Saxe G N, van der Kolk B A, Berkowitz R, Chinman G, Hall K, Lieberg G, Schwartz J
Trauma Clinic, Harvard Medical School, Department of Psychiatry, Massachusetts Mental Health Center, Boston.
Am J Psychiatry. 1993 Jul;150(7):1037-42. doi: 10.1176/ajp.150.7.1037.
This study attempted to determine 1) the prevalence of dissociative disorders in psychiatric inpatients, 2) the degree of reported childhood trauma in patients with dissociative disorders, and 3) the degree to which dissociative experiences are recognized in psychiatric patients.
A total of 110 patients consecutively admitted to a state psychiatric hospital were given the Dissociative Experiences Scale. Patients who scored above 25 were matched for age and gender with a group of patients who scored below 5 on the scale. All patients in the two groups were then interviewed in a blind manner, and the Dissociative Disorders Interview Schedule, the Traumatic Antecedent Questionnaire, and the posttraumatic stress disorder (PTSD) module of the Structured Clinical Interview for DSM-III-R, Nonpatient Version, were administered. Chart reviews were also conducted on all patients.
Fifteen percent of the psychiatric patients scored above 25 on the Dissociative Experiences Scale; 100% of these patients met DSM-III criteria for a dissociative disorder. These patients had significantly higher rates of major depression, PTSD, substance abuse, and borderline personality than did the comparison patients, and they also reported significantly higher rates of childhood trauma. Chart review data revealed that dissociative symptoms were largely unrecognized.
A high proportion of psychiatric inpatients have significant dissociative pathology, and these symptoms are underrecognized by clinicians. The proper diagnosis of these patients has important implications for their clinical course.
本研究试图确定1）精神科住院患者中分离性障碍的患病率，2）分离性障碍患者报告的童年创伤程度，以及3）精神科患者中分离性体验被识别的程度。
对一家州立精神病院连续收治的110名患者进行分离性体验量表测试。得分高于25分的患者按年龄和性别与量表得分低于5分的一组患者进行匹配。然后对两组的所有患者进行盲法访谈，并使用分离性障碍访谈量表、创伤性经历问卷以及《精神疾病诊断与统计手册》第三版修订本非患者版结构化临床访谈中的创伤后应激障碍（PTSD）模块。还对所有患者的病历进行了审查。
15%的精神科患者在分离性体验量表上得分高于25分；这些患者中有100%符合《精神疾病诊断与统计手册》第三版中分离性障碍的标准。与对照组患者相比，这些患者的重度抑郁症、创伤后应激障碍、药物滥用和边缘型人格障碍的发生率显著更高，他们报告的童年创伤发生率也显著更高。病历审查数据显示，分离性症状在很大程度上未被识别。
很大比例的精神科住院患者有明显的分离性病理症状，而这些症状未得到临床医生的充分认识。对这些患者进行正确诊断对其临床病程具有重要意义。
