Name: 解離與解離障礙記憶法（難忘的精神病學講座） (Dissociation and Dissociative Disorder Mnemonics (Memorable Psychiatry Lecture))
Uploaded: 2024-09-23T13:17:25.000Z
Duration: 20 min 21 s

關係子句

When I think of dissociation and dissociative disorders, the word that often comes to mind is murky.

提到解離症和解離障礙，我經常想到的一個詞是 "陰暗"。

There's a lack of consensus not only about what dissociative disorders are, but also how best to treat them.

人們不僅對什麼是分離性障礙缺乏共識，而且對如何最好地治療分離性障礙也缺乏共識。

In addition, it's not uncommon for mental health care professionals to have difficulty describing what dissociation even is, and many medical schools don't include dissociative disorders in their curriculum.

此外，心理保健專業人員很難描述什麼是解離症，這並不罕見，許多醫學院也沒有將解離症納入課程。

Nevertheless, ignoring dissociative disorders doesn't simply make them go away, and every hospital and clinic will encounter patients who experience dissociation, so in this video we'll attempt to cut through the fog and figure out how best we can help these patients.

是以，在本視頻中，我們將嘗試撥開迷霧，找出幫助這些患者的最佳方法。

Let's first define what exactly the word dissociation means.

讓我們先來定義一下 "解離 "一詞的確切含義。

Dissociation refers to a feeling of being detached from one's sense of reality.

解離指的是一種脫離現實的感覺。

While any mental condition that involves one's concept of reality may make you think of psychosis, dissociation and psychosis are in fact separate and distinct experiences.

雖然任何涉及現實概念的精神狀況都可能讓人聯想到精神病，但解離和精神病實際上是不同的、截然不同的體驗。

At its core, dissociation is a feeling of unreality, while psychosis is an inability to distinguish between reality and unreality.

就其核心而言，解離是一種不真實的感覺，而精神病則是一種無法區分現實與非現實的感覺。

This means that, while a person in a state of dissociation will say that their experiences don't feel real, they are still able to recognize that they are real.

這意味著，雖然處於解離狀態的人會說他們的經歷感覺不真實，但他們仍然能夠認識到這些經歷是真實的。

In contrast, someone in a state of psychosis is genuinely unable to tell that their experiences are not part of a shared reality, and their reality-testing ability, such as their ability to tell that the voices they are hearing are not in fact coming from the outside world, is distinctly impaired.

與此相反，處於精神病狀態的人確實無法分辨他們的經歷不是共同現實的一部分，他們的現實測試能力，比如分辨他們聽到的聲音實際上並非來自外部世界的能力，明顯受損。

While this feeling of unreality lies at the core of dissociation, it's not the whole picture.

雖然這種不真實感是解離症的核心，但它並不是全部。

Instead, dissociation involves other signs and symptoms as well.

相反，解離還涉及其他跡象和症狀。

These can roughly be divided into three categories, subjective experiences, memory abnormalities, and hypnotic phenomena.

這些現象大致可分為三類：主觀體驗、記憶異常和催眠現象。

To help keep these straight, let's use the mnemonic dreams.

為了幫助大家理清思路，讓我們使用夢的記憶法。

The first two letters refer to the subjective experiences of dissociation, which is the feeling of unreality that we talked about already.

前兩個字母指的是解離的主觀體驗，也就是我們已經談到過的不真實感。

First is depersonalization, which is the feeling of having become detached from your own body and sense of self.

首先是人格解體，這是一種脫離自己的身體和自我意識的感覺。

People experiencing depersonalization may suddenly feel a strange sensation that they are not real or that their body is unfamiliar to them.

經歷人格解體的人可能會突然感到一種奇怪的感覺，覺得自己不是真實的，或者自己的身體對自己來說是陌生的。

They may look at their body and think, I'm not myself, or look in the mirror and say, that isn't me.

他們可能會看著自己的身體想，我不是我自己，或者對著鏡子說，那不是我。

This can also be experienced as a sense that their body is out of their control or that they are observing their body from an outside perspective, or that their behavior is being controlled by someone else as if they were a doll or puppet.

這也可能是一種感覺，即他們的身體不受自己控制，或者他們正在從外部角度觀察自己的身體，或者他們的行為被別人控制，就像玩偶或木偶一樣。

Derealization is a sudden and profound sense that your current experience of the world is illusory or fake.

去理想化是一種突然而深刻的感覺，即你當前對世界的體驗是虛幻或虛假的。

People often describe derealization as a mental fog or veil that suddenly descends and makes their surroundings seem alien or dreamlike.

人們通常把 "去理想化 "描述為突然降臨的精神迷霧或面紗，使周圍的環境顯得陌生或像夢境一樣。

Familiar places such as their own home or street may feel different or foreign.

他們熟悉的地方，如自己的家或街道，可能會讓他們感覺不同或陌生。

People in a state of derealization also report that they feel unsteady or uneasy, like they are walking on shifting sand.

處於 "去理想化 "狀態的人還會說，他們感到不穩定或不安，就像走在移動的沙子上一樣。

Notably, depersonalization and derealization are not in any way mutually exclusive states, and people will often feel both at the same time.

值得注意的是，人格解體和去人格化並不是相互排斥的狀態，人們經常會同時感受到這兩種狀態。

The next two letters refer to the memory abnormalities which are a key clinical symptom of dissociation.

接下來的兩個字母指的是記憶異常，這是解離症的一個主要臨床症狀。

Instead of broad memory losses, the memory changes seen in dissociation take on very specific forms.

解離狀態下的記憶變化不是廣泛的記憶喪失，而是以非常特殊的形式出現。

The first form is retrograde amnesia which is when previously encoded memories are lost, as opposed to anterograde amnesia where new memories cannot be encoded.

第一種形式是逆行性遺忘症，即丟失了先前編碼的記憶，而逆行性遺忘症則無法編碼新的記憶。

For example, someone with dissociative amnesia may be unable to remember anything that happened in their life in the months after the death of their child a year ago, but they would be able to memorize new information such as a list of items to buy from the grocery store.

例如，患有分離性失憶症的人可能記不起一年前孩子去世後幾個月內發生的任何事情，但他們卻能記住新資訊，如在雜貨店購買物品的清單。

The E refers to memory errors of commission.

To understand this better, let's define what we mean by errors of both omission and commission.

為了更好地理解這一點，讓我們先來定義一下我們所說的疏忽和失誤的含義。

Omission errors are things that happen that you can't remember, like not being able to recall where you went for dinner last week.

遺漏錯誤是指發生了你記不起來的事情，比如想不起來上週去哪裡吃飯了。

In effect, you have omitted the information from your mind.

實際上，你已經從腦海中省略了這些資訊。

In contrast, commission errors are false memories of things that didn't actually happen, like thinking that you had texted someone when in fact you never did.

與此相反，委託錯誤是指對實際上沒有發生的事情的錯誤記憶，比如認為自己給某人發過簡訊，但實際上從未發過。

In effect, you remember yourself committing an act that hasn't actually been committed.

實際上，你記得自己實施了一個實際上並沒有實施的行為。

Omission errors are incredibly common, even among people without dissociative disorders.

遺漏錯誤非常常見，即使在沒有分離障礙的人中也是如此。

In contrast, commission errors are less common and appear to be specifically related to the capacity to dissociate, as evidenced by the fact that people who dissociate frequently differ from most people primarily in the increased number of commission errors rather than omission errors that they make.

與此相反，委託錯誤並不常見，而且似乎與解離能力特別相關，這一點可以從以下事實中得到證明：經常解離的人與大多數人的區別主要在於他們所犯的委託錯誤而不是遺漏錯誤的數量增加了。

This is not to say that most people don't make commission errors of memory as well, as they absolutely do.

這並不是說大多數人不會犯記憶錯誤，因為他們絕對會犯這樣的錯誤。

However, people who dissociate tend to remember false or suggested memories with a much higher frequency than most people, and with a vividness closer to their memories of actual events.

然而，分離的人往往會比大多數人更頻繁地回憶起虛假或暗示的記憶，其生動程度也更接近於他們對真實事件的記憶。

The last three signs and symptoms of dissociation all overlap with phenomena observed during a state of hypnosis.

解離的後三種跡象和症狀都與催眠狀態下觀察到的現象重疊。

In fact, dissociation may even be the same thing as hypnosis, with the main difference being that it occurs spontaneously rather than being induced by others, with some using the term auto-hypnosis to refer to dissociation.

事實上，解離甚至可能與催眠是一回事，主要區別在於它是自發發生的，而不是由他人誘導的，有些人使用 "自動催眠"（auto-hypnosis）來指解離。

The first of these hypnotic symptoms is absorption, which is a state of being highly engaged in or entranced by mental imagery to the exclusion of everything else going on in the outside world.

這些催眠症狀中的第一種是 "吸收"，這是一種高度投入或陶醉於心理想象的狀態，完全不顧外界發生的一切。

Think of someone who is taking a walk in the woods while listening to a gripping fantasy audiobook.

想想一個人一邊在森林裡散步，一邊聽著扣人心絃的奇幻有聲讀物。

This person may be so absorbed in their imagination that they are not consciously aware of everything going on around them, and they may later find that they don't have awareness of or memory of what happened around them while in this state.

這種人可能會沉浸在自己的想象中，無法有意識地察覺到周圍發生的一切，事後他們可能會發現，在這種狀態下，他們對周圍發生的事情沒有任何意識或記憶。

In someone experiencing dissociation, this can take the form of poor awareness of the outside world because they are so engaged in their own thoughts.

在經歷解離的人身上，這種情況可能表現為對外界的感知很差，因為他們沉浸在自己的想法中。

Next, motor automaticity refers to behaviors that someone does automatically without conscious awareness or effort.

其次，"運動自動性 "是指一個人不需要有意識或努力就會自動做出的行為。

To continue the example from before, for someone who is absorbed in the audiobook, the process of walking is done without conscious awareness of effort, including even more complex tasks like staying on a path or avoiding walking into a tree.

繼續前面的例子，對於一個全神貫注聽有聲讀物的人來說，走路的過程是在不自覺的情況下完成的，甚至包括更復雜的任務，如保持在一條小路上或避免撞到樹上。

In states of dissociation, this may result in the patient not being aware that they are doing a certain behavior, like moving their hand, and not reporting any desire to do the behavior if asked about it.

在解離狀態下，這可能會導致患者意識不到自己在做某種行為，比如移動手，而且在被問及此事時也不會說自己想做這種行為。

Finally, suggestibility is a trait of being inclined to accept and act on the ideas of others.

最後，受暗示性是一種傾向於接受他人想法並按其行事的特質。

People who are highly suggestible may believe information without critically examining it, or may change their emotions in response to what others are telling them.

受暗示程度高的人可能會在沒有經過嚴格審查的情況下就相信資訊，或者會根據別人的說法改變自己的情緒。

For example, let's say someone goes on a roller coaster for the first time and feels that they are having a great time while on it.

比如說，有人第一次坐雲霄飛車，覺得坐得很開心。

However, after getting off the ride, if a friend tells them, you look so terrified, they may now remember being terrified on the ride rather than excited if they are highly suggestible.

然而，下了遊樂設施後，如果朋友告訴他們，你看起來好害怕，如果他們的暗示性很強，他們現在可能會想起在遊樂設施上的害怕，而不是興奮。

Suggestibility can intertwine with the memory abnormalities seen in dissociation as well.

暗示性也會與解離狀態下的記憶異常交織在一起。

For example, a lawyer may ask leading questions in an attempt to get an eyewitness to remember something differently, such as asking, what was the defendant wearing on the night of the murder, which assumes that the defendant is connected to the murder and makes the witness more likely to link the defendant to the crime, even if, in reality, they're completely innocent.

例如，律師可能會提出一些誘導性問題，試圖讓目擊證人記住一些不同的事情，如詢問被告在謀殺當晚穿的是什麼衣服，這就假定被告與謀殺案有關，使證人更有可能將被告與犯罪聯繫起來，即使實際上他們是完全無辜的。

好了，讓我們花點時間檢查一下。

Dissociation is notoriously difficult to explain, even with a mnemonic.

解離是出了名的難以解釋，即使是用記憶法。

In fact, one of the most common words that people who have dissociated use to describe the experience is indescribable.

事實上，離群者最常用來描述這種經歷的一個詞就是 "無法形容"。

The closest experience that most people have had to dissociation is a transient head rush of lightheadedness that occurs when you stand up too quickly.

大多數人最接近解離的體驗是，當你站起來太快時，會出現短暫的頭暈目眩。

When this happens, there is often a fleeting yet distinct sense of unreality that is similar to what people in a state of derealization or depersonalization will describe.

當這種情況發生時，往往會有一種短暫而明顯的不真實感，這種感覺與處於去現實化或去人格化狀態的人所描述的類似。

Like lightheadedness, the onset of dissociation is often sudden, startling, and unsettling.

就像頭暈一樣，解離症的發作往往是突然的、令人吃驚的、令人不安的。

While it can be unpleasant, dissociation is not an inherently pathological state.

雖然解離可能令人不快，但它本質上並不是一種病態。

In fact, up to 20% of people have experienced depersonalization or derealization in the past year, with it being particularly common following traumatic experiences.

事實上，多達 20% 的人在過去一年中經歷過人格解體或去人格化，尤其是在經歷創傷之後。

However, for some people, dissociative experiences can become frequent or severe enough that they turn into a dissociative disorder.

然而，對於某些人來說，分離性體驗可能會變得足夠頻繁或嚴重，以至於演變成分離性障礙。

While dissociative experiences are common, dissociative disorders are much more rare, with estimates placing the prevalence at around 1-3% of the population.

雖然分離性體驗很常見，但分離性失調症卻罕見得多，據估計，其發病率約佔總人口的 1-3%。

They are most commonly diagnosed in early adulthood, with very few cases beginning after one's 20s or 30s.

這種疾病最常在成年早期被診斷出來，只有極少數病例在二三十歲後才開始發病。

Non-pathological dissociation occurs with approximately the same frequency in both men and women.

男性和女性發生非病理性分離的頻率大致相同。

However, pathological dissociation appears to be much more common in women, with dissociative disorders being diagnosed up to 10 times more often in women than men.

然而，病理性解離症似乎在女性中更為常見，女性被診斷出解離症的頻率是男性的 10 倍。

This discrepancy is believed to be at least partially related to higher rates of abuse histories in women compared to men, as a history of trauma, especially during early childhood, is a major risk factor for developing a dissociative disorder, with more than 90% of people diagnosed with these disorders reporting a history of childhood trauma.

這種差異被認為至少部分與女性比男性有更高的虐待史有關，因為創傷史，尤其是幼年時期的創傷史，是罹患分離性障礙的一個主要風險因素，90%以上被診斷患有這些障礙的人都報告有童年創傷史。

Dissociative disorders are generally associated with high levels of distress and dysfunction, related not only to the dissociative experiences themselves, but also due to the many psychiatric symptoms like mood, anxiety, and sleep changes that tend to co-occur.

解離性障礙通常與高度的痛苦和功能障礙有關，這不僅與解離體驗本身有關，而且還由於情緒、焦慮和睡眠變化等許多精神症狀往往同時出現。

Other features, such as substance abuse, unstable interpersonal relationships, increased rates of physical illness, and an elevated risk for suicide are often present as well.

其他特徵，如藥物濫用、不穩定的人際關係、軀體疾病發病率增加以及自殺風險升高也經常出現。

Because of this, dissociative disorders are some of the most disabling conditions, with studies consistently finding low rates of employment and high utilization of healthcare services and social welfare.

正因為如此，解離性障礙是一些致殘率最高的疾病，研究不斷髮現其就業率低，對醫療服務和社會福利的利用率高。

Interestingly, the prognosis for the dissociative disorders themselves is often better than it is for the patient as a whole.

有趣的是，解離障礙本身的預後往往比整個患者的預後要好。

One study found that, a decade after diagnosis, only a quarter of patients still met criteria for a dissociative disorder.

一項研究發現，在確診十年後，只有四分之一的患者仍然符合分離性障礙的標準。

However, over 80% of patients still met criteria for any psychiatric disorder, with anxiety, somatoform, and personality disorders, especially borderline personality disorder, being common.

然而，仍有超過 80% 的患者符合任何精神障礙的標準，其中焦慮症、軀體形式障礙和人格障礙（尤其是邊緣型人格障礙）最為常見。

Unfortunately, treatment for dissociative disorders is severely under-researched.

遺憾的是，對分離性障礙的治療研究嚴重不足。

Part of the problem is that it's not always clear what the specific outcome of treatment should be, with there being some controversy over whether the goal is to try to eliminate all episodes of dissociation, or simply try and reduce the distress and disability related to them.

問題的一部分在於，治療的具體結果是什麼並不總是很清楚，對於治療的目標是試圖消除所有解離症發作，還是僅僅試圖減少與解離症相關的痛苦和殘疾，還存在一些爭議。

Treatment studies on dissociative disorders also have an unfortunate tendency to refer to treatment in a general sense, and not provide any details on the exact type of interventions used.

關於分離性障礙的治療研究也有一種令人遺憾的傾向，即籠統地提及治療，而不提供關於所使用的干預措施的確切類型的任何細節。

Because of this, there is a lack of clearly defined treatment strategies for dissociative disorders, with most studies referencing a grab bag of therapies in different forms, like CBT, DBT, supportive therapy, hypnosis, art therapy, experiential therapy, and psychoeducation.

正因為如此，解離性障礙缺乏明確定義的治療策略，大多數研究都參考了各種不同形式的療法，如 CBT、DBT、支持療法、催眠、藝術療法、體驗療法和心理教育等。

Interestingly, therapy appears to be only somewhat effective at addressing dissociation itself.

有趣的是，治療似乎只能在一定程度上有效地解決解離問題本身。

Instead, the most robust effects of therapy tend to involve reducing comorbid symptoms related to depression, anxiety, suicidality, trauma, and borderline personality disorder.

相反，治療效果最顯著的往往是減少與抑鬱、焦慮、自殺、創傷和邊緣型人格障礙相關的合併症狀。

Studies have suggested that effective therapy for dissociative disorders typically requires long-term treatment in the order of years rather than weeks or months.

研究表明，解離性障礙的有效治療通常需要數年而不是數週或數月的長期治療。

However, since we know that dissociative phenomena tend to naturally lessen over time even without treatment, it's unclear whether the beneficial effects observed with therapy are a direct result of therapy, or simply the natural course of the disorder.

然而，由於我們知道，即使不進行治療，分離現象也會隨著時間的推移而自然減輕，是以目前還不清楚治療所產生的有益效果是治療的直接結果，還是僅僅是失調症的自然發展過程。

As before, there is a clear need for more rigorously designed studies.

和以前一樣，顯然需要進行更嚴格設計的研究。

While the jury is still out on therapy, it's quite clear that medications are distinctly unhelpful at improving outcomes in dissociative disorders.

雖然治療的效果尚無定論，但很明顯，藥物對改善分離性障礙的療效毫無幫助。

Many medications like antidepressants simply have no effect, and certain drugs like benzodiazepines may even have a pro-dissociative effect.

許多藥物（如抗抑鬱藥）根本沒有效果，某些藥物（如苯二氮卓）甚至可能有促進解離的作用。

In general, meds are to be avoided in dissociative disorders.

一般來說，解離性障礙患者應避免服用藥物。

Okay, let's now turn our attention to the three dissociative disorders listed in the

好了，現在讓我們把注意力轉移到《美國醫學雜誌》中列出的三種分離性失調症上。

DSM, dissociative amnesia, depersonalization derealization disorder, and dissociative identity disorder.

解離性遺忘症、人格解體症和解離性身份識別障礙。

In comparison to other videos, we won't be using a lot of mnemonics for dissociative disorders.

與其他視頻相比，我們不會大量使用解離性障礙的記憶法。

This is because the DSM criteria for these disorders are more like definitions than lists, with only one or two key features, which makes mnemonics rather pointless.

這是因為這些疾病的 DSM 標準更像是定義而不是列表，只有一兩個關鍵特徵，這使得記憶法變得毫無意義。

Instead, focus on understanding the nuances that make these disorders unique rather than memorizing lists of criteria.

與其死記硬背標準清單，不如集中精力瞭解使這些疾病與眾不同的細微差別。

The first disorder is dissociative amnesia.

第一種失憶症是分離性失憶症。

This condition involves episodes of retrograde amnesia that lead to gaps in one's autobiographical memory.

這種症狀包括逆行性遺忘發作，導致自傳體記憶出現空白。

These gaps often occur around the time of traumatic events and tend to have well-defined borders, with everything before and after a specific time period being remembered, just not the time itself.

這些空白往往發生在創傷事件發生的前後，而且往往有明確的邊界，特定時間段前後的一切都會被記住，只是時間本身不記得了。

The amnesia can be brief, lasting only a few minutes or hours, but it usually only becomes a disorder when it lasts for a while, like weeks or months.

失憶可能很短暫，只持續幾分鐘或幾小時，但通常只有在持續一段時間後，如幾周或幾個月，才會成為一種障礙。

In severe cases, the amnesia can be so profound that people forget their own name and identity, leading to a fugue state in which they will wander around with no knowledge of who they are or where they're from.

在嚴重的情況下，失憶症會嚴重到忘記自己的名字和身份，從而進入一種迷幻狀態，在這種狀態下，他們會四處遊蕩，不知道自己是誰，也不知道自己來自哪裡。