Derleme
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Az Bilinen Bir Tanı' Dissosiyatif Kimlik Bozukluğu' : Bir Gözden Geçirme

Yıl 2024, Cilt: 5 Sayı: 10, 45 - 66, 19.12.2025
https://doi.org/10.51503/gpd.1496630

Öz

Bu derleme çalışması, Dissosiyatif Kimlik Bozukluğu (DKB) hakkında mevcut literatürü incelemeyi ve bu bozukluğun etiyolojisi, tanı süreçleri, klinik özellikleri ve tedavi yaklaşımlarını değerlendirmeyi amaçlamaktadır. DKB, genellikle çocukluk çağı travmaları ve ciddi stres faktörleri ile ilişkilendirilen karmaşık bir ruhsal bozukluktur. Literatürde, DKB'nin yaygınlığı yaklaşık %1 olarak tahmin edilmekte olup, kadınlarda erkeklere göre daha fazla görüldüğü bildirilmektedir. DKB'nin etiyolojisi, genetik ve çevresel faktörlerin bir kombinasyonunu içermektedir. Çocukluk döneminde yaşanan travmatik olayların, özellikle istismar ve ihmalin, DKB gelişiminde önemli bir rol oynadığı gösterilmiştir. Nöroanatomik çalışmalar, DKB'li bireylerde hipokampus, amigdala ve diğer beyin yapılarında yapısal değişiklikler olduğunu ortaya koymaktadır. Bu bulgular, travma ile ilişkili dissosiyatif bozuklukların biyolojik temellerine dair önemli ipuçları sunmaktadır. DKB'nin teşhisi, Dissosiyatif Deneyimler Ölçeği gibi çeşitli ölçüm araçları kullanılarak yapılmaktadır. Ancak, DKB belirtilerinin diğer psikiyatrik bozukluklarla örtüşmesi nedeniyle, doğru teşhis koymak oldukça zordur. Bu nedenle, DKB'nin tanı sürecinde dikkatli ve kapsamlı bir değerlendirme yapılması gerekmektedir. Tedavi açısından, DKB'nin spesifik olarak onaylanmış bir farmakolojik tedavisi bulunmamaktadır. Bunun yerine, tedavi genellikle psikoterapiye dayanmaktadır. Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşleme (EMDR) ve hipnoz gibi yöntemler, tedavi sürecinde önemli rol oynamaktadır. Bu yöntemler, alter kişiliklerin merkez kişilik ile bütünleştirilmesine ve bireyin işlevselliğinin artırılmasına yardımcı olmaktadır. Sonuç olarak, DKB karmaşık ve zor bir bozukluktur. Bu bozukluğun daha iyi anlaşılması ve tedavi edilmesi için daha fazla araştırma yapılması gerekmektedir. Literatürde mevcut bulgular, DKB'nin travmatik deneyimlerle sıkı bir ilişki içinde olduğunu ve genetik, nöroanatomik, psikososyal ve çevresel etkenlerin birlikte ele alınması gerektiğini göstermektedir. Bu tür bütüncül bir yaklaşım, DKB'nin anlaşılmasını ve tedavi edilmesini daha etkili kılacaktır.

Kaynakça

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.; DSM-III). American Psychiatric Association.
  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.; DSM-III-R). American Psychiatric Association.
  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.; DSM-IV). American Psychiatric Association.
  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.; DSM-IV-TR). American Psychiatric Association.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5). American Psychiatric Association.
  • Atilan Fedai, Ü., & Asoğlu, M. (2022). Analysis of demographic and clinical characteristics of patients with dissociative identity disorder. Neuropsychiatric Disease and Treatment, 18, 3035–3044. https://doi.org/10.2147/NDT.S386648
  • Aydın, E. F., & Laçin, T. K. (2022). A case of dissociative identity disorder and attention deficit hyperactivity disorder comorbidity. European Psychiatry, 65(1), 471. https://doi.org/10.1192/j.eurpsy.2022.1196
  • Barach, P. M. (1991). Multiple personality disorder as an attachment disorder. Dissociation: Progress in the Dissociative Disorders.
  • Becker-Blease, K. A., Deater-Deckard, K., Eley, T., Freyd, J. J., Stevenson, J., & Plomin, R. (2004). A genetic analysis of individual differences in dissociative behaviors in childhood and adolescence. Journal of Child Psychology and Psychiatry, 45(3), 522–532. https://doi.org/10.1111/j.1469-7610.2004.00242.x
  • Blihar, D., Delgado, E., Buryak, M., Gonzalez, M., & Waechter, R. (2020). A systematic review of the neuroanatomy of dissociative identity disorder. European Journal of Trauma & Dissociation, 4(3), Article 100148. https://doi.org/10.1016/j.ejtd.2020.100148
  • Boon, S., & Draijer, N. (1993). Multiple personality disorder in the Netherlands: A clinical investigation of 71 patients. American Journal of Psychiatry, 150(3), 489–494. https://doi.org/10.1176/ajp.150.3.489
  • Bowlby, J. (2008). Attachment. Basic Books.
  • Burdzik, E., & Burdzik, M. (2023). Dissociative identity disorder as an interdisciplinary problem: Part I—Psychiatric and psychological aspects. Psychiatria Polska, 57(1), 147–162. https://doi.org/10.12740/pp/146969
  • Chalavi, S., Vissia, E. M., Giesen, M. E., Nijenhuis, E. R., Draijer, N., Cole, J. H., & Reinders, A. A. (2015). Abnormal hippocampal morphology in dissociative identity disorder and posttraumatic stress disorder correlates with childhood trauma and dissociative symptoms. Human Brain Mapping, 36(5), 1692–1704. https://doi.org/10.1002/hbm.22730
  • Costabile, T., Bilo, L., De Rosa, A., Pane, C., & Saccà, F. (2018). Dissociative identity disorder: Restoration of executive functions after switch from alter to host personality. Psychiatry and Clinical Neurosciences, 72(3), 189. https://doi.org/10.1111/pcn.12630
  • DePrince, A. P., Huntjens, R. J., & Dorahy, M. J. (2015). Alienation appraisals distinguish adults diagnosed with dissociative identity disorder from PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 7(6), 578–584.
  • Huntjens, R. J., Rijkeboer, M. M., & Arntz, A. (2019). Schema therapy for dissociative identity disorder (DID): Rationale and study protocol. European Journal of Psychotraumatology, 10(1), Article 1571377. https://doi.org/10.1080/20008198.2019.1571377
  • Kabene, S. M., Balkır Neftçi, N., & Papatzikis, E. (2022). Dissociative identity disorder and the law: Guilty or not guilty? Frontiers in Psychology, 13, Article 891941. https://doi.org/10.3389/fpsyg.2022.891941
  • Kaplan, A. M., & Smith, C. M. (2021). Schizotypal personality disorder disguised as dissociative identity disorder. BMJ Case Reports CP, 14(7), e243454. https://doi.org/10.1136/bcr-2021-243454
  • Krüger, C., & Fletcher, L. (2019). Predicting a dissociative disorder from type of childhood maltreatment and abuser–abused relational tie. In The abused and the abuser (pp. 114–130). Routledge. https://doi.org/10.4324/9781351213981
  • Lebois, L. A., Ross, D. A., & Kaufman, M. L. (2022a). “I am not I”: The neuroscience of dissociative identity disorder. Biological Psychiatry, 91(3), 11–13. https://doi.org/10.1016/j.biopsych.2021.11.004
  • Lebois, L. A., Kaplan, C. S., Palermo, C. A., Pan, X., & Kaufman, M. L. (2022b). A grounded theory of dissociative identity disorder: Placing DID in mind, brain, and body. In Dissociation and the dissociative disorders (pp. 392–408). Routledge. https://doi.org/10.4324/9781003057314
  • Lyons-Ruth, K., Dutra, L., Schuder, M. R., & Bianchi, I. (2006). From infant attachment disorganization to adult dissociation. Psychiatric Clinics of North America, 29(1), 63–86. https://doi.org/10.1016/j.psc.2005.10.011
  • Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences and infant disorganized attachment. In M. T. Greenberg et al. (Eds.), Attachment in the preschool years (pp. 161–182). University of Chicago Press.
  • Middleton, W., & Butler, J. (1998). Dissociative identity disorder: An Australian series. Australian & New Zealand Journal of Psychiatry, 32(6), 794–804. https://doi.org/10.3109/00048679809073868
  • Öztürk, E. (2018). Travma merkezli alyans model terapi. Türkiye Klinikleri Psychology – Special Topics, 3, 31–38.
  • Öztürk, E., & Derin, G. (2021). Dissosiyatif bozukluklarda kendine zarar verme davranışları ve intihar eğilimleri. Aydın İnsan ve Toplum Dergisi, 7(1), 9–31. https://doi.org/10.17932/IAU.AIT.2015.012/ait_v07i1001
  • Putnam, F. W., Helmers, K., & Trickett, P. K. (1993). Development, reliability, and validity of a child dissociation scale. Child Abuse & Neglect, 17(6), 731–741. https://doi.org/10.1016/S0145-2134(08)80004-X
  • Reinders, A. A., Dimitrova, L. I., Schlumpf, Y. R., et al. (2022). Normal amygdala morphology in dissociative identity disorder. BJPsych Open, 8(2), e70. https://doi.org/10.1192/bjo.2022.36
  • Reinders, A. A., & Veltman, D. J. (2021). Dissociative identity disorder: Out of the shadows at last? British Journal of Psychiatry, 219(2), 413–414. https://doi.org/10.1192/bjp.2020.168
  • Ross, C. A., Norton, G. R., & Wozney, K. (1989). Multiple personality disorder: An analysis of 236 cases. Canadian Journal of Psychiatry, 34(5), 413–418. https://doi.org/10.1177/070674378903400509
  • World Health Organization. (2022). International classification of diseases (11th rev.; ICD-11).
  • World Health Organization. (2023). ICD-11 for mortality and morbidity statistics. https://icd.who.int/browse11

A Little-Known Diagnosis 'Dissociative Identity Disorder': A Review

Yıl 2024, Cilt: 5 Sayı: 10, 45 - 66, 19.12.2025
https://doi.org/10.51503/gpd.1496630

Öz

This review aims to examine the existing literature on Dissociative Identity Disorder (DID) and evaluate its etiology, diagnostic processes, clinical features, and treatment approaches. DID is a complex mental disorder often associated with childhood traumas and severe stress factors. The literature estimates the prevalence of DID to be around 1%, with a higher incidence in women compared to men. The etiology of DID involves a combination of genetic and environmental factors. Traumatic events experienced during childhood, especially abuse and neglect, play a significant role in the development of DID. Neuroanatomical studies have revealed structural changes in the hippocampus, amygdala, and other brain structures in individuals with DID. These findings provide important insights into the biological foundations of trauma-related dissociative disorders. The diagnosis of DID is made using various assessment tools, such as the Dissociative Experiences Scale. However, the overlapping symptoms of DID with other psychiatric disorders make accurate diagnosis challenging. Therefore, a careful and comprehensive evaluation is required in the diagnostic process of DID. In terms of treatment, there is no specifically approved pharmacological treatment for DID. Instead, treatment generally relies on psychotherapy. Techniques such as Eye Movement Desensitization and Reprocessing (EMDR) and hypnosis play significant roles in the treatment process. These methods help integrate alter personalities with the host personality and improve the individual's functionality. In conclusion, DID is a complex and challenging disorder. More research is needed to better understand and treat this condition. The current literature suggests that DID is closely related to traumatic experiences and that genetic, neuroanatomical, psychosocial, and environmental factors should be considered together. Such a holistic approach will enhance the understanding and treatment of DID.

Kaynakça

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.; DSM-III). American Psychiatric Association.
  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.; DSM-III-R). American Psychiatric Association.
  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.; DSM-IV). American Psychiatric Association.
  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.; DSM-IV-TR). American Psychiatric Association.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5). American Psychiatric Association.
  • Atilan Fedai, Ü., & Asoğlu, M. (2022). Analysis of demographic and clinical characteristics of patients with dissociative identity disorder. Neuropsychiatric Disease and Treatment, 18, 3035–3044. https://doi.org/10.2147/NDT.S386648
  • Aydın, E. F., & Laçin, T. K. (2022). A case of dissociative identity disorder and attention deficit hyperactivity disorder comorbidity. European Psychiatry, 65(1), 471. https://doi.org/10.1192/j.eurpsy.2022.1196
  • Barach, P. M. (1991). Multiple personality disorder as an attachment disorder. Dissociation: Progress in the Dissociative Disorders.
  • Becker-Blease, K. A., Deater-Deckard, K., Eley, T., Freyd, J. J., Stevenson, J., & Plomin, R. (2004). A genetic analysis of individual differences in dissociative behaviors in childhood and adolescence. Journal of Child Psychology and Psychiatry, 45(3), 522–532. https://doi.org/10.1111/j.1469-7610.2004.00242.x
  • Blihar, D., Delgado, E., Buryak, M., Gonzalez, M., & Waechter, R. (2020). A systematic review of the neuroanatomy of dissociative identity disorder. European Journal of Trauma & Dissociation, 4(3), Article 100148. https://doi.org/10.1016/j.ejtd.2020.100148
  • Boon, S., & Draijer, N. (1993). Multiple personality disorder in the Netherlands: A clinical investigation of 71 patients. American Journal of Psychiatry, 150(3), 489–494. https://doi.org/10.1176/ajp.150.3.489
  • Bowlby, J. (2008). Attachment. Basic Books.
  • Burdzik, E., & Burdzik, M. (2023). Dissociative identity disorder as an interdisciplinary problem: Part I—Psychiatric and psychological aspects. Psychiatria Polska, 57(1), 147–162. https://doi.org/10.12740/pp/146969
  • Chalavi, S., Vissia, E. M., Giesen, M. E., Nijenhuis, E. R., Draijer, N., Cole, J. H., & Reinders, A. A. (2015). Abnormal hippocampal morphology in dissociative identity disorder and posttraumatic stress disorder correlates with childhood trauma and dissociative symptoms. Human Brain Mapping, 36(5), 1692–1704. https://doi.org/10.1002/hbm.22730
  • Costabile, T., Bilo, L., De Rosa, A., Pane, C., & Saccà, F. (2018). Dissociative identity disorder: Restoration of executive functions after switch from alter to host personality. Psychiatry and Clinical Neurosciences, 72(3), 189. https://doi.org/10.1111/pcn.12630
  • DePrince, A. P., Huntjens, R. J., & Dorahy, M. J. (2015). Alienation appraisals distinguish adults diagnosed with dissociative identity disorder from PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 7(6), 578–584.
  • Huntjens, R. J., Rijkeboer, M. M., & Arntz, A. (2019). Schema therapy for dissociative identity disorder (DID): Rationale and study protocol. European Journal of Psychotraumatology, 10(1), Article 1571377. https://doi.org/10.1080/20008198.2019.1571377
  • Kabene, S. M., Balkır Neftçi, N., & Papatzikis, E. (2022). Dissociative identity disorder and the law: Guilty or not guilty? Frontiers in Psychology, 13, Article 891941. https://doi.org/10.3389/fpsyg.2022.891941
  • Kaplan, A. M., & Smith, C. M. (2021). Schizotypal personality disorder disguised as dissociative identity disorder. BMJ Case Reports CP, 14(7), e243454. https://doi.org/10.1136/bcr-2021-243454
  • Krüger, C., & Fletcher, L. (2019). Predicting a dissociative disorder from type of childhood maltreatment and abuser–abused relational tie. In The abused and the abuser (pp. 114–130). Routledge. https://doi.org/10.4324/9781351213981
  • Lebois, L. A., Ross, D. A., & Kaufman, M. L. (2022a). “I am not I”: The neuroscience of dissociative identity disorder. Biological Psychiatry, 91(3), 11–13. https://doi.org/10.1016/j.biopsych.2021.11.004
  • Lebois, L. A., Kaplan, C. S., Palermo, C. A., Pan, X., & Kaufman, M. L. (2022b). A grounded theory of dissociative identity disorder: Placing DID in mind, brain, and body. In Dissociation and the dissociative disorders (pp. 392–408). Routledge. https://doi.org/10.4324/9781003057314
  • Lyons-Ruth, K., Dutra, L., Schuder, M. R., & Bianchi, I. (2006). From infant attachment disorganization to adult dissociation. Psychiatric Clinics of North America, 29(1), 63–86. https://doi.org/10.1016/j.psc.2005.10.011
  • Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences and infant disorganized attachment. In M. T. Greenberg et al. (Eds.), Attachment in the preschool years (pp. 161–182). University of Chicago Press.
  • Middleton, W., & Butler, J. (1998). Dissociative identity disorder: An Australian series. Australian & New Zealand Journal of Psychiatry, 32(6), 794–804. https://doi.org/10.3109/00048679809073868
  • Öztürk, E. (2018). Travma merkezli alyans model terapi. Türkiye Klinikleri Psychology – Special Topics, 3, 31–38.
  • Öztürk, E., & Derin, G. (2021). Dissosiyatif bozukluklarda kendine zarar verme davranışları ve intihar eğilimleri. Aydın İnsan ve Toplum Dergisi, 7(1), 9–31. https://doi.org/10.17932/IAU.AIT.2015.012/ait_v07i1001
  • Putnam, F. W., Helmers, K., & Trickett, P. K. (1993). Development, reliability, and validity of a child dissociation scale. Child Abuse & Neglect, 17(6), 731–741. https://doi.org/10.1016/S0145-2134(08)80004-X
  • Reinders, A. A., Dimitrova, L. I., Schlumpf, Y. R., et al. (2022). Normal amygdala morphology in dissociative identity disorder. BJPsych Open, 8(2), e70. https://doi.org/10.1192/bjo.2022.36
  • Reinders, A. A., & Veltman, D. J. (2021). Dissociative identity disorder: Out of the shadows at last? British Journal of Psychiatry, 219(2), 413–414. https://doi.org/10.1192/bjp.2020.168
  • Ross, C. A., Norton, G. R., & Wozney, K. (1989). Multiple personality disorder: An analysis of 236 cases. Canadian Journal of Psychiatry, 34(5), 413–418. https://doi.org/10.1177/070674378903400509
  • World Health Organization. (2022). International classification of diseases (11th rev.; ICD-11).
  • World Health Organization. (2023). ICD-11 for mortality and morbidity statistics. https://icd.who.int/browse11
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Psikoloji
Bölüm Derleme
Yazarlar

Umutcan Altunkaya 0009-0004-7960-3273

Çiçek Hocaoğlu 0000-0001-6613-4317

Gönderilme Tarihi 5 Haziran 2024
Kabul Tarihi 17 Ağustos 2024
Yayımlanma Tarihi 19 Aralık 2025
Yayımlandığı Sayı Yıl 2024 Cilt: 5 Sayı: 10

Kaynak Göster

APA Altunkaya, U., & Hocaoğlu, Ç. (2025). Az Bilinen Bir Tanı’ Dissosiyatif Kimlik Bozukluğu’ : Bir Gözden Geçirme. Gelişim ve Psikoloji Dergisi, 5(10), 45-66. https://doi.org/10.51503/gpd.1496630

Gelişim ve Psikoloji Dergisi (GPD) (Journal of Development and Psychology (JODAP)) yılda iki kez yayınlanan uluslararası hakemli ve akademik bir dergidir. e-ISSN 2717-7858