On the differential diagnosis of multiple personality in the forensic context?

Abstract

The problems of diagnosing multiple personality disorder in a forensic context are discussed, and illustrated by the case of Stute u. Kenneth Birrnchi (1979), a defendant who was both charged with first degree murder and suspected of having the disorder. Because of the secondary gain (e.g., avoiding the death penalty) associated with the diagnosis of multiplicity in such a case, hypotheses had to be developed to permit an informed differential diagnosis between multiple personality and malingering. If a true multiple personality disorder existed, then (a) the structure and content of the various personalities should have been consistent over time, (b) the boundaries between different personalities should have been stable and not readily altered by social cues, (c) the response to hypnosis should have been similar to that of other deeply hypnotized subjects, and (d) those who had known him over a period of years should have been able to provide examples of sudden, inexplicable changes in behavior and identity, and evidence to corroborate his claimed intermittent amnesias. None of these proved to be the case. Rather, the content, boundaries, and number of personalities changed in response to cues about how to make the condition more believable, and his response to hypnosis appeared to reflect conscious role playing. Further, the life history indicated a persistent pattern of conning and deliberate deception. It is concluded that Mr. Bianchi was simulating a multiple personality and the diagnosis of Antisocial Personality Disorder with Sexual Sadism was made. Differential diagnoses and the clinical aspects that appeared to account for his behavior are discussed.