Dissociative Disorders
Major changes in dissociative disorders in DSM-5 include the following: 1) derealization is included in the name and symptom structure of what previously was called depersonalization disorder and is now called depersonalization/derealization disorder, 2) dissociative fugue is now a specifier of dissociative amnesia rather than a separate diagnosis, and 3) the criteria for dissociative identity disorder have been changed to indicate that symptoms of disruption of identity may be reported as well as observed, and that gaps in the recall of events may occur for everyday and not just traumatic events. Also, experiences
of pathological possession in some cultures are included in the description of identity disruption.


Dissociative Identity Disorder
Several changes to the criteria for dissociative identity disorder have been made in DSM-5. First, Criterion A has been expanded to include certain possession-form phenomena and functional neurological symptoms
to account for more diverse presentations of the disorder. Second, Criterion A now specifically states that transitions in identity may be observable by others or self-reported. Third, according to Criterion B, individuals
with dissociative identity disorder may have recurrent gaps in recall for everyday events, not just for traumatic experiences. Other text modifications clarify the nature and course of identity disruptions.

DSM-5 dissociative identity disorderwww.dissociative-identity-disorder.org/DSM-5.html ‎ A discussion of the DSM-5 criteria for dissociative identinty disorder (multiple
personality disorder).



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DSM-5 300.14: Dissociative Identity Disorder

I. Dissociative Disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released May 18, 2013. The DSM criteria and explanations listed here are not meant to self-diagnose, but instead are given to help improve public understanding of dissociative identity disorder. A trauma specialist with experience in the dissociative disorders should be contacted if you suspect you have any dissociative disorder. Many mental health professionals lack the training needed to recognize and treat this class of disorders. See the symptoms page for more.

II. Diagnostic and Statistical Manual of Mental Disorders DSM-5 (300.14)
criteria for Dissociative Identity Disorder

• Disruption of identity characterized by two or more distinct personality parts. This disruption may be observed by others, or reported by the patient. • Amnesia between parts of the personality. • The disturbance is not a normal part of broadly accepted cultural, religious practice, or part of the normal fantasy play of children. The last two points are commonly stressed with any mental illness. • Causes clinically significant distress and impairment in social, occupational, or other important areas of functioning. • The disturbance is not due to the direct physiological effects of a substance. (APA, DSM-5) See our page on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

III. Discussion of Diagnostic and Statistical Manual of Mental DisordersDSM-5 criteria for dissociative identity disorder. To receive a diagnosis of dissociative identity disorder, an individual must meet all five DSM-5 criteria.

Criteria 1

Distinct personality state
The first criterion refers to the most distinguishable aspect of dissociative identity disorder: the distinct personality states.  There is a lot of misconception and confusion about what these states are even among mental health professionals. Separate personalities or people are of course not carried around inside an individual with dissociative identity disorder. So what does the DSM-5 mean when it refers to a distinct personality state? There are other terms used in the literature that might confuse readers, so here is a list of labels often used other than distinct personality state: alternate personality, alternate identity (alter), dissociated identity (identity) dissociated part (part), dissociated state (state), dissociated personalities (personalities), personality state, self-state, dissociated part of the personality, part of the self, part of the mind, disaggregate self-state, and so on, but the idea is that this is a part of a person's personality is distinct and has been dissociated due to severe trauma and abuse experienced during their early years of childhood. (Chu, 2011)  (Howell, 2011, p. 6,55,58)  

Dissociative boundaries
It's important to understand that the distinct personality states seen in dissociative identity disorder are contained within dissociative boundaries, with the degree of dissociation experienced between them as defining the dissociative disorder.  (Howell, 2011, p. 8)  In other words, when the dissociative boundary between two distinct personality states is so great that those distinct personality states are unable to communicate with each other, then an individual meets the first criteria for dissociative identity disorder. This is often referred to as an amnesic boundary.
Normal personality states
Most mental health professionals and neurologists agree that the personality of all individuals is made up of states which are not distinct or dissociative. Mentally healthy people are less aware of these states because their states work together to a far greater extent than does someone with dissociative identity disorder.  (Howell, 2011, p. 8,88-89) The parts of the personality that did not integrate due to early childhood abuse are called Apparently Normal Parts (ANP)  in one of the three accepted models of etiology called Structural Dissociation. (van der Hart, 2006, p 83-88) The two other accepted models would identify these alters as hosts. ANP's (hosts) are not the only alters that act as hosts however. In the model of Structural Dissociation the alters that hold trauma memories are called Emotional Parts (EP). (van der Hart, 2006, p 83-88) (Howell, 2011, p. 59,109-114, 87-88,133-144)

Note: The ANP also have emotion, but the ANP are not triggered by unprocessed trauma memories like the EP are. The emotion from the EP can seem irrational and out of place.

Criteria 2

Amnesia
There are many types of amnesia, but that found in dissociative identity disorder is unique in that it occurs when an alter takes the place of the alter that is usually in executive control (host/ANP) of the individual. (Howell, 2011p. 6,58-59)  Amnesia is not clearly defined in the DSM-5, it but it does not make sense that it would inability to recall childhood since studies show that 20% of the population who don't appear to have ever suffered any trauma cannot recall their childhood.  (Siegel 2012 p 67-90)
Switching & amnesia
In dissociative identity disorder the amnesia can refer to different types of amnesia. One important type means that one of two things happen often. The ANP (who are often the host during times when the individual is not in danger) switches with another ANP, that they lack the ability to share memory with. An EP (alter that holds trauma memories) switches with the ANP (alter that does not hold trauma memories) that is usually in executive control of the individual who the EP does not share memory with.
Amnesia for amnesia
Individuals with undiagnosed dissociative identity disorder often do not noticed switching, amnesia, or even partial dissociation (intrusions). This is one reason why dissociative identity disorder is often unidentified. If an individual comes to a mental health professional for help it is usually for other problem such as PTSD, depression, eating disorders, or relationship problems. Some individuals with dissociative identity disorder are so dissociated, then can be in a car one moment, and their house the next, and are so use to this that they don't even acknowledge it. This can go for a lifetime or until it is caught by someone other than the individual with the problem. (Howell, 2011, p. 148)

Last 3 Criteria

Distruption in life   
The last 3 criteria are common to most mental health diagnosis
and simply mean that the symptoms are severe enough to be disrupting life, the symptoms are not due to religious or cultural practice, and the symptoms are not due to any type of drug. (Siegel 2011)

Reviewed by Sara Staggs, LICSW, MSW, MPH

DSM-5 Category: Dissociative Disorders

IntroductionDissociative Identity Disorder (DID), previously referred to as multiple personality disorder, is one of several dissociative disorders, as described in DSM-5. The key element in this diagnosis is the presence of at least two distinct and separate personalities within an individual. Although multiple personalities (alters) exist within a single person, only one is manifested at a time; each with its own memories, behaviors and life preferences. At least two of these identities take control of a person’s conduct at any given time. Lastly, it is critical that the observed disturbances are not a consequence of a substance (drug addiction and/or alcohol addiction) or a general medical condition, e.g., epileptic seizure (Spiegel, Loewenstein, Lewis-Fernandez, Sar, Simeon, Vermetten, et al, 2011).
The diagnosis of DID has been controversial for many years, with many mental health professionals alternatively attributing the disorder to misdiagnosis, social contagion or simply hypnotic suggestion. As a result, only a handful of specialized psychiatrists are responsible for most DID diagnoses (Gillig, 2009).
Symptoms of Dissociative Identity DisorderThe diagnosis of DID may be complicated by the ambiguity of its presentation; many symptoms experienced by patients with DID may resemble other physical or mental disorders, to include post-traumatic stress disorder, substance abuse or seizure disorders. The most commonly observed symptoms include:

• Inability to recall large memories of childhood;
• Lack of awareness of recent events, and if they do remember, inability to explain them, for example not being able to explain how the patient got somewhere, or how the acquired a possession;
• “lost time,” or frequent memory loss;
• Flashbacks or sudden return of memories;
• Feelings of disconnection or detachment from body or thoughts;
• Hallucinations or voices;
• So called “out of body ” experiences;
• Self-harm or suicidal thoughts;;
• Changes in handwriting;
• Functional changes: from nearly disabled to highly functioning
• Less commonly observed manifestations observed in patients with DID:
• Mood swings or depression;
• Anxiety, nervousness, panic attacks or phobias;
• Eating and food issues;
• Unexplained sleep disorders;
• Headaches or general body pain;
• Sexual issues, sex addiction or sexual avoidance (AAMFT, 2014).

PrevalenceLikely due to the difficulties in diagnosing DID, it is not straight forward to determine the frequency of its occurrence. While the number of psychiatric patients with DID may range from 0.4% to 7.5%, the general population prevalence may range from 0.4% to 3.1%. While these figures represent a very wide range in their estimates, they also indicate that the population of diagnosed and undiagnosed DID is quite large, and is deserving of broader research efforts to better focus its diagnosis and treatment (Johnson 2012).
PresentationThe DID population appears to be somewhat homogeneous, with many common traits shared by diagnosed patients. DID is typically manifested in females, often in their 3rd decade of life. Their psychiatric history is likely to show that the onset of dissociative symptoms appeared between the ages of 5-10, with the appearance of alters by the age of 6. As the patient ages, the numbers of alters increases, with adult DID patients reporting up to 16 separate and distinct alters. As many as 24 alters have been reported in adolescents, though in both cases, many of these will fade, if effective treatment is provided (Gillig 2009).
A reported history of childhood abuse is common, with a high frequency of sexual abuse. Suicidal ideation with attempts at suicide is commonly reported. While sexual promiscuity is unremarkable, many patients report a decreased libido and inability to reach orgasm. Further to that, patients sometimes dress in clothing appropriate for the opposite gender or state that they, themselves, are of the opposite gender (Gillig 2009).
Patients with DID sometimes experience hallucinations, report hearing voices, amnesia and periods of depersonalization. On many occasions, when referring to themselves, they may use the plural “we” instead of “I” (Gillig 2009).
Treatment for Dissociative Identity DisorderThe cardinal objective of therapy is integrated functioning. As such, the DID patient should be viewed as a whole adult person with multiple identities sharing in the responsibilities of life. Switches among identities may occur at any time, usually in response to changes in the patient’s mental state or to environmental demands. As such, the therapist must constantly contend with the alters’ competing points of view. Since the identity in control may be unaware of the others or disown them, it is critical that the therapist helps the identities become aware of each other, legitimize them, negotiate and resolve their conflicts. It would be counterproductive for the therapist to tell patients to ignore or get rid of the different identities. It is critical that the therapist not play favorites among the alternate identities, or try to eliminate the disruptive or unlikable alters. At the same time, there is no reason to try and have the patient create additional identities, name them or suggest that they function differently (International Society for the Study of Trauma and Dissociation, 2011).
With regard to an optimum therapeutic outcome, an intermediate goal is to achieve integration; a state where the identities can harmoniously coexist. The next goal of therapy is referred to as fusion, a point in time when the alternate identities join together, with a total loss of subjective separateness. At the time when the patient’s sense of self totally shifts from having multiple identities to that of a unified self, final fusion has occurred. Since the definitions of fusion and final fusion are similar and can be confusing, some clinicians have advocated for the use of the term unification to avoid potential mis-characterizations (International Society for the Study of Trauma and Dissociation, 2011).
It is critical to note that final fusion may not be achievable or desired by some patients. A variety of factors can contribute to this inability, including stress, unresolved painful life issues, lack of adequate treatment, comorbidities. In these cases, it may be more realistic to broker a cooperative arrangement designed to permit optimum functioning. Nonetheless, it is critical to note that such patients are likely to be at increased risk of later decompensation if sufficiently stressed (International Society for the Study of Trauma and Dissociation, 2011).
The most successful treatment modality for DID is likely to be individual psychotherapy. A reasonable generalized therapeutic approach would employ a phased treatment strategy, broadly described, below:
Phase 1: Establish safety, stabilization and reduction of symptoms
Phase 2: Confronting, working through and integration of traumatic memories
Phase 3: Integration and rehabilitation (International Society for the Study of Trauma and Dissociation, 2011).
In addition to psychotherapy, some individuals may also benefit from cognitive therapy, family systems therapy, creative therapy (art and/or music therapy) or clinical hypnosis. Since the basis of DID is not biochemical in nature, it cannot be treated with medication. Nonetheless, if a patient with DID also suffers from depression or anxiety, they could benefit from a psychopharmacologic approach to those disorders (Cleveland Clinic, 2014).
References
American Association for Marriage and Family Therapy (2014). AAMFT Therapy Topics: Dissociative Identity Disorder. AAMFT.org. Retrieved 17 February 2014 from http://www.aamft.org/imis15/content/consumer_updates/Dissociative_identity_disorder.aspx
Cleveland Clinic (2012). Dissociative Identity Disorder (multiple personality disorder). Myclevelandclinic.org. Retrieved 17 February 2014 from http://my.clevelandclinic.org/disorders/dissociative_disorders/hic_dissociative_identity_disorder_multiple_personality_disorder.aspx
Gillig, P.M. (2009). Dissociative Identity Disorder. Psychiatry (Edgmont), 6, 24-29.
International Society for the Study of Trauma and Dissociation (2011). Guidelines for treating dissociative identity disorder in adults, third revision: summary version. Journal of Trauma & Dissociation, 12, 188-212. DOI: 10.1080/15299732.2011.537248
Johnson, K. (2012). The problem of prevalence- how common is Dissociative Identity Disorder?. PODS: Positive Outcomes for Dissociative Survivors. Retrieved 17 February 2014, from http://www.pods-online.org.uk/problemofprevalence.html
Spiegel, D., Loewenstein, R.J., Lewis-Fernandez, R., Sar, V., Simeon, D., Vermetten, E., et al (2011). Dissociative Disorders in DSM-5. Depression and Anxiety, 28, 824-852. DOI 10.1002/da.20874

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Diagnostic criteria for 300.14 Dissociative Identity Disorder

These criteria are obsolete.DSM IV - TR(cautionary statement)
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
B. At least two of these identities or personality states recurrently take control of the person's behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance(e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, thesymptoms are not attributable to imaginary playmates or other fantasy play.
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association


DSM IV(cautionary statement)
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
B. At least two of these identities or personality states recurrently take control of the person's behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance(e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, thesymptoms are not attributable to imaginary playmates or other fantasy play.
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association

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Dissociative Identity Disorder – DSM IV Definition
Dissociative Identity Disorder is codified 300.14 in DSM IV. The disorder was formerly known as Multiple Personality Disorder.
Diagnostic Criteria
According to DSM IV, the following criteria must be met in order for the individual to be diagnosed for dissociative identity disorder:
Criterion A: two or more distinct identities or personality states are present in the individual.
Criterion B: these distinct identities take control over the behavior recurrently.
Criterion C: the individual is unable to recall important personal information, and this inability is too severe to be attributed to mere ordinary forgetfulness.
Criterion D: the disturbance is not an outcome of substance abuse or general medical condition.
The individual affected with Dissociative Identity Disorder finds it challenging to integrate the different aspects of their identity, memory and consciousness. The disorder is diagnosed three to nine times more frequently in adult females than in adult males. The number of identities in such an individual is reported to be from 2 to more than 100. Females tend to have more identities than do males, averaging 15 or more, whereas males average approximately 8 identities.
Each of the personality states that the individual experiences has its own distinct personal history, self-image, and identity, including different age, different gender, and also a different name. There usually exists a main, primary identity which carries the individual’s given name. When this primary identity takes over or regains consciousness, the individual is usually passive, dependent, guilty and depressed. On the other hand, the alternate identities have personalities which contrast the primary personality, for example, they may be dominating, hostile, aggressive, etc.
These alternate identities emerge and take over the individual’s consciousness due to some trigger such as psychosocial stress. The time required to switch between two identities may be a few seconds, or may be gradual. Others around may discern that the switch has happened by specific symptoms such as rapid blinking, facial changes, changes in voice or demeanor, or sudden change of track of the individual’s thoughts. The alternate identities take control in sequence, one after another. They may deny knowledge of the existence of the other alternate identities altogether, or may be critical of the others, or there may be open conflict between the alternate identities. At times, the role of allocating time to take control over the individual is abrogated by the alternate identity that emerges as the most powerful.
In terms of memory recall, the individual’s primary identity appears to experience gaps in memory in both recent and remote episodes, including an overall loss of biographic memory for an extended period of childhood, adolescence or even adulthood. Amongst the alternate identities, the passive ones have more constricted memory recall, while the ones with hostile, controlling or protecting personalities have near-complete memory recall. An identity with less controlling power may gain access to consciousness by producing auditory or visual hallucinations – such as in the form of a voice that gives instructions.


Associated Features and Disorders
Individuals with Dissociative Identity Disorder have been found to be highly hypnotizable and especially vulnerable to suggestive influences. These individuals may also concurrently manifest posttraumatic symptoms such as nightmares, flashbacks and startle responses, or also PTSD. In some alternate identities, self-mutilation and suicidal and aggressive behavior, along with impulsivity and sudden changes in relationships have warranted a concurrent diagnosis of borderline personality disorder. In some cases, certain identities have been found to experience conversion symptoms (e.g. pseudoseizures), or to possess the ability to control pain.
In a number of cases, these individuals report having experienced severe physical and sexual abuse, especially during childhood. There may also be a repetitive pattern of relationships involving physical and sexual abuse.
Course
The average time period from first symptom presentation to diagnosis is six to seven years. Episodic and continuous courses have both been described. The disorder may reduce in intensity and frequency after the age of forty. However, any psychosocial stress such as trauma or substance abuse may trigger a fresh episode.
Dissociative Identity Disorderhttps://www.youtube.com/watch?v=XWdpHBvtzPo

來源:
http://psychotherapyandcounseling.org/dissociative-disorders-category/dissociative-identity-disorder

音樂治療:
當人格沒有指向性時,不受原先生命所賦予的任務時.
去 我執

===>

   空  

===>等一等這些

傷會自由


6.口是心非 (修改)
https://www.youtube.com/watch?v=nR3W9tqq-WM


作詞：張雨生
作曲：張雨生
編曲：Koji Sakurai

口是心非　你深情的承諾都隨著西風飄渺遠走
癡人夢話　我鐘情的倚托就像枯萎凋零的花朵
星火燎原　我熱情的眼眸曾點亮最燦爛的天空
晴天霹靂　你絕情的放手在我最需要你的時候

於是愛恨交錯人消瘦　怕是怕這些苦沒來由
更多更詳盡歌詞 在 ※ Mojim.com　魔鏡歌詞網
於是悲歡起落人靜默　等一等這些傷會自由

口是心非　你矯情的面容都烙印在心靈的角落
無話可說　我縱情的結果就像殘破光禿的山頭
渾然天成　我純情的悸動曾奔放最滾燙的節奏
不可收拾　你濫情的拋空所有晶瑩剔透的感受



[00:03.00]張雨生 - 口是心非
[01:05.80]口是心非　你深情的承諾都隨著西風飄渺遠走
[01:15.18]癡人夢話　我鐘情的倚托就像枯萎凋零的花朵
[01:26.93]星火燎原　我熱情的眼眸曾點亮最燦爛的天空
[01:36.32]晴天霹靂　你絕情的放手在我最需要你的時候
[01:44.95]於是愛恨交錯人消瘦　怕是怕這些苦沒來由
[01:54.28]於是悲歡起落人靜默　等一等這些傷會自由
[02:04.09]於是愛恨交錯人消瘦　怕是怕這些苦沒來由
[02:13.63]於是悲歡起落人靜默　等一等這些傷會自由
[02:23.76]
[02:47.22]口是心非　你矯情的面容都烙印在心靈的角落
[02:56.98]無話可說　我縱情的結果就像殘破光禿的山頭
[03:06.42]渾然天成　我純情的悸動曾奔放最滾燙的節奏
[03:15.95]不可收拾　你濫情的拋空所有晶瑩剔透的感受
[03:24.98]於是愛恨交錯人消瘦　怕是怕這些苦沒來由
[03:34.23]於是悲歡起落人靜默　等一等這些傷會自由
[03:43.69]於是愛恨交錯人消瘦　怕是怕這些苦沒來由
[03:53.18]於是悲歡起落人靜默　等一等這些傷會自由
[04:04.08]
[04:05.54]會自由
[04:10.25]會自由