慢性に経過した解離性障害患者のQOL

抄録

We will discuss a case involving a patient with dissociative disorder who has been in bed due to "lumbago" for the last 20 years starting at 32 years of age. Pain in this patient, differing from general "pain" associated with the presence of a specific organic base, lacked an organic base, and the mechanism of the pain was unclear. However, this symptom was similar to conventional pain with respect to invasibeness, limitation of activity and reduction of objective QOL. However, the patient did not consider the limitation of activity an important issue. There was a marked "dissociation between QOL as subjective satisfaction and objective QOL". With respect to this aspect, a relationship between "pain and QOL" in this patient significantly differed from that in patients with other physical diseases. In this patient, "pain"appeared as a conversion symptom as an unconscious strategy to relieve intolerable stress. Therefore, it was speculated that relief of pain may lead the patient to an inconsistent status of "strategy for strategy ".causing an aporia that a new successful strategy causes the patient recurrent intolerable pain. Therefore, in this patient, a "coping strategy" to prevent pain rather than improve pain should be established. A system that facilitates "positive and aggressive posture and management against pain" must be prepared from both individual and environmental perspectives. Psychiatric vulnerability in this patient may give the patient a marked handicap with respect to "improvement in QOL". However, it is suggested that an approach such as psychological therapy may relieve "pain" without an organic base, resulting in the disappearance of a dissociation between improvement of objective QOL and subjective satisfaction.