Meganck Reitske
Department of Psychoanalysis and Clinical Consulting, Ghent UniversityGhent, Belgium.
Front Psychol. 2017 May 16;8:789. doi: 10.3389/fpsyg.2017.00789. eCollection 2017.
Dissociative identity disorder (DID) is a widely contested diagnosis. The dominant posttraumatic model (PTM) considers early life trauma to be the direct cause of the creation of alter identities and assumes that working directly with alter identities should be at the core of the therapeutic work. The socio-cognitive model, on the other hand, questions the validity of the DID diagnosis and proposes an iatrogenic origin of the disorder claiming that reigning therapeutic and socio-cultural discourses create and reify the problem. The author argues that looking at the underlying psychical dynamics can provide a way out of the debate on the veracity of the diagnosis. A structural conception of hysteria is presented to understand clinical and empirical observations on the prevalence, appearance and treatment of DID. On a more fundamental level, the concept of identification and the fundamental division of human psychic functioning are proposed as crucial for understanding the development and treatment of DID.
分离性身份障碍（DID）是一种备受争议的诊断。占主导地位的创伤后模型（PTM）认为早年创伤是产生交替身份的直接原因，并假定直接与交替身份合作应是治疗工作的核心。另一方面，社会认知模型质疑DID诊断的有效性，并提出该障碍的医源性起源，声称占主导地位的治疗和社会文化话语创造并强化了这个问题。作者认为，审视潜在的心理动力学可以为关于该诊断准确性的争论提供一条出路。本文提出了一种癔症的结构概念，以理解关于DID的患病率、表现和治疗的临床及实证观察。在更基本的层面上，认同概念和人类心理功能的基本划分被认为对理解DID的发展和治疗至关重要。
