A clinical case of Dissociative Identity Disorder (DID) treated with EMDR and ICV: a certain integration (that for

the
the patient has represented a major revitalizing experience.
Artículo | Trastornos infantiles y de la adolescencia | 2006-02-15

Autor(es):Conxita Vidal1, Antonia Santed2, Juana Sánchez3, Guillermo Mattioli4, [Link]é Serrano2.
Original title: A clinical case of Dissociative Identity Disorder (DID) treated with EMDR and ICV: a certain integration has
been reached (which for the patient has represented a major revitalizing experience).

SUMMARY

Introduction

We present a case of dissociative identity disorder (DID), previously known as multiple personality disorder, treated in our
center and whose most interesting aspects have been the mobility of identity dissociative symptoms and the capacity of the
EMDR therapy combined with ICV to pursue those evolutions to different characters who try to escape or manipulate; this
without retraumatizing the patient but cornering her dissociative resources until she herself begins to have insight into it
game, and gradually acquires a transitional space that it did not have.

Case presentation

48-year-old woman who comes to consultation for a feeling of emptiness, I feel like I'm not myself, I live without emotions and
I feel so much anger that I could kill, sometimes I have the sensation of being two, us, reason and emotion.

Psychobiography as she tells it:

Refers to 'emotional blocks' in childhood: at 6 years old, while leaving school, he/she approaches the other moms and takes them.
holding hands and asks them to please take her home. Later in therapy, Laura remembers that at 5 years old, her father
she learns through her that her mother has a lover and then Laura finds herself caught between the two, her mother blames her
for having snitched and the father can't stand having found out and also the guilt.

Later on, other childhood memories arise in therapy: she comments that her father was a very strange, taciturn man.
extremely jealous; describes him as a man without friends, very obsessive. Because of all this and what has been said as an adult
with her mother, and because the therapeutic process has facilitated the integration of internal characters, she questions the
the infidelity of his mother.

She has a memory from when she was little of her mother trying to drown her in the bathtub.

Later, the memory of her mother trying to drown her in the bathtub can be placed alongside the fact that she
Mother suffered from chronic depression and also from other images in which she visualizes her mother, more or less, but taking care of her.

Laura was obese as a child, until her teenage years, her mother took her to an endocrinologist but only twice because it was very
dear, while the older brother was being paid for some motorcycle booklets. At 12 years old, he has the fantasy of
that her parents die and she takes care of her little sisters.

She defines herself as a self-saboteur. She talks about her suicide attempt by jumping off the balcony at the age of 13, the
her uncle picks her up. At 14 years old when she was in high school she was "a disgusting, greasy, sweaty fatty and feels contempt towards
she, disgusted with herself, deserves nothing, only to die, a pig.

She has had 4 relationships with guys during her life, but none have lasted more than 6 months.

Psychiatric history:

Dysphoric states from 16 to 25 years, first treatment at 23, irregular psychiatric treatments with antidepressants
and anxiolytics.

Start and evolution of the current treatment:

At the beginning of psychotherapy, three characters appear: the one who comes for consultation, the saboteur who laughs at the one who comes to
a consultation and a scared girl. EMDR (5 sessions) and ICV (2 sessions) are used working to rescue that girl and bring her to
Present; she comments that she does not have the capacity to enjoy life because she lacks that girl, the innocence, the desire to live.
the joy, the lack of emotions cannot grasp life; after the EMDR sessions she says she feels
more cohesive.

Throughout the first EMDR session in which the primary childhood trauma focus is addressed, it is seen that the sabotager and the
girl are the same character and are that part of emotions that have been left somewhere and that is why today she feels that emptiness:
the saboteur was an ageless being; in the first fusion, he lost it as a terrorist and turned into a 5-year-old girl who
threw tantrums.
During the treatment with ICV, the traumatic situation continues to be addressed, providing tools to that girl and helping her to...
arriving in the present, making it go through different events of the years that have passed. Repeating this cycle several times the
the girl ends up integrating.

In an EMDR session, Laura dissociates and starts insulting the girl, that disgusting girl... She doesn't stop eating, she's a pig.
let her go, let her die... Her voice changes and then it is worked that the girl was eating because she felt bad, that there was
she did that to survive, and thanks to her survival she can be here now, and Laura begins to accept that the girl
He survived and thanks to that he is here. When the session ends, he starts talking about how he had a hard time when he was young.
I had started to eat and eat to calm the anxiety. (it justifies itself).

In an EMDR session, they start to feel unwell: it is very tight, very tight, they feel like they are suffocating, that they feel very
tight (birth canal) at the end it says that it goes with twists of cord and that when it is born it says that no one takes it and no one
wants. What I expressed in the EMDR is: I shouldn't have been born, nobody loves me, I'm disgusting, a piece of shit, I'm worthless.
Not at all. The anguish of that moment of being born is worked through where no one wanted him, my mother didn't want me to be born, never.
I shouldn't have been born, I shouldn't have been born. The therapist picks her up telling her how much it cost her to be born and that she has already done it.
It's real, it's here, that can be seen, that can be held and embraced because that baby is very important to her. In the end, it.
achieve a good level of desensitization and reprocessing in that session.

In another EMDR session, they worked on the abandonment by the mother and began to see that their mother did take care of them, that she had
fed and that she attended to her as best as she could because she was sick. She incorporates some ideas that the mother to her
he did what he could.

In the last ICV session, she comments that she feels understood because she had always had the sensation that it was like
a lost girl who needed to be rescued and finally there is a language she understands. She feels that she is recovering.
parts of herself that had been left behind in the past and that now do not feel that disgust or anger nor does she feel so useless,
more capable of doing things, even if I don't do them very well.

Comments

As Anabel González points out in an excellent article published in Interpsiquis in 2004, there is evidence that the
Dissociative Identity Disorder is a diagnosis much more common than previously thought, assessment tools, and
specific therapies that seem to offer good results. And since these are generally patients with poor outcomes,
we must overcome the dominant skepticism and try new diagnostic and therapeutic strategies. In our case, we have
approached therapy as suggested with much wisdom by Raquel Solvey (2) thinking of work as in psychotherapy
normal, with a number of special techniques mixed with it.

Among these techniques, we have chosen EMDR and life cycle integration as techniques of choice, due to their speed and
action specificity, to significantly shorten the patient's treatment and facilitate the integrative process. The ICV
supplements the action of EMDR at the level of the reprocessing stage.

As Raquel Solvey (2) points out, the dissociative patient has used dissociation in a complex way to cope with
his childhood trauma, in therapy he must recover and integrate the conflicts, feelings, and memories of childhood abuse. He must
learning to be one person, this implies unlearning and freeing oneself from disassociation, and acquiring a new set of
more adaptive and flexible strategies to function in your life.

Lastly, we fully agree with Eduardo Cabazat (3) when he draws attention to the importance of trauma, as
in his excellent article that provides a historical overview of the concept of psychic and somatic dissociation and their relationship
evident with early trauma, as well as the fact that, as research progresses in the field of
study of trauma and dissociation, the idea of including psychological trauma in the understanding of the origin of the
mental disorders.

Bibliography

1. Anabel González Vázquez. Diagnosis of dissociative disorders. SOURCE: INTERPSIQUIS. 2004; (2004). Psychiatry Service. Juan Canalejo Hospital.
Coruña. E-mail: anabelvladi@[Link].

2. Raquel Solvey. General guidelines for the treatment of dissociative disorders.

INTERPSIQUIS. 2003; (2003) Email:solvey@[Link].

3. Eduardo [Link]ón histórica del concepto de disociación. FUENTE: INTERPSIQUIS. 2005; (2005)

Trauma psicológico, Disociación, Trastorno disociativo de la identidad, Personalidades múltiples, Terapia EMDR, Terapia ICV.
5 real cases of multiple personality

You may have heard of multiple personality, but you might not know exactly what it is. We will tell you.
What it consists of and what real cases have occurred throughout history.

Thepersonalitymultiple is characterized by the person who suffers from it having several alter egos and each one relates to
a different way with his environment. It is an involuntary process. When one of the personalities predominates in a
a determined moment and the rest disappears.

The first known case of multiple personality disorder

The first case of this disease was detected by the German-born doctor Eberhardt Gmelin in the year 1791. This doctor
he dated a German girl who suddenly started speaking in French or German with a French accent. There was a relationship.
between the two personalities, the secondary personality already knew the primary one and kept its memories, although
Elementary school did not know secondary school.

Mary Reynolds: the serious girl and the jokester girl

A few years later, in 1816, another case appeared that was documented by Samuel Lotham Mitchell. It was about a
woman who was born in England but moved to the United States.

She was a shy and lonely young girl who, after experiencing a state of total blindness and deafness for 6 weeks, totally changed.
of personality and became a completely extroverted and joking person. He did not know how to write or read and could not
recognize his family. Shortly after, the primary personality reappeared and the personalities began to change to the
fifteen years long.

Felida X: shy and lively personality

This is the third case that appeared in history and it occurred in the 19th century. Felida X was a shy and serious young woman who had
another completely different personality, much more active. Her secondary personality mocked the personality
primary. Over time, the secondary personality became the predominant one until it was implanted by
complete.

Miss Beauchamp and hypnosis

This case is mentioned in many cases ofpsychology. She was a young woman who arrived at the psychologist's office.
Morton Price saying that he felt a lot of fatigue and lack of vigor. The young woman underwent some hypnosis sessions and appeared.
a second personality that hated responsibilities, some time later a third and fourth appeared
Personality. The third alter ego was very obsessive and got angry often.

Doris Fisher and her five personalities

Doris Fisher was a woman who, in 1917, was studied for developing up to five different personalities. Some
Doris's primary personality only manifested for five minutes a day. One of the personalities was named
Margaret self-harmed so that the primary personality would feel pain.

In 1976, a movie titled Sybil was released that would bring awareness to the disorder of multiple personalities.
The movie narrated the life of a woman with multiple personality disorder who had more than 16 different types of personalities.
 Case study
Simulation or multiple personality disorder?

Resumen

Dissociative identity disorder (DID) may be considered a rare disorder, given its apparently low prevalence, but
In recent years, there are indications of its possible underdiagnosis due to its complexity and the confusion that may arise.
time to establish the differential diagnosis. On the other hand, the simulation of mental psychopathology can have a great impact
socioeconomic and legal, of particular relevance in this type of disorder, given the great disability it generates and its
diagnostic complexity. In this paper, we will refer to the case of a patient who is admitted to the brief hospitalization unit.
from the Dr. Rodríguez Lafora Hospital (Madrid) with depressive symptoms, which later seemed to evolve into a case
of the TID. The evaluation consisted of a psychological anamnesis and the application of the Semi-Structured Simulation Inventory
Symptoms (SIMS) and the Millon Multiaxial Clinical Inventory (MCMI-II). The results showed a clearly altered profile.
of personality, as well as a possible simulation of symptoms that prevented determining the existence or non-existence of the TID.
the light of the results discusses the possible implications of this case.

Dissociative disorders

The conceptual evolution of dissociation has varied over time, from the pioneering work of the American
Rush, in which he included several examples of dissociation cases. This author argued that the dissociative condition was due to
a disconnection between the brain hemispheres(Rush, 1786). Within this classical vision we also find Charcot,
who in 1889 developed his theory on hysteria and argues that after a traumatic event a state occurs
hypnotic in which traumatic ideas are isolated from consciousness(Cazabat, 2004).

It was Pierre Janet, however, who was the main exponent of the study of dissociation. In 1889 he proposed the term disaggregation.
mental to refer to non-integration(Pérez and Galdón, 2003) and establishes as a basic process in dissociation the
called 'narrowing of consciousness' that prevents the person from perceiving and integrating certain events, especially those
traumatic(Putnam, 2006). This narrowing is defined as a form of mental depression in which the emphasis is on
mental weakness that motivates the appearance of dissociative symptoms(Janet, 1907).

In the 20th century, starting from World War II, the victims began to exhibit specific symptoms of
it was called shell shock. The symptoms included a whole series of dissociative reactions, such as amnesia regarding oneself
identity, leaks, conversion blindness and paralysis(Menninger, 1945). Later, with the publication of Divided
Consciousness(Hilgard, 1977), a new definition of dissociation was proposed which states that mental functioning
It is organized in structures and substructures arranged hierarchically that maintain a relationship of interdependence.
In addition, the idea of the dissociative continuum was proposed, ranging from partial dissociation to total disconnection.(Bernstein and
Putnam, 1986).

In 1990, Spiegel defined dissociation as the separation of content that would normally be integrated in a normal situation. His theory
it is based on three fundamental pillars(Spiegel and Cadeña, 1991): Dissociation implies a lack of connection between the parts of
the consciousness or memory, (2) there is a connection between dissociation and trauma, with trauma being the main factor of these
phenomena and (3) autobiographical memory (self) is the integration of personal experience.

The last two important authors within this new view of dissociation are Kihlstrom and [Link]
(1994)define dissociation as the mechanism by which some mental elements are not consciously encoded,
That is to say, they are dissociated. This alteration can affect different areas of mental [Link] (1994), for her
part, investigate this disorder focusing especially on the child population, as many dissociative experiences that
they can be pathological in adults but are not considered as such in children or adolescents, such as the emergence of a 'friend'
"invisible." This last author defends the idea of a continuum in dissociation that would range from brief episodes that appear
due to a specific situation, even frequent, very intense dissociative experiences that appear in non-contexts
appropriate(Putnam, 1993).

Be that as it may, the international epidemiological data obtained at the beginning of the 21st century seemed to indicate a
infradiagnosis of dissociative disorders in general which, contrary to what has been defended for a long time
decades, showed that this kind of problems were much more common in clinical environments than was usually assumed
a principle, which motivated a review of the psychodiagnostic criteria for this type of disorder in order to prepare
from the DSM-5:

Globally, independent studies from various countries clearly demonstrate that dissociative disorders constitute a
frequent mental health problem not only in clinical practice but also in the community. The lack of sections on the
dissociative disorder in the general psychiatric screening instruments commonly used has led to the omission of
dissociative disorders in large-scale epidemiological studies. Although studies using instruments
specific have begun to correct this perception, the inclusion of dissociative disorders in screening studies of the
general psychiatry will help obtain detailed information on comorbidity topics. […] The differences between the
Rates obtained in various situations may be related to differences in treatment-seeking behavior.
and in the mental health management systems. [...] In particular, the relatively high prevalence of ADHD
[unspecified dissociative disorder], both in clinical situations and in the community, indicates the need for a review
exhaustive of the dissociative disorders section of the DSM-IV(Sar, 2006, p. 228).
Multiple personality

Dissociative Identity Disorder (DID) - commonly known as 'multiple personality disorder' - seems
Infrequent in clinical settings, but nevertheless very popular among the public thanks to the influence of literature and cinema.
Está definido en las principales clasificaciones diagnósticas (CIE-10, DSM-5) como la alteración de las funciones integradoras
of consciousness, memory, and identity. It seems to begin in childhood to manifest a few years later,
diagnosed more in women than in men(APA, 2012). The latest theoretical positions regarding this disorder
they are related to trauma, suggestibility, and post-traumatic stress disorder( Gershuny and Thayer, 1999).

According toSar (2006), The concept of 'trauma' is not equivalent to that of 'harmful event or experience' as is commonly portrayed.
It is understood. For this author, it would be a complex sociopsychological process that encompasses objective and subjective components.
In this sense, the 'psychic trauma' would be, on one hand, the loss by the subject of the cohesion of their internal world.
cohesion of the external reality and, on the other hand, the disconnection between them. In such a way, trauma creates a loss of the
psychic harmony at a specific moment in a person's life and from there it projects into their future(Sar and Ozturk
2005), understanding trauma and dissociation in this way as a split or rupture of mental processes(APA,
2004), so both concepts remain closely linked.

At the time, the DSM IV-TR indicated the following criteria for the diagnosis of [Link] (APA, 2012):

Presence of two or more identities or personality states (each with its own relatively persistent pattern)
of perception, interaction, and conception of the environment and oneself.

At least two of these identities, or states of personality, recurrently control the individual's behavior.

Inability to remember important personal information, too broad to be explained by ordinary forgetfulness.

The disorder is not due to the direct physiological effects of substance use or to a medical condition.
However, the new classification established by the DSM-5, revised from the epidemiological criteria to which
previously mentioned, indicates that the criteria for the diagnosis of ADHD are:

Disturbance of identity characterized by two or more well-defined personality states that can be
to describe in some cultures as a "possession experience." The disturbance of identity implies a discontinuity
important sense of self and sense of entity, accompanied by related alterations in affect, behavior,
awareness, memory, perception, knowledge and/or sensory-motor function. These signs and symptoms
They can be observed by other people or communicated by the individual.

Recurrent lapses in the memory of everyday events, important personal information, and/or traumatic events.
that are too broad to be compatible with ordinary forgetfulness.

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
functioning of the subject.

The alteration is not a normal part of a widely accepted cultural or religious practice. It is noted that in children the
symptoms should not be confused with the presence of 'imaginary friends' or other fantasy games.

The symptoms cannot be attributed to the physiological effects of substance use (for example, episodes of
mental lag or chaotic behavior during alcohol intoxication) or another medical condition (such as
complex partial epilepsy.

According to the ICD-10 (WHO,

1992), the TID is included within the category designated for dissociative or conversion disorders
(F44) is defined as a 'rare' disorder regarding which there is no agreement on the extent to which it is iatrogenic or inherent to
a specific culture. This is a logical note, considering that at the time this guide was published
there was a very different criterion regarding the epidemiological impact of dissociative disorders and, furthermore, DID
had become very popular in the media while being under a strong suspicion of
overdiagnosis(Kluft, 1991). The essential fact in this case is the apparent existence of two or more personalities.
different in the same individual and that only one of them manifests at a time. Each personality is complete, with its own
memories, behavior, and preferences, which can be very different from the unique premorbid personality.

In the common form of two personalities, one personality dominates over the other, but they never have access to their memories.
respective and, almost always, each one ignores the existence of the other(WHO, 1992)The changes or steps of a personality to
the other in the first instance are sudden and are closely related to traumatic events. The changes
often limited to dramatic or stressful events or presented during sessions with a
therapist who uses relaxation, hypnosis, or abreaction procedures(WHO, 1992)1It happens, however, that the evaluation
and the diagnosis of TID has evolved over time, as it has been understood that it is not essential
that one personality completely overrides or replaces the other. It may be a mere confusion of one's own
identity, including gender, as well as the alteration of the state of identity or a defined change of identity in
specific and concrete sense. In this case, the individual affected by DID can assume a role, a name, a
a personality or behavior different from the usual( Steinberg and Schnall, 2000). In this regard, referring to a case
specificGarcía Andrade (2001)explain:

In these cases, it is possible to share different memories or behavior patterns, with one of these personalities being able to take the...
absolute control of the person, with more or less sudden transitions, sometimes consciously or not with others
personalities, and even yield different results with the tests, which was mistakenly interpreted as simulation (pp. 22-
23).

Therefore, it should be noted that TID is one of the most difficult disorders to diagnose, both due to its own characteristics.
as it overlaps with other borderline pathologies, from dissociative amnesia and dissociative fugue to the own
schizophrenia. In fact, dissociation tends to be observed as a manifestation of histrionic personality.
it is common for people who exhibit isolated symptoms of dissociation to be diagnosed with different disorders of
personality but rarely of DID(Johnson, Cohen, Kasen and Brook, 2005). This has led to the current prevalence
the disorder may be less than 1% in the general population, potentially reaching 5% in the clinical population, with the higher percentage
the one corresponding to the female sex, just as happens with the rest of the dissociative disorders(Gershuny and Thayer, 1999; Sar,
2006).

Simulation

The United Nations (UN) held the World Summit on Diseases in September 2011.
Chronicles. There it was recognized that mental disorders, among other illnesses, pose a challenge of 'proportions
epidemic”, with a serious impact on the socioeconomic development of countries(World Health Organization, 2011). From there the
the need for proper identification of cases of symptom simulation in sick leave (or incapacities), both
temporary as permanent, due to chronic illnesses(Santamaría, Capilla and González Ordi, 2013).

It must be acknowledged that both cunning and deceit, as well as the simulation of symptoms of various diseases, have been
strategies widely used by humans throughout history. It is worth noting that simulation already appears
recorded in the Bible, where it narrates the moment when David, to escape the wrath of the king of Gath, feigned suffering a
mental disorder (I Samuel 21: 10-14).

There are several classifications regarding simulation, none of which has reached clinical and/or academic consensus.
generalized. Antoine Porot proposed one of the most well-known in 1921, in order to classify the simulation of mental syndromes
in three types of mental simulation: total or true, oversimulation, and metasimulation. Subsequently, the ownPoroto
(1977) expanded its classification based on the personality and attitude of the simulator, distinguishing between:

Passive simulators, or those that focus on functional defects.

Active simulators, or those in which their symptoms manifest through active psychomotor processes.

Absurd simulators, that is, those that exhibit extravagant behaviors.

Likewise, based on the personality of the simulator,Vallejo-Nájera (1930) it pointed out two types: on one hand, the simulators
occasional, among which he differentiated between uncultured simulator, suggestible simulator, paranoid simulator, simulator
hysterical, pathological liar or fabulist, emotional simulator, amoral simulator and professional simulator and on the other hand, he spoke
of the permanent simulators, who usually present more psychological anomalies.

Another subsequent classification is the one established byUtitz (1950), differentiating self-simulation, where the subject believes in the
authenticity of their symptoms, of the concealment, which consists of the conscious and voluntary hiding to
achieve an end.

Therefore, we can define simulation as the intentional production of false or exaggerated physical or psychological symptoms.
motivated by external incentives(Ramírez Chapel, González Ordi and Santamaría Fernández, 2008).

Despite being a central topic in the field of medical diagnosis in general and psychodiagnosis in particular, it
was incorporated as a diagnostic clinical entity belatedly in the DSM-III (1980). Simulation involves the existence of
external rewards (insurance collection and compensations, penitentiary or legal rewards, etc.), unlike the
factitious disorders, and it is carried out consciously and deliberately, unlike somatoform disorders(APA, 2000).
Numerous studies have tried to establish the incidence of simulation, although it is certainly difficult to provide data.
precise, due to the significant variability depending on the field of study or the pathology being addressed(Gonzalez
Ordi, Capilla Ramírez and Matalobos Veiga, 2008). Likewise, the research conducted to date seems to indicate that
Human beings are not better detectors of lies than what can be explained by chance, and not even professionals.
linked to simulation contexts, such as psychologists, police officers, or judges, would show a special skill for this
regarding(Aamodt and Custer, 2006; Faust and Ackley, 1998). Nonetheless, there appears to be a higher incidence rate of simulation in
the medical-legal field related to the assessment of disability, and consequently with the possible benefits
labor, legal, penitentiary, and socioeconomic associated( Mittenberg, Patton, Canyock and Condit, 2002).

A fundamental principle in the detection of simulation is that the more inconsistencies a patient presents in the
different tests and relatively independent dimensions, it will be more plausible to think that their performance reflects a
deliberate effort to present an unrealistic image of their capabilities or symptoms( Bianchini, Greve and Glynn, 2005). From
there that the convergence of data from different sources of information is crucial to ensure the diagnosis of
simulation(Capilla Ramírez et al., 2008). However, different studies have shown how by recording tests of
cognitive processing of memory both the simulators and the individuals with the disorder provided similar levels in
memory, recognition, and primacy among the different identities(Allen and Movius, 2000; Eich, Macaulay, Loewenstein and
Dihle, 1997; Huntjens, Peters et al., 2005; Huntjens et al., 2006; Huntjens, Peters, Woertman, Van der Hart and Postma, 2007;
Huntjens et al., 2002; Kong, Allen, and Glisky, 2008; Silberman, Putnam, Weingartner, Braun, and Post, 1985). Similarly, the
people diagnosed with the disorder showed less effective information processing than people
simulators of the disorder(Dalenberg et al., 2012), as well as significantly slower reaction times than the
simulators(Allen and Movius, 2000; Huntjens et al., 2002; Huntjens, Postma, Woertman, Van der Hart and Peters, 2005).

Case presentation

A patient voluntarily admits to the short-stay hospitalization unit of Dr. Rodríguez Lafora Hospital in Madrid.
19 years old of Dominican nationality reporting feeling low mood.

The patient attends the interviews with a well-groomed appearance, clean and appropriate to the social situation they are in.
Stay focused on the three spheres during all sessions and maintain a coherent and fluid discourse, referring to your
Biography without hesitation or distractions. Maintains eye contact effortlessly and interacts skillfully.

The patient reports that the symptoms that worry him first appeared when he arrived in Spain at the age of 18.
These begin with a depressed mood. When the mood is lower, it appears to him as
an external figure, a tall man dressed in black, named Noob 2to which only the eyes are visible. With him, one can talk about things
to forget about their mood. Some time after the eruption of the Noob entity into the patient's life, it begins to
There are times when he feels like a woman, adopts feminine postures, paints his nails, and does things that, like him,
it says, "they belong to women." When he adopts this feminine role – note that the patient indicates "when she
appears" and does not speak at any moment of "possession"–feels protected, stays away from fights and knows what things he has to
do to feel good. Until now, the patient does not report episodes of drug use.

Later, he starts consuming marijuana and shortly after begins to adopt - the term used to refer to this adoption,
never possession, becomes 'to appear' – which is considered the 'worst' of personalities: it is very violent, showing itself
as the strongest and most dominant of all. When it appears, sometimes the patient loses track of time, they may do
things of which it then does not retain memories and experiences fear upon their appearance (amnesia and dissociative fugue). This
the personality is called 'Cross or Die.' Its arrival is linked to a particularly traumatic event for the subject: their
stepfather, who was trafficking drugs, forces him to help by acting as a mule and thus carrying the merchandise
introduced into his body rectally from Spain to Germany. During the journey, the patient reports noticing that presence.
dark. At first, "Cross or die" is shown as dialogical and tries to persuade him through thought. It tells him
he killed his stepfather since he is making his life impossible, while also insulting him. Gradually this
the personality transitions from inner dialogue to the control of its actions, involving it in serious fights and inciting it to drink.

Upon reviewing his biography, during the anamnesis process, the patient states that since he was very young
I had an invisible friend named 'Jack', which shows that these dissociative episodes delve into a very childhood.
traumatic and complex. The patient reports that "Jack" and he spent many years together, until at 15 years old he said goodbye.
about him and left, telling him that he was already old enough to be alone. When asked about the details of his
niñez, la recuerda en general con tristeza, como un niño maltratado por su padre, abandonado en las calles de Santo Domingo
and who had to survive amidst fights and shootings. The fact is that his father kicked him out of the house at the age of 11, and in a way
accidental, he was shot at the age of 13. Later, when he arrived in Spain, he lived with his mother for a while, but then
ésta le abandonó al marcharse sola al extranjero, concretamente a Holanda.

The patient states that at that moment he tried to commit suicide by jumping from a ninth floor, as he believed he was worthless.
in this world and that he was very lonely. He explains that it was an impulsive and unplanned act that ultimately did not lead to
term for not feeling worthy of it and being a religious person, which led him to consider that this behavior would be
sinful. After a while he goes to Holland, where he lives with his mother and his stepfather, who mistreats both of them. One day
after returning from a school trip he does not find his mother at home and is informed that she has been stabbed
and burned his stepfather for which he is in prison. The news surprised him. The patient reports that he is afraid that he could harm
to someone, since 'Cross or die' will not harm him but can harm others.

Evaluation and results

The evaluation of the patient is proposed using different instruments:

Psychological anamnesis previously mentioned, the summary of which we find in thetable 1.

 Table 1.

Timing of stressful events mentioned in the anamnesis

Traumatic Event Age Personality

Child maltreatment 8-15 years Jack
Mother is going to Spain 10 years
Change of residence to Spain 18 years Noob
The mother is going to live in Holland. 19 years Woman
Drug trafficking 'mule' 19 years Cross or die

Semi-Structured Inventory of Symptom Simulation (SIMS;Widows and Smith, 2005; Spanish translation ofGonzález Ordi and
Santamaría Fernández, 2009)It consists of 75 true or false items that evaluate five scales: psychosis, deterioration
neurological, amnesic disorders, low intelligence, and affective disorders. It is a brief and simple application test.
interpretation. It allows us to observe, through the means of screening, what atypical symptoms appear or if the subject intends
simulate a specific disorder, with a cutoff point beyond which simulation suspicion can be considered
(verfig. 1).

Figure 1.(0.16MB).
Results of the SIMS test.

Millon Clinical Multiaxial Inventory II (MCMI-II; Millon, 1994; Spanish version, 2004). The MCMI-II provides information
empirically validated to support diagnosis in various fields: clinical, medical, and forensic. It is suitable for application to
Individuals who present both emotional and behavioral or interpersonal problems. It has 4 validity indices and
24 clinical scales according to the level of severity: clinical patterns of personality, severe personality pathology,
clinical syndromes and severe clinical syndromes(Winberg and Vilalta, 2009). The qualitative assessment of the obtained results
for the patient presents in thetable 2.

Table 2.
Qualitative assessment of the results of the MCMI-II
Schizoid
Phobic Social inhibition, feelings of inferiority and
hypersensitivity to negative evaluation.
Dependent
Histrionic Excessive emotionality and seeking attention
Narcissist Grandiosity, need for admiration, and lack of empathy
Antisocial General pattern of disdain and violation of rights
the others.
The Sadist Hostile, aggressive, abusive, and destructive pattern
Compulsive Concern for order, perfectionism, and control, to
expenses of flexibility, spontaneity, and efficiency.
Aggressive
 Masochist
Schizotypal Unbalanced pattern
Limit
Paranoid Uncompensated pattern
Anxiety
Somatization
Hypomania Significant
Dysthymia
A. Alcohol
A. Drugs Significant
P. Psychotic
Depression M.
T. Delirante Psychosis suspicion

The results found after applying the SIMS to the patient(fig. 1) they showed signs of suspicion of simulation, both in
psychosis as in neurological deterioration, after obtaining a direct score of 7 and 5 respectively.

Discussion and conclusions

It is based on the hypothesis that each of the personalities referred to by the patient emerges in moments of intense stress.
who does not know how to cope due to the lack of the necessary tools for it, as well as the appropriate compensatory environment.
that helped him to overcome these adversities.

The first of them, 'Jack', could not be properly classified as a personality, as it appears during the
childhood in the form of an invisible friend who helps and supports him, surely to face the mistreatment suffered by
his father and a socio-environmental situation that is absolutely unfavorable, in what would be a topical episode of psychological defense
through escape or refuge in fantasy.

Later on, however, once settled in Spain, a new hallucination called Noob appears, with which he can
talk when feeling depressed to reduce your discomfort. When his mother abandons him by going to Holland, he would appear.
the first of the dissociated personalities, to the extent that we are no longer facing an hallucination or external character.
individual but to an internal figure, also feminine, which allows us to hypothesize about coping with abandonment
maternal. This personality helps him stay away from fights and not use drugs to maintain the attachment to the figure
lost mother(Freyd, 1997). It is very relevant that this personality appears right now and particularly associated with a
suicidal attempt, as literature establishes the high prevalence of affective disorders and high rates of suicide attempts.
associated with dissociative disorders(APA, 2014).

The obligation imposed by the stepfather to traffic drugs, an act that also happens in a particularly
traumatic as having to use one's own body as a vessel, gives rise to 'Cross or Die', a personality
completely opposite to hers that presents itself in situations where physical confrontation is necessary
risk situations in which one does not feel capable. All of this would fit with the literature on dissociative disorders, in
so much that, as we have been indicating, refers to appearing in especially traumatic situations, rooted in childhood, and
later it evolves into more complex forms. It should be noted that, in contrast to the usual topics
spread by cinema and literature regarding how the individual experiences OCD, the reality is that the affected individuals
they often experience it as a change in their personality or as if another person inside them were taking control, such that
one or more identities can arise. Generally, the affected person does not remember the episodes of the alterations, but
It is neither necessary nor essential for the formal diagnosis of the TID - we have already mentioned the criteria before - since the
The depersonalization experienced by the subject can also be characterized by sensations of unreality, altered self-perception.
and a persistent and recurrent feeling of detachment from the processes of one's own body, alongside the sense of
reality remains intact. It is very symptomatic that patients report a "sense of unreality," even being
aware that it is their own perception that is altered(Colonel, 1987), element that would differentiate it from
more psychotic disorders.

The results provided by the MCMI-II are not considered conclusive for the diagnosis of DPD, as shown
in thetable 2, The patient scores significantly on too many scales. This may be due to multiple factors:
from the simulation of symptoms to the interference of the different conflicting personalities, as the patient, when answering
the questionnaire expresses that he prefers to do it taking into account not only his own actions and criteria but also those of his
personalities, problem, by the way, common in the diagnosis of dissociative disorders, due to the lack of tools
appropriate(Sar, 2006).

On the other hand, and despite the results obtained in the SIMS test, if we analyze the items that could mean
simulation of psychosis, we see that many of them could fit as symptoms of DID from a clinical perspective, already
that the SIMS is not a diagnostic tool as such, nor a personality test and, consequently,
It has also not been designed to accurately discriminate this type of elements. However, it is indeed used.
as a descreening test(Widows and Smith, 2005).

Even so, despite the fact that the case clinic may agree with a possible diagnosis of ADHD, the lack of a further evaluation
exhaustive, the scores above the cutoff point of the SIMS and the personality profile found (histrionic,
narcissistic, antisocial) may cast doubt on the hypothesis of the presence of a dissociative disorder. There are many similarities
between disorder and simulation in relation to the recognition of other personalities. We must not forget that the study
ofGiesbrecht, Lynn, Lilienfeld and Merckelbach (2008)it proposes that people who simulate are often indistinguishable from those
individuals diagnosed with the disorder, as there is a social influence on the etiology of the disorder.

In view of future lines of research, it would be advisable to conduct a broader evaluation using instruments
specifically developed for the diagnosis of dissociative disorders, such as the Dissociative Experiences Scale
(DES;Bernstein and Putnam, 1986) or the Structured Clinical Interview for DSM Disorders for Dissociative Disorders (SCID-
D;Steinberg, 1993), which often yields higher severity results for individuals diagnosed with the disorder than for
simulators(Welburn et al., 2003), study the patient's profile to see if other commonly found characteristics are present
related to dissociation, such as suggestibility(Dienes et al., 2009) or the fantasy(Merckelbach, Horselenberg and
Schmidt, 2002), and the possible presence of somatoform symptoms(Nijenhuis, Spinhoven, Van Dyck, Van der Hart and
Vanderlinden, 1996) and deepen the evaluation of cognitive processes(Kong et al., 2008). In the same way, with the aim
To clarify the simulation hypothesis, it would be necessary to expand, if possible, the evaluation to other sources of information.
close to the patient and specify the possible existence of objective external benefits(González Ordi et al., 2008).

In this case, since the patient was hospitalized in the acute unit, showing stability, he was discharged and
there was not enough time to adequately delve into the case. Furthermore, the lack of instruments for the
The diagnosis of this disorder at the time of admission also posed an additional challenge when it came to evaluating and carrying out
a differential diagnosis. In this regard, it would be important to have more studies on this little-known disorder and
that it can sometimes be underdiagnosed, when not simply misdiagnosed(Sarbin, 1997), in the face of the realization of
appropriate interventions and follow-ups.

Conflict of interest

The authors of this article declare that they have no conflict of interests.
Financing

This work has been funded by the Vice-Rectorate of Research and Innovation of Camilo José Cela University.

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1. Release of emotions and/or feelings linked to memories or experiences usually painful from childhood that have
have been repressed by the patient.

A word used in English, in a derogatory manner, to refer to newcomers or beginners.

THE 10 TRUE CASES OF PERSONALITY DISORDERS THAT INSPIRED 'MULTIPLE'

M. Night Shyamalan directed 'Múltiple' (Split) and tells the story of a man named Kevin (James McAvoy) who suffers from
a multiple personality disorder. His illness manifests with 23 different personalities that appear.
unexpectedly. One of his personalities decides to kidnap three teenagers and lock them in a room without
windows. The girls manage to convince one of Kevin's personalities to let them go out before his appearance.
personality number 24 - a merciless monster.

I take this movie as an opportunity to talk to you about Dissociative Identity Disorder (DID), popularly known as the
Multiple Personality Disorder; a rather rare and special disorder. It usually appears as a result of
a childhood of abuse and trauma. If healed in time, the personalities can merge into one. But if not healed,
More and more personalities may start to appear.

Although 'Multiple' stigmatizes this mental illness, it highlights all the issues related to mental health.
para ayudar a las personas que lo sufren. Sobre todo, ayuda a que deje de ser un tema tan tabú en nuestra sociedad.

Here are some of the most famous cases of people with multiple personality disorders. You will find from
people who suffered with 10 personalities to others who had up to 100!

10. Louis Vivet

Número de personalidades: 10

His story inspired: Dr. Jekyll and Mr. Hyde, a novel by Robert Louis Stevenson

Louis Vivet was one of the first people to be diagnosed with DID. On February 12
In 1863, his mother, a prostitute, gave birth to Louis. She ignored him for almost his entire childhood, and because of that,
he committed his first crime at only 8 years old. Vivet was arrested many times and lived in a
correctional until the age of 18.

His disorder manifested when he was 17 years old, and his personalities appeared when he started working on a vineyard.
A snake wrapped around his hand and although it did not bite him, it caused him trauma. He started having seizures and
he was paralyzed from the waist down. His symptoms were not physical, but psychosomatic. For that reason, he was sent to
a psychiatric and his disorder became even more complicated. He became a completely new person, with his own personality and
without recognizing anyone who was close to him.

Between 1880 and 1881, they changed him several times between asylums to treat him with different techniques such as hypnosis and metal therapy.
Later on, a doctor was able to diagnose him correctly and discovered that he had 10 different personalities; each with its own traits.
and stories.

9. Lurancy Vennum, el Watseka Wonder

Number of personalities: Unspecified

His story inspired: The Possessed, a documentary/mini-series

SyFy of 2009

Many cynics will say that the Watseka Wonder was nothing more than
a false spiritual possession. Lurancy Vennum believed she was
being possessed by Mary Roff, a girl who died a few years before all this happened.

Vennum was from Watseka, Illinois and her case was called 'Watseka Wonder' because she suffered from epileptic seizures that sometimes
they left him unconscious; when he woke up he told his family that he had gone to heaven and had seen the angels of his
deceased siblings. When she started to suffer more epileptic seizures, the doctors recommended that the family admit her.
in a psychiatric hospital. Asa B. Roff, her neighbor, convinced the family that her experiences were real and not to admit her.

Lurancy was 'possessed' by different spirits, but later she decided that she was only possessed by Mary Roff, the daughter.
Death of Asa Roff. The Roffs welcomed Vennum into their home for a long time. Psychologists discovered more
go ahead that 'Mary' only manifested when the Roff were present.

Years later, Lurancy returned home and married a man who did not believe in spiritualism. From then on, 'Mary'
he left his body and never manifested again.

8. Judy Castelli

Number of personalities: 44

Castelli suffered for years from physical and sexual abuse; he struggled with the voices he had inside his head and from a
depression. She was hospitalized several times for serious self-harm and multiple suicide attempts, and every time she went, the
they were mistakenly diagnosed with chronic schizophrenia.

Still, Judy has had a good artistic life. In 1980, one of her personalities began her career as a singer in
clubs in the Greenwich neighborhood of New York. He was even about to sign with Columbia Records but the guy was let go.
who was in charge of her and was left wanting. However, even though she couldn't release an album with the record label, Castelli sang
in a renowned off-Broadway work, Bottomline.

She was correctly diagnosed in 1994 and they found out she had 44 multiple personalities: writers, musicians,
sculptors, etc.
7. Herschel Walker

Number of personalities: Approximately12

Herschel Walker was a professional American football player and arts expert.
martial arts. He also owns a food company. At first glance
seems like a very normal successful person, but in reality, inside they are
struggling with a very difficult disorder. He was diagnosed with TID
after retiring from American football. As a child, he had always been
he was bullied for his weight and because he stuttered. But Herschel fought until
who could surpass everyone academically and athletically.

Herschel created another person inside him: a person who would never give up; almost like a superhuman. And he let it...
completely dominate.

He did an interview forCBNand described his struggle against the TID:

When you start putting on a hat–a red hat that you wear to play football, and you put on the white hat
to be at home and a blue one to go to work. But suddenly when you leave the house, you put on the red hat; you put it on.
At home. You get tangled up with so many hats. So now, that aggressiveness you have on the football field you have at home.
Why are you wearing the wrong hat.

In 2008, Herschel wrote a book called Breaking Free: My Life with Dissociative Identity Disorder where he shared all his
experiences for everyone to better understand their disorder.

6. Truddi Chase

Número de personalidades: 92

Her story inspired: Voices Within: The Lives of Truddi Chase, a TV

movie from 1990

Truddi's personalities never clashed with each other and were

quite aware of their presence in Truddi's body. She them
called "the troops" (in Spanish, squad or troops) and did not want
they would merge because they had gone through too many experiences together.
Truddi claims that she was physically and sexually abused by her stepfather when she was two years old, while her mother abused her.
she emotionally for 12 years. She was dedicated to real estate, but was unable to work well. It's when she decided to go to
a psychiatrist and found that he had multiple personality disorder... and he had 92 different personalities! His
the youngest personality was five years old and is named Lamb Chop (in Spanish, chuletas de cerdo) and the oldest was Ean, a
Irish philosopher and poet of 1000 years.

She and her psychiatrist wrote together about their experiences with DID in a book called When Rabbit Howls. The book was adapted to
a miniseries.

5. Robert Oxnam

Number of personalities: 11

Robert Oxnam nunca fue abusado de pequeño. De hecho, investiga y estudia la cultura china.
He worked as a private consultant in Chinese affairs and cultures but became an alcoholic in 1989.
When he decided to quit his therapy to be able to stop drinking, Tommy suddenly appeared, a
angry young man who lived in a castle. Later, 10 other personalities appeared that
they were talking about their terrible lives.

After many years of therapy, he managed to reduce his personalities to three: Robert or Bob, his personality
main; Bobby, a very happy man who loves to skate in Central Park; and Wanda, a Buddhist. Wanda was part of another
a personality that was a witch, but ended up falling in love with Buddhism because of her love for Chinese culture.

In 2005, Oxnam wrote a memoir called A Fractured Mind: My Life With Multiple Personality Disorder.

4. Kim Noble

Número de personalidades: 100

What would it be like to live with 99 people who control your life? Kim Noble lives with this problem and
can have up to four or five personalities a day.

Kim was born in England in the 1960s to an unhappy working-class family. Since she was little
suffered physical abuse and may have contributed to the mental issues he/she experienced since then
she was a teenager. In fact, Kim said that her most destructive personalities emerged
when I was about 20 years old. Julie was one of them; Kim was a van driver and a
One day, Julie appeared while she was driving and caused her to crash into several parked cars.

Another destructive experience was when one of her personalities named Hayley was involved in a network of pedophiles.
When Kim was able to regain control, she went straight to the police. From there, she started receiving death threats, someone...
threw acid in the face and nearly burned down his house.

Finally, in 1995, Kim was diagnosed with dissociative identity disorder and has been receiving treatment since then.
luck, now one of her calmer and more responsible personalities, Patricia, has become the personality
dominant.

Kim works as an artist and has written a book called All of Me: How I Learned to Live with the Many Personalities Sharing My
Body.

3. Chris Costner Sizemore

Número de personalidades: 22

Her story inspired: The Three Faces of Eve, a 1957 movie

Unlike most people on this list, Chris Costner

Sizemore came from a good family. One of the incidents that triggered his PTSD was
when she saw how they pulled a man out of a ditch when she was two years old. That event made her
It changed all of life.

As she grew older, different personalities started to emerge and began to change her life. When she gave birth to her daughter Taffy,
One of her personalities, 'Eve Black', tried to strangle the baby; fortunately, 'Eve White' was able to stop her.

Dr. Corbett H. Thigpen diagnosed her with multiple personality disorder and while he was treating her, another personality emerged. Cris saw a
a total of 8 psychiatrists in the last 25 years and had 22 different personalities. Sometimes she could even
he had three personalities at the same time!
Finally, in 1974, after four years of therapy with Dr. Tony Tsitos, they managed to merge all the personalities into
one. His case was compiled by Dr. Thigpen and Hervery M. Cleckley in a book called The Three Faces of Eve. Later it was
adapted into a movie.

2. Shirley Mason

Número de personalidades: 16

Her story inspired: Sybil, a miniseries from 1976

Shirley Mason was born on January 25, 1923, in Dodge, Minnesota, to a sadistic mother.
The difficulties of her childhood were unimaginable; Shirley's mother used to
give enemas to fill his stomach with cold water.

When he grew older, he would lose consciousness and 'wake up' in other cities without knowing how he had gotten there. One of his
One of the worst experiences was when they found themselves in a store in front of several expensive products without knowing how they had arrived.

In 1954, Shirley sought help to try to address her mental health issues. She maintained a long relationship with Dr. Cornelia Wilbur.
During the therapies, the personalities started to appear, totaling 16 different personalities. Later on
Shirley admitted that some of these personalities were false. From then on, Shirley became addicted to the
barbiturates and became very dependent on Dr. Cornelia, who paid her debts and gave her money.

Billy Milligan

Número de personalidades: 24

His story inspired: The Crowded Room, a movie that will be portrayed by Leonardo DiCaprio.

This story seems to have come straight out of a thriller movie—except that it really
It happened in the late 70s. Ohio State University became famous for three kidnappings that occurred.
between October 14 and 26 in 1977. The women were taken to a remote area where they were
stolen and raped. The victims had different testimonies about the suspect's personality.
One claimed that she had a German accent. Another said that the boy was really nice. Physically,
They described the same boy, but sexually, the 'suspects' could not be more different.

All the evidence led the police to Billy Milligan, a 22-year-old young man. They conducted psychological tests on him and he was
diagnosed with DID of 24 different personalities. The defense claimed that two of the personalities were the ones that
they committed the crimes: Ragen, a man from Yugoslavia and Adalana, a lesbian.

Billy was the first American to receive a 'not guilty' verdict from a jury due to his disorder. Instead of
to imprison him, he was confined in a psychiatric hospital until 1988. They say that all his personalities merged into one.

Daniel Keyes, a very well-known author, wrote the biography of Billy Milligan in a book called ‘The Extraordinary Mind of
Billy Milligan.

The blind woman who can see when she changes personality
Lucía Blasco BBC World

A woman with multiple personality disorder and more than 10 different identities, who can see when she adopts one of them.
it helped to better understand how the brain can control the flow of visual information.

She was 33 years old when she first visited the psychiatric clinic of the German doctor Bruno Waldvogel, accompanied by her
guide dog, as he had been accustomed to for more than 10 years.

I had completely lost my sight, specifically 13 years ago, after suffering a traumatic accident from which the doctors did not
they want to give details.

At that moment, she had been diagnosed with cortical blindness, caused –according to her medical report– by the damage
cerebral caused during the incident.

But the reasons that led him to Dr. Waldvogel's clinic had nothing to do with his blindness.

The protagonist of this story, whose initials are B.T., also suffered from identity disorder.
dissociative (multiple personality), a mental disorder that I was already suffering from before the traumatic event.
He presented more than 10 personalities, states the report issued by Dr. Waldvogel and the associate professor of psychology.
doctor from the Institute of Psychological Medicine in Munich (IMP), Hans Strasburger, who also treated the patient.

He changed identities spontaneously. In each personality, he adopted a name, age, gender, skills and
"different temperaments," it reads in the report, recently published in the specialized magazine PsyCh Journal.

In the case of B.T., each identity had a different name, gender, and characteristics. They even spoke different languages.

In some cases, he even spoke different languages; sometimes only English, other times German, and at times he mixed them.
explain there.

According to the medical analysis, the patient had lived for several years during her childhood in an English-speaking country, which is why
I knew the language.

The most surprising thing was when, in the fourth consultation session, embodying the identity of a boy
adolescent, suddenly regained vision," Professor Strasburger tells BBC Mundo.

"Somewhere in our brain, our personality is generated."

The patient recognized some words in the title of a magazine.

At first, they were just letters, but then, very quickly, it began to visualize objects, until it reached
regain vision completely.

The doctors began to use hypnotherapeutic techniques, and B.T.'s visual capacity "extended to other identities.
the states of personality," they assert.

Psychological blindness

It's incredible how this patient is able to switch from one state to another, so that sometimes they see and other times they do not.
the first case known of these characteristics," says Strasburger.

According to the specialist, none of his colleagues had heard of a similar case.

How can the mind control what we see and who we are?

Y Waldvogel and Strasburger concluded that the first diagnosis had been wrong: the blindness of
B.T. was not cortical, because it was not due to the cranioencephalic trauma after the accident.

It was a "psychological" blindness: a "psychogenic disturbance of vision," as described by Sigmund Freud.

in 1910.

It's not something so rare, it sometimes happens and it's a concept that has been known for many years,

What had never happened until now is that a person could be blind and see at the same time, depending on the personality that
"adopt," he pointed out.

According to the doctor, the patient is no longer in therapy and her current situation is that of a blind person who, at times, can see.

One of the most interesting conclusions, according to Strasburger, is "the implications of the brain's capacity to
control the flow of visual information.

People with blindness due to brain damage rarely recover their vision and, if they do, it takes them many years.
The fact that B.T. suddenly regained his sight is very revealing.

The brain, that great unknown

The case reveals the biological implications in mental disorders.

In her case, to identify the patient's brain activity, the doctors placed electrodes on the part
the back of his head, with the aim of measuring the response of the central nervous system to sensory stimuli, what is
known as "evoked potential" (EP, for its acronym in English).

Usually, information travels from the eye to the thalamus (in the center of the brain) and then to the back,
the visual cortex.
But psychiatrists discovered, thanks to this technique, that the information was being "blocked" in B.T.'s brain and not
he/she arrived at his/her final destination.

"Este caso muestra cómo el cerebro es capaz de bloquear información y también revela que hay una base biológica en los
psychogenic visual disturbances and multiple personality disorders," says Strasburger.

The specialist assures that many people believe that those who suffer from psychological blindness "pretend not to see," but this is not the case.
so because, in fact, "there are mechanisms in the brain that prevent it."

According to the doctors, B.T.'s case demonstrates that the differences between the states of personality vary depending on
sensory information and have biological foundations.

Right now you and I are having a conversation. You have your personality and I have mine. But these are,
some way, invented: they are generated in some part of our brain,