DID是甚麽？多重人格/解離性身份障礙20問（下）

Received: November 2022

【Authors/ 作者】

Andy H.W. Fung, PhD, RSW (Social worker and researcher from Hong Kong) (andyhwfung@gmail.com)

Cindy C.Y. Leung, MSS, RCP (Clinical psychologist from Hong Kong) (cinleung927@gmail.com)

Elly C.Y. Lee, MD(Psychiatrist from Taiwan) (u8901006@gmail.com)

【中文概要】

「多重人格」或「人格分裂」是大家都聽過的心理障礙，不時出現在電影情節裡。然而，大家對這個現已改名為「解離性身份障礙」（DID）的精神科診斷，了解又有多少？上篇已回答12個關於DID的常見問題，附以科學文獻供參考。本篇則會解答餘下8個問題。

本文亦獲「國際創傷與解離學會」（ISSTD）前理事長Dr. Colin A. Ross, M.D.支持和給予寶貴意見。原來，DID這個充滿戲劇性的現象，離我們可能不遠。原來，多重人格有可能是孩子面對長期痛苦時的倖存方法。當我們都疼惜孩子、好好保護孩子，原來就有可能預防DID。

13. Do people with DID always have amnesia?

According to the DSM-5, one of the diagnostic criteria for DID is amnesia, which can involve the inability to recall one’s life experiences, including traumatic experiences, having memory gaps (e.g., unable to remember what happened when other alters had taken control of the body), or the inability to recall important personal information about oneself.

If a person experiences clinically significant levels of dissociative symptoms (including identity alteration) and is deeply disturbed, but does not have recurrent amnesia, and if their distress is not better explained by other physical/medical factors, and the person does not fully meet the diagnostic criteria for other dissociative disorders, the most appropriate diagnosis may be “other specified dissociative disorder” (OSDD). 

In addition, with appropriate treatment and successful development of internal harmony and cooperation among different alters, individuals with DID may no longer suffer from amnesia.

14. Can the alters be aggressive or violent?

As is the case with other trauma survivors, the symptoms of people with DID are often understandable and meaningful; the alters were developed to help the person survive adverse circumstances and to protect themselves. Although their methods may sometimes be self-destructive or no longer work, a few alters may sometimes go to extreme lengths to protect themselves; they are like wounded beings trying to protect themselves. By rebuilding their sense of security through therapy and social support, their roles and functioning can transform to become more adaptive, healthy and positive.

15. Can I recover from DID?

People with DID generally respond well to specialized psychotherapy, and people with DID can also be socially well and able to work. Therefore, it is important that people with DID are accurately assessed as early as possible so that they can receive timely support.

16. What kind of treatment does a person with DID need?

While medication may be of some help, people with DID primarily need specialized psychotherapy. The goal of therapy is to enable the individual to deal with safety issues (e.g., staying away from ongoing traumatic environment or toxic stress), to re-establish safety, to process and integrate the dissociated parts of self, to communicate and work well with alters, and to achieve co-consciousness and “internal harmony”. In addition, the support of those close to the individual can play a pivotal role in his or her recovery. More self-help information about recovery from trauma and dissociation can be found in the book Be a teammate with yourself: Understanding trauma and dissociation (2019).

17. What can we do to prevent DID?

DID is closely related to childhood adversities such as family conflicts, violence, neglect, abuse, bullying, and other significant events. We believe that if a child grows up with adequate protection and love, and receives appropriate care and attention even when traumatized, the chance of developing DID can be greatly reduced.

18. What can we do to support a loved one with DID?

It can be challenging to support a person with trauma and dissociation, but it can also be very rewarding. The most important thing is self-care. We need to ensure the safety of ourselves as well as that of our loved one – not only physical safety, but also psychological safety. Social support and love from a caregiver can sometimes be more therapeutic than psychotherapy. We need to assist our loved one to remain safe and stay away from ongoing trauma or toxic stress. We need to respect, acknowledge and be a friend with different parts (e.g., alters) of our loved one – all of them should be respected as they are equally important and our loved one is the sum of all of the inner parts (despite the fact that some alters may not be very cooperative). If possible, consult a mental health practitioner who is experienced in supporting people with DID, or at least read reliable books or articles written by experts in the field or books written by experts by experience. For example, we have a psychoeducation book Be a teammate with yourself: Understanding trauma and dissociation (2019) that introduces the concept of dissociation and healthy strategies to cope with dissociative reactions. The book, Anger: Wisdom for Cooling the Flames (2001), is also recommended because we often need to take care of the emotions of our loved one. It is important to remember that, although the behaviors or symptoms of the survivor can be difficult to manage, they are always based on understandable reasons (e.g., an alter is easily angry because she only knows this way to protect herself; an alter cannot trust you because she has been betrayed before). As a caregiver, we may also need professional support.

19. Is it necessary to fuse all alters into one?

It really depends. The primary goal of treatment is to reduce symptoms and improve life functioning. To do so, people with DID need to remain safe, acknowledge, communicate and cooperate with their inner teammates, and learn healthy strategies (e.g., safely express emotions) to replace unhealthy strategies (e.g., tending to dissociate when feeling stressed). When there is good communication and cooperation among the alters, the person may live with his or her alters as a wonderful team, no longer having unwanted switching or amnesia. Thus, it may not be necessary to blend all alters into one. Integration is the goal of recovery, and it is a process of acknowledging, accepting, managing, and cooperating with one’s inner experiences, including the alters. Integration does not necessarily involve full fusion of all the parts. However, if you want to have a complete fusion of all your parts, you must work on integration first.

20. Are there any celebrities or successful people who live with DID?

Robert Oxnam: Former White House advisor, and a China studies expert, served as president of the Asia Society for over 10 years, brought the President of the United States and Bill Gates and others to China, and is the author of the autobiography A Fractured Mind: My Life and Multiple Personality Disorder; one of his alters was fluent in Chinese.

Herschel Walker: A famous American football player.

Cameron West: PhD in psychology, author of the autobiography First Person Plural: My Life as a Multiple. 

Kim Noble: Artist.

Judy Castelli: Artist and advocate for DID.

Notes: An early Chinese version of this article was published in health.businessweekly.com.tw in 2017.

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