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躯体化障碍患者的分离、童年人际创伤及家庭功能

Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder.

作者信息

Brown Richard J, Schrag Anette, Trimble Michael R

机构信息

Department of Clinical Neurology, Institute of Neurology, London, UK.

出版信息

Am J Psychiatry. 2005 May;162(5):899-905. doi: 10.1176/appi.ajp.162.5.899.

Abstract

OBJECTIVE

The goals of this study were to determine 1) the occurrence of various dissociative phenomena in patients with somatization disorder, 2) the occurrence of six different types of childhood interpersonal trauma in these patients, and 3) the nature of these patients' early family environment.

METHOD

Twenty-two patients with somatization disorder and 19 medical comparison subjects completed the Structured Clinical Interview for DSM-IV Dissociative Disorders, the Childhood Trauma Interview, and the Family Functioning Scale.

RESULTS

The somatization disorder patients reported significantly higher level of dissociative amnesia than the comparison subjects. The two groups reported similar levels of depersonalization, derealization, identity confusion, and identity alteration. Somatization disorder patients reported significantly greater childhood emotional abuse and more severe forms of physical abuse, relative to the comparison subjects, with chronic emotional abuse being the best predictor of unexplained symptoms. Childhood sexual abuse, separation/loss, and witnessing violence were equally common in the two groups. The somatization disorder group reported significantly more family conflict and less family cohesion.

CONCLUSIONS

Only some types of dissociation are more severe in patients with somatization disorder, relative to medical comparison subjects. Many patients with somatization disorder are raised in an emotionally cold, distant, and unsupportive family environment characterized by chronic emotional and physical abuse. Sexual abuse is not a necessary prerequisite for the disorder.

摘要

目的

本研究的目的是确定1)躯体化障碍患者中各种分离现象的发生率,2)这些患者中六种不同类型儿童期人际创伤的发生率,以及3)这些患者早期家庭环境的性质。

方法

22名躯体化障碍患者和19名医学对照受试者完成了《精神疾病诊断与统计手册》第四版分离性障碍结构化临床访谈、儿童创伤访谈和家庭功能量表。

结果

与对照受试者相比,躯体化障碍患者报告的分离性遗忘水平显著更高。两组报告的人格解体、现实解体、身份混淆和身份改变水平相似。与对照受试者相比,躯体化障碍患者报告的儿童期情感虐待显著更多,身体虐待形式更严重,慢性情感虐待是无法解释症状的最佳预测因素。儿童期性虐待、分离/丧失和目睹暴力在两组中同样常见。躯体化障碍组报告的家庭冲突显著更多,家庭凝聚力更少。

结论

与医学对照受试者相比,只有某些类型的分离在躯体化障碍患者中更严重。许多躯体化障碍患者成长于一个情感冷漠、疏远且缺乏支持的家庭环境中,其特点是长期存在情感和身体虐待。性虐待并非该障碍的必要先决条件。

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