Oae H, Abiru T, Domon Y
Ogaki Municipal Hospital.
Seishin Shinkeigaku Zasshi. 2001;103(5):411-25.
The term depersonalization has been vaguely used in clinical contexts and there is confusion over its nosological positioning. Although the syndrome has been assigned a niche of its own in the European psychiatric taxonomy, the American's Diagnostic and Statistical Manual of Mental Disorders (DSM-III, IV) labeled it under the term Dissociative Disorder. The latter, which does not agree with the classical theory of Janet, seems to have no basis on traditional psychopathology and is not derived from any dissociative theories. In this paper the descriptive characteristics of depersonalization are discussed with regard to the features of "observing self" and the relationship between experiences and selves, according to which the authors distinguish two types of depersonalization: an "excessive-self-reflecting type" and an "absorbed-in-experience type". Whereas the former coinsides with the typical depersonalization neurosis, in which excessive self-reflection plays an important role in reducing the sense of reality, in the latter over-absorption in some situations leads the patient to construct a wall to block out reality. We suggest that in making a distinction between these two types, the psychopathology of depersonalization will be better clarified.
人格解体这一术语在临床环境中使用较为模糊，其疾病分类定位也存在混淆。尽管该综合征在欧洲精神病学分类中有其独立位置，但美国的《精神疾病诊断与统计手册》（第三版、第四版）将其归类于分离性障碍。后者与让内的经典理论不一致，似乎没有传统精神病理学依据，也并非源自任何分离理论。本文根据“观察自我”的特征以及体验与自我之间的关系，讨论了人格解体的描述性特征，据此作者区分了两种人格解体类型：“过度自我反思型”和“专注于体验型”。前者与典型的人格解体神经症相符，其中过度的自我反思在降低现实感方面起重要作用，而后者在某些情况下过度专注会导致患者构建一道屏障来阻挡现实。我们认为，区分这两种类型将有助于更好地阐明人格解体的精神病理学。
