心理動(dòng)力學(xué)診斷與治療：邊緣型人格障礙

BORDERLINEPERSONALITYDISORDER邊緣型人格障礙DESCRIPTIVEVERSUSDYNAMIC

對(duì)比描述性和動(dòng)力性Hoch-Polatin,Grinker,Gunderson–descriptive:refertoDSM霍克-波拉汀，格林科，岡德森——描述性：參考DSMKernberg–dynamic:Egoweakness;lowanxietytolerance,impulsivity,nosubliminatorychannels肯伯格——?jiǎng)恿π裕鹤晕掖嗳跣?；低焦慮容忍度，沖動(dòng)性，缺乏升華渠道Shifttoprimaryprocessthinking轉(zhuǎn)向初級(jí)思考過(guò)程Defensiveoperations:splitting,primitiveidealization,projectiveidentification

防御操作：分裂、原始理想化、投射性認(rèn)同

Pathologicalinternalobjectrelationsallgood/allbad

病理性的內(nèi)化客體關(guān)系全好/全壞SYMPTOMATOLOGY癥狀學(xué)Beginningwithearlyadulthood:Pervasiveinstability:affects,selfimage,relations,impulsivity始于成人早期；廣泛的不穩(wěn)定性：情感、自我意象、關(guān)系、沖動(dòng)性FearsofAbandonment害怕被拋棄Idealization/devaluation理想化/貶低Identitydisturbance認(rèn)同障礙Impulsivity沖動(dòng)性Affectinstability,anger,fights情感不穩(wěn)定、憤怒、爭(zhēng)執(zhí)Suicidalbehavior/gestures自殺行為/自殺姿態(tài)Emptiness空虛Transientpsychosis暫時(shí)性的精神病DEMOGRAPHICSANDCOURSE

人口學(xué)特征和病程Generalpopulation:0.7%–1.8%一般人群流行率：0.7%–1.8%Clinicalpopulation:15%-25%臨床人群流行率：15%-25%Woman>men女性高于男性Mostpatientsdowell大部分病人預(yù)后良好PSYCHODYNAMICUNDERSTANDING

精神動(dòng)力學(xué)理解Earlytheories:Maternaloverinvolvementversusneglect早期理論：母親過(guò)度干涉對(duì)比母親的忽視Contemporarytheories當(dāng)代理論

Maternalrelationship:conflicted,distant,uninvolved母親的關(guān)系：沖突、疏遠(yuǎn)、不參與

Father’sabsence父親的缺失

Disturbedrelationshipwithbothparents與父母雙方的關(guān)系困擾Sexualabuse,childhoodtrauma性虐待，兒童期創(chuàng)傷MENTALIZATION心智化BPDassociatedwithpreoccupiedorunresolved/disorganizedsubtypesofinsecureattachment邊緣型人格障礙與不安全依戀的先占或未解決/紊亂的亞型相關(guān)NEUROBIOLOGY神經(jīng)生物學(xué)HPAaxis腎上腺軸Leftamygdalaactivation;negativelyinterpretneutralfaces左側(cè)杏仁核活化；負(fù)面地解釋中性面部表情Readingthefacialexpression讀取面部表情MRI:reducedhippocampus,amygdalavolumes核磁共振成像：海馬體、杏仁核體積減少Decreasedleftorbitofrontalvolumes左側(cè)視額葉體積減少BPDHASAMULTIFACTORIALETIOLOGY!

邊緣型人格障礙有多種病因！Traumatichomeenvironment創(chuàng)傷性家庭環(huán)境Biologicallybasedvulnerabletemperament生物學(xué)基礎(chǔ)的易感氣質(zhì)Triggeringevents誘發(fā)事件PHARMACOTHERAPYCOMBINEDWITHPSYCOTHERAPY

藥物合并心理治療BASICPRINCIPLESOFPSYCHOTHERAPY

心理治療的基本原則Maintainflexibility保持彈性Establishconditionsthatmaketherapyviable建立使治療可行的情景Avoidpassivestance避免被動(dòng)的立場(chǎng)Allowtransformationintobadobject允許被轉(zhuǎn)化為壞的客體Empathizewiththepainthatisundertheanger共情病人憤怒之下的痛苦Promotementalization促進(jìn)心智化BASICPRINCIPLESOFPSYCHOTHERAPY

心理治療的基本原則SetLimitswhenneeded在需要的時(shí)候設(shè)立限制Helpthepatientintrojecttheprojectedaspectsofself幫助病人內(nèi)攝自體被投射出去的部分Establish/maintaintherapeuticalliance建立/保持治療聯(lián)盟Countertransferencefeelings反移情感受EFFECTIVETHERAPIES有效的治療方法

(BYRANDOMIZEDTRIALS)（通過(guò)隨機(jī)試驗(yàn)）Psychodynamic精神動(dòng)力學(xué):

MBT基于心智化的治療

TFP以移情為焦點(diǎn)的心理治療