a Psychology Department , Towson University , Towson , Maryland , USA.
J Trauma Dissociation. 2014;15(1):52-65. doi: 10.1080/15299732.2013.828150.
Proponents of the iatrogenic model of the etiology of dissociative identity disorder (DID) have expressed concern that treatment focused on direct engagement and interaction with dissociated self-states harms DID patients. However, empirical data have shown that this type of DID treatment is beneficial. Analyzing data from the prospective Treatment of Patients With Dissociative Disorders (TOP DD) Study, we test empirically whether DID treatment is associated with clinically adverse manifestations of dissociated self-states: acting so differently that one feels like different people, hearing voices, and dissociative amnesia. We show that, over the course of the study, there were significant decreases in feeling like different people and hearing voices. These results indicate that this form of DID treatment does not lead to symptomatic worsening in these dimensions, as predicted by the iatrogenic model. Indeed, treatment provided by TOP DD therapists reduced, rather than increased, the extent to which patients experienced manifestations of pathological dissociation. Because severe symptomatology and impairment are associated with DID, iatrogenic harm may come from depriving DID patients of treatment that targets DID symptomatology.
分离性身份障碍（DID）病因的医源性模型的支持者表示担心，专注于与分离的自我状态直接接触和互动的治疗会伤害 DID 患者。然而，实证数据表明，这种类型的 DID 治疗是有益的。通过分析前瞻性治疗分离性障碍患者（TOP DD）研究的数据，我们实证检验 DID 治疗是否与分离的自我状态的临床不良表现有关：表现得如此不同，以至于感觉自己像不同的人，听到声音，和分离性遗忘。我们发现，在研究过程中，感觉自己像不同的人以及听到声音的情况有了显著的减少。这些结果表明，这种形式的 DID 治疗不会导致这些方面的症状恶化，正如医源性模型所预测的那样。事实上，TOP DD 治疗师提供的治疗减少了，而不是增加了，患者经历病理性分离表现的程度。因为严重的症状和损伤与 DID 有关，所以医源性伤害可能来自于剥夺 DID 患者针对 DID 症状的治疗。
