27 May
2012

 Case Study of Dissociative Identity Disorder

Subject Arron Stampler

Character From Primal Fear

Kelly A. Burton

Walden University

Abstract

This case study on dissociative identity disorder is based on the movie Primal Fear, starring Edward Norton and Richard Gere.  This paper covers data collection methodology, Five Axis Diagnosis, proposed treatment plan, and followup criteria for people who suffer from dissociative identity disorder.

Case Study of Dissociative Identity Disorder

Subject Arron Stampler

Character From Primal Fear

The selection of character for this case study in Dissociative Identity Disorder (DID) is Arron Stampler from the movie Primal Fear (1996) played by Edward Norton,  based on the book of the same title written by William Diehl.  This was Edwards Norton’s first film which he won a Golden Globe for Best Actor in a supporting role and was nominated for an Academy Award for Best Supporting Actor (IMDB, 2012).

BackGround

Arron Stampler, white male 19 years of age working as an alter boy and singing in the choir at the Savior House was arrested for the alleged brutal murder of Arch Bishop Rushman, who was stabbed over 78 times, throat slashed, fingers cut off, eyes gouged out, and the number B32.156 carved in his chest.  Stampler was found running from the church covered in blood that matched the victim.  Arron when questioned by the Police stated he did not know why he was covered in blood from the victim.  He stated that he went to see Arch Bishop, lost time and then saw the body and blood, got scared and run off.  Arron states that he sometimes “loses time”, where he cannot recall what or where he was at certain times.

Stampler ran away from home at 16 as a result of the abuse from his father back in Creekside, Kentucky.  Bishop Rushman found him on the street and took him in, offering him food, shelter, allowed him to work as an alter boy in the church.  Normally when boys turn 18 they are supposed to leave the church, however Arron states that bishop Rushman liked him and allowed him to stay on working as an alter boy.  Arron’s demeanor is one quite shy and reserved.  Often his speech is often stuttered and his self esteem is quite low.  Psychological evaluation was requested by his attorney Martin Vale played by Richard Gere (Diehl, 1996).

Data Collection

Data collection for Arron’s case is personal interviews captured on video tape. The utilization of the video tape is necessary for documenting the occurrences of the alternate personalities.  Utilization of the Disorders Interview Schedule (DDIS) which can be administered in 30 to 45 minutes and offers capabilities to differentiate between several disorders including DID with limited chance for any false positives reported in journal article from Ross et al (as cited in Dunn,  1992).  The Dissociative Experiences Scale (DES), a 28 item self report test can be utilized to help diagnose DID according to Berstein and Putnam (as cited in Dunn, 1992). Additionally the Questionnaire of Experiences of Dissociation (QED) while limited samples sizes have produced very reliable results and can be utilized to help discover DID in a patient Riley’s Journal Article (as cited in Dunn, 1992).

The examinations listed above were utilized for Arron, the results show that Arron has characteristics of dissociative identity disorder. In addition to the examinations, during interviewing Arron, questioning about his girlfriend Linda, who left without an explanation, Roy appeared, an alternate personality of Arron’s.

Roy is Arron’s protector, he stated this during the interview, he spoke of how Arron is a little baby and can not take care of himself.  Roy also admitted to Killing Bishop Rushman because of the sexual abuse towards Arron.  Roy does not approve of Linda, and does not believe that she is Arron’s actual girlfriend, rather Arron is just confused.  When Roy disappeared and Arron reappeared Arron has no recollection of Roy, only gaps in his memory.  This is consistent with DSM-IV Manual and its definition of dissociative identity disorder.   According to the DSM the following criteria must be met for a diagnosis of dissociative identity disorder (300.14):

  • The presences 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).
  • At least two of these identities or personality states recurrently take control of the person’s behavior.
  • Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
  • 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.

Five Axis Diagnosis

Axis I: 300.14 Dissociative Identity Disorder

Axis II: V71.09 No Diagnosis

Axis III: None

Axis IV: Issues and factors relating to Arron’s history and current state that attribute to Arron’s initial diagnosis of Dissociative Identity Disorder.

Career and Vocational Issues

Arron works at the Savior House as an alter boy and sings in the choir, however he has no other skills.  Running away from home at 16 and living in the Savior House has not prepared him for any career paths.  Additionally his social skills are lacking due do his shy nature and self consciousness about his speech impediment.

Psychosocial and Family Issues

Aaron was victim of abuse from his father, verbal and sometimes psychical. His father, an alcoholic would often drink, then yell at him and his mother, often beating the mother and sometimes Arron himself.  At age 10 or so Arron started having memory gaps, normally when his mother and father were fighting. It is at this time that he created Roy his protector.  This falls in line with the common theory that childhood trauma and the child’s inability to cope with the trauma will cause their personalities to split, the other personalities can form other roles for the person such as in this case with Arron splitting and forming Roy who is the stronger more aggressive protector (Pais 2009).  Arron is not aware of Roy, however Roy is aware of Arron.  Roy (The Protector), is the complete opposite of Arron, bold brash and very arrogant.

At the age 16 he ran away from home, and went to Chicago.  In Chicago he was taken in by Bishop Rushman at the Savior House.  Initially Bishop was very kind to Arron, but as time went on Arron states that Rushman made him perform in special sermons.  Arron along XXXX and Linda, were made to perform sexual acts in front of Bishop Rushman who would video tape them. Putnam et al (as cited by MacGregor, 1996), points out that most DID clients suffer sexual abuse as a child, Arron’s abuse is as a young teen, however during treatment there is a possibility that he did suffer from sexual abuse as a child.  Linda left the savior house after many months of abuse, which Arron has not coped with, feeling a sense of abandonment.  Arron still feels a strong bond of love for Bishop Rushman, stating he is like a father to him.  However deep inside I feel that he has the same resentment and feelings of anger towards Bishop Rushman who is sexually abusing him as his father who physically,mentally and possibly sexually abused him.

Potential Legal Issues

Arron was arrested for the murder of Bishop Rushman, the police caught him fleeing from the scene of the crime covered in the victims blood.  Additionally Arron’s fingerprints are all over the crime scene, and discovery of the Bishop’s special sermon tape has surfaced providing a motive towards Arron killing the Bishop.  During interviews with Arron, Roy, an alternate personality surfaced and admitted to killing the Bishop.  Roy states that Arron is not able to protect himself and was suffering at the hands of the Bishop, therefore Roy, as the protector took care of the problem for Arron. This is a legal dilemma, as physically Arron did kill the Bishop, however mentally he was not in control of his body at the time, Roy was.  Since Arron is the primary personality, and is unaware of the crime, he legally should be held accountable.  However there is the issue of proving that Arron has dissociative personality disorder and was not in control of his physical body at the time of the crime.

Potential Ethical Issues

Treatment of Arron will have to be from another practitioner, as my role in this case is in the forensic capability. Because I was hired by Arron’s Lawyer, I am compelled to evaluate and give my recommendations to the court on Arron’s competency to stand trail and his over all mental conditioning.  This report does include additional treatment information for the clinician who provides therapeutic services for Arron.

Axis V: GAF = 55 (Current)

Proposed Treatment and Intervention Options

            The main focus of treating DID is getting to the root cause of the pain in the individual that caused the disassociate process initially. Psychotherapy can be utilized to resolve the issues causing the dissociative conditions, there many theories on what steps are needed to accomplish this, for the treatment of Arron the methods of Kluft will be utilized.  There are nine steps that are followed in treating DID (Kluft 1999),

  • Establishing the psychotherapy
  • Preliminary interventions
  • History gathering and mapping
  • Metabolism of the trauma
  • Moving towards integration / resolution
  • Integration / Resolution
  • Learning new coping skills
  • Solidification of gains and working thorough
  • Follow-up

Establishing the psychotherapy

The first thing one must due when establishing the psychotherapy is to work gaining the trust of the patient.  Arron in the past has suffered trauma from role model male figures in his life, first in the hands of his father and then from Arch Bishop Rushman during the time he lived at the church.  As a male doctor trust and safety must be insured in order to have a honest open flow of communication. During this period the plan for therapy will be completely disclosed to Arron, this disclosure ensures Arron will know what to expect during this treatment and allow him to give his consent to treatment.

Preliminary interventions

In this stage the focus is to help the patient deal with their disorder and work on getting them stable in order to give consent to treatment.  Recognition of the alters and if possible getting all of the personalities to work together in the treatment of the client.  For Arron who so far has only shown one alternate personality (Roy) treatment will involve getting Roy to cooperate with Arron in getting him well.  Kluft (1999) recommends using hypnosis during this phase of treatment to work at getting to the core of the hurt, once discovered the therapy can be tailored to working towards working through this trauma.

History gathering and mapping

Complete psychology history will be gathered here from Arron.  Additionally mapping of the alternate personalities is conducted during this phase.  Arron initially has one alter (Roy) who is working as his protector and admits to killing Bishop Rushman in order to protect Arron.  Use of hypnosis can be utilized during this phase to help find any other alters at point.  This phase will include mapping the characteristics and their role in the collection of personalities. According to Kluft (1999) this phase is necessary before going into addressing the trauma of the client in order to know what personalities might surface during treatment.  Obtaining the alters from the client can be difficult, one method recommended is to have the alters write their name on a piece of paper placing their name on the paper where they reside in the personality hierarchy, those that cannot write their names (such as small child alters) can place a mark on the paper Fine’s journal articles (as cited by Kluft, 1999).

Metabolism of the trauma

            Aaron has three major incidents of trauma that must be worked through, the first during his childhood that has not been uncovered, the sexual abuse from Bishop Rushman, and the departure of his girlfriend Linda.  In order to work towards full integration of the personalities all trauma must be addressed and worked though, lessening its effect on the client to help alleviate the need for the dissociation (Kluft 1999).  In order to discover what happened to Arron hypnosis can be utilized to walk him back through time to the point where he was traumatized, split and created Roy.  During these sessions where the client will be working through their trauma Kluft’s rule of thirds should be utilized. When working through traumatic events Kluft recommends leaving the client in a safe mental state at the end of the session, working with the painful material in the first two thirds of the session, and re-stabilizing and calming the client during the last third of the session (Kluft 1999).

Moving towards integration / resolution

            After working through Arron’s trauma, it will be time to start working on getting his alter Roy to work with Arron and for them to work together as one.  Kluft lists this as a separate step, however I believe that it is the end part of the metabolism of the trauma step and the beginning of the integration step.

Integration / Resolution

            During this phase work will be done with Arron to get Roy to stay dormant and let Arron have full control of his body at all times. Because Roy is violent and has admitted to killing Bishop Rushman in order to protect Arron, he needs to be locked away.  Arron will be able to accomplish this as he is worked through his traumas and taught new ways to cope with the pain.

Learning new coping skills

            In order for Arron’s resolution of eliminating Roy from his life, he will need to learn new ways to deal with his trauma’s. Trauma’s from his past can be worked through with hypnosis and desensitization. New traumas can be dealt with easier as he is an adult and can be taught to stand up for himself.  Boosting his self esteem and working with a speech therapist to resolve his stutter will help him gain the confidence needed to face the adult world.

Solidification of gains and working thorough

            Once Arron has learned his new coping skills he needs to be monitored to ensure that he utilizes the new skills and not the old dissociative patterns that caused Roy to surface.

Follow-up

            Arron’s initial therapy is estimated to take 5-7 years, three times a week of 60 minute sessions. Once he is able to function without Roy surfacing, followup sessions can be set to once a month for the first year, quarterly the second year, and every six months after that.

Continuing Assessment and Proposed Follow-up

            In addition to treatment for Arron’s DID other measures need to be addressed in order for Arron to return to society as a normal member.  Arron will need vocational training and employment, his early adult life was as a choir and alter boy, he never learned any skills outside of the church that can help sustain him. Recommend finding his strength areas and moving him to employment in that area.  A suitable place for living will need to be found, he can not go back to the savior house as it a source of trauma for him.   Additionally participation in religious based activities is not recommended, this is another source of trauma for Arron and should be avoided until he has completely mastered his new abilities to handle his problems without resorting to his dissociative techniques that caused Roy to surface.

During Arron’s psychologists visits assessments should be utilized to verify the treatment is working and there has been no regression to previous patterns of dissociative behavior.  Continued work on this speech and self esteem will need to be accomplished in order to maintain his confidence and reduce the chance for slipping back into old behaviors.  Group therapy is suggested for Arron once his confidence level is high enough, to help him to relate to others that were sexually abused and allow him to work though any feelings in a healthy atmosphere.

References

American Psychiatric Association. (2008). Diagnostic and statistical manual of mental disorders – dsm-iv-tr. (4TH ed.). Arlington, VA: American Psychiatric Association.

Dunn, G. E. (1992). Multiple personality disorder: A new challenge of psychology. Professional Psychology: Research and Practice, 23(1), 18-23.

IMDB. (2012). Biography for edward norton. Retrieved from http://www.imdb.com/name/nm0001570/bio

Kluft, R. P. (1999). An overview of the psychotherapy of dissociative identity disorder. American Journal of Psychotherapy, 53(3), 289-319.

Diehl, W. (Writer) (1996). Primal fear [DVD].

MacGregor, M. W. (1996). Multiple personality disorder: Etiology, treatment, and treatment techniques from a    psychodynamic perspective. Psychoanalytic Psychology, 13(3), 389-402.

Pais, S. (2009). A systemic approach to the treatment of dissociative identity disorder. Journal of Family Psychotherapy, 20, 72-88.

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