Coons P M
Larue D. Carter Memorial Hospital, Indianapolis, Indiana 46202.
J Nerv Ment Dis. 1994 Aug;182(8):461-4. doi: 10.1097/00005053-199408000-00007.
The diagnostic validity of multiple personality disorder (MPD) and its association to trauma have been questioned because corroboration of child abuse in studies of patients with MPD is scant. The purpose of this study was to determine on a retrospective basis whether external corroboration of child abuse could be found in a group of patients with MPD and dissociative disorder not otherwise specified. A group of child and adolescent psychiatric inpatients and outpatients was chosen because of the extensive number of collateral records collected on them in a tertiary care setting. This group was also chosen because of the intense interest paid by child protective services and courts to child abuse during the past 15 years. This retrospective chart review confirmed child abuse in eight of nine patients with MPD and in all 12 cases of dissociative disorder not otherwise specified. This study provides further evidence of the association of severe dissociative disorders with trauma, particularly child abuse. Future studies should be prospective and blinded to avoid the possibility of investigator bias, and should include a control group for comparison of base rate of child abuse.
多重人格障碍(MPD)的诊断效度及其与创伤的关联一直受到质疑,因为在对MPD患者的研究中,对儿童期受虐情况的佐证很少。本研究的目的是通过回顾性研究,确定在一组MPD患者和未另行说明的分离性障碍患者中,是否能找到儿童期受虐的外部佐证。选择了一组儿童和青少年精神科住院患者及门诊患者,原因是在三级医疗环境中收集了大量关于他们的旁证记录。选择这组患者也是因为在过去15年中,儿童保护服务机构和法院对儿童期受虐问题高度关注。这项回顾性病历审查证实,9例MPD患者中有8例存在儿童期受虐情况,12例未另行说明的分离性障碍患者均存在该情况。本研究进一步证明了严重分离性障碍与创伤,尤其是儿童期受虐之间的关联。未来的研究应该是前瞻性的且采用盲法,以避免研究者偏倚的可能性,并且应该纳入一个对照组,以比较儿童期受虐的基础发生率。