解离性身份疾患

title: 临床症状.
content: 多重人格患者的每一个人格都是稳定、发展完整、拥有个别思考模式和记忆的。分裂出的人格包罗万象,可以有不同的性别、年龄、种族,甚至物种。他们轮流出现控制患者的行为。分裂出的人格之间知道彼此的存在,称为「并存意识」(co-consciousness)。如果并存意识较好的,他们甚至可以进行内部沟通/会议,或进行外部会议(如果人格间进行外部沟通/会议时,在旁人看来会像是个自言自语的疯子);也有一些情况,人格之间并没有察觉到彼此的存在,这会导致严重的「遗失时间」现象。 原人格不一定是主人格。原人格即未产生多重人格前的原始人格,而主人格则是在平常大部分时间主宰身体的人格。虽然原人格通常也会是主人格,但也有原人格仍然停留于儿童时期,身体则交由会长大的主人格管理的情况。 原本的人格不知道「他们」的存在的情况下,即使发现自己的记忆有截断(记忆断层)的现象,也无法知道自己有多重人格。也有一些严重的病例,原人格甚至「沉睡」十多年,但分裂出的人格中往往会有一个是知道所有事的,如果这个人格愿意合作,治疗人员就能从中得知许多有益的资料。另外,多重人格患者发生记忆断层或人格强硬地想出现时有可能伴随强烈的头痛。哈佛大学心理学系教授,迈耐利(Richard J. McNally)的实验,认为没有证据可以证实在各人格之间存在记忆障碍,那些声称自己被记忆障碍所困扰的患者,可能更多是为了符合文化期望,而非真的。不过,近年顶尖的医学发现,则有另一个观点,根据不少关于大脑的研究显示,尽管是同一个人(同一个身体和大脑),不同人格的脑部摄影结果皆不相同,另外也有其他对大脑的研究和实验,有力地显示多重人格既不是「伪装」出来,也不是因为社会文化期望或治疗师的暗示(suggestion)所产生出来的。
title: 成因.
content: 多重人格的成因多有争议。有理论认为多重人格与童年创伤相关,因为此时正是人格的形成阶段。当受到难以应付的冲击时,患者以「放空」的方式,以达到「这件事不是发生在我身上」的感觉,这对长期受到严重伤害的人来说,或许是必要的。  国际上的新知为7岁以前(黄金6年)/学龄前有冲击过大或重复发生的身体虐待、情绪虐待,以及强大的压力事件,甚至源自从婴儿开始的「混乱型依附行为」(Disorganized Attachment)。
title: 传统的治疗方法.
content: 多重人格的根治需要好几年的时间。治疗人员主要是在多重人格中找出一位熟悉所有人格的内在人格,通常为「内在自助者」(Inner Self Helper,ISH),让其成为核心人格,且让各种内在人格互相对谈而认识其他人格,然后找出性格上相似的人格率先整合,从而逐步削减内在人格后整合为一,但即使治疗成功,也可能因外在压力,造成人格再次解离。 另外,由于患者受暗示性很高,因此在临床上的治疗常利用催眠来召唤患者不同的人格,以便治疗。不过,根据临床经验,催眠治疗多半是辅助式的,或只作为一种技术,并非治本之法。
title: ICD-10-CM疾病诊断代码.
content: ICD-10-CM:F44.81

Summary: 解离性身份疾患,或多重人格,是心理疾病的一种,常与思觉失调症搞混,较早的《精神疾病诊断与统计手册》(DSM)版本将其命名为多重人格障碍(英语:Multiple Personality Disorder,英语:MPD),后来改名为解离性身份疾患(英语:Dissociative Identity Disorder,英语:DID),多重人格即具有超过一个人格存在(若只有两个则称为“双重人格”),就有如「在一个身体里住着好几个灵魂」。

Dissociative identity disorder: Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD), is a mental disorder characterized by the maintenance of at least two distinct and relatively enduring personality states. The illness is accompanied by memory gaps beyond what would be explained by ordinary forgetfulness. The personality states alternately show in a person's behavior; presentations, however, are variable. Other conditions that often occur in people with DID include posttraumatic stress disorder (PTSD), personality disorders (especially borderline and avoidant), depression, substance use disorders, conversion disorder, somatic symptom disorder, eating disorders, OCD, and sleep disorders. Self-harm, non-epileptic seizures, flashbacks with amnesia for content of flashbacks, and anxiety disorders and suicidality are also common. DID is associated with overwhelming traumas, or abuse during childhood. In about 90% of cases, there is a history of abuse in childhood, while other cases are linked to experiences of war, or medical procedures during childhood. Biological factors are also believed to play a role. The diagnosis should not be made if the person's condition is better accounted for by substance abuse, seizures, other mental health problems, imaginative play in children, or religious practices. Treatment generally involves supportive care and psychotherapy. The condition usually persists without treatment. It is believed to affect about 1.5% of the general population (based on a small US community sample) and 3% of those admitted to hospitals with mental health problems in Europe and North America. DID is diagnosed about six times more often in females than males. The number of recorded cases increased significantly in the latter half of the 20th century, along with the number of identities claimed by those affected. DID is controversial within both psychiatry and the legal system. In court cases, it has been used as a rarely successful form of the insanity defense. It is unclear whether increased rates of the disorder are due to better recognition or sociocultural factors such as media portrayals. The typical presenting symptoms in different regions of the world may also vary depending on culture, for example medically unexplained neurological symptoms or fragmented identities taking the form of possessing spirits, deities, or mythical figures in cultures where normative possession states are common. The possession form of dissociative identity disorder is involuntary, distressing and occurs in a way that violates cultural or religious norms.