Dissosiyatif Kimlik Bozukluğu ve Diğer Tanılar İle İlişkisi

Öz

Dissosiyatif kimlik bozukluğu dissosiyatif bozukluklar içerisinde en kapsamlı, ağır ve kronik olan bozukluktur. Dissosiyatif kimlik bozukluğunda temel problem örüntüsü normalde bütün halinde olması gereken kişinin bellek; davranış, duygu, bilinç ve kimliğinde bölünmeler ve süreksizlik olmasıdır. Bu ayrışma ve bölünmelerin görülmesi kişide pek çok alanda psikolojik işlevlerin zarar görmesine ve ek olarak kişide diğer psikolojik bozuklukların görülmesine neden olmaktadır. Dissosiyatif kimlik bozukluğunun oluşmasında diğer tanılara kıyasla çevresel etkenlerin görülme durumu daha sıktır. Bunun nedeni dissosiyatif bozukluğunun etiyolojisinde özellikle çocukluk çağında yaşanılan tekrarlı; sistematik ve yineleyici travmatik deneyimlerin yatmasıdır. Dissosiyatif kimlik bozukluğunun tarihsel akışına bakıldığında tanısal olarak geç farkedildiği, travma ile olan ilişkisinin ihmal edildiği görülmektedir. Alter kimliklerin varlığının ve dissosiyatif kimlik bozukluğunun zor farkedilmesinin bu duruma etki ettiği düşünülürken, bu durum diğer tanılar ile dissosiyatif kimlik bozukluğu ilişkisinin araştırılmasında da gecikmeye neden olmuştur. Bu nedenle bu araştırmada dissosiyatif kimlik bozukluğunun tarihçesi, tanısal kriterleri, tedavisi ve dissosiyasyon gibi kavramların yanı sıra diğer tanılarla ilişkisinin incelenmesi amaçlanmıştır. Travma, travma sonrası stres bozukluğu, şizofreni, sınırda kişilik bozukluğu, somatizasyon, yeme bozukluğu, dikkat eksikliği ve hiperaktivite bozukluğu gibi ele alınan diğer tanılar özellikle dissosiyatif kimlik bozukluğu ile arasında kuvvetli ilişkinin bulunduğu tanılardır. Değerlendirilen bu tanıların dissosiyatif kimlik bozukluğu ile ilişkisi ortak belirtiler; eştanı durumu, etiyoloji, epidemiyoloji gibi bağlamlarla ele alınmıştır. Dissosiyatif kimlik bozukluğunun tanısal ve tedavisel protokollerinin geç tanınması; bu nedenle diğer tanılar ile olan ilişkisinin alanyazında ihmal edilmesi araştırmanın önemini ortaya koymaktadır.

Anahtar Kelimeler

• dissosiyatif kimlik bozukluğu
• eştanı
• travma
• depresyon
• sınırda kişilik bozukluğu

Dissociative Identity Disorder and Its Relationship with Other Diagnoses

Abstract

Dissociative identity disorder is the most complex, severe, and chronic condition within the category of dissociative disorders. The core issue in dissociative identity disorder involves significant divisions and discontinuities in an individual's memory, behavior, emotions, consciousness, and identity, which typically function as a cohesive whole. These dissociative experiences lead to impairments in various psychological functions and are often accompanied by other psychological disorders. Compared to other mental health conditions, environmental factors play a more prominent role in the development of dissociative identity disorder. This is primarily because the etiology of dissociative disorders is closely linked to repeated, systematic, and traumatic experiences, particularly during childhood. Historically, dissociative identity disorder has been diagnosed late, and its association with trauma has often been overlooked. The presence of alter identities and the challenges in recognizing dissociative identity disorder have contributed to this oversight, resulting in a delay in exploring the connections between dissociative identity disorder and other diagnoses. This study aims to investigate the history, diagnostic criteria, treatment approaches, and dissociative aspects of dissociative identity disorder, as well as its relationships with other mental health disorders. Notably, dissociative identity disorder has strong associations with conditions such as post-traumatic stress disorder, schizophrenia, borderline personality disorder, somatization, eating disorders, and attention deficit hyperactivity disorder. The interplay between these diagnoses and dissociative identity disorder is examined through the lens of shared symptoms, comorbidity, etiology, and epidemiology. The delayed recognition of the diagnostic and therapeutic protocols for dissociative identity disorder and the consequent neglect of its relationship with other disorders in the literature underscore the significance of this study. By highlighting these connections, we can enhance our understanding and improve the treatment of individuals affected by dissociative identity disorder and its comorbid conditions.

Keywords

• dissociative personality disorder
• trauma
• comorbidity
• deppression
• borderline personality disorder

Kaynakça

1. Akcan G, Öztürk E (2018) Dissosiyatif temel belirtiler ve terapötik yaklaşımlar Türkiye Klinikleri Psikoloji Özel Dergisi, 2018; 3(3):20-30.
2. APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Washington DC, American Psychiatric Association.
3. Atchley R, Bedford C (2021) Dissociative symptoms in posttraumatic stress disorder: A systematic review. J Trauma Dissociation, 22:69-88.
4. Ayar E, Celbiş O (2023) Savaş, terör, travma ve dissosiyasyon. In Savaş Psikolojisi (Ed. E Öztürk):104-112. Ankara,Türkiye Klinikleri.
5. Aydın EF, Laçin TK (2022). A case of dissociative identity disorder and attention deficit hyperactivity disorder comorbidity. Eur Psychiatry, 65(Suppl 1):S471-
6. Balcıoğlu YH, Balcıoğlu İ (2018) Dissosiyatif bozuklukların tanımı ve tanı ölçütleri. Türkiye Klinikleri Psikoloji Özel Dergisi, 3(3):8-13.
7. Ball J, Links P (2009) Borderline personality disorder and childhood trauma: evidence for a causal relationship.Curr Psychiatry Rep, 11:63-68.
8. Beato L, Cano T, Belmonte A (2003) Relationship of dissociative experiences to body shape concerns in eating disorders. Eur Eat Disord Rev, 11:38-45.

9. Bob P, Fedor-Freybergh P, Jasova D, Bizik G, Susta M, Pavlat J et al. (2008) Dissociative symptoms and neuroendocrine dysregulation in depression. Med Sci Monit, 14:CR499-CR504.
10. Bob P, Konicarova J (2018) ADHD, Stress and Development. Cham, Springer.
11. Brand B, Classen C, Lanins R, Loewenstein R (2009) A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians. Psychol Trauma, 1:153-171.
12. Carlson ET (1981) The history of multiple personality in the United States: I: The beginnings. Am J Psychiatry, 38:666-668.
13. Chalavi S, Vissia M, Giesen E, Nijenhuis E, James ND, Cole JH et al. (2015) Abnormal hippocampal morphology in dissociative identity disorder and post-traumatic stress disorder correlates with childhood trauma and dissociative symptoms. Hum Brain Mapp, 36:1692-1704.
14. Christensen MA (2022) Structural differences in brain structure after trauma (Masters thesis). Tromsø, Norway, UiT The Arctic University of Norway.
15. Christianson S, Loftus E (1987) Memory for traumatic events. Appl Cogn Psychol, 1:225-239.
16. Chu A, DePrince A (2006) Development of dissociation: Examining the relationship between parenting, maternal trauma and child dissociation. J Trauma Dissociation, 7:75-89.
17. Cleveland J, Reuther BT, Gold SN (2020) The varied relationship between hypnosis and dissociative phenomena: Implications for traumatology. Am J Clin Hypn, 63:139-149.
18. Coşkun F, Tamam L, Demirkol ME (2020) Erişkin tip dikkat eksikliği ve hiperaktivite bozukluğunda kronotip ve klinik özellikler. Dicle Tıp Dergisi, 47:312-323.
19. Dalenberg C, Carlson EB (2012) Dissociation in posttraumatic stress disorder part II: How theoretical models fit the empirical evidence and recommendations for modifying the diagnostic criteria for PTSD. Psychol Trauma, 4:551-559.
20. De Bellis MD, Keshavan MS, Clark DB, Casey BJ, Giedd JN, Boring AM et al. (1999) Developmental traumatology: II. Brain development. Biol Psychiatry,45:1271–1284.
21. Demitrack MA, Putnam FW, Brewerton TD, Brandt HA, Gold PW (1990) Relation of clinical variables to dissociative phenomena in eating disorders. Am J Psychiatry, 147:1184-1188.
22. Derin G, Öztürk E (2018) Dissosiyatif bozukluklar ve sınırda kişilik bozukluğunda ruhsal travma. Bartın Üniversitesi Edebiyat Fakültesi Dergisi, 3(3):29-42.
23. Dorahy M, Middleton W, Seager L, McGurrin P, Williams M, Chambers R. (2015). Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups. J Affect Disord, 172:195-203.
24. Egeland B, Susman-Stillman A (1996) Dissociation as a mediator of child abuse across generations. Child Abuse Negl, 20:1123-1132.
25. Ellason JW, Ross CA, Fuchs DL (1996) Lifetime axis I and II comorbidity and childhood trauma history in dissociative identity disorder. Psychiatry, 59:255-266.
26. Ellason JW, Ross CA (1997) Two-year follow-up of inpatients with dissociative identity disorder. Am J Psychiatry, 154:632-639.
27. Endo T, Sugiyama T, Someya T (2006). Attention-deficit/hyperactivity disorder and dissociative disorder among abused children. Psychiatry Clin Neurosci, 60:434–438.
28. Esprito-Santo H, Pio-Abreu J (2009) Psychiatric symptoms and dissociation in conversion, somatization and dissociative disorders. Austr NZJ Psychiatry, 43:270-276.
29. Everill J, Waller G, Macdonald W (1995) Dissociation in bulimic and non-eating-disordered women. Int J Eat Disord, 17:127–134.
30. Fırat S, Baskak B (2020) Gelişimsel travmanın uzun dönem etkileri ve bunlara aracılık eden nörobiyolojik mekanizmalar. Kriz Dergisi, 20:25-41.
31. Firoozabadi A, Golshani S, Razeghian L, Rahimi S, Sepehry A, Farnia V et al. (2019) Dissociative experiences in iranian depressed patients. J Trauma Dissociation, 20:445-456.
32. Foote B, Park J (2008) Dissociative identity disorder and schizophrenia: Differential diagnosis and theoretical issues. Curr Psychiatry Rep,10:217-222.
33. Forrest KA (2001) Toward an etiology of dissociative identity disorder: A neurodevelopmental approach. Conscious Cogn, 10:259–293.
34. Ganaway G (1995) Hypnosis, childhood trauma, and dissociative identity disorder: Toward an integrative theory, Int J Clin Exp Hypn, 43:127-144
35. Gentile J, Dillon K, Gilli P (2013) Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innov Clin Neurosci, 10(2):22-29.
36. Gleaves D, Eberenz K (1995) Correlates of dissociative symptoms among women with eating disorders. J Psychiatr Res, 29:417-426.
37. Green R (2023) Dissociation in ADHD. https://www.verywellmind.com/adhd-symptom-spotlight-dissociation-5270278# (Accessed 04.03.2024).
38. Gunderson JG (2010) Revising the borderline diagnosis for DSM-V: an alternative proposal. J Pers Disord,24:694–708.
39. Güz H, Doğanay Z, Özkan A, Çolak E, Tomaç A, Sarısoy G (2004) Conversion and somatization disorders dissociative symptoms and other characteristics. J Psychosom Res, 56:287-291.
40. Hallings-Pott C, Waller G, Watson D, Scragg P (2005) State dissociation in blumic eating disorders: An experimental study. Int J Eat Disord, 38:37-41.
41. Harrison AG, Wilson JB (2005) Inattention and dissociation: overlapping constructs? ADHD Rep, 13:9–11.
42. Hawayek J (2024) Epidemiology of dissociative identity disorder. In Dissociative Identity Disorder: Treatment and Management (Eds. H Tohid, IH Rutkofsky):49-52. Springer, Cham.
43. Herman JL (1992) Trauma and Recovery. New York, Basic Books.
44. Howell E (2011) Understanding and treating dissociative identity disorder: A relational approach. New York, Routledge.
45. Howell E (2016) Models of dissociation in Freud’s work: Outcomes dissociation of trauma in theory and practice. In The Dissociative Mind in Psychoanalysis: Understanding and Working With Trauma (Eds. E Howell, S Itskowitz):73-85. New York, Routledge.
46. Hyland P, Shevlin M, Fyvie C, Cloitre M, Karatzias T (2020) The relationship between ICD-11 PTSD, complex PTSD and dissociative experiences. J Trauma Dissociation, 21:62-72.
47. International Society for the Study of Trauma and Dissociation (2011) Guidelines for treating dissociative identity disorder in adults. J Trauma Dissociation, 12:115-187.
48. İlk G, Bilge Y (2020) Borderline kişilik bozukluğu ve duygu düzenleme güçlüğü. Turkish Studies, 15:2991-3012.
49. İnanç L, Semiz Ü (2017) Dissosiyatif bozukluklar ve psikiyatrik eştanı. Türkiye Klinikleri Psikiyatri Dergisi, 10:209-216.
50. Johnson JG, Cohen P, Kasen S (2006) Dissociative disorders among adults in the community, impaired functioning, and axis I and II comorbidity. J Psychiatr Res, 40:131–140.
51. Kabene SM, Neftçi NB, Papatzikis E (2022) Dissociative identity disorder and the law: Guilty or not guilty? Front Psychol, 13:891941.
52. Kandeğer A, Boysan M, Karaoğlan G, Tekdemir R, Şen B, Tan Ö el al. (2022) Heterogeneity of associations between dissociation and attention deficit symptoms. Curr Psychol, doi: 10.1007/s12144-022-03836-y.
53. Kendler KS, Mishara A (2019) The prehistory of Schneider’s first-rank symptoms: Texts From 1810 to 1932. Schizophr Bull, 45:971-990.
54. Kent DA, Tomason K, Coryell W (1995) Course and outcome of conversion and somatization disorders. A four-year follow-up. Psychosomatics, 36:138-144.
55. Kitayama N, Brummer M, Hertz L, Quinn S, Kim Y, Bremner J (2007) Morphologic alterations in the corpus callosum in abuse-related posttraumatic stress disorder. J Nerv Ment Dis,195:1027-1029
56. Kluft R (1987a) First rank symptoms as a diagnostic clue to multiple personality disorder. Am J Psychiatry,114: 293-298.
57. Kluft R (1987b) The parental fitness of mothers with multiple personality disorder: A preliminary study. Child Abuse Negl, 11:273-280.
58. Kluft R (1991) Clinical presentations of multiple personality disorders. Psychiatr Clin North Am, 14:605-629.
59. Kluft R (1996) Dissociative Identity Disorder. In Handbook of Dissociation: Theoretical, Empirical, and Clinical Perspectives (Eds. LK Mitchelson, WJ Ray):337-366. New York, Plenum Press.
60. Kluft R (2000) The psychoanalytic psychotherapy of dissociative identity disorder in the context of trauma therapy. Psychoanal Inq, 20:259-286.
61. Kluft R (2006) Dealing with alters: A pragmatic clinical perspective. Psychiatr Clin North Am, 29:281-304.
62. Kluft R (2007) Applications of innate affect theory to the understanding and treatment of dissociative identity disorder. In Traumatic Dissociation: Neurobiology and Treatment (Eds. E Vermetten, M Dorahy, D Spiegel):311-317. Washington DC, American Psychiatric Publishing.
63. Kompella S, Kaushal S (2023) Dissociative identity disorder and schizophrenia. In Dissociative Identity Disorder: Treatment and Management (Eds H Tohid, IH Rutkofsky):93-100. Cham, Springer.
64. Krause-Utz A, Frost R, Winter D, Elzinga B (2017) Dissociation and alterations in brain function and structure: Implications for borderline personality disorder. Curr Psychiatr Rep, 19:6.
65. La Mela C, Maglietta M, Castellini G, Amoroso L, Lucarelli S. (2010) Dissociation in eating disorders: relationship between dissociative experiences and binge-eating episodes. Compr Psychiatry, 51:393-400.
66. Laddis A, Fell P, Korzekwa M (2016) Comparing the symptoms and mechanisms of “Dissociation” in dissociative identity disorder and borderline personality disorder. J Trauma Dissociation, 18:139-173.
67. Lanius RA, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD et al. (2010) Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry, 167:640–647.
68. Liotti G (1999) Understanding the dissociative processes: The contribution of attachment theory. Psychoanal Inq, 19:757-783.
69. Loewenstein RJ (2018) Dissociation debates: Everything you know is wrong. Dialogues Clin Neurosci, 20:229-242.
70. Lynn SJ, Polizzi C, Merckelbach H, Chiu C, Maxwell R, van Heugten D et al. (2022) Dissociation and dissociative disorders reconsidered: Beyond sociocognitive and trauma models toward a transtheoretical framework. Annu Rev Clin Psychol,18:259-289.
71. Madden S (2015) Depersonalization/ derealization disorder: A neglected disease in psychiatry. The Undergraduate Journal of Psychology, 8:24-33.
72. Matsumoto T, Imamura F (2007) Association between childhood attention-deficit–hyperactivity symptoms and adulthood dissociation in male inmates: Preliminary report. Psychiatry Clin Neurosci, 61:444-446.
73. Mitra P, Jain A (2023) Dissociative Identity Disorder. Treasure Island, FL, StatPearls.
74. Moskowitz A (2011) Schizophrenia, trauma, dissociation, and scientific revolutions. J Trauma Dissociation, 12:347-357.
75. Nelson MD, Saykin AJ, Flashman LA, Riordan HJ (1998) Hippocampal volume reduction in schizophrenia as assessed by magnetic resonance imaging. Arch Gen Psychiatry, 55:433-440.
76. Nesbit A, Dorahy MJ, Palmer R, Middleton W, Seager L, Hanna D (2022) Dissociation as a mediator between childhood abuse and hallucinations: An exploratory investigation using dissociative identity disorder and schizophrenia spectrum disorders. J Trauma Dissociation, 23:521-538.
77. Nilsson D, Ljonclou A, Holmqvist J (2020) Psychoform and somatoform dissociation among individuals with eating disorders. Nord J Psychiatry, 74:1-8.
78. Nijenhuis ERS, Spinhoven P, Van Dyck R, Van der Hart O, Vanderlinden J (1996) The development and the psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20). J Nerv Ment Dis,184:688-694.
79. Nijenhuis ERS, Van der Hart O (2011) Dissocation in trauma: A new definiton and comparison with previous formulation. J Trauma Dissociation, 12:416-445.
80. Nijenhuis ERS (2001) Somataform dissociation. J Trauma Dissociation, 1:7-12.
81. Nijenhuis ERS, Van der Hart O, Steele K (2002) The emerging psychobiology of trauma-related dissociation and dissociative disorders. In Biological Psychiatry (Eds H. D’haenen, JA den Boer, P Willner ):1079–1098. Hoboken, NJ, Wiley.
82. Özden MŞ (2018) Travma ve dissosiyatif bozukluklar: Genel bir bakış. Bartın Üniversitesi Edebiyat Fakültesi Dergisi, 3:71-76.
83. Öztürk E (2018) Travma merkezli alyans model terapi: Dissosiyatif kimlik bozukluğu’nun psikoterapisi. Türkiye Klinikleri Psikoloji Özel Dergisi, 3(3):31-38.
84. Öztürk E, Derin G (2020) Psikotravmatoloji. Aydın İnsan ve Toplum Dergisi,6:181-214.
85. Öztürk E, Şar V (2016) The Trauma-self and its resistances in psychotherapy. Journal of Psychology and Clinical Psychiatry, 6: 00386.
86. Pais S (2009) A systemic approach to the treatment of dissociative identity disorder. J Fam Psychother, 20:72-88.
87. Pietkiewics IJ, Nowak AB, Tomalski R, Boon S (2021) Revisiting false-positive and imitated dissociative identity disorder. Front Psychol, 12:637929.
88. Powell RA, Gee TL (1999) The effects of hypnosis on dissociative identity disorder: A reexamination of the evidence. Can J Psychiatry, 44:914-916.
89. Pugh M, Waller G, Esposito M (2018). Childhood trauma, dissociation, and the internal eating disorder ‘voice’. Child Abuse Negl, 86:196-205.
90. Read J, Fink PJ, Rudegeair T, Felitti V, Whitfield CL (2008) Child maltreatment and psychosis: a return to a genuinely integrated bio-psycho-social model. Clin Schizophr Relat Psychoses, 2:235-254.
91. Ross CA, Miller SD, Reagor P (1990) Schneiderian symptoms in multiple personality disorder and schizophrenia. Compr Psychiatry, 31:111–118.
92. Ross C, Keyes B (2004) Dissociation and schizophrenia. J Trauma Dissociation, 5:69-83
93. Ross C (2007) Borderline personality disorder and dissociation. J Trauma Dissociation, 8:71-80.
94. Ross C, Ferrel L, Schroeder E (2013) Co-occurrence of dissociative identity disorder and borderline personality disorder. J Trauma Dissociation, 15:79-90.
95. Saxe G, Chinman G, Berkowitz R, Hall K, Lieberg G. Schwartz J et al. (1994) Somatization in patients with dissociative disorders. Am J Psychiatry, 151:1329-1334.
96. Saxena M, Tote S, Sapkale B (2023) Multiple personality disorder or dissociative identity disorder: Etiology, diagnosis, and management. Cureus, 15:e49057.
97. Scalabrini A, Mucci C, Esposito R, Damiani S, Northoff G (2020) Dissociation as a disorder of integration: On the footsteps of Pierre Janet. Prog Neuropsychopharmacol Biol Psychiatry, 101:109928..
98. Schmidt U, Tiller J, Treasure J (1993) Psychosocial factors in the origins of bulimia nervosa. Int Rev Psychiatry, 5:51–59.
99. Schulze L, Schmahl C, Niedtfeld I (2016). Neural correlates of disturbed emotion processing in borderline personality disorder: A multimodal meta-analysis. Biol Psychiatry, 79:97-106.
100. Sierra M, Hunter EC, David AS (2004) The epidemiology of depersonalization and derealization A systematic review. Soc Psychiatry Psychiatr Epidemiol, 39:9-18.
101. Sissons B (2023) What is dissociation in people with ADHD? www.medicalnewstoday.com/articles/adhd-dissociation (Accessed 05.03.2024).
102. Shalev AY (1996) Stress versus traumatic stress: From acute homeostatic reactions to chronic psychopathology. In Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society (Eds BA Van der Kolk, AC McFarlane, L Weisaeth):77-101. New York, Guilford Press.
103. Soffer-Dudek N (2014) Dissociation and dissociative mechanisms in panic disorder, obsessive–compulsive disorder, and depression: A review and heuristic framework. Psychol Conscious, 1:243-270.
104. Spiegel D (1984) Multiple personality as post traumatic stress disorder. Psychiatr Clin North Am, 7:101-110.
105. Spiegel D, Hunt D, Dondershine H (1988) Dissociation and hypnotizabilty in post traumatic stress disorder. Am J Psychiatry,453:301-304.
106. Spiegel D (1997) Trauma, dissociation and memory. In Psychobiology of Post Traumatic Stress Disorder (Eds R Yehuda, AC McFarlane):225-237. New York, New York Academy of Sciences.
107. Spiegel D, Loewenstein R, Lewis-Fernandez R, Şar V, Simeon D, Vermetten E et al. (2011) Dissociative disorders in DSM-5. Depress Anxiety, 28:17-18.
108. Stein MM, Koverola C, Hanna C, Torchia MG, McClarty B (1997) Hippocampal volume in women victimized by childhood sexual abuse. Psychol Med, 27:951–959.
109. Steinberg M, Cıcchetti D, Buchanan J, Rakfeldt J, Rounsaville B (1994) Distinguishing between multiple personality disorder (dissociative identity disorder) and schizophrenia using the Structured Clinical Interview for DSM-IV Dissociative Disorders. J Nerv Ment Dis, 182:495-502.
110. Swart S, Wildschut M, Draijer N, Langeland W, Smit JH (2020) Dissociative subtype of posttraumatic stress disorder or PTSD with comorbid dissociative disorders: Comparative evaluation of clinical profiles. Psychol Trauma, 12:38–45.
111. Şar V (1998) Dissosiyatif kimlik bozukluğu: tani ve nozolojik sorunlar. Klinik Psiyatri Dergisi, 1:13-21.
112. Şar V (2000) Çoğul kişilik kavramı ve dissosiyatif bozukluklar. Psikiyatri Dünyası, 4:7-11.
113. Şar V, Tutkun H, Alyanak B, Bakim B, Baral I (2000) Frequency of dissociative disorders among psychiatric outpatients in Turkey. Compr Psychiatry, 14:216-222.
114. Şar V, Taycan O, Bolat N, Özmen M, Duran A, Öztürk E et al. (2010) Childhood trauma and dissociation. Psychopathology, 43:33-40.
115. Şar V (2011) Dissociative depression: a common cause of treatment resistance. In Female Turkish Migrants with Recurrent Depression (Ed W Rennder):112-124. Innsbruck, Studia.
116. Şar V, Akyüz G, Öztürk E (2013) Dissociative depression among woman in the community. J Trauma Dissociation, 14:423-438.
117. Şar V, Kundakçı T, Kızıltan E, Yargıç İL, Tutkun H, Bakım B et al. (2003) The Axis-I Dissociative disorder comorbidity of borderline personality disorder among psychiatric outpatients. J Trauma Dissociation, 4:119-136.
118. Şar V (2015) Dissociative depression is resistant to treatment-as-usual. Journal of Psychology and Clinical Psychiatry, 3:00128.
119. Şar V (2017) Dissosiyatif bozukluklar. In Psikiyatri (Eds R Tükel, S Çakır):65-72. İstanbul, Güneş Tıp Kitapevi.
120. Şar V, Dorahy M, Krüger C (2017) Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective. Psychol Res Behav Manag, 10:137-146.
121. Şar V (2018) Dissosiyatif Bozukluklar. In Temel ve Klinik Psikiyatri (Ed O. Karamustafalıoğlu):1-8. İstanbul, Güneş Tıp Kitapevi.
122. Şarlak D, Öztürk E (2018) Dissosiyatif bozuklukların epidemiyolojisi. Türkiye Klinikleri Psikoloji Özel Dergisi, 3(3):14-19.
123. Tamam L, Özpoyraz N, Ünal M (1996) Çoğul kişilik bozukluğu (Dissosiyatif kimlik bozukluğu): Bir gözden geçirme. 3P Dergisi, 4:45-55.
124. Tutkun H, Sar V, Yargiç LI, Özpulat, T, Yanik M, Kiziltan E (1998) Frequency of dissociative disorders among psychiatric inpatients in a Turkish university clinic. Am J Psychiatry, 155:800-805.
125. Usta ZB, Karas H (2021) The effect of Attention-Deficit/Hyperactivity Disorder symptoms on somatization and dissociation: The mediating role of difficulties in emotion regulation. Psychiatry and Behavioral Sciences, 11:277-283.
126. Van Der Hart O, Nijenhuis ERS, Steele K (2005) Dissociation: An insufficiently recognized major feature of complex posttraumatic stress disorder. J Trauma Stress, 18:413–423.
127. Van der Kol BA (2009) Developmental trauma disorder: towards a rational diagnosis for chronically traumatized children. Prax Kinderpsychol und Kinderpsychiatr, 58:572–586.
128. Van der Kolk BA, Fisler R (1995) Dissociation and the fragmentary nature of traumatic memories: Overview and exploratory study. J Trauma Stress, 8:505–525.
129. Van Minnen A, Tibben M (2021) A brief cognitive-behavioural treatment approach for PTSD and Dissociative Identity Disorder, a case report. J Behav Ther Exp Psychiatry, 72:101655.
130. Vanderlinden J, Vandereycken W (1997) The Link Between Trauma and Dissociation: Trauma, Dissociation and Impulse Dyscontrol in Eating Disorders. Pensylvania, Brunner Mazel.
131. Vermetten E, Schmahl C, Lindner S, Loewenstein RJ, Bremner JD (2006) Hippocampal and amygdala volumes in dissociative identity disorder. Am J Psychiatry, 163:630–636.
132. Walusinski O, Bogousslavsky J (2020) Charcot, Janet and French models of psychopathology. Eur Neurol, 83:333-340.
133. Watkins J, Watkins H (1997) Ego States: Theory and Therapy. New York, Norton.
134. Weinstein D, Staffelbach D, Biaggio M (2000) Attention-deficit hyperactivity disorder and posttraumatic stress disorder: differential diagnosis in childhood sexual abuse. Clin Psychol Rev, 20:359–378.
135. Yanık M (2018) Bölünmüş Zihinler: Dissosiyatif Kimlik Bozukluğunun Tanı ve Tedavisi. İstanbul, İstanbul Tıp Kitapevleri.
136. Yargic LI, Sar V, Tutkun H, Alyanak B (1998) Comparison of dissociative identity disorder with other diagnostic groups using a structured interview in Turkey. Compr Psychiatry, 39:345-351.
137. Yu J, Ross C, Keyes B, Li Y, Dai Y, Zhang T et al. (2010) Dissociative disorders among Chinese inpatients diagnosed with schizophrenia. J Trauma Dissociation, 11:358-372.