We have mentioned several times an American psychiatrist who has worked with multiples for many years – Dr Richard Kluft. He wrote an article called “Clinical Presentations of Multiple Personality Disorder” (in “The Psychiatric Clinics of North America Multiple Personality Disorder Volume 14, Number 3, September 1991”). In it he describes something we have never seen before or since in any article or book on multiplexity. He talks about different “presentations” or arrangements of alters that multiples might display. Multiple personality is not necessarily a static condition and a person may show many different appearances in their lifetime.
Classic presentation
This is the arrangement or configuration of alters that fits the DSM criteria (see our post #3 for the criteria) and it fits the symptoms for months, years or even a lifetime. The change of control happens often and different alters have different memories of their life.
Variant presentations
These are when the typical signs of multiplexity are only seen intermittently or they have some unique features that hide the multiplexity.
Latent presentation
Most of the alters are inactive until they are triggered to emerge by some stressor in their current life and which triggers memories of childhood trauma
Posttraumatic presentation
Similar to latent where the multiplexity stays hidden until the person experiences some kind of event that is overwhelming such as rape, combat, witnessing violence, or some sort of betrayal.
Complex or polyfragmented
Here there is a wide variety of alters who switch quite frequently. The person feels confused and their identity is constantly fluctuating.
Epochal or Sequential Presentation (“Rip Van Winkle” form)
Switching happens rarely and an alter takes over for a long period of time while the others go dormant. When these alters return from being dormant it is a shock for them much like Rip Van Winkle.
Isomorphic Presentation
A group of similar alters are mostly in control and they may try to pass as one person. A therapist might be able to see an unevenness of memory and skills, different degrees of being able to function and some inconsistencies in character. Many multiples show this kind of arrangement.
Coconscious presentation
The alters know about each other and there seems to be no time loss or memory gaps but usually the amnesia is covered over.
Possessioniform presentation
This one might be the result of the culture the person grew up in. The alter who is out presents herself/himself as a demon or devil. Such a presentation might be seen as psychotic-type behaviour.
Atypical presentations
This group of multiples are rarely ever diagnosed and are usually quite high-functioning. One of these is called Private Presentation where the alters are aware of each other and they consciously pass as one person. It is only when the multiplexity is uncovered (presumably by a therapist) they each show their individual selves.
Secret presentations
Similar to the Atypical presentations the alters never emerge except when the person is alone. However, the host personality (see our post #5a for types of alters) is not aware of the other alters. There have been cases that are a combination of the Private and Secret presentations where many of the alters who know each other present as a unified personality until they are alone, but there are also other alters who are unknown to them.
Ostensible Imaginary Companionship
This is an adult version of a child’s imaginary companion but the “companion” here is actually an alter who is coconscious and co-present with the host. When this is explored (presumably by a therapist) the alter is found to have executive control and other alters are often found as well.
Covert presentations
This is the truly classic form of multiplexity and most multiples are like this according to Dr Kluft. Here the person experiences their mental life and behaviour as out of their control.
Puppeteering or Passive-Influence Dominated Presentation
The host personality is dominated by alters who rarely emerge and either feels like a victim of influences from within (as Shell (1, 2) says “always the passenger, never the driver”) or may express herself or himself in very confusing and contradictory ways.
Phenocopy presentation
The person may show symptoms of other mental disorders such as Obsessive Compulsive Disorder, Schizophrenia, Borderline Personality Disorder
Somatoform presentation
Is a very common arrangement for multiples. Here a painful past event is re-experienced and causes discomfort but there is no conscious connection made between the symptom and the past.
Other types of presentations
Switch-Dominated Presentation
Frequent and/or rapid switching of alters is the telltale sign of multiple personality. The host personality seems bewildered, confused and forgetful. This is the most common configuration for multiples who have very complex and large systems of alters.
Ad Hoc Presentation
One alter who rarely emerges, creates a series of short-lived alters. This alter may advise the host on how to frustrate any exploration (presumably by a therapist) and keep the multiplexity covered up
Modular presentation
While this may be pretty uncommon at this time it may become more common in the future because the person has clear analogies with computer functioning. The person may seem to be brilliant, show bizarre symptoms and have an inconsistent show of alters.
Quasi-Roleplaying presentation
The person (most likely the host) tries to deny the multiplexity and will say she’s simply faking it. But with more exploration (by therapist) it is found that she or he is very upset about being multiple and simply wants to deny it.
So there you have a variety of ways that a multiple may present. As for our own presentation, well, we can identify with several of them at different times, which is not uncommon according to Dr Kluft. Some multiples may have only one way of being for the whole of their life while others may change several times. Some of these arrangements can also make it much more difficult to detect the multiplexity and diagnosis can be missed.
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