Thành viên:NguoiDungKhongDinhDanh/Rối loạn đa nhân cách/Dấu hiệu và triệu chứng

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Theo Sổ tay Phân tích và Thống kê các Rối loạn Tâm thần, quyển thứ 5 (DSM-5), các triệu chứng của DID gồm có "sự hiện diện của ít nhất hai nhân cách tách biệt", và gặp khó khi phải nhớ lại thông tin cá nhân, không như thói đãng trí thông thường. Other DSM-5 symptoms include a loss of identity as related to individual distinct personality states, and loss referring to time, sense of self and consciousness.[1] In each individual, the clinical presentation varies and the level of functioning can change from severely impaired to minimal impairment.[2][3] The symptoms of dissociative amnesia are subsumed under the DID diagnosis so should not be diagnosed separately if DID criteria are met. Individuals with DID may experience distress from both the symptoms of DID (intrusive thoughts or emotions) and the consequences of the accompanying symptoms (dissociation rendering them unable to remember specific information). The majority of patients with DID report childhood sexual or physical abuse,[3] though the accuracy of these reports is controversial.[4][Is this still current? cần kiểm chứng] Amnesia between identities may be asymmetrical; identities may or may not be aware of what is known by another.[3] Individuals with DID may be reluctant to discuss symptoms due to associations with abuse, shame, and fear.[4] DID patients may also frequently and intensely experience time disturbances.[5]

Around half of people with DID have fewer than 10 identities and most have fewer than 100; as many as 4,500 have been reported.[6]:503 The average number of identities has increased over the past few decades, from two or three to now an average of approximately 16. However, it is unclear whether this is due to an actual increase in identities, or simply that the psychiatric community has become more accepting of a high number of compartmentalized memory components.[6][không khớp với nguồn]

Comorbid disorders

The psychiatric history frequently contains multiple previous diagnoses of various disorders and treatment failures.[7] The most common presenting complaint of DID is depression, with headaches being a common neurological symptom. Comorbid disorders can include substance use disorder, eating disorders, anxiety disorders, post-traumatic stress disorder (PTSD), and personality disorders.[8] A significant percentage of those diagnosed with DID have histories of borderline personality disorder and bipolar disorder.[9]Bản mẫu:Disputed inline Further, data supports a high level of psychotic symptoms in individuals with DID, and that both individuals diagnosed with schizophrenia and those diagnosed with DID have histories of trauma.[10]Bản mẫu:Disputed inline Other disorders that have been found to be comorbid with DID are somatization disorders, major depressive disorder, as well as history of a past suicide attempt, in comparison to those without a DID diagnosis.[11] Individuals diagnosed with DID demonstrate the highest hypnotizability of any clinical population. The large number of symptoms presented by individuals diagnosed with DID has led some clinicians to suggest that, rather than being a separate disorder, diagnosis of DID is actually an indication of the severity of the other disorders diagnosed in the patient.[6][nhấn mạnh quá mức? – thảo luận]

Borderline personality disorder

The DSM-IV-TR states that acts of self-mutilation, impulsivity, and rapid changes in interpersonal relationships "may warrant a concurrent diagnosis of borderline personality disorder."[1] Steven Lynn and colleagues have suggested that the significant overlap between BPD and DID may be a contributing factor to the development of therapy induced DID, in that the suggestion of hidden alters by therapists who propose a diagnosis of DID provides an explanation to patients for the behavioral instability, self-mutilation, unpredictable mood changes and actions they experience.[12][nhấn mạnh quá mức? – thảo luận] In 1993 a group of researchers reviewed both DID and borderline personality disorder (BPD), concluding that DID was an epiphenomenon of BPD, with no tests or clinical description capable of distinguishing between the two. Their conclusions about the empirical proof of DID were echoed by a second group, who still believed the diagnosis existed, but while the knowledge to date did not justify DID as a separate diagnosis, it also did not disprove its existence.[13][cần nguồn thứ cấp] [không khớp với nguồn] Reviews of medical records and psychological tests indicated that the majority of DID patients could be diagnosed with BPD instead, though about a third could not, suggesting that DID does exist but may be over-diagnosed.[13][cần nguồn thứ cấp] 

Between 50 and 66% of patients also meet the criteria for BPD, and nearly 75% of patients with BPD also meet the criteria for DID, with considerable overlap between the two conditions in terms of personality traits, cognitive and day-to-day functioning, and ratings by clinicians.Bản mẫu:Verification needed Both groups also report higher rates of physical and sexual abuse than the general population, and patients with BPD also score highly on measures of dissociation.[6]Bản mẫu:Disputed inline Even using strict diagnostic criteria, it can be difficult to distinguish between dissociative disorders and BPD (as well as bipolar disorder and schizophrenia),[14] though the presence of comorbid anxiety disorders may help.[8]
  1. ^ a b American Psychiatric Association (tháng 6 năm 2000). Diagnostic and Statistical Manual of Mental Disorders-IV (Text Revision). 1. Arlington, VA, USA: American Psychiatric Publishing, Inc. tr. 526–529. doi:10.1176/appi.books.9780890423349. ISBN 978-0-89042-024-9.
  2. ^ Cardena E, Gleaves DH (2011). “Dissociative Disorders”. Trong Hersen M, Turner SM, Beidel DC (biên tập). Adult Psychopathology and Diagnosis. John Wiley & Sons. tr. 473–503. ISBN 978-0-471-74584-6.
  3. ^ a b c Lỗi chú thích: Thẻ <ref> sai; không có nội dung trong thẻ ref có tên Mer2019Pro
  4. ^ a b Maldonado, JR; Spiegel D (2008). “Dissociative disorders — Dissociative identity disorder (Multiple personality disorder)”. Trong Hales RE; Yudofsky SC; Gabbard GO (biên tập). The American Psychiatric Publishing textbook of psychiatry (ấn bản 5). Washington, DC: American Psychiatric Pub. tr. 681–710. ISBN 978-1-58562-257-3.
  5. ^ Onno van der Hart; Kathy Steele (1997). “Time Distortions in Dissociative Identity Disorder: Janetian Concepts and Treatment”. Dissociation. 10 (2): 91–103.
  6. ^ a b c d Lynn, SJ; Berg J; Lilienfeld SO; Merckelbach H; Giesbrecht T; Accardi M; Cleere C (2012). “14 - Dissociative disorders”. Trong Hersen M; Beidel DC (biên tập). Adult Psychopathology and Diagnosis. John Wiley & Sons. tr. 497–538. ISBN 978-1-118-13882-3.
  7. ^ Johnson, K (26 tháng 5 năm 2012). “Dissociative Identity Disorder (Multiple Personality Disorder): Signs, Symptoms, Treatment”. WebMD. Truy cập ngày 3 tháng 8 năm 2012.
  8. ^ a b Dorahy MJ, Brand BL, Sar V, Krüger C, Stavropoulos P, Martínez-Taboas A, Lewis-Fernández R, Middleton W (2014). “Dissociative identity disorder: An empirical overview” (PDF). Australian and New Zealand Journal of Psychiatry. 48 (5): 402–417. doi:10.1177/0004867414527523. hdl:2263/43470. ISSN 1440-1614. PMID 24788904. DID treatment outcome has been systematically studied for three decades via case studies, case series, cost-efficacy studies, and naturalistic outcome studies with follow-ups as long as 10 years (e.g. Coons and Bowman, 2001 ... Research indicates that therapy utilising a phasic trauma treatment model consistent with expert consensus guidelines is beneficial to DID individuals (Brand et al., 2009c; International Society for the Study of Trauma and Dissociation... Treatment was associated with reductions in diagnoses of comorbid axis I and II disorders, suicidality and substance abuse; improvements were maintained at two-year followup (Brand et al., 2009c; ... The phasic model of DID treatment involves patients working towards establishing safety and stability in Stage 1. Some DID patients may lack interest in, and/or the psychological or practical resources for, moving beyond Stage 1. The consistency between these experts' recommendations, those described in the ISSTD Treatment Guidelines (2011), and the interventions documented in the Treatment of Patients with Dissociative Disorders (TOP DD) study (Brand et al., 2009b) suggest that a standard of care for the treatment of DID is emerging... The longitudinal international TOP DD study ... prospectively assessed treatment response from 230 DID patients and their therapists from 19 countries, across four data collection points over 30 months (Brand et al., 2009c, 2013). Overtime, patients showed statistically significant reductions in dissociation, PTSD, distress, depression, hospitalisations, suicide attempts, self-harm, dangerous behaviours, drug use and physical pain, as well as higher Global Assessment of Functioning scores (Brand etal.,2013).Even participants with the highest levels of dissociation and the most severe depression showed improvement over time (Engelberg and Brand, 2012; Stadnik and Brand, 2013)... Only 1.1% of patients showed worsening over more than one data collection point, a rate that compares favourably to the 5-10% of general patients who show worsening symptoms during treatment (Hansen et al., 2002). The consistency of statistical improvement across a range of symptoms and adaptive functioning strongly suggests that treatment contributed to improvements.
  9. ^ Lilienfeld SO, Lynn SJ (2014). “Dissociative Identity Disorder: A Contemporary Scientific Perspective”. Science and Pseudoscience in Clinical Psychology. Guilford Publications. tr. 141. ISBN 978-1-4625-1789-3.
  10. ^ Foote B, Park J (2008). “Dissociative identity disorder and schizophrenia: Differential diagnosis and theoretical issues”. Current Psychiatry Reports. 10 (3): 217–222. doi:10.1007/s11920-008-0036-z. PMID 18652789. S2CID 20543900.
  11. ^ Sar, V. (2007). “Prevalence of dissociative disorders among women in the general population”. Psychiatry Research. 149 (1–3): 169–76. doi:10.1016/j.psychres.2006.01.005. PMID 17157389. S2CID 42070328.
  12. ^ Lynn, S. J.; Lilienfeld, S. O.; Merckelbach, H.; Giesbrecht, T.; Van Der Kloet, D. (2012). “Dissociation and Dissociative Disorders: Challenging Conventional Wisdom”. Current Directions in Psychological Science. 21 (1): 48–53. doi:10.1177/0963721411429457. S2CID 4495728.
  13. ^ a b Lỗi chú thích: Thẻ <ref> sai; không có nội dung trong thẻ ref có tên Gillig
  14. ^ Kihlstrom JF (2005). “Dissociative disorders”. Annual Review of Clinical Psychology. 1 (1): 227–53. doi:10.1146/annurev.clinpsy.1.102803.143925. PMID 17716088.
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