Kluft Richard P
a Department of Psychiatry , Temple University School of Medicine , Philadelphia , Pennsylvania , USA.
J Trauma Dissociation. 2017 May-Jun;18(3):259-283. doi: 10.1080/15299732.2017.1295376. Epub 2017 Mar 1.
Problematic sexual behaviors are frequently encountered in the treatment of patients suffering Dissociative Identity Disorder and related forms of dissociative disorders. These may include unfortunate patterns of ready acquiescence or submission to overtly or potentially aggressive or sexual approaches/encounters, subtle and/or overt seductive signaling and behaviors, and even overt sexually provocative patterns of verbalizations and actions. This paper discusses the possibility that in some instances, sexual behavior has become weaponized; that is, deployed in circumstances under which assertiveness and/or aggression or other self-protective measures might be expected, probably because such behaviors were not within the range of the possible or were not understood as potentially successful for some victims of trauma. Clinical manifestations are described and discussed. An animal model in which sexual behaviors substitute for aggressive behaviors is described. A speculative hypothesis is offered, postulating that in some cases, such patterns in traumatized humans might represent an epigenetic response to exogenous trauma. Exploration of this model may lead to improved understandings and approaches to trauma victims who manifest such behavior, hopefully destigmatizing them further, facilitating reduction of their shame and guilt, and supporting their recoveries. Clinical interventions are suggested.
在分离性身份障碍及相关形式的分离障碍患者的治疗中，经常会遇到有问题的性行为。这些行为可能包括一些不良模式，如轻易默认或屈从于明显的或潜在的侵犯性或性接触、微妙和/或明显的诱惑信号及行为，甚至是明显的性挑衅言语和行为模式。本文探讨了在某些情况下性行为已被武器化的可能性；也就是说，在可能预期会有坚定立场和/或攻击性或其他自我保护措施的情况下出现性行为，这可能是因为此类行为超出了某些创伤受害者的应对能力范围，或者他们不认为这些行为可能成功。文中描述并讨论了临床表现。介绍了一个用性行为替代攻击行为的动物模型。提出了一个推测性假设，假定在某些情况下，受过创伤的人类的此类模式可能代表对外源性创伤的一种表观遗传反应。对该模型的探索可能会增进对表现出此类行为的创伤受害者的理解并改进治疗方法，有望进一步消除对他们的污名化，减轻他们的羞耻感和内疚感，并支持他们康复。文中还提出了临床干预措施。
