青年期前期に解離を呈した自閉症スペクトラム障害男子の症例

A Case of a Boy with Autism Spectrum Disorder who Presented Dissociative Symptoms in the Early Adolescence

抄録　幼児期から周期性嘔吐症を呈し，青年期前期に至って解離を発症した自閉症スペクトラム障害男子例を報告した。過剰同調性，感覚過敏といった解離準備状態を持ちあわせていた患児は，小学校卒業までは過適応状態であった。しかし，家族をはじめとする周囲への反発が強まる青年期前期に，より高まった陰性感情が解離を通じて表現された。この解離は，年齢相応の陰性感情の言語化が可能になって改善した。児童青年精神医学臨床においては，症状の意味を生来の特性と発達過程の中で理解することが重要である。

　We report a case of a boy with high-functioning autism spectrum disorder who presented dissociative episodes in the early adolescence. He had a history of idiosyncratic sensory experiences such as periodic vomiting and non-psychotic visual hallucinations since early childhood. The boy also paid close attention to how others felt constantly and was excessively agreeable. However, this tendency engendered subconscious conflicts in the early adolescence when he felt rebellious against others-including his family members. Heightened negative emotions were expressed through dissociative symptoms after entering middle school and caused significant distress to himself and others. Recovery was possible only when he became capable of verbalizing these emotions. The authors emphasize the importance of understanding the meanings of symptoms in the context of emotional developmental processes in child and adolescent psychiatry practice.