（由莉莉翻译）多重人格的分裂与整合

Dissociation versus Integration

分离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.

信息被处理的时候，最基本形式的整合就发生了。当一个人把一个事实融入到他们对自己的理解中，或者把一个事件融入到他们对个人历史的理解中，那就是整合。分离可以被视为整合失败的结果。当一个人患有人格解体或者现实解体时，他们难以实时处理关于自己或环境的相关信息。当一个人患有分离性失忆症时，他们对创伤性或引起紧张的事件的记忆与其他记忆是分开的，那些记忆也许可以在分离性闪回中接触到。当个体患有分离性身份识别障碍（DID）或其他特定的分离性障碍亚型1（OSDD-1）时，信息存储在不同的分离部分，称为子人格

。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.每个经历过创伤的人都必须在一定程度上整合，作为治疗过程的一部分。这意味着要接受创伤的发生，使其成为个人叙事的一部分，并以一种不会导致强烈的创伤元素再体验的方式使其能够被读取。在这样做的过程中，一个人也许需要接受与他们的创伤有关的想法、感受和冲动。例如，患有创伤后应激障碍（PTSD）的个体可能会发现，当他们将自己的创伤史融入个人叙事时，他们还必须处理无助感、背叛感、恐惧感或愤怒感。在结构分离方面，患有PTSD的个体必须整合与创伤相关的情感部分（EP），这意味着必须拥有这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.对于DID或OSDD-1患者来说，他们的一些或者全部部分可能不只是简单的创伤材料容器，并且这些部分可能具有强烈的独立自主感和自我意识。然后，个体必须做出选择，在他们想要在多大程度上整合自己的子人格作为治疗的一部分上。同样，某种程度的整合是不可避免的。个人必须整合创伤材料，才能从创伤后应激障碍中康复。同样，子人格之间必须有足够的整合，以便于沟通，各部分之间不再有分离性失忆，以及能够在当下和身体中有一种持续的扎根感。个人必须能够对系统的所有行为负责，系统中的所有子人格都应该朝着相同的目标共同努力。减少部分之间分离墙的另一个目的是能够自由获取技能、记忆和特征，而不用依赖于正在主导的人格来使用它们。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.为了完全整合两个或多个子人格（ISST-D称之为“融合”，而“最终融合”指的是所有分离部分的完全整合），个体需要拿走所有的思想、感觉、记忆、冲动、技能和其他从前与这些自我部分相关的特征的所有权。当所涉及的部分之间没有主观差异时，整合就完成了；只有一种自我意识保留了下来。当子人格和一个或多个其他子人格之间的冲突或不和谐得到解决时，这可能会自发发生；或者借助“融合仪式”，例如代表统一的图像；或者在部分之间协商并达成整合的协议后。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进行。对于碎片（仅具有最小差异的部分），整合可能只需要其他子人格能够在不需要切换的情况下访问那些碎片所持有的信息。其他子人格对自己或世界的看法可能没有重大变化。即使是更成熟的子人格，也可能出现一个子人格似乎融入了另一个，因此产生的部分保留了其中一个子人格的身份，但获得了另一个的一些技能、特征、偏好或观点的情况。另一种可能性是，两个或多个子人格的整合可能会产生一个看似“新”的子人格，其中包含整合部分的一些特征的结合。这个子人格可能觉得自己像是所有参与整合的子人格，或者不是其中的任何一个，无论怎样，是对不再需要分开存放参与整合的子人格持有的信息的承认。最后，整合可能表明系统中已经发生了变化。例如，如果一个子人格主要接受同性欲望，那么随着整个系统逐渐接受他们的性取向，这个子人格可能不再被认为是独立的。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.必须注意的是，并不是所有子人格曾拥有的特征都会以与整合前完全相同的方式出现在最终的整合部分中。性别认同、性取向或宗教信仰等特征在不同的部分可能有所不同，个体需要自己弄清楚自己在这些和其他冲突点上的整合后的立场。一些子人格的偏好在不再被相对隔离时可能会被减弱；例如，一个真正热爱硬摇滚的子人格的整合不太可能完全改变一个热爱古典音乐的人的音乐偏好，但这个人可能会发现整合让他们对摇滚音乐有更大的包容度，或者拓宽他们喜欢的音乐的范围。有些特征可能会完全消失，比如一个子人格失去了忽视痛苦的不健康能力，作为尊重一个人的身体极限的代价。最后，一些子人格曾具有的技能或能力可能需要作为一个完整的个体进行额外的练习，才能充分表达出来。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.即使某些特征丢失了，从长远来看，没有被迫或仓促的整合也不应该让人觉得是一种损失。健康的整合感觉上就像他们应该是什么一样：接受自己之前无法完全接受的自我的方面。有些人确实需要花一些时间来哀悼一个单独的子人格的逝去，但另一些人体验的整合是快乐的！子人格可能想要整合，这样他们就不再错过系统的大部分生命，这样他们的情绪范围就不再受到限制，或者这样他们就可以始终如一地为系统的功能和安全做出贡献。总的来说，融合会带来一个更稳定、更全面的个人，他能够持续接触自己的所有部分。随着个体学会与自己的所有想法、感觉和行为联系起来，他们将学会减少对分离的依赖，他们的一般分离症状也会减少。一个完全整合并实现最终融合的个体可能不太容易因未来的压力而增加分离症状或分裂成新的部分。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.必须承认，有时，分离的减少可能会在短时间内或长期导致非常负面的体验，例如，如果增加整合会降低个人关闭对慢性疼痛的意识的能力。虽然这种整合仍然是健康的，并且可以让个人更好地尊重他们身体的极限，但它仍然可能会带来压力或令人不安，尤其是刚开始时。同样，当一个人不得不接受自己的任何部分都没有真正摆脱整个系统所经历的创伤以及由此产生的情感痛苦和残疾时，他们可能不得不承受很多悲伤。在某些情况下，融合引起的人格变化可能对个人非常有益，但会破坏他们现有的关系，例如原来的家人和朋友使这个人不能获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). 一些系统选择在ISST-D称之为“解”（resolution，“解决”“和解”）的程度止步，或者也可以称作功能性多元。在这种情况下，系统可以保留任何数量的独立行动的子人格。目前选择完全整合与选择功能性多元的系统比例可能非常相似。 2017 年的一项研究(Myrick et al.) 对 61 位治疗师进行了随访，追踪他们的特定患者六年内的生活质量。12.8% 的治疗师报告说他们的患者因达到稳定的整合，而完全相同百分比的治疗师报告他们的患者已终止治疗，由于他们（有碍于生活的）症状在没有完全整合的情况下已经解决。现在完全整合的比例可能比过去低，因为很多治疗师现在不那么坚持完全整合是 DID唯一可能的治疗方法。即使对于那些想要完全整合的人来说，这也是一件好事，因为它可以防止该过程过于仓促。永久的整合是不能被强迫的，而发生在系统准备好之前的整合非常可能会崩裂。这会使系统对于再次尝试更加犹豫，或可能更难以确定哪些内容真的被处理完毕，哪些内容只是为了取悦他们的治疗师，被声称处理了（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).选择不完全整合的理由可以包括：感觉完全整合是不必要的;不明白整合实际上会涉及什么，并害怕“失去”或甚至“杀戮”子人格；不确定如何以一个完整的人的身份驾驭世界；害怕无法在不依赖分离的情况下处理未来的创伤；习惯于有子人格在身边陪伴、娱乐或支持；子人格拥有难以舍弃的独特的关系；子人格想要为了自己留下而保持分离；或个人不想要失去在保持分离的情况下得到的关注、支持或一种觉得自己独特的感觉。在某些情况下，朋友和家人可能会公开或私下地表示他们更喜欢个体保持多重状态，可能由于对个体的子人格有依恋，或因为不喜欢他们融合后性格会发生变化这一点。如果系统在面向患有DID/OSDD-1的人的空间，整合可能会从根本上改变他们的关系和在社区中的位置。一些有DID/OSDD-1的个人甚至质疑永久整合是否真的可能，这当然使得它更难实现（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，他们也可能发现整合所有部分或者长期保持一个稳定的整合后人格是不可能的。这可能发生当个人处于高度压力，或处在不安全的环境，不能让自己充分接受或处理他们的创伤史，不能使自己完全承认自己的碎片化或功能障碍的程度，无法获得了解 DID 的专业人士的治疗，负担不起继续治疗，或体验到了融合后的人格的症状的强烈影响或其他疾病。最后，在一些情况下，整个系统可能会想要或声称想要整合，但个别部分可能不同意并公开或秘密地试图保持分离；有时，这是暂时的，只会持续到个人的所有部分都真正相信他们可以作为一个统一的整体发挥作用时（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).即使是表达了不想整合的愿望的DID系统，他们也比较可能会在处理和治愈过程中自发地整合一些子人格和片段，并且许多系统愿意整合到只有几个子人格的程度（包括一些著名的系统，如Robert Oxnam）。Kluft发现，值得注意的是，优先合作的系统会自然地走向一体化，即使他们最初希望保持多重性，这让他相信大脑渴望并将会实现统一。然而，并不是所有的整合都是稳定的。如果所涉及的子人格还没有完全准备好，如果一个压力源出现，特别是在其中一个子人格就是为了应对这类压力时，那么整合可能会崩溃。或者，如果所涉及的子人格需要来自其他子人格的影响，以便在他们的统一中保持稳定（例如，需要一个内部助手来处理一段紧张的时间，以防止更大的问题、痛苦和随后的分离）。即使一个整合失败了，在正确的支持下也可能会很快重新实现（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.许多完全整合的个人确信整合是最佳选择，并有研究支持确实是这样。例如，Ellason和Ross（1997）发现完全整合与降低总体上的分离、健忘症、躯体症状、施耐德首级症状群（备注1），边缘症状、抑郁和自杀。Coons和Bowman（2001）还发现相比不整合的个体，整合的个体更少抑郁，更少受躯体症状影响，创伤后压力较小，总体而言他们分离症状出现得较少，类似于普遍人口的程度。此外，他们相比不整合的人更少住院和更少焦虑。然而，值得注意的是本研究中的达到整合的案例在进入治疗时也是显示出较少的病征的。备注1：施耐德（1935）首级症状群（Schneider first-rank symptoms1、思维化声；2、对话性幻听；3、评论性幻听；4、躯体被动体验；5、思维被夺；6、思维被插入；7、思维被扩散或被广播；8、被强加的情感；9、被强加的冲动；10、被强加的意志行为；11、妄想性知觉。（摘自好大夫在线《精神分裂症的诊断.治疗.预后》赵长印）It 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).必须指出的是，即使一个人成功地完全整合，这种整合也有可能在紧张或冲突期间暂时分解。在短期内，如果治疗的稳定期不够，并且患者缺乏在不依赖分离的情况下处理生活所需的应对技能，则很可能出现这种情况。即使是一两年后，另一次创伤、施虐者的死亡或一个重要人物的死亡都可能导致分裂的回归。在某些情况下，看似完整的整合可能实际上并非如此，只有当个体足够稳定和强大，能够处理某些子人格的创伤记忆或解决他们的保护行为时，他们才会出来。例如，当一个人充分处理了与儿童期性虐待有关的创伤记忆后，一个曾经过度进食以试图看起来不吸引人并防止成为性兴趣对象的人可能才会出现。重要的是要记住，所有这些都是整合进程中正常的一部分，不是一个坏迹象或挫折。同样值得注意的是，在复发事件中返回的子人格通常不再那么独立，并且很快重新融合。分离疾病专家的治疗可能会使整体整合变得更可能，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对由不同治疗师治疗的DID患者进行了检查，这些治疗师中大多数在之前没有治疗DID的经验，并发现18名患者中，在平均39个月后，有5名完全整合并保持整合，2名暂时整合但在额外创伤后重新分裂，2名部分整合。在对12名DID患者进行的10年随访研究中（Coons&Bowman，2001），4人完全整合，2人整合，但由于压力而重新分裂。两名退出治疗的患者仍然没有整合，在诊断后不得不在多名治疗师之间切换的患者中，整合的可能性也较小。此外，虽然个体平均需要5.4年才能整合，但两名青少年参与者都在2年或更短的时间内整合。有趣的是，研究中的整合个体和非整合个体在随访期间经历了相似数量的生活事件，但整合个体对这些事件的看法是积极的，而非整合群体对这些事件的看法是消极的。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将整合定义为一个完整的27个月的周期，其中没有失忆症或身份分裂的迹象（包括观察到的多样性迹象、有部分的主观感觉，或不被本人承认的曾经与子人格有关的观点或特征）。这是因为他发现，在融合并保持融合至少3个月的个体中，有60%的人在未来不会再次出现分离现象，而这一数字在27个月的时间里持续上升。在接受Kluft治疗的123例DID患者的10年随访中（Kluft&Donne，1984），33例达到了这个完全稳定整合的定义，另有50例完全整合，但未达到这一严格标准；在这50人中，有16人还没有满27个月，20人无法再次联系，来查看他们是否符合标准。两年后，Kluft发表了一份额外的随访报告（Kluft，1986），其中包括之前的33名患者和新的19名患者，他们经历了至少27个月的稳定融合。在本例中，患者库中包括另外54名患者，他们已融合至少3个月，但尚未实现稳定融合。在52名据称整合稳定的个体中，只有11人出现了“复发事件”，这仅表明3例患者出现完整的子人格和健忘症。截至发表时，11名患者中只有2名仍处于分离状态，其他患者在接受额外治疗后已实现稳定整合。在13名维持整合5年或5年以上的个体中，只有1人经历了的模糊分化部分的容易解决的复发，另一人发现了一个之前处于休眠状态的部分，因此其材料没有整合。对于男性和较小的系统（少于18个子人格），稳定整合的可能性更大，也更容易实现。更大的系统需要更长的时间来治疗，并且往往有更多的复发事件。然而，这些系统仍然能够在正确的治疗下整合，就算是那些具有严重边缘特征的系统也是如此。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一样，Kluft发现孩子们与成人和青少年相比，他们的整合速度通常非常快。在一项对5名年龄在8到11岁之间的男性儿童的研究中（Kluft，1985年），4例实现了明显的整合。一些整合是自发的，还有一些为了让孩子参与并帮助他们理解这种过程，加入了创造性想象。2个可以跟踪后续的孩子，整合已经分别维持22个月和69个月。Kluft相信子人格可能会在整个童年和青春期继续发展，这意味着儿童时期的DID表现可能并不全面成型（即缺少可以完全切换或精细的部分），并且不那么复杂（即缺乏具有高度专项功能的部分或内部部分的安排），因此可能更容易被治疗。即使存在完全成形的子人格，他们通常较少地投入于他们的持续发展，相比于在青少年和成人中的子人格。患有DID/OSDD-1的儿童常常为失忆症、被指控为行为反常和感到来自其他部分的冲动感到困惑、害怕和情绪低落，以及他们的子人格可能在意识到他们试图帮忙造成负面影响时，渴望退后一步。他们经常表达整合并变得“正常”的愿望。Post-Fusion Therapy and Integrative Work融合后治疗与整合工作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.在尝试最终融合后，可能需要一些时间让个人习惯作为一个完整的身份生活。和其他事情一样，学习一种看待自己的新方式和如何依赖分离以外的反应方式需要多加练习！此外，一定要明白，最终融合本身并不是治愈。只有当一个人完全处理完所有的记忆并没有出现任何有意义的碎片化，才可以说是完全的整合了。这需要的不仅仅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结合成一个整体，个人必须处理能够访问其完整的创伤叙事，从一个完整的，第一人称的角度看问题。他们必须处理各种相关的情绪和情绪认知，包括对由于创伤导致的机遇错失和个人的功能障碍引起的悲痛。这需要在治疗中得到承认和处理。此外，必须帮助个人接受他们的子人格曾经具有的其他记忆、特征或采取的行动。承认、记住并完全取得所有情感上的痛苦，弱点、残疾、对他人造成的伤害、自我伤害和以前与子人格有关的自我破坏的所有权可以是非常困难和痛苦的。整合可能无法改变消极的核心信念，如感觉对他人没有价值或有害；相比之下，似乎没有被这些信念影响到的过去的日常生活部分，也许需要在能够理解和透过他们的子人格的滤镜感受之后，彻头彻尾地解决问题。最后，整合可能会导致重要关系的转变，这需要处理，以及个人可能只有在完全整合后才稳定到足以解决成人生活中的问题，如亲密的伙伴关系或就业。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.在个体最终融合后，治疗应该继续一段时间，这是为了支持这个过程。在某些情况下，融合后治疗可能比之前的工作时间还要长。此外，即使在终止治疗或从治疗中“毕业”之后，患者可能还需要短暂地恢复治疗以解决暂时性的整合空缺，分离的增加，应对新的压力源或其他新的问题。Other Resources on Integration Versus Cooperation其他关于整合vs合作的资料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.这是一个来自一名专业领域在创伤和分离的治疗师的博客，其相信整合不是必须的，就是一定会有好处的。链接：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).这是一篇由一个想要整合的DID个人所书的文章。它详细地说明了想要子人格消失（这是不可能的）和完全接纳他们（是对于整合来说必须的）的区别。链接：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.这是一篇由一个患有DID并选择整合的个人所书的文章。它详细地说明了整合是什么，以及为什么整合是作者认为的治疗的最好目标。链接：http://www.sidran.org/wp-content/uploads/2018/11/Understanding-Integration.pdfOther Useful Resources on Treatment for DID/OSDD-1其他关于DID/OSDD-1治疗的实用资源For dissociative individuals:为分离的个人准备的读物：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:为临床医师准备的读物：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). Treatment progress in 20 patients with multiple personality disorder. The Journal of Nervous and Mental Disease, 174(12), 715-721. doi: 10.1097/00005053-198612000-00002Coons, P. M. & Bowman, E. S. (2001). Ten-year follow-up study of patients with dissociative identity disorder. Journal of Trauma and Dissociation, 2(1), 73-89. doi: 10.1300/J229v02n01_09Ellason, J. W. & Ross, C. A. (1997). Two-year followup of inpatients with dissociative identity disorder. American Journal of Psychiatry, 154(6), 832-839. doi: 10.1176/ajp.154.6.832International Society for the Study of Trauma and Dissociation [Chu, J. A., Dell, P. F., Van der Hart, O., Carde?a, E., Barach, P. M., Somer, E., Loewenstein, R. J., Brand, B., Golston, J. C., Courtois, C. A., Bowman, E. S., Classen, C., Dorahy, M., ? Sar, V., Gelinas, D. J., Fine, C. G., Paulsen, S., Kluft, R. P., Dalenberg, C. J., Jacobson-Levy, M., Nijenhuis, E. R. S., Boon, S., Chefetz, R.A., Middleton, W., Ross, C. A., Howell, E., Goodwin, G., Coons, P. 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患者语录"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“分离感觉上就像你在拼一副拼图，却缺少了一块。你很担心无论你多么努力地寻找它，这幅图都永远不会被完成。要做的最好的事就是专注于没有完成的图画是多么的美。”——Alpha“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.“我觉得人们想到DID会产生的看法是，我可能疯了，不稳定，功能性很低。确诊后，我冒了一次险和几个朋友分享我的故事。失去了一和一个朋友的长期关系挺让人不高兴的，因为她不能接受我的诊断。但这促使我采取行动。我希望人们能够知道任何得了DID的人都可能做到实现高功能的生活。我在一项事业上取得成功，我结婚生子，在许多活动中非常活跃。我的功能非常强大是因为我可以通过我的子人格把创伤从我的生活中分离出来。根本上，我活了下来就是因为DID。这并不是说我在一路上没有摔过跟头。曾经有过长期的治疗访问，和大量的住院治疗与抑郁，药物调整和自杀企图。一年后，我是一个真正的DID患者这一点变得显然，我的治疗师和精神科医生为我开了诊断。我有两个选择。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，我可以接受它并为我将要如何处理它做出选择。我的治疗师告诉我当面对DID的时候，一个病人可以学习着与子人格们共处，并让他们成为生命的一部分。或者，病人也可以将子人格整合到一个人，也就是主导者，这样就不会再有子人格。每个人都不一样。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.”患者和治疗师需要决定哪一种选择对于病人来说是最好的。其次，另一种选择就是不接受自己有子人格的事实，过得痛苦，困在一个会持续地残废的存在中。大多数DID患者都会认知到自己身上有什么不对，即使他们没有得到正式的诊断。我的治疗师值得信赖、诚实、富有同情心。我相信，没有一刻她会把我引向错误的方向。在她的帮助和指导下，我选择了学习并理解我的紊乱。这是一个转折点。”― Esmay T. Parker, A Shimmer of Hope