into my body's tiny opening, stretching and tearing the skin. The scream I was hearing rose to a painful wail, blocking out all other sounds, then faded into silence. The person who had made the sound me, Christina, was gone. My body was physically unable to physically flee the attack, so my mind handled the escape for me. At that moment, I had made a mental leap into the nightmare world of insanity. I had become a multiple personality."

The third criterion is that the abused patient's parents are polarized, one appearing good and the other bad. However, mother and father keep switching roles from one to the other. When first abused, the child intuitively knows the other parent will not rescue them, so dissociation is the only way to survive.

Evidence of Polarity of Parents She describes her mother's role, on pages 13-14: "My birth was different from the births of my brother and sister. Perhaps having babies was no longer a novelty. Or perhaps my father's twisted mind no longer had room for children. Whatever his reasoning, he decided I wasn't worth his attention. He ignored me, leaving my care entirely in Mother's hands.

"My father's lack of love might have been easier to take had my mother been able to compensate for his coldness. But she didn't seem to care about me either. She fed me and kept me dry but ignored me the rest of the time. I can vividly remember being placed in a playpen where I would be left alone for hours at a time."

The fourth criterion is that only this child is abused, while siblings are treated normally. Of course, this does not apply if the patient was an only child. Evidence of Polarity of Siblings, with Only the Patient being Abused Her description of her siblings is on pages 12-13: "My brother Al was the first born child, arriving in 1939, a year after my parents got married. He was adored by my father who played with him for hours on end. Both Al and my father had red hair, so they became known as 'Red' and 'Little Red.' The two of them were inseparable.

"Two years after Al's birth, my sister Miriam was born. The idea of a daughter delighted my father as much as he had enjoyed the birth of his son. He showered Miriam with attention, calling her his 'little Rose.' All his spare time was spent with the two babies and he seemed delighted when my mother became pregnant once more.

"Around March of 1942, a couple of months before my birth, my father began changing radically. He started quarreling with my mother, picking fights for both real and imagined slights."

Christina meets all four of the criteria which I use to qualify a patient for a diagnosis of MPD, by these strict standards.

Now we look at the clinical picture resulting from these four factors being present.

First, the Original Personality disappears from executive control of the body at the time of the original life-threatening trauma.

Christina disappeared, at age five, into the room inside her mind for thirty years. Subsequently, there was "no one home"

to have a Dissociative Identity Disorder (DID). Only Christina, the Original Personality, could have such a disorder, and Christina was no longer in this world. Therefore DID would not be an appropriate diagnosis.

The abuse caused the creation of a "Persecutor Alter-Personality."

This one is designed to hold and manage all the anger and rage which the child developed toward the abuser. Creation of the Angry Persecutor Alter-Personality On page 29, she writes: "Linda was first created during the rape. A part of my mind was outraged at my father's abuse. It wanted to lash out and hurt him to break the fingers that held my throat and slash the penis penetrating my body. It was the part of me who, in later years, would be capable of killing without emotions."

A False Front Alter-Personality is formed at the time of the abuse. The False Front is designed to placate the abuser, to run the body during most of the day, and to keep the body alive.

Creation of the False Front Alter-Personality On page 17, she writes: "Marie awakened for the first time in a strange bed in a large room filled with countless other beds.

She was thirsty, scared and alone. Nothing was familiar."

She had been left in a Catholic orphanage by her father after the rape. Marie was a False Front alter-personality in charge of the body at that time.

A Rescurer Alter-Personality is formed to clean up the mess made by the Persecutor. Evidence of a Rescuer Alter-Personality On page 19, she writes: "Marie had been overcome by fear but Charlene could handle the pain and terror. Charlene was created to deal with pain."

An ISH was found in all my cases of MPD, by this new definition, as it is a job title, like Disaster Control Officer, for the dissociated Essence (Plato's Rational Soul), one part of the human mind. Evidence of the (ISH) On page 185-6, we read: "Marie was lying in bed with her eyes open. She felt there was energy in the room and seemed to see whirling dots of blackness. A piercing, whirring noise filled her ears. She felt horror and needed to hide. She seemed to be crawling away to find shelter, only there was none. The room kept changing and she felt a smothering sensation that was slowing overwhelming her.

"Suddenly Marie heard a voice telling her to be calm. It was familiar and yet she was unable to place the speaker. The voice told her to rest and fear no more. It said that her journey out of darkness had begun.

"'Who are you?' asked Marie, though whether she spoke with her mouth or just her mind, she didn't know.

"'You may call me Michael,' said the voice."

I talked to Michael on the telephone and in person. He appeared in the judge's chambers to offer suggestion for her post-conviction placement. He was an ISH who did not integrate with her personalities.

All of the alter-personalities must be worked with to the point that they are able to integrate with the Original Personality.

Evidence of Psychological Integration She describes her integration on page 205: "I recognized the people in the room, yet they were strangers to me. I had returned to control my own body once again. Marie, Babs, Linda, Charlene all were gone. In their place was the person who had retreated into my mind at five years of age. Christina Peters had been born again in a thirty-three-year-old woman's body."

PURE DISSOCIATIVE IDENTITY DISORDER The case of "Ester Minor" was reported by Ashby (Ashby, 1979).

In retrospect, she would now qualify for the label of DID by my current criteria. She created only one alter- personality, never showed an ISH, and her Original Personality was usually in charge of her body.

Ester had been diagnosed as having MPD by her psychiatrist and confirmed by a prison psychologist when she was incarcerated on bad check charges. Her defense attorney called me to see her after a mistrial on a subsequent bad check charge. Only after the hung jury verdict was rendered did her one alter-personality, "Raynell Potts," come out and talk to him, and he realized he had a defense in the scheduled retrial. He requested a forensic evaluation, but I insisted on seeing her for treatment to determine if I could block Raynell Potts from writing more bad checks.

I saw her for treatment for a week prior to the retrial, two hours a day for four days. Transcriptions of all sessions were supplied to the jury. She was acquitted, with Raynell Potts then under Ester's control.

One criterion for DID is that the patients are in the upper 50% of hypnotizability, Grades III, IV, or V. They may not be able to do age revivification, but they can age regress. They are good subjects for hypnotherapy and are highly suggestible.

Ester was hypnotized in my sessions, but never age revivified.

She age regressed to report episodes of trauma in her family, but nothing life threatening to her.

Another criterion for DID is that the first dissociation occurs after the age of seven, in response to a trauma which the child is too immature to manage. These patients can usually report the onset of their dissociative episodes during the intake process and readily remember the age when it occurred.

Her dissociation occurred at age nine when she was raped by her 13-year-old cousin. She created Raynell Potts, a prostitute, who enjoyed sex and used it to control men.

Ester's bad check writing habit was copied from her mother, who "had a handwriting problem." The latest offence was forgery of her employer's signature on an office check for money Ester used on her vacation. Raynell Potts did this in revenge for Ester's employer sexually harassing Ester, as Ester was too cowardly to reject his advances. Raynell stole from Ester's employer as a punishment for his sexual harassment of Ester.

One could reasonably say that Ester Minor had a Dissociative Identity Disorder, as she frequently did not know who she was.

Her arrest on this latest charge is reported on page 6: "Officers were waiting to arrest her when she returned to work after a vacation. Minor's initial confusion and dismay quickly turned to hostility, and she had to be forcibly subdued by the officers.

Raynell later explained that she took over during the arrest.

Raynell withdrew during the ride to the police station, leaving a weeping, anguished Ester in her place, then reappeared again after questioning by an officer.

"The startled detective . . . told of seeing a sudden transformation in which the crying and confused Ester Minor was replaced by a flat, cold calculating person who told him there was a 'problem.' "'I want you to understand who you're talking to,' the officer was told. The woman explained that she was Raynell Potts, a different person from Ester Minor, even though both shared the same body. Raynell took responsibility for the bad checks.

"'She's so goody-goody. She liked the job,' Raynell had said, later explaining that she (Raynell) didn't like the manager whose name she had forged because he mistreated Ester. When the interview was over, Ester reappeared and asked the officer when he was going to start asking questions."

PURE INTERNALIZED IMAGINARY COMPANIONS "Fred" was a 25-year-old man who had killed a cab driver after robbing him. He was facing sentencing after conviction. An examining psychologist thought he had MPD and that one of his alter-personalities had committed the murder. His sister had testified that she, Fred, and another sister had each created imaginary playmates after their father shot their mother several times in front of them. Fred was seven years old at the time. After the shooting, Fred exhibited two IIC's, one of whom had to be perfect, and the other one was a bully. She, herself, had made an assertive IIC, which disappeared when she became pregnant at age 16. From her testimony, it seemed obvious that the bully IIC, "Chuck,"

was controlling Fred's body when he shot several bullets into the cab driver. His method of murder duplicated what he had seen his father do to his mother.

At the start of my interview at the jail, Chuck tried to choke me. I walked out on the interview, and Fred was placed in a noncontact interview room. On orders from his attorney, he moved Chuck outside of his body onto the wall of the room, where he could still hear him talking to him. I continued the interview with a soft-spoken, well behaved Fred via telephone.

INTERNALIZED IMAGINARY COMPANIONS FIRST, FOLLOWED BY MULTIPLE PERSONALITY DISORDER In his autobiography, "Henry Hawksworth" (Hawksworth & Schwarz, 1977) describes how he imagined into existence two IIC's before he dissociated at age four. Then, he dissociated his first alter-personality, and he created a second alter-personality a few years later.

On page 23, he writes: "Soon, like other lonely children, I began countering the emotional strain of not having real friends by inventing imaginary playmates who lived only in my head.

The first of these, unfortunately, was Johnny. I would spend hours alone carrying on conversations with him. Shortly after my second birthday I was given a Charlie McCarthy doll and I pretended that Johnny lived inside it. I would hold the doll on my knee and make the mouth move whenever Johnny was supposed to be talking. . . .

"I began blaming Johnny whenever my father became mad at me.

. . . Johnny was the one who was bad and should be punished."

He describes his second ICC on pages 23-24: "When I was three I created a new playmate. This was Peter; he formed in my mind shortly after I received a book about Peter Pan for my third birthday. The story, of course, is about a boy filled with nothing but goodness. He loves nature and can talk with flowers. He is 100 years old, yet he never grows up. He is tender and gentle yet remains all boy. He is able to express emotions I, too, had always felt, but which I had had to hide because they didn't fit my father's concept of masculinity."

The next year, when he feared death at his father's hands, his Essence/ISH, Jerry, dissociated from his Original Personality, Henry, who went into hiding in his mind for the next 40 years.

Jerry created Dana, a False Front alter-personality, to run the body. Later, Phil was created as a Rescuer alter-personality to clean up the messes Johnny created with his misbehavior.

When he was 43 years old, Henry came back into charge of the body, after he destroyed both IIC's. Now it was safe for both alter-personalities, Dana and Phil, to integrate into the Original Personality, Henry.

INTERNALIZED IMAGINARY COMPANIONS FIRST, FOLLOWED BY DISSOCIATIVE IDENTITY DISORDER In chapter three of Minds in Many Pieces (Allison, 1980), I describe "Carrie," whom I thought was my second case of MPD.

In retrospect, I now realize that she was not. She started creating IIC's at the age of 19 months, and 11 of her 12 "alter-personalities"

were actually products of her vivid imagination. The first alleged "alter-personality" I met was "Wanda" who was created at age 19 months when her mother, following her pediatrician's recommendation, shaved off Carrie's beautiful blonde hair because Carrie was eating it. As I wrote on page 70, "Her mind took the action that her brain would not. Carrie retreated into the recesses of her mind and Wanda was created.

"Wanda was born to violence, filled with hatred and capable of acting out all the anger Carrie was unable to express. Wanda was destined to treat the world as disdainfully as she perceived herself to be treated. She would hurt people any way she could."

Since dissociation is only used as a self survival mechanism, a murderous entity is not a useful survival tool. As my criminal examples illustrate, it is consistent with the use of Emotional Imagination, a method we all have available for devising methods of revenge against those we see as our enemies.

I was in too much of a hurry to apply the diagnosis of MPD to Carrie after meeting Wanda, who roundly cursed me during her first appearance. At her next visit, I told Carrie that she had MPD. This "emotional trauma" caused the creation, by dissociation, of her one and only alter-personality, Debra. I therefore created an iatrogenic alter-personality, giving her DID. Fortunately, Debra was a suicide preventer and brought Carrie back alive from numerous suicide attempts, until the last one, which was successful.

I describe this session on page 76: "Carrie's face didn't show any change as I explained the multiple-personality concept to her. She nodded from time to time, always watching me intently.

What I couldn't see was a mounting internal hysteria that was overwhelming her. She was unable to cope with my words and reacted by forming an alter-personality. . . .

"This new personality, whom I named Debra, had been developed in my office. She believed Janette [my first MPD patient] and I were her parents since we were the first adults she had ever met. She was extremely childlike, yet seemed to protect Carrie from any new hurts, including, for the moment, facing the truth about her illness."

MULTIPLE PERSONALITY FIRST, FOLLOWED BY INTERNALIZED IMAGINARY COMPANIONS During three years working in a mental health clinic, I treated to personality integration a woman with the most complex case of MPD I have ever seen. After hypnotherapy with age revivification, "Marie" integrated into her Original Personality all 69 of her alter-personalities. As we were achieving this goal, the job became unmanageable for me, and I decided to move to another county.

When I told the integrated Marie of my decision to move out of town, she panicked. She had no support system and considered me the only person who could help her learn how to live in a world she had left 30 years before. She had first dissociated at the age of six months, when her mother tried to kill her in her crib.

In a wild attempt to persuade me to stay in town, she created a number of IIC's. As a member of a conservative Christian church, whose pastor preached about the Devil and his dangerous demons, she believed that evil demons were everywhere. She used her Emotional Imagination to created "evil demons" which used her body during her next session. They identified themselves as agents of Satan and Beelzebub, sent here to kill me. They tried to choke me and hit me with hard objects. They did not respond to any kind of therapeutic verbal interpretation. My life was at stake, as far as I could tell.

I responded in the only practical way I could, by invoking the same Christ which they claimed to hate. I knew Marie had been engaged to the assistant minister at this church, so I used whatever religious imagery I could think of. When these "evil demons" shrank back at my mention of Christ, I knew I had them on the run. I continued in that vein, and they were finally conquered "by the power of Christ." I then moved out of town as planned.

After my departure, she was hospitalized in the state hospital for nine days. There she did her own "cleansing" of her mind.

Since she had failed to seduce me into remaining in town, she would have to make it on her own. She told all of the remaining "evil demons" inside her mind to be gone, thereby destroying them by her own act of will. She had made them by an act of will, and she destroyed them in the same way.

Thirteen years later, we met and agreed to write her story.

When we came to this part of her story, she explained how she had decided to make up these imaginary demonic creatures, modeled after what her preacher had told her were "real." She had hoped to persuade me to stay and take care of her, but, when I did not respond as desired, she had to get rid of them herself.

Only by interviewing her 13 years later did I learn she had not been really "demon possessed." During therapy, she was not about to tell me the truth about her attempts to manipulate me. She was only free to do that over a decade later.

SUMMARY These case examples have made it clear that we should use MPD and DID for two distinct groups of dissociating patients. However, the description of DID in DSM-IV is grossly inadequate.

"Diagnostic criteria for 300.14 Dissociative Identity Disorder A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).

B. At least two of these identities or personality states recurrently take control of the person's behavior.

C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play."

These criteria apply equally well to alter-personalities and IIC's, which can be made by adults as well as children. I recognize that DSM-IV prefers criteria which can be observed by anyone, in contrast to any etiological concept. However, in the case of MPD and DID, this has gone so far as to make these criteria useless. The time has come for recognizing this crucial distinction in etiology is important.

My criteria for the diagnosis of Multiple Personality Disorder are:

1. The patient is very highly hypnotizable, in the top 4% of the population.

2. The first dissociation occurs before the age of seven, due to life threatening trauma.

3. The parents are seen by the abused child as polarized, one good and one bad. However, mother and father keeps switching which one is which.

4. The siblings are polarized, with only this patient having been the abused one. The other children are treated normally by the abuser.

These factors result in the patient having an ISH and several types of alter-personalities, but no Original Personality prior to therapy.

My criteria for the diagnosis of Dissociative Identity Disorder are:

5. The patient is highly hypnotizable, in the top 50% of the population.

6. The patient dissociates first after the age of seven. The trauma need not be life threatening, but it is too overwhelming for the immature child to cope with by socially appropriate means.

A patient having these factors has the Original Personality operating the body except when one of the few alter-personalities takes over. No ISH exists.

Imaginary Companions may be either internal or external to the body of their creating Original Personality, or placed into objects such as dolls. When internalized, they act superficially like alter-personalities, but they were not formed by dissociation, a defensive method used by the Essence for saving the life of the child. They were formed by the Original Personality and given any of a wide variety of emotions, such as hatred and revenge, as well as a limited capacity to think and pick targets.

IIC's can occur at any age and must not be confused with alter- personalities, if proper therapy is to be provided.

REFERENCES Allison, R.B. (1977). When the psychic glue dissolves, Hypnos-nytt,6(7),25-27.

Allison, R.B. (1980). Minds in many pieces. New York: Rawson/Wade Allison, R.B. (1998). The case of alter-personalities v. imaginary playmates, American Journal of Forensic Psychiatry, in press.

Ashby, A., (1979). Ester Minor: Multiple personalities in court, Forum, 6(2), 5-8 & 29-30. Hawksworth, H. & Schwarz, T. (1977).

The five of me; The autobiography of a multiple personality.

Chicago, Henry Regnery Company Peters, C. & Schwarz, T. (1978) Tell me who I am before I die.

New York: Rawson Associates Stone, M.H. (1997). Healing the mind; A history of psychiatry from antiquity to the present.

New York: W.W. Norton

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