?、?1 CCMD-3(Chinese Classification of Mental Disorders，中國精神障礙分類與診斷標(biāo)準(zhǔn)第3版），中華精神科學(xué)會，2001 40.13 癔癥性身份識別障礙 分類：⑷癔癥、應(yīng)激相關(guān)障礙、神經(jīng)癥 ?。?0）癔癥 【診斷標(biāo)準(zhǔn)】 ⑴符合癔癥診斷標(biāo)準(zhǔn)；以自我身份識別障礙為主，喪失自我統(tǒng)一感，有雙重人格或多重人格； ⑵對周圍環(huán)境缺乏覺察，周圍意識狹窄或?qū)ν饨绱碳ぎ惡鯇こ５淖⒁猹M窄和選擇性注意，并與病人改變了的身份相聯(lián)系； ?、巧鲜霭Y狀必須是非己所欲，發(fā)生在宗教或文化背景認(rèn)可情境中的類似狀態(tài)之外或系其延伸； ?、葻o幻覺、妄想等精神病性癥狀； ?、膳懦至寻Y及其相關(guān)障礙、情感性精神障礙。 ?、?2 ICD-10（Inational Classification of Diseasesnter，國際疾病分類第十次修訂版），WHO,1993 F44.8 其它分離（轉(zhuǎn)換）性障礙 F44．81 多重人格障礙 本障礙罕見，關(guān)于是醫(yī)源性問題還是文化特有的問題也有爭議。基本特征是，同一個體具有兩種或更多完全不同的人格，但在某一時間，只有其中之一明顯。每種人格都是完整的，有自己的記憶、行為、偏好，可以與單一的病前人格完全對立。 ?、?3 DSM-Ⅳ（Diagnostic and Statistical Manual of Mental Disorders，精神疾病的診斷與統(tǒng)計手冊第四版，APA（美國精神病學(xué)會），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.
