9つの交代性人格特性をもつ青年における解離性同一性障害：ケーススタディ

Dissociative Identity Disorder in an Adolescent With Nine Alternate Personality Traits: A Case Study.

抄録

解離性同一性障害（DID）は幻聴や支配妄想など統合失調症と類似した症状を示すため、鑑別診断に困難が伴う。以前別の病院で精神分裂病と診断された16歳の思春期男性患者が、幻聴と自殺企図の評価のために当院の入院精神科病棟に入院した。精神鑑定の結果、患者は同一性交代、解離、健忘に罹患していることが判明した。診断評価としては、診断基準に関する精神医学的面接、精神状態検査、臨床検査、脳画像検査、脳波検査、思春期心理学的検査、思春期解離体験尺度の自己申告による測定が実施された。患者はDIDと診断され、薬物療法、自我状態療法、感情に関する心理教育、安定化を含むトラウマ焦点化心理療法、家族療法が行われた。治療後、内的次元において、患者は感情を担当する9つの代替的アイデンティティを認識できるようになり、アイデンティティの潜在的統合の基礎を確立した。外的次元では、家族間の葛藤や登校拒否の問題に改善がみられた。本症例は韓国で初めて報告された青年期のDID症例であり、統合失調症、双極性障害、心的外傷後ストレス障害などの他の精神疾患の鑑別診断においてDIDを考慮することを強調するとともに、自我状態療法の手順を共有することによってDIDの治療機会を拡大するものである。

Since dissociative identity disorder (DID) has symptoms similar to schizophrenia, such as auditory hallucinations and delusional thoughts of being controlled, there are difficulties in its differential diagnosis. A 16-year-old adolescent male patient who was previously diagnosed with schizophrenia from a different hospital was admitted to our inpatient psychiatric unit for the evaluation of auditory hallucinations and suicide attempts. Through psychiatric evaluations, it was determined that the patient suffered from identity alternation, dissociation, and amnesia. As for the diagnostic evaluations, the following measures were implemented: a psychiatric interview regarding the diagnostic criteria, mental status examination, laboratory tests, brain imaging studies, electroencephalography, and full psychological test for adolescents, and the self-reported measure of the Adolescent Dissociative Experiences Scale. The patient was diagnosed with DID, and the following treatments were administered: pharmacotherapy, ego state therapy, psychoeducation regarding emotions, trauma-focused psychotherapy including stabilization, and family therapy. Following treatment, in the internal dimensions, the patient was able to recognize the nine alternate identities in charge of his emotions, which established a basis for the potential integration of identities. In the external dimensions, he showed improvements in the aspects of family conflicts and issue of school refusal. This is the first reported case of DID in an adolescent in Korea; it emphasizes the consideration of DID in the differential diagnosis of other mental illnesses such as schizophrenia, bipolar disorder, and posttraumatic stress disorder and expands the treatment opportunities for DID by sharing the procedures of ego state therapy.