⒋43DSM-Ⅳ（DiagnosticandStatisticalManualofMentalDisorders，精神疾病的诊断与统计手册第四版，APA（美国精神病学会），1994300.14DissociativeIdentityDisorderDefinedastheoccurrenceoftwoormorepersonalitieswithinthesameindividual,eachofwhichduringsometimeintheperson'slifeisabletotakecontrol.Thisisnotoftenamentallyhealthythingwhenthepersonalitiesvieforcontrol.Symptomsareofcoursesomewhatself-explanatory,butitisimportanttonotethatoftenthepersonalitiesareverydifferentinnature,oftenrepresentingextremesofwhatiscontainedinanormalperson.Sometimes,thediseaseisasymmetrical,whichmeansthatwhatonepersonalityknows,theothersinherentlyknow.Thepatienthasatleasttwodistinctidentitiesorpersonalitystates.Eachofthesehasitsown,relativelylastingpatternofsensing,thinkingaboutandrelatingtoselfandenvironment.Atleasttwoofthesepersonalitiesrepeatedlyassumecontrolofthepatient'sbehavior.Commonforgetfulnesscannotexplainthepatient'sextensiveinabilitytorememberimportantpersonalinformation.Thisbehaviorisnotdirectlycausedbysubstanceuse(suchasalcoholicblackouts)orbyageneralmedicalcondition.AssociatedFeatures:TraumaDepressionMoodswingsSuicidaltendenciesSleepdisorders(insomnia,nightterrors,andsleepwalking)PanicattacksPhobiasAlcoholanddrugabuse,DifferentialDiagnosisSomedisordershavesimilaroreventhesamesymptoms.Theclinician,therefore,inhis/herdiagnosticattempthastodifferentiateagainstthefollowingdisorderswhichneedtoberuledouttoestablishaprecisediagnosis.Effectsofasubstance-AlcoholIntoxicationGeneralMedicalCondition-(e.g.,complexpartialseizures)Post-TraumaticStressDisorder(PTSD)Cause:Whenfacedwithoverwhelminglytraumaticsituationsfromwhichthereisnophysicalescape,apatientmayresortto"goingaway"inhisorherhead.Thisabilitymaybeusedandisextremelyeffectivedefenseagainstacutephysicalandemotionalpain,oranxiousanticipationofthatpain.Bythisdissociativeprocess,thoughts,feelings,memories,andperceptionsofthetraumaticexperiencescanbeseparatedoffpsychologically,allowingthepatienttofunctionasifthetraumahadnotoccurred.Often,evenafterthetraumaticcircumstancesarelongpast,theleft-overpatternofdefensivedissociationremains.Chronicdefensivedissociationmayleadtoseriousdysfunctioninwork,social,anddailyactivities.Repeateddissociationmayresultinaseriesofseparateentities,ormentalstates,whichmayeventuallytakeonidentitiesoftheirown.Theseentitiesmaybecometheinternal"personalitystates,"Changingbetweenthesestatesofconsciousnessisdescribedas"switching."Treatment:Treatmentmethodsincludepsychotherapyandtheuseofspecificmedicationseitherontheirownor,whichismoreeffectiveinconjunctionwitheachother.CounselingandPsychotherapy[SeeTherapySection]:Psychotherapyisthetreatmentofchoiceforindividualssufferingfromanytypeofdissociativedisorder.Approachesvarywidely,butgenerallytakeanindividualmodality(asopposedtofamily,grouporcouplestherapy)andemphasizetheintegrationofthevariouspersonalitystatesintoone,cohesivewholepersonality.Theroleofhypnosisremainscontroversialpartlybecauseofconcernsthathypnosismayincreasetheriskofcreatingfalsememories.Pharmacotherapy[SeePsychopharmacologySection]:Theuseofmedication,exceptforthetreatmentofacute,specificconcurrentAxisIdisorders,isnotrecommended.Maintenanceandeffectiveuseofprescriptionsgiventhemultiplepersonalitystatesisdifficulttoattain.Ifmedicationisprescribed,itshouldbecarefullymonitored.病例人格分裂症就是一个人有很多的性格。