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分离性身份障碍(DID)诊断与治疗的若干要点——病例报告

Selected Aspects of Diagnosis and Therapy in Dissociative Identity Disorder (DID)-Case Report.

作者信息

Orlof Wiktor, Sołowiej-Chmiel Justyna, Waszkiewicz Napoleon

机构信息

Department of Psychiatry, Medical University of Bialystok, 15-089 Bialystok, Podlaskie Voivodeship, Poland.

出版信息

J Clin Med. 2025 Apr 11;14(8):2617. doi: 10.3390/jcm14082617.

Abstract

Dissociative identity disorder (DID) is a condition characterized by the presence of at least two distinct identities. The experience of severe trauma, particularly in childhood and especially related to physical and emotional abuse, is considered the most common etiological source, leading to the development of dissociative mechanisms, as confirmed by both the literature and the authors' research findings. The diagnosis of DID is complex and requires a multimodal approach. This report presents a comprehensive psychiatric and psychological assessment using an integrated diagnostic framework combining clinical observation, psychometric evaluation, and neuroimaging. A 33-year-old woman presented to the Psychiatric Clinic due to numerous amnestic episodes and recurrent identity switches, resulting in a lack of continuity in autobiographical memory and heterogeneous functioning. The patient had previously been treated at the Mental Health Outpatient Clinic with suspected schizophrenia. The patient's history was difficult to collect and switches between identities were observed, with a marked change in behavior. The patient declared the presence of 46 different personalities. The stories she reported changed, depending on the dominant identity, each of which varied in terms of gender, name, sexual orientation, interests, or pattern of behavior. The patient underwent a thorough laboratory diagnosis, including toxicologic diagnosis, neuroimaging, and psychological diagnosis. On the basis of the information collected, based on the ICD-10 Classification, the diagnosis was: F44.8-dissociative identity disorder. The clinical entity described by the authors still poses many diagnostic and therapeutic uncertainties. In the literature, we do not find a case description that holistically encompasses DID. Therefore, the following description represents a unique bibliographic item that is useful to professionals in planning medical and therapeutic care.

摘要

分离性身份障碍(DID)是一种以至少存在两种不同身份为特征的病症。严重创伤的经历,尤其是在童年时期,特别是与身体和情感虐待相关的创伤,被认为是最常见的病因来源,导致了分离机制的发展,这一点已得到文献以及作者研究结果的证实。DID的诊断很复杂,需要采用多模式方法。本报告展示了一项全面的精神科和心理评估,使用了一个综合诊断框架,该框架结合了临床观察、心理测量评估和神经影像学。一名33岁女性因多次失忆发作和反复的身份转换而就诊于精神科诊所,这导致了自传体记忆的连续性缺失和功能的异质性。该患者此前曾在心理健康门诊被怀疑患有精神分裂症。患者的病史很难收集,观察到其身份之间的转换,行为有明显变化。患者宣称存在46种不同的人格。她讲述的故事因占主导的身份而异,每种人格在性别、名字、性取向、兴趣或行为模式方面都有所不同。该患者接受了全面的实验室诊断,包括毒理学诊断、神经影像学和心理诊断。根据收集到的信息,依据国际疾病分类第十版(ICD - 10),诊断结果为:F44.8 - 分离性身份障碍。作者所描述的临床实体仍然存在许多诊断和治疗上的不确定性。在文献中,我们没有找到一个全面涵盖DID的病例描述。因此,以下描述是一个独特的文献资料,对专业人员规划医疗和治疗护理很有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c59d/12028308/51958ce2c5f2/jcm-14-02617-g001.jpg

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