解離的機制：教養風格、創傷事件、和執行功能

Abstract

解離被定義為常態下應當整合之心智功能發生崩解的情形。實徵資料顯示可能存在有病態型與非病態型兩種不同的解離症狀。生物遺傳因素與早期教養經驗可能造成非病態型的解離傾向，而此非病態型的解離傾向與創傷經驗的交互作用可能進一步形成病態型解離傾向。文獻中存在三個未解決的問題。第一，病態型解離的臨床表現是否在不同社會文化情境具有普同性。第二，早期教養經驗與創傷經驗在病態型與非病態型解離是否扮演不同的角色。第三，不同的執行功能對病態型與非病態型解離是否有不同的關聯。本論文設計三個研究探討這三個未解決的問題。研究一的結果顯示病態型解離在台灣病人的臨床表現（含括精神科共病、常見臨床特徵、人際創傷事件史）與歐美國家所報告出的臨床表現相似。研究二的結果顯示早期教養經驗和病態與非病態型解離有顯著關聯，且此關聯無法以其他精神科症狀做為解釋；童年與成人時期都曾經歷重大創傷事件可再增加對病態型解離症狀的解釋力，但卻無法增加對非病態性解離症狀的解釋力。研究三的結果顯示非病態型解離與自我相關的來源監控缺損有關，而病態型解離與快速的作業轉換與優異的表徵更新有關。本研究的結果支持對病態與非病態型解離的區分；也支持早期教養經驗與創傷經驗在解離的病理發展可能扮演不同的角色。

Dissociation is defined as a disruption of ordinarily integrated functions in mental processing. There seemingly exist two qualitatively different types of dissociation (normative and pathological). The tendency toward normative dissociation, contributed by biological predisposition and parental dysfunctions, may interact with victimization for pathological dissociation to emerge. There are three questions unresolved in the literature. First, it is unclear whether the clinical profile of pathological dissociation is universal or culture may shape the manifestations or interpretation of dissociation. Second, it is unclear whether normative and pathological dissociation are differentially related to parental dysfunctions and victimization. Third, it is unclear whether there exist different underlying cognitive mechanisms (e.g., executive functions) in normative and pathological dissociation. Three studies were conducted to address these questions. Study one showed that the clinical profile of dissociative disorders in Taiwanese patients, in terms of co-morbid psychiatric disorders, associated features, and adverse interpersonal experience, is similar to the findings from patients in Europe and North America. Study two showed that both normative and pathological dissociation had an independent association with parental dysfunctions when the effect of general psychopathology was removed; the presence of both childhood and adulthood victimization explained additional variance of pathological, but not normative dissociation. Study three showed that normative dissociation is associated with a self-related source monitoring bias and pathological dissociation correlated with rapid switching and superior updating. Our findings support for distinctive roles of parental dysfunctions and victimization in the developmental trajectory of dissociation. Our findings clearly support for the differentiation between normative and pathological dissociation.