FULL TEXT (全文ー英語のみ)
Dissociative Symptomatology in Japan
Sir: The literature (1) has suggested that multiple personality does not exist in Japan because of the low reported incidence of child abuse there. We report a Japanese case (2) with MPD symptoms given structured testing for dissociation.
Inpatient treatment included individual, milieu, and recreation therapies, and medication (Sulpiride, 300mg po Qd for anxiety, and Lormetazepam 1mg po QHs for sleep). Work-up including blood tests, neurologic exam, CT, and EEG were negative. Overall IQ was 102. There were no symptoms of mood disorder, and no thought disorder. Personality alternation and hallucinations ceased after admission and sulpride was discontinued after 6 weeks. After 4 months she was discharged to outpatient on no medication.
Ten months later we administered the Dissociative Disorders Interview Schedule (DDIS)(3), and the Dissociative
Experiences Scale (DES)(4) in Japanese (the first use of these scales in Japan that we are aware of). The DDIS was modified into a self report questionnaire because Japanese may not respond directly about sensitive issues in interviews. Informed consent was obtained.
Scores on the DDIS subscales tested were (patient vs means of 102 American MPD cases): Schneiderian Symptoms= 3 vs 6.4, Secondary features of MPD= 8 vs 10.2, Borderline Criteria= 0 vs 5.2 , ESP (includes supernatural experiences, ESP experiences, and cult involvement)= 3 vs 5.6. Over five secondary features of MPD may be pathognomonic for MPD (3). The patient also reported amnesia, trances, fugue and depersonalization, but no abuse. 95.1% of American MPD cases reported abuse (3). On the DES she scored 41.7, compared with a mean of 41.4 for 82 American MPD cases (3). Scores above 30 are correlated with a high likelihood of MPD or Post Traumatic Stress (4). The dissociative symptoms in this case were accurately reflected by western instruments. Witnessing her mother's death may have been psychologically similar to an abusive experience. Although we are attempting to study dissociation and abuse here, abuse groups in Japan are secretive (possibly biasing official statis- tics), and reluctant to participate in research. We hope studies of this type will help break the ice.
REFERENCES
1. Takahashi, Y: Is multiple personality really rare in Japan?
Dissociation 1990; 2:57-59
2. Nakajima K, Mizoguchi R: A case of dissociative disorder as
multiple personality. Seishin Igaku (Clin Psychiatry, in
Japanese) 1993; In Press
3. Ross CA, Miller SD, Reagor P, Bjornson L, Fraser GA, Anderson
G: Structured interview data on 102 cases of multiple person-
ality disorder from four centers. Am J Psychiatry 1990; 596-
601
4. Ross CA, Joshi S, Currie R: Dissociative experiences in the
general population. Am J Psychiatry 1990; 1547-1552
Douglas Berger, M.D.
Yutaka Ono, M.D.
Kazunori Nakajima, M.D.
Hiroyuki Suematsu, M.D.
Tokyo, Japan
After breaking with her boyfriend, a 19 year old Japanese female suddenly developed amnesia, alternate distinct personalities, occasional auditory hallucinations of an alternate personality (she was aware the voices weren't real), and fugue. She had no past medical, psychiatric, drug/alcohol, or significant family history. She witnessed her mother die suddenly from a subarachnoid bleed at 13 years old.
