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Yıl:2017; Cilt: 10; Sayı: 3>> Özet
Türkiye Klinikleri Psikiyatri Özel Dergisi; 2017;10(3):185-193
Dissosiyatif Kimlik Bozukluğu'nun Tedavisi
M Yanık
İbn Haldun Üniversitesi, İstanbul
Dissosiyatif Kimlik Bozukluğu (DKB) toplumda en az %1 gözükmesine rağmen, tanı koyma problemleri ve tedavi eden azlığı nedeniyle Türkiye için bir halk sağlığı sorunudur. DKB'nin tanı konma sürecinde üç küme belirti ön plana çıkar. Bunlar; iç ses, afekt değişimleri ve hafıza sorunlarıdır. DKB'nin alemeti farikası alter kimliklerin varlığıdır. Özellikle alterlerin dinamik etkileşimi ile oluşan alter sistemini anlamak önemlidir. Tedaviye oldukça iyi cevap veren DKB'de tedavi üç aşamadan oluşur. İlk aşama tanı koyma, kişiyi hastalık hakkında eğitme, alter siteminin tanınması ve stabilizasyonun sağlanmasından oluşur. İkinci aşamada, bölünmeye neden olan travmatik anılar üzerine çalışılır. Üçüncü aşama ise, alterlerin birleştirilmesi anlamına gelen entegrasyon ve yeniden bölünmeme çalışmasından oluşur. DKB tedavisi için genel psikoterapi kuralları ve müdahaleleri geçerli olmakla birlikte, DKB doğası gereği DKB'ye özgün teknikler de vardır. Bunlardan en sık kullanılan beş tanesi; alterlerle konuşma, haritalandırma, gerçekliğe oryantasyon, yuvarlak masa tekniği ve birleştirme ritüelleridir. DKB tedavisinde rahatsızlığın psikopatolojisini tedavi eden ilaç yoktur. Ayrıca travmatik anılar için EMDR ve hipnoz kullanılabilir.
Treatment of Dissociative Identity Disorder
Dissociative Identity Disorder (DID) is a condition seen in at least 1% of the population. However, due to errors in its diagnosis and lack of qualified practitioners for its treatment, it is a public health problem in Turkey. The differential diagnosis of DID consist of three distinct symptoms; an inner voice, changes in affect and memory problems, while the presence of alter personalities are its trademark feature. It's specifically significant to understand the alter system that arises from the dynamic interaction of these alter personalities. Being an illness that responds well to treatment, DID treatment consists of three stages. The first stage involves diagnosis, psychoeducation on DID as well as the alter system at hand, and stabilization. The second stage focuses on the traumatic memories that caused dissociation in the first place. The third stage involves integration, that is the unification of the alter personalities, and initiatives to prevent future dissociation. Though the general principles and methods of psychotherapy apply to the treatment of DID, due to its nature, there are also some methods that are unique and specific to the treatment of DID. The most common of these are the methods of talking with alters, mapping, orientation to reality, round table technique and integration rituals. There is no medication to cure the psychopathology of DID. However, EMDR and hypnosis can be useful for traumatic memories.

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