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多重人格障碍 Multiple Personality Disorder

简介 Introduction

多重人格障碍(MPD),现称为解离性身份障碍(DID),是一个正式的精神病,国际上的诊断手册(DSM和ICD)也将之包括在内。DID之主要特征包括:(1) 出现至少两个明显不同的身份或人格部分,反复控制事主的行为(e.g., 从一个交替人格转换成另一个交替人格),以及 (2) 心理失忆(e.g., 记忆断层、无法回忆起个人资料或创伤事件)。在某些文化里,DID之症状或会被描述成附身经验。很多DID患者会同时出现其他症状,譬如抑郁、幻听及其他创伤后症状 (Ross, 1997)。尽管关于DID之争议犹在,有些学者提出DID具有效度及与创伤相关之证据 (Brand et al., 2016)。流行病学研究指出,一般人口中1%可能患有DID,在精神科单位里DID甚至更普遍 (Şar, 2011)。DID患者往往在医疗与社会服务系统里被当成其他问题(e.g., 抑郁、思觉失调/精神分裂症)来治疗多年,才得到正确诊断和恰当治疗。DID跟童年创伤有密切关系,譬如肢体虐待、情绪虐待、情感忽视、家庭暴力等。DID一般被认为是最严重的创伤后心理障碍,而且是一个跨越文化的创伤心理病。DID患者往往对专门心理治疗有良好反应。事实上,DID是从复杂创伤中幸存下来的创造性和适应性策略,允许受害人在遭受难以承受之经历时仍继续应付日常的生活(e.g., 在课堂中学习、进行社交活动)。

Multiple personality disorder (MPD), now known as dissociative identity disorder (DID), is an officially recognized mental disorder and has been included in the international diagnostic manuals (DSM and ICD). The major features of DID include (1) the presence of at least two distinct identities or personality states that recurrently take control of the individual's behaviour (e.g., switching from one alternate personality states to another) and (2) psychological amnesia (e.g., memory gaps, inability to remember personal information or traumatic events). In some cultures, the symptoms of DID may be described as an experience of possession. Many persons who live with DID also suffer from other psychiatric symptoms, such as depression, auditory hallucinations and other posttraumatic symptoms (Ross, 1997). Although there are debates regarding DID, some researchers provide evidence of DID’s validity and its relationship with trauma (Brand et al., 2016). Epidemiological studies suggest that about 1% of the general population may have DID; in psychiatric settings, DID is even more common (Şar, 2011). However, patients with DID usually have been in the health and social service systems and treated as having other conditions (e.g., depression, psychosis/schizophrenia) for many years before they are correctly diagnosed and appropriately treated. DID is highly associated with childhood trauma, such as physical abuse, emotional abuse, emotional neglect and family violence. DID is generally understood as the most severe form of posttraumatic psychopathology, and a cross-culturally occurring trauma disorder. Patients with DID usually respond well to specialized psychotherapy. In fact, DID is a creative and adaptive strategy for surviving complex trauma, allowing the victim to continue to manage daily life (e.g., learn in class, socially engage with friends) despite having overwhelming experiences.

作者/Author: Hong Wang Fung & Colin A. Ross


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