Dissociation versus Integration

分離vs整合

Integration in its most basic form occurs any time that information is processed. When an individual incorporates a fact into their understanding of their self or an event into their understanding of their personal history, that's integration. Dissociation can be seen as a failure of integration. When an individual is struggling with depersonalization or derealization, they're having difficulty processing relevant information about their self or environment in real time. When an individual has dissociative amnesia, their memory of the traumatic or stressful event(s) are kept separate from their other memories and may be accessible only through dissociative flashbacks. When an individual has dissociative identity disorder (DID) or other specified dissociative disorder subtype 1 (OSDD-1), information is stored in separate dissociated parts, known as alters.

信息被處理的時候，最基本形式的整合就發(fā)生了。當一個人把一個事實融入到他們對自己的理解中，或者把一個事件融入到他們對個人歷史的理解中，那就是整合。分離可以被視為整合失敗的結(jié)果。當一個人患有人格解體或者現(xiàn)實解體時，他們難以實時處理關(guān)于自己或環(huán)境的相關(guān)信息。當一個人患有分離性失憶癥時，他們對創(chuàng)傷性或引起緊張的事件的記憶與其他記憶是分開的，那些記憶也許可以在分離性閃回中接觸到。當個體患有分離性身份識別障礙（DID）或其他特定的分離性障礙亞型1（OSDD-1）時，信息存儲在不同的分離部分，稱為子人格

。Every individual who has been through trauma must integrate to some extent as part of healing. This means accepting that the trauma occurred, making it part of one's personal narrative, and making it accessible in a way that does not cause intense re-experiencing of trauma elements. In doing so, an individual may have to accept thoughts, feelings, and urges associated with their trauma. For example, an individual with posttraumatic stress disorder (PTSD) may find that as they integrate their trauma history into their personal narrative, they have to also process feelings of helplessness, betrayal, fear, or anger. In terms of structural dissociation, the individual has to integrate the emotional part(s) associated with their trauma, and that means having to take ownership of everything that the part(s) contained.每個經(jīng)歷過創(chuàng)傷的人都必須在一定程度上整合，作為治療過程的一部分。這意味著要接受創(chuàng)傷的發(fā)生，使其成為個人敘事的一部分，并以一種不會導(dǎo)致強烈的創(chuàng)傷元素再體驗的方式使其能夠被讀取。在這樣做的過程中，一個人也許需要接受與他們的創(chuàng)傷有關(guān)的想法、感受和沖動。例如，患有創(chuàng)傷后應(yīng)激障礙（PTSD）的個體可能會發(fā)現(xiàn)，當他們將自己的創(chuàng)傷史融入個人敘事時，他們還必須處理無助感、背叛感、恐懼感或憤怒感。在結(jié)構(gòu)分離方面，患有PTSD的個體必須整合與創(chuàng)傷相關(guān)的情感部分（EP），這意味著必須擁有這些部分所包含的一切。Integration of Alters (Fusion)子人格的整合（融合）For individuals with DID or OSDD-1, some or all of their parts likely go beyond simple containers of traumatic materials, and the parts may have strongly developed independent senses of autonomy and self. The individual must then make the choice of to what extent they want to integrate their alters as part of their healing. Again, some degree of integration is inevitable. The individual must integrate traumatic materials in order to heal from PTSD. As well, enough integration between alters must occur to allow for easy communication, a lack of dissociative amnesia between parts, and a consistent sense of being grounded in the present and in the body. The individual must be able to take responsibility for all of the system's actions, and all alters in the system should work together towards the same goals. Another goal of reduced dissociative barriers between parts is being able to freely access skills, memories, and traits without these being dependent on the alter present.對于DID或OSDD-1患者來說，他們的一些或者全部部分可能不只是簡單的創(chuàng)傷材料容器，并且這些部分可能具有強烈的獨立自主感和自我意識。然后，個體必須做出選擇，在他們想要在多大程度上整合自己的子人格作為治療的一部分上。同樣，某種程度的整合是不可避免的。個人必須整合創(chuàng)傷材料，才能從創(chuàng)傷后應(yīng)激障礙中康復(fù)。同樣，子人格之間必須有足夠的整合，以便于溝通，各部分之間不再有分離性失憶，以及能夠在當下和身體中有一種持續(xù)的扎根感。個人必須能夠?qū)ο到y(tǒng)的所有行為負責(zé)，系統(tǒng)中的所有子人格都應(yīng)該朝著相同的目標共同努力。減少部分之間分離墻的另一個目的是能夠自由獲取技能、記憶和特征，而不用依賴于正在主導(dǎo)的人格來使用它們。In order to fully integrate two or more alters (which the ISST-D refers to as "fusion," with "final fusion" referring to a complete integration of all dissociated parts), the individual needs to take ownership of all thoughts, feelings, memories, urges, skills, and other traits that were previously associated with those parts of the self. Integration is complete when there are no subjective differences between the parts involved; only one sense of self remains. This can happen spontaneously, when conflicts or dissonance between the alter and one or more other alters are resolved; with the help of "fusion rituals", such as imagery representing unification; or after negotiation between parts and an agreement to integrate.為了完全整合兩個或多個子人格（ISST-D稱之為“融合”，而“最終融合”指的是所有分離部分的完全整合），個體需要拿走所有的思想、感覺、記憶、沖動、技能和其他從前與這些自我部分相關(guān)的特征的所有權(quán)。當所涉及的部分之間沒有主觀差異時，整合就完成了；只有一種自我意識保留了下來。當子人格和一個或多個其他子人格之間的沖突或不和諧得到解決時，這可能會自發(fā)發(fā)生；或者借助“融合儀式”，例如代表統(tǒng)一的圖像；或者在部分之間協(xié)商并達成整合的協(xié)議后。Integration of alters can be experienced in different ways. For fragments (parts with only minimal differentiation), integration may simply entail other alters being able to access what those parts held without a switch being necessary. There may be no major change in how other alters perceive themselves or the world. Even with more developed alters, one alter may seem to integrate into the other so that the resulting part retains the identity of one of the alters involved but gains some of the skills, traits, preferences, or views of the other. Another possibility is that the integration of two or more alters may lead to the creation of a seemingly "new" alter that contains some combination of traits from the parts that integrated. This alter may feel like all or none of the alters involved but is regardless an acknowledgment that what the alters held no longer needs to be kept separate. Finally, an integration may indicate a shift that has already occurred in the system. For example, if an alter primarily held acceptance of same sex desires, that alter may no longer be perceived as separate as the system as a whole moves towards accepting their sexuality.子人格的整合可以以不同的方式進行。對于碎片（僅具有最小差異的部分），整合可能只需要其他子人格能夠在不需要切換的情況下訪問那些碎片所持有的信息。其他子人格對自己或世界的看法可能沒有重大變化。即使是更成熟的子人格，也可能出現(xiàn)一個子人格似乎融入了另一個，因此產(chǎn)生的部分保留了其中一個子人格的身份，但獲得了另一個的一些技能、特征、偏好或觀點的情況。另一種可能性是，兩個或多個子人格的整合可能會產(chǎn)生一個看似“新”的子人格，其中包含整合部分的一些特征的結(jié)合。這個子人格可能覺得自己像是所有參與整合的子人格，或者不是其中的任何一個，無論怎樣，是對不再需要分開存放參與整合的子人格持有的信息的承認。最后，整合可能表明系統(tǒng)中已經(jīng)發(fā)生了變化。例如，如果一個子人格主要接受同性欲望，那么隨著整個系統(tǒng)逐漸接受他們的性取向，這個子人格可能不再被認為是獨立的。It must be noted that not every trait that an alter held will be experienced in the resulting integrated part in the exact same way as it was prior to integration. Traits such as gender identity, sexuality, or religion may have differed between parts, and the individual will need to figure out for themself their integrated stance on these and other points of conflict. Some preferences that alters had may be muted when no longer contained in relative isolation; for example, the integration of an alter who really loved hard rock is unlikely to completely change the musical preferences of an individual who loves classical music, but the individual might find that the integration results in a greater tolerance for rock music or widens the range of music that they enjoy. Some traits may be lost entirely, such as an alter's unhealthy ability to ignore pain at the expense of respecting one's physical limits. Finally, some skills or abilities that alters excelled at may require additional practice as an integrated individual before they can be fully expressed.必須注意的是，并不是所有子人格曾擁有的特征都會以與整合前完全相同的方式出現(xiàn)在最終的整合部分中。性別認同、性取向或宗教信仰等特征在不同的部分可能有所不同，個體需要自己弄清楚自己在這些和其他沖突點上的整合后的立場。一些子人格的偏好在不再被相對隔離時可能會被減弱；例如，一個真正熱愛硬搖滾的子人格的整合不太可能完全改變一個熱愛古典音樂的人的音樂偏好，但這個人可能會發(fā)現(xiàn)整合讓他們對搖滾音樂有更大的包容度，或者拓寬他們喜歡的音樂的范圍。有些特征可能會完全消失，比如一個子人格失去了忽視痛苦的不健康能力，作為尊重一個人的身體極限的代價。最后，一些子人格曾具有的技能或能力可能需要作為一個完整的個體進行額外的練習(xí)，才能充分表達出來。Even when some traits are lost, integration that was not forced or rushed should not feel like a loss in the long-term. Healthy integrations feel like what they are: an acceptance of aspects of oneself that one wasn't previously able to fully accept. Some individuals do need to take some time to mourn the loss of experiencing an alter as separate, but others experience integration as joyous! Alters may want to integrate so that they no longer miss out on so much of the system's life, so that their emotional range is no longer limited, or so that they can consistently contribute to the system's functioning and safety. Overall, integration leads to a more stable and well-rounded individual who has consistent access to all parts of themself. As the individual learns to connect with all of their thoughts, feelings, and behaviors, they will learn to rely less on dissociation, and their general dissociative symptoms will decrease. An individual who is fully integrated and has achieved final fusion may be less vulnerable to increased dissociation or splitting into new parts as a result of future stress.即使某些特征丟失了，從長遠來看，沒有被迫或倉促的整合也不應(yīng)該讓人覺得是一種損失。健康的整合感覺上就像他們應(yīng)該是什么一樣：接受自己之前無法完全接受的自我的方面。有些人確實需要花一些時間來哀悼一個單獨的子人格的逝去，但另一些人體驗的整合是快樂的！子人格可能想要整合，這樣他們就不再錯過系統(tǒng)的大部分生命，這樣他們的情緒范圍就不再受到限制，或者這樣他們就可以始終如一地為系統(tǒng)的功能和安全做出貢獻?？偟膩碚f，融合會帶來一個更穩(wěn)定、更全面的個人，他能夠持續(xù)接觸自己的所有部分。隨著個體學(xué)會與自己的所有想法、感覺和行為聯(lián)系起來，他們將學(xué)會減少對分離的依賴，他們的一般分離癥狀也會減少。一個完全整合并實現(xiàn)最終融合的個體可能不太容易因未來的壓力而增加分離癥狀或分裂成新的部分。That said, it must be acknowledged that sometimes, a decrease in dissociation can be experienced as very negative either temporarily or in the long-term, such as if increasing integration decreases an individual's ability to shut off awareness of chronic pain. While the integration is still healthy and allows the individual to better respect their body's limits, it can nonetheless be stressful or upsetting, especially at first. Similarly, an individual may have to process a lot of grief when they have to accept that no part of them is truly free from the trauma and resulting emotional pain and disability that the system as a whole experiences. In some cases, personality changes as a result of integration may be highly beneficial for the individual but disrupt their existing relationships, such as family and friends not approving of the individual gaining assertiveness and the ability to maintain healthy boundaries.必須承認，有時，分離的減少可能會在短時間內(nèi)或長期導(dǎo)致非常負面的體驗，例如，如果增加整合會降低個人關(guān)閉對慢性疼痛的意識的能力。雖然這種整合仍然是健康的，并且可以讓個人更好地尊重他們身體的極限，但它仍然可能會帶來壓力或令人不安，尤其是剛開始時。同樣，當一個人不得不接受自己的任何部分都沒有真正擺脫整個系統(tǒng)所經(jīng)歷的創(chuàng)傷以及由此產(chǎn)生的情感痛苦和殘疾時，他們可能不得不承受很多悲傷。在某些情況下，融合引起的人格變化可能對個人非常有益，但會破壞他們現(xiàn)有的關(guān)系，例如原來的家人和朋友使這個人不能獲得自信和保持健康界限的能力。Partial Integration (Resolution or Functional Multiplicity)部分整合（找到解，或功能性多元）Some systems choose to stop at what the ISST-D calls resolution, or what may also be called functional multiplicity. In this case, systems may retain any number of independently acting alters. The current rates of complete integration and functional multiplicity may be very similar. A 2017 study (Myrick et al.) followed up on 61 therapists about the well-being of specific patients of theirs after 6 years; 12.8% of therapists reported that their patients had terminated therapy due to achieving stable integration, and exactly the same percentage reported that their patients had terminated therapy due to resolution of symptoms without full integration. The rate of complete integration might be lower than it was in the past because many therapists are now less insistent that full integration is the only possible treatment for DID. This is a good thing even for those who want to fully integrate because it prevents the process from being rushed. Permanent integration cannot be forced, and an integration that occurs before the system was ready for it is very likely to fall apart. This can make the system more hesitant to try again or can make it difficult to identify what the individual has truly processed versus is only claiming to have processed to please their therapist (Kluft, 1986). 一些系統(tǒng)選擇在ISST-D稱之為“解”（resolution，“解決”“和解”）的程度止步，或者也可以稱作功能性多元。在這種情況下，系統(tǒng)可以保留任何數(shù)量的獨立行動的子人格。目前選擇完全整合與選擇功能性多元的系統(tǒng)比例可能非常相似。 2017 年的一項研究(Myrick et al.) 對 61 位治療師進行了隨訪，追蹤他們的特定患者六年內(nèi)的生活質(zhì)量。12.8% 的治療師報告說他們的患者因達到穩(wěn)定的整合，而完全相同百分比的治療師報告他們的患者已終止治療，由于他們（有礙于生活的）癥狀在沒有完全整合的情況下已經(jīng)解決?，F(xiàn)在完全整合的比例可能比過去低，因為很多治療師現(xiàn)在不那么堅持完全整合是 DID唯一可能的治療方法。即使對于那些想要完全整合的人來說，這也是一件好事，因為它可以防止該過程過于倉促。永久的整合是不能被強迫的，而發(fā)生在系統(tǒng)準備好之前的整合非?？赡軙懒选＿@會使系統(tǒng)對于再次嘗試更加猶豫，或可能更難以確定哪些內(nèi)容真的被處理完畢，哪些內(nèi)容只是為了取悅他們的治療師，被聲稱處理了（Kluft，1986 年）。Reasons for choosing not to fully integrate can include: feeling that full integration is unnecessary; not understanding what integration actually entails and being afraid of "losing" or even "killing" alters; uncertainty over how to navigate the world as one integrated person; fear of not being able to handle future traumas without relying on dissociation; being used to having alters around for company, entertainment, or support; alters having their own unique relationships that they're hesitant to lose; alters wanting to remain separate for their own sakes; or the individual not wanting to lose attention, support, or a sense of being unique that they feel is associated with remaining dissociated. In some cases, friends and family may overtly or covertly communicate that they prefer the individual to remain multiple, possibly because of attachment to individual alters or because of disliking how the individual's personality shifts as they fuse. If the system is in spaces oriented towards those with DID/OSDD-1, integrating may fundamentally alter their relationships and place in the community. Some individuals with DID/OSDD-1 question if integration is even permanently possible, which of course makes it harder to achieve (ISST-D, 2011; Kluft, 1986).選擇不完全整合的理由可以包括：感覺完全整合是不必要的;不明白整合實際上會涉及什么，并害怕“失去”或甚至“殺戮”子人格；不確定如何以一個完整的人的身份駕馭世界；害怕無法在不依賴分離的情況下處理未來的創(chuàng)傷；習(xí)慣于有子人格在身邊陪伴、娛樂或支持；子人格擁有難以舍棄的獨特的關(guān)系；子人格想要為了自己留下而保持分離；或個人不想要失去在保持分離的情況下得到的關(guān)注、支持或一種覺得自己獨特的感覺。在某些情況下，朋友和家人可能會公開或私下地表示他們更喜歡個體保持多重狀態(tài)，可能由于對個體的子人格有依戀，或因為不喜歡他們?nèi)诤虾笮愿駮l(fā)生變化這一點。如果系統(tǒng)在面向患有DID/OSDD-1的人的空間，整合可能會從根本上改變他們的關(guān)系和在社區(qū)中的位置。一些有DID/OSDD-1的個人甚至質(zhì)疑永久整合是否真的可能，這當然使得它更難實現(xiàn)（ISST-D，2011；Kluft，1986）。Unfortunately, even some individuals who might otherwise want to integrate can find it impossible to integrate all of their parts or to maintain one integrated personality over time. This can occur when an individual is in a highly stressful or unsafe environment, can't bring themself to fully accept or process their trauma history, can't bring themself to fully admit to their degree of fragmentation or dysfunction, can't access treatment from professionals who are knowledgeable about DID, can't afford to continue treatment, or experiences intense interference from symptoms of comorbid personality or other disorders. Finally, in some cases, the system as a whole may appear or claim to want integration, but individual parts may disagree and openly or secretly try to remain separate; sometimes, this is temporary and only lasts until all parts of the individual are truly convinced that they can function as a unified whole (ISST-D, 2011; Kluft, 1986).不幸的是，即使另一些人可能想要整合，他們也可能發(fā)現(xiàn)整合所有部分或者長期保持一個穩(wěn)定的整合后人格是不可能的。這可能發(fā)生當個人處于高度壓力，或處在不安全的環(huán)境，不能讓自己充分接受或處理他們的創(chuàng)傷史，不能使自己完全承認自己的碎片化或功能障礙的程度，無法獲得了解 DID 的專業(yè)人士的治療，負擔不起繼續(xù)治療，或體驗到了融合后的人格的癥狀的強烈影響或其他疾病。最后，在一些情況下，整個系統(tǒng)可能會想要或聲稱想要整合，但個別部分可能不同意并公開或秘密地試圖保持分離；有時，這是暫時的，只會持續(xù)到個人的所有部分都真正相信他們可以作為一個統(tǒng)一的整體發(fā)揮作用時（ISST-D，2011；Kluft，1986）。Even individuals with DID who are vocal about their desire not to integrate are likely to spontaneously integrate some alters and fragments as they process and heal, and many systems willingly integrate down to a few alters (including well known systems such as Robert Oxnam). Kluft found it noteworthy that systems that prioritized cooperation naturally moved towards integration even if they originally desired to remain multiple, convincing him that the mind desires and will work towards unity. However, not all integrations are stable. Integrations might fall apart if the alters involved weren't completely ready yet, if a stressor arises that one alter in particular was created to handle, or if the alters involved need influence from other alters in order to remain stable in their unity (e.g., an internal helper part is needed to handle a stressful period of time to prevent greater problems, distress, and subsequent dissociation). Even if an integration falls apart, it may be quickly re-achieved with the right support (Kluft, 1986).即使是表達了不想整合的愿望的DID系統(tǒng)，他們也比較可能會在處理和治愈過程中自發(fā)地整合一些子人格和片段，并且許多系統(tǒng)愿意整合到只有幾個子人格的程度（包括一些著名的系統(tǒng)，如Robert Oxnam）。Kluft發(fā)現(xiàn)，值得注意的是，優(yōu)先合作的系統(tǒng)會自然地走向一體化，即使他們最初希望保持多重性，這讓他相信大腦渴望并將會實現(xiàn)統(tǒng)一。然而，并不是所有的整合都是穩(wěn)定的。如果所涉及的子人格還沒有完全準備好，如果一個壓力源出現(xiàn)，特別是在其中一個子人格就是為了應(yīng)對這類壓力時，那么整合可能會崩潰。或者，如果所涉及的子人格需要來自其他子人格的影響，以便在他們的統(tǒng)一中保持穩(wěn)定（例如，需要一個內(nèi)部助手來處理一段緊張的時間，以防止更大的問題、痛苦和隨后的分離）。即使一個整合失敗了，在正確的支持下也可能會很快重新實現(xiàn)（Kluft，1986）。Full Integration完全整合Many individuals who are fully integrated are convinced that integration is the best option, and there is research supporting that this is the case. For example, Ellason and Ross (1997) found that complete integration was associated with reduced overall dissociation, amnesia, somatic symptoms, Schneiderian first-rank symptoms, borderline symptoms, depression, and suicidality. Coons and Bowman (2001) also found that compared to unintegrated individuals, integrated individuals are less depressed, less affected by somatic symptoms, have less posttraumatic stress, and are overall less dissociative to the extent that their symptoms match those of the general population. Additionally, they have fewer hospitalizations and less anxiety compared to those who are unintegrated. However, it's worth noting that those who achieved integration in this study were also less symptomatic upon entering treatment.許多完全整合的個人確信整合是最佳選擇，并有研究支持確實是這樣。例如，Ellason和Ross（1997）發(fā)現(xiàn)完全整合與降低總體上的分離、健忘癥、軀體癥狀、施耐德首級癥狀群（備注1），邊緣癥狀、抑郁和自殺。Coons和Bowman（2001）還發(fā)現(xiàn)相比不整合的個體，整合的個體更少抑郁，更少受軀體癥狀影響，創(chuàng)傷后壓力較小，總體而言他們分離癥狀出現(xiàn)得較少，類似于普遍人口的程度。此外，他們相比不整合的人更少住院和更少焦慮。然而，值得注意的是本研究中的達到整合的案例在進入治療時也是顯示出較少的病征的。備注1：施耐德（1935）首級癥狀群（Schneider first-rank symptoms1、思維化聲；2、對話性幻聽；3、評論性幻聽；4、軀體被動體驗；5、思維被奪；6、思維被插入；7、思維被擴散或被廣播；8、被強加的情感；9、被強加的沖動；10、被強加的意志行為；11、妄想性知覺。（摘自好大夫在線《精神分裂癥的診斷.治療.預(yù)后》趙長?。㊣t must be noted that even if an individual successfully fully integrates, it is possible for the integration to temporarily dissolve during times of stress or conflict. In the short term, this is very likely if the stabilization phase of therapy wasn't sufficient and the individual lacks the coping skills necessary to handle life without relying on dissociation. Even one or two years out, another trauma, the death of an abuser, or the loss of an important individual may all lead to the return of fragmentation. In some cases, an integration that appeared complete may actually not have been so, and more alters may emerge only when the individual is stable and strong enough to handle the alters' traumatic memories or resolve the protective behaviors they engage in. For example, only once an individual has sufficiently processed traumatic memories related to childhood sexual abuse might an alter be revealed who previously used over-eating to attempt to look unattractive and prevent being an object of sexual interest. It's important to keep in mind that all of this is a normal part of the progression of integration and is not a bad sign or a setback. It's also worth noting that alters that return during relapse events are often less separate and re-fuse rapidly. Treatment by dissociation specialists may make integrations more likely in general and more likely to be permanent (Kluft & Donne, 1984; Kluft, 1986).必須指出的是，即使一個人成功地完全整合，這種整合也有可能在緊張或沖突期間暫時分解。在短期內(nèi)，如果治療的穩(wěn)定期不夠，并且患者缺乏在不依賴分離的情況下處理生活所需的應(yīng)對技能，則很可能出現(xiàn)這種情況。即使是一兩年后，另一次創(chuàng)傷、施虐者的死亡或一個重要人物的死亡都可能導(dǎo)致分裂的回歸。在某些情況下，看似完整的整合可能實際上并非如此，只有當個體足夠穩(wěn)定和強大，能夠處理某些子人格的創(chuàng)傷記憶或解決他們的保護行為時，他們才會出來。例如，當一個人充分處理了與兒童期性虐待有關(guān)的創(chuàng)傷記憶后，一個曾經(jīng)過度進食以試圖看起來不吸引人并防止成為性興趣對象的人可能才會出現(xiàn)。重要的是要記住，所有這些都是整合進程中正常的一部分，不是一個壞跡象或挫折。同樣值得注意的是，在復(fù)發(fā)事件中返回的子人格通常不再那么獨立，并且很快重新融合。分離疾病專家的治療可能會使整體整合變得更可能，并且更可能是永久性的（Kluft&Donne，1984；Kluft，1986）。In 1986, Coons examined DID clients treated by different therapists, the majority of whom had no prior experience treating DID, and found that of 18 patients after on average 39 months, 5 had fully integrated and remained integrated, 2 had temporarily integrated but re-fragmented after additional trauma, and 2 had partially integrated. In a 10 year follow-up study of 12 individuals with DID (Coons & Bowman, 2001), 4 had completely integrated, and 2 had integrated but re-fragmented due to stress. The 2 patients who had dropped out of treatment remained unintegrated, and integration was also less likely in those who had to switch between several therapists post-diagnosis. Additionally, although it took 5.4 years on average for the individuals to integrate, both teenager participants did so in 2 or fewer years. Interestingly, integrated and unintegrated individuals in the study had experienced a similar number of life events during the follow-up period, but the integrated individuals viewed these events positively while the unintegrated group viewed them negatively.1986年，Coons對由不同治療師治療的DID患者進行了檢查，這些治療師中大多數(shù)在之前沒有治療DID的經(jīng)驗，并發(fā)現(xiàn)18名患者中，在平均39個月后，有5名完全整合并保持整合，2名暫時整合但在額外創(chuàng)傷后重新分裂，2名部分整合。在對12名DID患者進行的10年隨訪研究中（Coons&Bowman，2001），4人完全整合，2人整合，但由于壓力而重新分裂。兩名退出治療的患者仍然沒有整合，在診斷后不得不在多名治療師之間切換的患者中，整合的可能性也較小。此外，雖然個體平均需要5.4年才能整合，但兩名青少年參與者都在2年或更短的時間內(nèi)整合。有趣的是，研究中的整合個體和非整合個體在隨訪期間經(jīng)歷了相似數(shù)量的生活事件，但整合個體對這些事件的看法是積極的，而非整合群體對這些事件的看法是消極的。Kluft defined integration as a full 27 month period with no amnesia or signs of identity fragmentation (including observed signs of multiplicity, a subjective sense of having parts, or disowning opinions or traits previously associated with alters). This is because he found that 60% of individuals who integrate and remain integrated for at least 3 months show no future return of dissociation, and this figure continues to rise throughout the 27 month period. In a 10 year follow-up of 123 individuals with DID treated by Kluft (Kluft & Donne, 1984), 33 achieved this strict definition of full and stable integration, and another 50 were fully integrated but had not met this strict criteria; of these 50, 16 simply hadn’t hit 27 months yet, and 20 couldn’t be contacted again to see whether or not they met the criteria. Two years later, Kluft published an additional follow-up (Kluft, 1986) which included the previous 33 patients and a new 19 patients who had experienced stable fusion for at least 27 months. In this case, the pool included another 54 patients who had been integrated for at least 3 months but had not achieved stable fusion. Of the 52 individuals with allegedly stable integrations, only 11 had had a “relapse event,” which only indicated full alters and amnesia in 3 cases. By the time of publication, only 2 of the 11 were still dissociative, with others having achieved stable integration after additional therapy. Of 13 individuals who maintained integration for 5 or more years, only 1 experienced an easily resolved relapse of vaguely differentiated parts, and another found a part that had previously been dormant and so had not had its materials integrated. Stable integration was more likely and more easily achieved for males and for individuals with smaller systems (fewer than 18 alters). Larger systems took longer to treat and tended to have more relapse events. However, these systems are still capable of integrating with the right treatment, as are even those with severe borderline features. Kluft將整合定義為一個完整的27個月的周期，其中沒有失憶癥或身份分裂的跡象（包括觀察到的多樣性跡象、有部分的主觀感覺，或不被本人承認的曾經(jīng)與子人格有關(guān)的觀點或特征）。這是因為他發(fā)現(xiàn)，在融合并保持融合至少3個月的個體中，有60%的人在未來不會再次出現(xiàn)分離現(xiàn)象，而這一數(shù)字在27個月的時間里持續(xù)上升。在接受Kluft治療的123例DID患者的10年隨訪中（Kluft&Donne，1984），33例達到了這個完全穩(wěn)定整合的定義，另有50例完全整合，但未達到這一嚴格標準；在這50人中，有16人還沒有滿27個月，20人無法再次聯(lián)系，來查看他們是否符合標準。兩年后，Kluft發(fā)表了一份額外的隨訪報告（Kluft，1986），其中包括之前的33名患者和新的19名患者，他們經(jīng)歷了至少27個月的穩(wěn)定融合。在本例中，患者庫中包括另外54名患者，他們已融合至少3個月，但尚未實現(xiàn)穩(wěn)定融合。在52名據(jù)稱整合穩(wěn)定的個體中，只有11人出現(xiàn)了“復(fù)發(fā)事件”，這僅表明3例患者出現(xiàn)完整的子人格和健忘癥。截至發(fā)表時，11名患者中只有2名仍處于分離狀態(tài)，其他患者在接受額外治療后已實現(xiàn)穩(wěn)定整合。在13名維持整合5年或5年以上的個體中，只有1人經(jīng)歷了的模糊分化部分的容易解決的復(fù)發(fā)，另一人發(fā)現(xiàn)了一個之前處于休眠狀態(tài)的部分，因此其材料沒有整合。對于男性和較小的系統(tǒng)（少于18個子人格），穩(wěn)定整合的可能性更大，也更容易實現(xiàn)。更大的系統(tǒng)需要更長的時間來治療，并且往往有更多的復(fù)發(fā)事件。然而，這些系統(tǒng)仍然能夠在正確的治療下整合，就算是那些具有嚴重邊緣特征的系統(tǒng)也是如此。Like Coons and Bowman, Kluft found that children often integrate very rapidly compared to adults and even adolescents. In a study of 5 male children between the ages of eight and eleven (Kluft, 1985), 4 achieved apparent integration. Some integrations were spontaneous, and others involved creative imagery to engage the children and help them understand the process. In the two children for whom follow-up was possible, integration had been maintained for 22 and 69 months respectively. Kluft believed that alters may continue to develop throughout childhood and adolescence, meaning that childhood presentations of DID may not be fully formed (i.e., lack parts that fully switch out or are well elaborated) and be less complex (i.e., lack parts with highly specialized functions or internal arrangements of parts) and so may be much easier to treat. Even when fully formed alters are present, they're usually less invested in their continued existence than alters often are in teenagers and adults. Children with DID/OSDD-1 are often confused, frightened, and upset by periods of amnesia, being accused of uncharacteristic behavior, and feeling impulses from other parts, and their alters may be eager to step back when made aware of the negative impacts of their attempts to help. They often express a desire to integrate and become "normal." 和Coons和Bowman一樣，Kluft發(fā)現(xiàn)孩子們與成人和青少年相比，他們的整合速度通常非?？?。在一項對5名年齡在8到11歲之間的男性兒童的研究中（Kluft，1985年），4例實現(xiàn)了明顯的整合。一些整合是自發(fā)的，還有一些為了讓孩子參與并幫助他們理解這種過程，加入了創(chuàng)造性想象。2個可以跟蹤后續(xù)的孩子，整合已經(jīng)分別維持22個月和69個月。Kluft相信子人格可能會在整個童年和青春期繼續(xù)發(fā)展，這意味著兒童時期的DID表現(xiàn)可能并不全面成型（即缺少可以完全切換或精細的部分），并且不那么復(fù)雜（即缺乏具有高度專項功能的部分或內(nèi)部部分的安排），因此可能更容易被治療。即使存在完全成形的子人格，他們通常較少地投入于他們的持續(xù)發(fā)展，相比于在青少年和成人中的子人格?；加蠨ID/OSDD-1的兒童常常為失憶癥、被指控為行為反常和感到來自其他部分的沖動感到困惑、害怕和情緒低落，以及他們的子人格可能在意識到他們試圖幫忙造成負面影響時，渴望退后一步。他們經(jīng)常表達整合并變得“正?！钡脑竿?。Post-Fusion Therapy and Integrative Work融合后治療與整合工作After an attempt at final fusion, it might take some time for the individual to become used to living as one integrated identity. Like everything else, learning a new way of viewing oneself and learning how to rely on responses other than dissociation take practice! Additionally, it is vital to understand that final fusion in of itself is not a cure. Only once an individual has fully processed all memories and experiences no meaningful fragmentation can they be said to be fully integrated. This requires more than the fusion of discrete alters alone.在嘗試最終融合后，可能需要一些時間讓個人習(xí)慣作為一個完整的身份生活。和其他事情一樣，學(xué)習(xí)一種看待自己的新方式和如何依賴分離以外的反應(yīng)方式需要多加練習(xí)！此外，一定要明白，最終融合本身并不是治愈。只有當一個人完全處理完所有的記憶并沒有出現(xiàn)任何有意義的碎片化，才可以說是完全的整合了。這需要的不僅僅是融合分裂的子人格。Once all alters have joined together as one, the individual has to process having access to their full trauma narrative from an integrated, first-person perspective for the first time. They have to deal with the full range of associated emotions and cognitions, including grief over the opportunities lost due to trauma and the individual’s resulting dysfunction. That needs to be acknowledged and addressed in treatment. Additionally, the individual must be helped to accept other memories, traits, or actions that their alters previously held. Acknowledging, remembering, and taking full ownership of all emotional pain, weaknesses, disabilities, harms caused to others, self-harm, and self-sabotage previously associated with alters can be difficult and painful. Integration may not fix negative core beliefs, such as feelings of being worthless or harmful to others; in contrast, these beliefs which may not have seemed to affect the daily life parts before may need to be fully addressed once they can be understood and felt through the lens of what all alters held. Finally, integration may lead to shifts in important relationships that need to be addressed, and an individual may only be stable enough to address adult-life concerns like intimate partnerships or employment once they're fully integrated.一旦所有的子人格都結(jié)合成一個整體，個人必須處理能夠訪問其完整的創(chuàng)傷敘事，從一個完整的，第一人稱的角度看問題。他們必須處理各種相關(guān)的情緒和情緒認知，包括對由于創(chuàng)傷導(dǎo)致的機遇錯失和個人的功能障礙引起的悲痛。這需要在治療中得到承認和處理。此外，必須幫助個人接受他們的子人格曾經(jīng)具有的其他記憶、特征或采取的行動。承認、記住并完全取得所有情感上的痛苦，弱點、殘疾、對他人造成的傷害、自我傷害和以前與子人格有關(guān)的自我破壞的所有權(quán)可以是非常困難和痛苦的。整合可能無法改變消極的核心信念，如感覺對他人沒有價值或有害；相比之下，似乎沒有被這些信念影響到的過去的日常生活部分，也許需要在能夠理解和透過他們的子人格的濾鏡感受之后，徹頭徹尾地解決問題。最后，整合可能會導(dǎo)致重要關(guān)系的轉(zhuǎn)變，這需要處理，以及個人可能只有在完全整合后才穩(wěn)定到足以解決成人生活中的問題，如親密的伙伴關(guān)系或就業(yè)。Treatment should continue for a while after an individual has achieved final fusion in order to support this process. In some cases, post-fusion treatment may be longer than the work preceding it. Additionally, even after terminating or "graduating" from therapy, an individual may need to briefly return to therapy in order to address temporary lapses in integration, an increase in dissociation in response to new stressors, or other novel problems.在個體最終融合后，治療應(yīng)該繼續(xù)一段時間，這是為了支持這個過程。在某些情況下，融合后治療可能比之前的工作時間還要長。此外，即使在終止治療或從治療中“畢業(yè)”之后，患者可能還需要短暫地恢復(fù)治療以解決暫時性的整合空缺，分離的增加，應(yīng)對新的壓力源或其他新的問題。Other Resources on Integration Versus Cooperation其他關(guān)于整合vs合作的資料Here is a blog post from a therapist who specializes in trauma and dissociation and who believes that integration is neither necessary nor always helpful.這是一個來自一名專業(yè)領(lǐng)域在創(chuàng)傷和分離的治療師的博客，其相信整合不是必須的，就是一定會有好處的。鏈接：https://www.discussingdissociation.com/2008/12/integration-a-requirement-for-did-therapy-or-not/Here is an article by an individual with DID who wants to integrate. It details the difference between wanting alters to disappear (which is impossible) and accepting them fully (which is necessary for integration).這是一篇由一個想要整合的DID個人所書的文章。它詳細地說明了想要子人格消失（這是不可能的）和完全接納他們（是對于整合來說必須的）的區(qū)別。鏈接：https://www.healthyplace.com/blogs/dissociativeliving/2010/10/integration-and-dissociative-identity-disorder-treatmentHere is an article by an individual who had DID and chose to integrate. It details what integration is and why the author views it as the best goal for healing.這是一篇由一個患有DID并選擇整合的個人所書的文章。它詳細地說明了整合是什么，以及為什么整合是作者認為的治療的最好目標。鏈接：http://www.sidran.org/wp-content/uploads/2018/11/Understanding-Integration.pdfOther Useful Resources on Treatment for DID/OSDD-1其他關(guān)于DID/OSDD-1治療的實用資源For dissociative individuals:為分離的個人準備的讀物：Alderman, T. & Marshell, K. (1998). Amongst ourselves: A self-help guide to living with dissociative identity disorder. New Harbinger Publications.A. T. W. (2005). Got parts?: An insider’s guide to managing life successfully with dissociative identity disorder. Loving Healing Press.Boon, S., Steele, K., & van der Hart, O. (2011). Coping with trauma-related dissociation: Skills training for patients and therapists. W W Norton & Co.For clinicians:為臨床醫(yī)師準備的讀物：Chefetz, R. A. (2015). Intensive psychotherapy for persistent dissociative processes: The fear of feeling real. W W Norton & Co.Chu, J. A. (2011). Rebuilding shattered lives: Treating complex PTSD and dissociative disorders (2nd ed.). John Wiley & Sons, Inc. https://doi.org/10.1002/9781118093146Howell, E. F. (2011). Understanding and treating dissociative identity disorder: A relational approach. Routledge/Taylor & Francis Group. https://doi.org/10.4324/9780203888261Steele, K., Boon, S., & van der Hart, O. (2017). Treating trauma-related dissociation: A practical, integrative approach. W W Norton & Co.Citations引用Coons, P. M. (1986). 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M., Frankel, A. S., Steele, K., Gold, S. N., Gast, U., Young, L. M., & Twombly, J.]. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115–187.Kluft, R. P. (1985). Hypnotherapy of childhood multiple personality fisorder. American Journal of Clinical Hypnosis, 27(4), 201-210. doi: 10.1080/00029157.1985.10402608Kluft, R. P. (1986). Personality unification in multiple personality disorder: A follow-up study. In B. G. Braun (Ed.), Treatment of multiple personality disorder (pp. 29-60). American Psychiatric Press, Inc.Kluft, R. P. & Donne, J. (1984). Treatment of multiple personality disorder: A study of 33 cases. Psychiatric Clinics of North America, 7(1), 9-29. doi: 10.1016/S0193-953X(18)30777-9Myrick, A. C., Webermann, A. R., Loewenstein, R. J., Lanius, R., Putnam, F. W., & Brand, B. L. (2017). Six-year follow-up of the treatment of patients with dissociative disorders study. European Journal of Psychotraumatology, 8(1), 1344080. doi: 10.1080/20008198.2017.1344080患者語錄"Dissociating feels like building a jig-saw puzzle and you're missing a piece. It bothers you that the picture will never be complete despite how hard you try to look at it. The best thing to do is focus on how beautiful that incomplete picture can be."-Alpha“分離感覺上就像你在拼一副拼圖，卻缺少了一塊。你很擔心無論你多么努力地尋找它，這幅圖都永遠不會被完成。要做的最好的事就是專注于沒有完成的圖畫是多么的美?！薄狝lpha“I believe the perception of what people think about DID is I might be crazy, unstable, and low functioning. After my diagnosis, I took a risk by sharing my story with a few friends. It was quite upsetting to lose a long term relationship with a friend because she could not accept my diagnosis. But it spurred me to take action. I wanted people to be informed that anyone can have DID and achieve highly functioning lives. I was successful in a career, I was married with children, and very active in numerous activities. I was highly functioning because I could dissociate the trauma from my life through my alters. Essentially, I survived because of DID. That's not to say I didn't fall down along the way. There were long term therapy visits, and plenty of hospitalizations for depression, medication adjustments, and suicide attempts. After a year, it became evident I was truly a patient with the diagnosis of DID from my therapist and psychiatrist. I had two choices.“我覺得人們想到DID會產(chǎn)生的看法是，我可能瘋了，不穩(wěn)定，功能性很低。確診后，我冒了一次險和幾個朋友分享我的故事。失去了一和一個朋友的長期關(guān)系挺讓人不高興的，因為她不能接受我的診斷。但這促使我采取行動。我希望人們能夠知道任何得了DID的人都可能做到實現(xiàn)高功能的生活。我在一項事業(yè)上取得成功，我結(jié)婚生子，在許多活動中非?；钴S。我的功能非常強大是因為我可以通過我的子人格把創(chuàng)傷從我的生活中分離出來。根本上，我活了下來就是因為DID。這并不是說我在一路上沒有摔過跟頭。曾經(jīng)有過長期的治療訪問，和大量的住院治療與抑郁，藥物調(diào)整和自殺企圖。一年后，我是一個真正的DID患者這一點變得顯然，我的治療師和精神科醫(yī)生為我開了診斷。我有兩個選擇。First, I could accept it and make choices about how I was going to deal with it. My therapist told me when faced with DID, a patient can learn to live with the live with the alters and make them part of one's life. Or, perhaps, the patient would like to have the alters integrate into one person, the host, so there are no more alters. Everyone is different.首先，我可以接受它并為我將要如何處理它做出選擇。我的治療師告訴我當面對DID的時候，一個病人可以學(xué)習(xí)著與子人格們共處，并讓他們成為生命的一部分?；蛘撸∪艘部梢詫⒆尤烁裾系揭粋€人，也就是主導(dǎo)者，這樣就不會再有子人格。每個人都不一樣。The patient and the therapist need to decide which is best for the patient. Secondly, the other choice was to resist having alters all together and be miserable, stuck in an existence that would continue to be crippling. Most people with DID are cognizant something is not right with themselves even if they are not properly diagnosed. My therapist was trustworthy, honest, and compassionate. Never for a moment did I believe she would steer me in the wrong direction. With her help and guidance, I chose to learn and understand my disorder. It was a turning point.”患者和治療師需要決定哪一種選擇對于病人來說是最好的。其次，另一種選擇就是不接受自己有子人格的事實，過得痛苦，困在一個會持續(xù)地殘廢的存在中。大多數(shù)DID患者都會認知到自己身上有什么不對，即使他們沒有得到正式的診斷。我的治療師值得信賴、誠實、富有同情心。我相信，沒有一刻她會把我引向錯誤的方向。在她的幫助和指導(dǎo)下，我選擇了學(xué)習(xí)并理解我的紊亂。這是一個轉(zhuǎn)折點。”― Esmay T. Parker, A Shimmer of Hope