解離性同一性障害（DID）の治療アセスメントTreatment assessment for dissociative identity disorder
Description
解離症状は、クライアントがストレスに対処する方法の一つとして現れるものである。解離性同一性障害（DID）は、最も重篤な解離性障害であり、解離性健忘を特徴とし、これが解離の障壁となる。そのため、初期段階では以下のような傾向が見られる： 1. クライアント自身が解離症状に気づいていない 2. 自分が行った行動を覚えていない 3. クライアントの周囲で奇妙な現象が起こる 4. クライアントの行動が、家族や周囲の人々が観察するものと一致しない その他の主な訴えとしては、過去のある期間の記憶喪失、日常生活における記憶障害、以前に習得していた技能の喪失、知らないうちに別の場所に移動していたことに気づく、そして自分が別人のように感じることなどが挙げられる。 治療者との面談時には、クライアントは一見すると非常に普通に見えることが多いが、治療者が人格状態（パーツ）とつながることで、背後には変化に富み複雑なシステムが存在していることが明らかになる。このような場合、解離の障壁があるため、治療者は非常に柔軟かつ受容的な姿勢で対応する必要がある。 また、治療にあたる者は、一時的な自我状態や病的退行を多重人格障害と過剰診断しないよう注意しなければならない。本稿では、私がDIDクライアントを治療した経験に基づき、アセスメントと治療目標について簡潔に説明する。
Dissociative symptom is one way that clients display how they are coping with stress. Dissociative identity disorder (DID) is the most severe dissociative disorder. DID is characterized by dissociative amnesia, which cause the barrier for dissociation. Therefore, in the initial stages, we find that 1) clients are often unaware of their dissociative symptoms, 2) clients do not remember performing certain actions, 3) strange phenomena occur around the clients, and 4) client's behaviors are inconsistent with those observed by family members and others around them. Other primary complaints include memory loss of a certain period in the past, memory disorders in daily living, the loss of previously-held skills, realizing that one has moved to another place without knowledge, and feeling like a different person, to name a few. When meeting with the therapist, clients will often seem quite normal, but once the therapist connects with the personality states (parts), a variable and complicated system is found in the background. In such instances, because of the dissociative barrier, therapists must address these issues in a very flexible and accommodating manner. In addition, those treating the client must also avoid over-diagnosing the temporary ego state or malignant regression as multiple personality disorder. In this paper, I provide a simple explanation about assessment and treatment objectives from my experiences with treating clients with DID.
Dissociative symptom is one way that clients display how they are coping with stress. Dissociative identity disorder (DID) is the most severe dissociative disorder. DID is characterized by dissociative amnesia, which cause the barrier for dissociation. Therefore, in the initial stages, we find that 1) clients are often unaware of their dissociative symptoms, 2) clients do not remember performing certain actions, 3) strange phenomena occur around the clients, and 4) client's behaviors are inconsistent with those observed by family members and others around them. Other primary complaints include memory loss of a certain period in the past, memory disorders in daily living, the loss of previously-held skills, realizing that one has moved to another place without knowledge, and feeling like a different person, to name a few. When meeting with the therapist, clients will often seem quite normal, but once the therapist connects with the personality states (parts), a variable and complicated system is found in the background. In such instances, because of the dissociative barrier, therapists must address these issues in a very flexible and accommodating manner. In addition, those treating the client must also avoid over-diagnosing the temporary ego state or malignant regression as multiple personality disorder. In this paper, I provide a simple explanation about assessment and treatment objectives from my experiences with treating clients with DID.
Format
Journal
Language
Japanese
Original Work Citation
Niki, K. (2017, May). [Treatment assessment for dissociative identity disorder]. Japanese Journal of EMDR Research and Practice, 9(1), 13-22. Japanese
Collection
Citation
“解離性同一性障害（DID）の治療アセスメントTreatment assessment for dissociative identity disorder,” Francine Shapiro Legacy Library, accessed June 12, 2026, https://francineshapirolibrary.omeka.net/items/show/24628.