Gauld Christophe, Espi Pauline, Revol Olivier, Fourneret Pierre
Service de Psychopathologie de l'enfant et de l'adolescent, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.
UMR CNRS 8590 IHPST, Université de la Sorbonne, Paris, France.
Front Psychiatry. 2022 Oct 10;13:965593. doi: 10.3389/fpsyt.2022.965593. eCollection 2022.
Dissociative Identity Disorders (DIDs) are controversial psychiatric conditions encountered in clinical practice and nosology. DID as described in the international classifications has little similarity with the clinical picture of "DID" met in current youth psychiatry. From this Perspective, we hypothesize that this current clinical presentation does not satisfy the categorical criteria of the international classifications. Based on the two terminological challenges related to the definition of DID (i.e., the notion of and the different meanings of the term ), we propose to differentiate two distinct entities from each other. The first is medical and listed in diagnostic criteria of international classifications; the second comes from popular culture and refers to the vast majority of clinical presentations received in daily clinical practice-presented under the term Dissociative Identity Conditions (DIC). Since the status of DIC is a hot topic in current clinical psychiatry, we aim to identify eight possible explanations that can be provided to support its occurrence: (1) impact of iatrogenicity; (2) factors of suggestibility and desire for social acceptability; (3) psychoanalytic explanations; (4) neuropsychological explanations; (5) socio-cognitive explanations; (6) emotional labeling; (7) narrative explanations; (8) and transient illnesses explanations. In conclusion, we sustain that DIC results from a narrative interpretation of medical discourse by popular culture, developing in patients presenting undeniable distress. Such a transient disease fits in an ecological niche, which echoes the values of society, persisting under the action of a need for narrative continuity of the self.
分离性身份障碍（DIDs）是临床实践和疾病分类学中存在争议的精神疾病。国际分类中所描述的分离性身份障碍与当前青少年精神病学中遇到的“分离性身份障碍”临床表现几乎没有相似之处。从这个角度来看，我们假设当前的这种临床表现不符合国际分类的类别标准。基于与分离性身份障碍定义相关的两个术语挑战（即“身份”的概念和该术语的不同含义），我们建议将两个不同的实体区分开来。第一个是医学上的，列在国际分类的诊断标准中；第二个来自流行文化，指的是日常临床实践中所接诊的绝大多数临床表现——以分离性身份状况（DIC）这一术语呈现。由于分离性身份状况的地位是当前临床精神病学中的一个热门话题，我们旨在确定可以提供的八种可能解释来支持其发生：（1）医源性影响；（2）暗示性因素和对社会可接受性的渴望；（3）精神分析解释；（4）神经心理学解释；（5）社会认知解释；（6）情感标签；（7）叙事解释；（8）短暂性疾病解释。总之，我们认为分离性身份状况是流行文化对医学话语进行叙事性解读的结果，在呈现出不可否认痛苦的患者中发展而来。这样一种短暂性疾病适合于一个生态位，它呼应了社会的价值观，在自我叙事连续性需求的作用下持续存在。
