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多重人格障礙Multiple Personality Disorder


簡介 Introduction

多重人格障礙(MPD),現稱為解離性身份障礙(DID),是一個正式的精神病,國際上的診斷手冊(DSM和ICD)也將之包括在內。DID之主要特徵包括:(1) 出現至少兩個明顯不同的身份或人格部分,反覆控制事主的行為(e.g., 從一個交替人格轉換成另一個交替人格),以及 (2) 心理失憶(e.g., 記憶斷層、無法回憶起個人資料或創傷事件)。在某些文化裡,DID之症狀或會被描述成附身經驗。很多DID患者會同時出現其他症狀,譬如抑鬱、幻聽及其他創傷後症狀 (Ross, 1997)。一些學者認為DID是社會建構而成的現象而非創傷心理障礙,但另一些學者提出DID具有效度及與創傷相關之證據 (Brand et al., 2016)。流行病學研究指出,一般人口中1%可能患有DID,在精神科單位裡DID甚至更普遍 (Şar, 2011)。DID患者往往在醫療與社會服務系統裡被當成其他問題(e.g., 抑鬱、思覺失調/精神分裂症)來治療多年,才得到正確診斷和恰當治療。DID跟童年創傷有密切關係,譬如肢體虐待、情緒虐待、情感忽視、家庭暴力等。DID一般被認為是最嚴重的創傷後心理障礙,而且是一個跨越文化的創傷心理病。DID患者往往對專門心理治療有良好反應。事實上,DID是從複雜創傷中倖存下來的創造性和適應性策略,允許受害人在遭受難以承受之經歷時仍繼續應付日常的生活(e.g., 在課堂中學習、進行社交活動)。

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). Some scholars believe that DID is a socially constructed phenomenon rather than a trauma disorder, while some other 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

新聞及政府資訊 News&Government Information

Whitworth, M. (2006, 2006-03-13, January 01). Me, my selves and I... The Telegraph.
Robert Oxnam is a renowned China scholar as well as a past President of the Asia Society (1981-1992). He has been a traveling China lecturer for various famous people, including Bill Gates, Warren Buffett and President George H.W. Bush. Despite this success in his career, he also suffered from DID. He wrote a book A Fractured Mind: My Life with Multiple Personality Disorder to share his own experience of living with DID. This news article talks about the story of Robert Oxnam and highlights his personal thoughts.
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陳怡妏. (2009, 2009-08-09, January 01). 多重人格畫家 擁12種畫風. 蘋果日報.
英國單親媽媽Kim Noble患有DID,接受藝術治療,意外發現某些人格部分喜歡在凌晨繪畫,而且畫風別具特色,不同的人格部分更有不同的畫風,有的畫風黑暗,有的色彩鮮豔,還有一位尤好雕刻。這些年來她創作了大量作品,亦在歐洲辦過多場畫展。
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馮康泓 、 李政洋. (2017, 2017-11-08, January 01). 每個人或多或少都有「多重人格」? 解開「多重人格障礙」17個秘密. 良醫健康網: 精神科醫師們的看診室.
社會上往往有很多關於DID的討論,但真正了解DID的人可能並不多,以致網上時常流傳著一些些關於DID的錯誤資訊。這篇文章以科學文獻為基礎,為大家逐一講解關於DID的十七個常見問題,包括什麼是解離、現實中是否有DID、DID跟精神分裂症是否一樣、DID患者是否真的有很多不同的人格、DID患者是否一定會失憶等等。這是一篇易讀而精簡的報導,讓讀者正確認識DID。
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毛記電視. (2017). 思. 裂 - 與我我我我我我我常在. 星期三港案.
有些人認為DID只出現在虛構作品中,也有些人認為DID主要只出現在北美地區。然而,DID既是真實存在的現象,也出現在不同的文化和地區──包括華人社會裡。是次報導訪問了一位真實的DID患者,事主是土生土長的香港人,她在影片裡講述了患有DID的真實經驗,影片末段,退休精神科醫生楊保謙(Dr. David Yeung)親身為觀眾講解DID。
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影視作品 Movie and TV Series

Munhwa Broadcasting Corporation, . (2015). Kill Me, Heal Me (킬미, 힐미). South Korea: Munhwa Broadcasting Corporation.
The main character in this non-fiction TV series from South Korea was a third-generation business heir with DID. He tried to regain control over other alters with the secret help of a female psychiatrist. He eventually discovered the roots of the problem and integrated the fragmented parts of in his mind.
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香港電視廣播有限公司. (2018). 三個女人一個「因」. 香港: 香港電視廣播有限公司.
此電視戲劇講述一位因童年創傷而患有DID的大律師如何藉由徒弟的幫助,與其他交替人格慢慢接觸和溝通,學懂接納自己,最後得以從創傷中復原。
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學術文章 Academic Papers

Brand, B. L. & Loewenstein, R. J. (2010). Dissociative disorders: An overview of assessment, phenomenology, and treatment. Psychiatric Times, 27(10), 62–69.
This paper provides an overview of dissociative disorders, including the causes, comorbidities, prevalence, clinical features, differential diagnosis, treatment and costs of dissociative disorders.
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Brand, B. L. et al. (2016). Separating fact from fiction: An empirical examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry, 24(4), 257–270.
There are a number of debates about DID in the field. For example, some argue that DID is only a North American phenomenon, that DID is the same entity as borderline personality disorder (BPD), or that the treatment for DID is harmful. This study reviewed the empirical literature and examined six commonly held myths regarding DID. The authors also emphasized the high personal and economic costs of ignorance about DID. Practitioners should be aware of the empirical evidence regarding DID in order not to overlook these patients in clinical practice.
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Dorahy, M. J. et al. (2014). Dissociative identity disorder: An empirical overview. Australian & New Zealand Journal of Psychiatry, 48(5), 402–417.
This study examined the empirical data related to DID in the literature in order to provide a scientific overview. According to the findings, DID is a valid disorder which can be discriminated from other mental disorders and DID is associated with a complex combination of developmental and cultural factors, including interpersonal trauma during childhood. It was also found that DID may be most prevalent in emergency psychiatric settings. In short, the existing empirical data show that DID is a valid disorder that is not rare.
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Fung, H. W. et al. (2018). Psychometric properties of the pathological dissociation measures among Chinese research participants – A study using online methods. Journal of Evidence-Informed Social Work, 15(4), 371–384.
This paper reports the validity of three dissociation measures in the Chinese context.
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Fung, H. W. et al. (in press). A preliminary investigation of depression in people with pathological dissociation. Journal of Trauma & Dissociation.
This paper shows that severe depression is common among people with pathological dissociation and that depressive symptoms are associated with more dissociative symptoms, post-traumatic stress disorder (PTSD) symptoms, borderline personality disorder (BPD) symptoms and poor symptom management; the level of depression is also associated with high-betrayal trauma but not with low-betrayal trauma.
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Fung, H. W. et al. (in press). A web-based psychoeducation program for people with pathological dissociation: Development and pilot testing. Journal of Evidence-Based Social Work.
This paper reports the development of a web-based psychoeducation program for people with pathological dissociation and describes the initial findings of a pilot study.
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International Society for the Study of Trauma and Dissociation, . (2011). Guidelines for treating dissociative identity disorder in adults, Third Revision. Journal of Trauma & Dissociation, 12(2), 115–187.
This comprehensive work reviews the assessment and treatment of DID and allied forms of dissociative disorder not otherwise specified (DDNOS) (now known as other specified dissociative disorder [OSDD]). As a practical guide to the management of adult patients with DID/OSDD, it represents a synthesis of current scientific findings.
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Şar, V. & . (2011). Epidemiology of dissociative disorders: An overview. Epidemiology Research International, 2011, 1–8.
There are debates about the prevalence of dissociative disorders and DID, despite the fact that quite a number of screening studies using assessment tools for dissociative disorders have been conducted across different countries. This study reviewed the data from epidemiological studies on dissociative disorders in the literature. It was suggested that DID and other dissociative disorders were not rare in both clinical and nonclinical populations. The lack of a measure for dissociative disorders in general mental health assessment tools has resulted in overlooking dissociative disorders in many epidemiological studies.
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Spanos, N. P. (1994). Multiple identity enactments and multiple personality disorder: A sociocognitive perspective. Psychological Bulletin, 116(1), 143.
Some scholars who endorse the sociocognitive model suggest that DID is not a valid trauma-related mental disorder. This article suggests that DID is a sociohistorical product as people “learn to construe themselves as possessing multiple selves” (p. 143).
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馮康泓 、 劉炎慧. (2017). 複雜解離症: 跨文化的創傷心理障礙. 臨床醫學, 79(1), 39–48.
複雜解離症,是創傷與解離領域的學者對DID和OSDD之統稱。複雜解離症被普遍認為是跨越文化、與心理創傷相關的精神科疾病。由於關於複雜解離症之中文文獻並不多,這篇文章概述創傷與解離領域之重要發現,回顧複雜解離病的診斷、盛行率、風險因素、評估、治療等資訊。
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馮康泓等人. (2017). 解離性身份障礙之評估和診斷. 北市醫學雜誌, 14(4), 425–439.
流行病學研究指出DID比傳統所認為的普遍,但對於部分臨床工作者而言,識別和評估DID並不容易。一般的專業培訓很少訓練臨床工作者如何診斷或排除DID此一診斷,而且華人社會也缺乏關於評估DID 的中文資訊或指南,因此這篇文章回顧相關之文獻,討論如何評估和診斷DID,並簡介DID 跟抑鬱症、思覺失調/精神分裂症、邊緣人格障礙、創傷後壓力症和雙相障礙症/躁鬱症的異同之處。
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書籍 Books

Dell, P. F. & O’Neil, J. A. (2009). Dissociation and the dissociative disorders: DSM-V and beyond. New York: Routledge.
This integrative book compiles excellent articles from outstanding experts in the field. Not only does this book provide readers with updated research findings, knowledge and theories about dissociation and dissociative disorders, but it also highlights the gaps in knowledge and suggests a research agenda for the field. Researchers, practitioners and students would find this book very informative and helpful in understanding the dissociation topics.
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Ross, C. A. (1997). Dissociative identity disorder: Diagnosis, clinical features, and treatment of multiple personality disorder. New York: John Wiley & Sons.
First published in 1989 and revised in 1997, this book provides a comprehensive and detailed review of the history, diagnosis and clinical features, and the treatment of DID with materials throughout based on scientific findings and clinical and forensic experience. This book also discusses important issues related to DID, such as the false memory controversy and scepticisms on DID. Those who are interested in DID may consider this book as a useful reference.
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Steinberg, M. & Schnall, M. (2000). The stranger in the mirror: Dissociation—The hidden epidemic. New York: HarperCollins.
This book introduces dissociation and dissociative disorders and discusses the use of a semi-structured interview to recognize the five core dissociative symptoms, namely amnesia, depersonalization, derealization, identity confusion and identity alteration. Although targeted at the general public, this easy-reading book is also an excellent reference book for mental health practitioners and researchers.
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