⒋21 CCMD-3(Chinese Classification of Mental Disorders,中国精神障碍分类与诊断标准第3版),中华精神科学会,2001 40.13 癔症性身份识别障碍 分类:⑷癔症、应激相关障碍、神经症 (40)癔症 【诊断标准】 ⑴符合癔症诊断标准;以自我身份识别障碍为主,丧失自我统一感,有双重人格或多重人格; ⑵对周围环境缺乏觉察,周围意识狭窄或对外界刺激异乎寻常的注意狭窄和选择性注意,并与病人改变了的身份相联系; ⑶上述症状必须是非己所欲,发生在宗教或文化背景认可情境中的类似状态之外或系其延伸; ⑷无幻觉、妄想等精神病性症状; ⑸排除分裂症及其相关障碍、情感性精神障碍。 ⒋22 ICD-10(Inational Classification of Diseasesnter,国际疾病分类第十次修订版),WHO,1993 F44.8 其它分离(转换)性障碍 F44.81 多重人格障碍 本障碍罕见,关于是医源性问题还是文化特有的问题也有争议。基本特征是,同一个体具有两种或更多完全不同的人格,但在某一时间,只有其中之一明显。每种人格都是完整的,有自己的记忆、行为、偏好,可以与单一的病前人格完全对立。 ⒋43 DSM-Ⅳ(Diagnostic and Statistical Manual of Mental Disorders,精神疾病的诊断与统计手册第四版,APA(美国精神病学会),1994 300.14 Dissociative Identity Disorder Defined as the occurrence of two or more personalities within the same individual,each of which during sometime in the person's life is able to take control. This is not often a mentally healthy thing when the personalities vie for control. Symptoms are of course somewhat self-explanatory,but it is important to note that often the personalities are very different in nature,often representing extremes of what is contained in a normal person. Sometimes,the disease is asymmetrical,which means that what one personality knows,the others inherently know. The patient has at least two distinct identities or personality states. Each of these has its own,relatively lasting pattern of sensing,thinking about and relating to self and environment. At least two of these personalities repeatedly assume control of the patient's behavior. Common forgetfulness cannot explain the patient's extensive inability to remember important personal information. This behavior is not directly caused by substance use (such as alcoholic blackouts) or by a general medical condition. Associated Features: Trauma Depression Mood swings Suicidal tendencies Sleep disorders (insomnia,night terrors,and sleep walking) Panic attacks Phobias Alcohol and drug abuse, Differential Diagnosis Some disorders have similar or even the same symptoms. The clinician,therefore,in his/her diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis. Effects of a substance - Alcohol Intoxication General Medical Condition - (e.g.,complex partial seizures) Post-Traumatic Stress Disorder (PTSD) Cause: When faced with overwhelmingly traumatic situations from which there is no physical escape,a patient may resort to "going away" in his or her head. This ability may be used and is extremely effective defense against acute physical and emotional pain,or anxious anticipation of that pain. By this dissociative process,thoughts,feelings,memories,and perceptions of the traumatic experiences can be separated off psychologically,allowing the patient to function as if the trauma had not occurred. Often,even after the traumatic circumstances are long past,the left-over pattern of defensive dissociation remains. Chronic defensive dissociation may lead to serious dysfunction in work,social,and daily activities. Repeated dissociation may result in a series of separate entities,or mental states,which may eventually take on identities of their own. These entities may become the internal "personality states," Changing between these states of consciousness is described as "switching." Treatment: Treatment methods include psychotherapy and the use of specific medications either on their own or,which is more effective in conjunction with each other. Counseling and Psychotherapy [ See Therapy Section ]: Psychotherapy is the treatment of choice for individuals suffering from any type of dissociative disorder. Approaches vary widely,but generally take an individual modality (as opposed to family,group or couples therapy) and emphasize the integration of the various personality states into one,cohesive whole personality. The role of hypnosis remains controversial partly because of concerns that hypnosis may increase the risk of creating false memories. Pharmacotherapy [ See Psychopharmacology Section ] : The use of medication,except for the treatment of acute,specific concurrent Axis I disorders,is not recommended. Maintenance and effective use of prescriptions given the multiple personality states is difficult to attain. If medication is prescribed,it should be carefully monitored.