The diagnosis of multiple personality disorder based on subtle dissociative signs.

Patients with multiple personality disorder (MPD) often present with subtle dissociative signs and symptoms rather than with the clear-cut, overt dissociative signs and symptoms usually associated with MPD. Because most MPD patients usually conceal their condition, there are only limited periods in their lives when they show florid, overt symptoms that can be easily diagnosed. During these other times, MPD patients often show subtle dissociative signs in their affects, thoughts, memories, behaviors, object relations, and transferences. These indirect manifestations of MPD are evidence of the patient's dissociative pathology and occur when their alters influence each other, partly emerge, or subtly shift. A familiarity with these subtle dissociative signs would allow the therapist to be aware of what MPD looks like when it is camouflaged and expressed indirectly. A recognition of these indirect manifestations would enable the clinician to suspect the diagnosis, explore the possible alters, and diagnose the patient's underlying dissociative pathology when present.