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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


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