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Yıl:2000; Cilt: 4; Sayı: 1>> Özet
Psikiyatri Dünyası; 2000;4(1):7-11
Çoğul Kişilik Kavramı ve Dissosiyatif Bozukluklar
V Şar
İ.Ü. İstanbul Tıp Fakültesi Psikiyatri Anabilim Dalı Klinik Psikoterapi Birimi ve Dissosiyatif Bozukluklar Programı, İstanbul
Çoğul kişilik ya da yeni bir adlandırmayla dissosiyatif kimlik bozukluğu genel toplumda en az şizofreni kadar sık görülen fakat psikiyatristlerce az tanınan bir ruhsal bozukluktur. Psikoterapi ile tam iyileşme sağlanabilmesi nedeniyle klinisyenlerce farkedilmesi önemlidir. Dissosiyatif kimlik bozukluğu olan hastalar dolaylı belirtilerle başvurarak ayırıcı tanı sorunları yaratır. Dirençli depresyon, sınırda kişilik bozukluğu belirtileri, histerik psikoz, intihar girişimi, kendi bedenine zarar verme davranışları, aniden hatırlanan travmatik anılar nedeniyle geçmişe geri dönme dönemleri gibi durumlar sık görülür. Dissosiyatif kimlik bozukluğu hastalarının onda dokuzu çocukluk çağına ilişkin istismar, ihmal ve başka travmatik yaşantılar tanımlarlar. Geriye kalan onda birinde ise çocukluk çağında ameliyat sırasında anesteziden uyanma ve benzeri acı verici ve travma oluşturan tıbbi girişimlere rastlanır. Bozukluğun patojenezinde bu travmatik yaşantılara uyum çabaları rol oynar. Öte yandan, bu bozukluğun temelini oluşturan dissosiyasyon düzeneği gündelik yaşamda da önem taşır. Görünürde normal olan bireylerin, grupların, hatta toplum kesimlerinin dissosiyasyonu sıkça kullanması kişisel ve toplumsal yaşamda demokrasi ve açıklık için bir tehlike oluşturabilir. Günümüzde, yer yer dissosiyatif bozukluklarla ilgilenen araştırmacı ve klinisyenlerin sıklıkla diğer profesyonellerin ve başka grupların haksız ve hatta örgütlü saldırılarına maruz kalmalarının altında büyük olasılıkla gündelik yaşamda dissosiyasyonun sık kullanılıyor olmasının tedirginliği yatmaktadır. Bu yazıda dissosiyasyon çeşitli yönleri ile tartışılmıştır.



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