[编辑本段]4.多重人格障碍
4.0 术语及分类
所谓“多重人格”在CCMD-3中称为“癔症性身份识别障碍”，属癔症；在ICD-10中称为“多重人格障碍 mutiple personality disorder”,属分离[转换]性障碍 （Dissociative [conversion] disorders））在DSM-IV中称为“分离性身份识别障碍（Dissociative Identity Disorder）”,属解离型障碍（Dissociative Identity Disorder）
4.1 流行病学
过去认为，多重人格在人群中的比率是非常低的。但近年的发现表明，多重人格其实并非那么少见。此症以女性为多，其发病率通常为男性的三至九倍。
4.2 诊断标准
4.21 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:(4)癔症、应激相关障碍、神经症
(40)癔症
【诊断标准】
(1)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；
(2)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；
(3)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；
(4)无幻觉、妄想等精神病性症状；
(5)排除分裂症及其相关障碍、情感性精神障碍。
4.22 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。
相对常见的形式是双重人格，通常其中一种占优势，但两种人格都不进入另一方的记忆，几乎意识不到另一方的存在。从一种人格向另一种的转变，开始时通常很突然，与创伤性事件密切相关；其后，一般仅在遇到巨大的或应激性事件、或接受放松、催眠或发泄等治疗时，才发生转换。
4.43 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.
4.23 病例
人格分裂症就是一个人有很多的性格。一般表现为双重人格。当然也有罕见的多重人格。以前有个英国的女性，她有罕见的七重人格！每个人格都具有不同的品位、性格、习惯、智商等等。而且一个人格会不记得另一个人格所做过的事。所以她常常会突然发现自己处于一个陌生的环境，也不知道该干些什么。她是天生的。也有些人格分裂是后天的。比如是受了某种刺激。这刺激的大小很难定义，要看每个人的心理承受能力了。那时就会有明显的主次人格之分。一般主人格很少记得自己干过些什么，只是刚从次人格转回来的时候会有些奇怪。这些人一般是靠周围的人发现病症的。一般的人格分裂都是不定期无规律的，有些则是在特殊的情况下会被激发。当医师询问时，患者难表达清楚，甚至觉得自己只是有些幻视、幻觉。发作时另一个人格能记得所有发生在自己身上的一切。一位女性患者的主人格喜欢在一个人时就会幻想出一个朋友，给她一个设定，与她交谈。最后渐渐失去自我，解放了次人格。那就是幻想过度所引发的。词患者主人格是个很孤独的人。这就是病因。因而过度渴望朋友，通过幻想来逃避现实。
4.24 治疗
这种人一经发现就要及时治疗。治疗成功的有很多例所以不用担心。一定要积极配合。如果担心自己得这种你可以询问身边的人自己是否有异常。一般精神疾病都是身边的人首先发现的。来我们这治疗的也都是由他人带着的。和他们相处其实也没什么困难，除非这个人格分裂的人的次人格很偏激，那可能这个次人格也存在某种精神疾病。其他的你只要把他当成多人就成的。就像我们平时都要面对不同种人。不要歧视或者冷淡他们，这样可能会加重他们的病情。记住他们也只是普通人，只要没有攻击性行为都是可以正常交往甚至做朋友的。
楼主 
