Lewis D O, Yeager C A, Swica Y, Pincus J H, Lewis M
Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
Am J Psychiatry. 1997 Dec;154(12):1703-10. doi: 10.1176/ajp.154.12.1703.
The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder.
This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects' family members and others. Handwriting samples were also examined. Data were analyzed qualitatively.
Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases.
This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.
由于缺乏客观记录，对于分离性身份障碍的存在及其引发的虐待行为一直存在怀疑。对于杀人犯中的这种障碍来说，由于存在伪装的嫌疑，情况更是如此。本文提供了一系列患有分离性身份障碍的成年杀人犯童年期分离症状和严重虐待行为的客观验证。
本研究包括对11名男性和1名女性患有DSM-IV定义的分离性身份障碍且实施过谋杀的临床记录进行回顾。数据收集自医疗、精神科、社会服务、学校、军队和监狱记录以及与受试者家庭成员和其他人的访谈记录。还检查了笔迹样本。对数据进行定性分析。
在所有12例病例中，童年期和成年期分离性身份障碍的体征和症状均得到多个独立来源的证实；11例获得了严重虐待的客观证据。受试者对大部分虐待行为失忆，且报告不足。10例记录到书写风格和/或签名有明显变化。
本研究彻底确立了早期严重虐待与分离性身份障碍之间的联系。此外，数据表明该障碍可与伪装及其他障碍相区分。研究表明，付出巨大努力后，有可能获得分离性身份障碍症状及其引发的虐待行为的客观证据。
