对边缘性人格障碍亚型的研究

边缘性人格障碍是一种最常见的人格障碍。描述性精神病学、心理测验和精神分析的研究发现,边缘性人格障碍可能是由若干个异质性的亚群体组成,不同的亚群在症状表现、病因、心理病理机制、对治疗干预的反应和预后等方面可能都存在着很大的差异,可以根据不同的维度将其进行亚型分类,而使同一个亚群中的个体差异小于不同亚群之间的个体差异。     

Children At-Risk for Borderline Personality Disorder

Adult patients who have been diagnosed with borderline personality disorder (BPD) have provided valuable information about events and family dynamics that are frequently associated with BPD. Clinicians who work with children are frequently aware of family or individual characteristics that may put a child at risk for developing BPD. Such situations frequently involve attachment issues with the child's caregivers and can include sexual abuse, divorce, alcoholism/substance use, illness/ death, and neglect. Child characteristics such as learning difficulties and temperament may also predict BPD. Yet, many children are resilient and seemingly unaffected by these events or situations, especially when early intervention may prevent development of BPD.     

Strategies Used in the Treatment of Borderline Personality Disorder: A Survey of Practicing Psychologists

One hundred and twenty three practicing psychologists completed surveys regarding the therapeutic techniques they employ for patients with Borderline Personality Disorder (BPD). Participants identified their predominant orientation and rated the frequency with which they used a range of 27 specific strategies. Logistic regression analyses identified an expected relationship between specific techniques and the theoretical orientations to which they are most closely linked. These findings suggest a high level of concordance between self-described theoretical orientation and the specific treatment techniques utilized, but also that some theoretical orientations are comprised of smaller independent clusters of strategies. The implications of these findings are discussed.     

Strategies for Securing Commitment to Treatment from Individuals Diagnosed with Borderline Personality Disorder

Individuals diagnosed with borderline personality disorder (BPD) are notoriously difficult to engage in treatment. The purpose of this paper is to highlight therapeutic strategies that are likely to facilitate early alliance in therapy with individuals diagnosed with BPD. The seven strategies include, collaborative assessment, the use of contracts, motivational interviewing, linking treatment targets to client goals, commitment strategies, validation, and the use of metaphors. Clinical vignettes are presented to elucidate the concepts described and demonstrate their use in clinical practice.     

克恩伯格边缘性人格组织理论述评

边缘性人格组织是人格障碍的内在结构。克恩伯格主要从非特异性自我虚弱性、现实检验、原始防御机制、病理性的内在客体关系以及身份认同紊乱五个方面阐述了边缘性人格组织理论。该理论弥补了DSM-Ⅳ中人格障碍诊断标准的无理论化倾向的缺陷,并为深入理解人格障碍的心理病理学提供了一个系统框架。     

Changing Ideas About the Treatment of Borderline Personality Disorder

Systematic treatment outcome studies and research on the structure and origins of the disorder are challenging many traditional ideas about the nature and treatment of borderline personality disorder. On the basis of this research, it is argued that a comprehensive treatment requires an eclectic approach that uses an array of interventions drawn from different therapeutic models that are delivered in an integrated and coordinated way. Such an approach conceptualizes treatment in terms of generic strategies designed to build an effective alliance and treat core self and interpersonal pathology and specific interventions to treat the various components of the disorder. It is also argued that there may be limits to the extent to which some aspects of borderline pathology can be changed. Borderline personality disorder is often a chronic condition that is best managed using a rehabilitation model.     

Treating Symptoms of Borderline Personality Disorder Through Narrative Therapy and Naltrexone

Abstract

Borderline Personality Disorder (BPD) is characterized by instability in interpersonal relationships, volatile perceptions of self-image and affects, and marked impulsivity, presenting in various contexts. Current BPD treatments are individual-centered, coping skills based, with a reduced emphasis on identifying etiology and systemic components. Narrative therapy focuses on deconstructing and reauthoring personal stories. A clinical case study shows narrative therapy to be efficacious, however, sometimes psychotherapeutic interventions alone are inadequate in managing these symptoms. Medication can serve as a useful adjunct in addressing self-injurious behaviors, suicidal ideation, and dissociation. Researchers further discuss the integration of naltrexone into treatment of BPD symptoms.     

Verbal Memory Dysfunction in Depressed Outpatients With and Without Borderline Personality Disorder

This study contrasts memory functions with emotional words between two groups of patients presenting with symptoms of major depressive disorder (MDD)—20 patients with a comorbid diagnosis of borderline personality disorder (BPD) and 20 patients without BPD—and a group of 20 community adult controls. BPD patients showed poorer recall and recognition memory performances than controls, while MDD patients and controls did not differ significantly on these tasks. BPD patients showed a lower accuracy of recognition memory than MDD patients, despite negligible differences between the two patient groups in the severity of depressive symptoms and in the general level of psychopathology. Controls and BPD patients showed positive word selectivity in recall, while MDD patients showed nonsignificant selectivity differences. These findings provide additional data regarding memory disturbances specific to MDD versus BPD. The selectivity differences are consistent with theories of mood-congruent memory in depression and may serve as a cognitive marker for differentiating BPD from prototypical MDD.     

Cognitive-Behavioral Treatment of Depression with Comorbid Borderline Personality Traits

Personality dysfunction can influence the onset and maintenance of depressive symptoms. When both depression and personality dysfunction are present, it is important to develop an integrated treatment plan that addresses both conditions. A case example is used to illustrate how features of borderline personality disorder can influence the assessment and treatment of major depression. Specific challenges encountered by the therapist include: 1) differentiating borderline personality from depressive symptoms, 2) maintaining the therapeutic alliance, 3) managing impulsivity and self-destructive tendencies, 4) staying focused on long-term therapeutic goals, and 5) coping with noncompliance. Over the course of 27 sessions, the client was able to make positive changes in mood, self-image, and impulsive tendencies. Although the client's borderline personality traits complicated the course of treatment for depression, neglecting these personality problems would have left the client vulnerable to depressive relapse.     

Dialectical Behavior Therapy: An Emotion-Focused Treatment for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment for borderline personality disorder (BPD) that is based on the theory that emotion dysregulation is the core feature of BPD. This article focuses on aspects of DBT theory and techniques that specifically address emotion. The dialectical and biosocial theories that underlie DBT are reviewed with an emphasis on how each relates to emotional experiencing in BPD. Selected treatment strategies that address emotion dysregulation and their hypothesized mechanisms of change are also described. Relevant research findings are incorporated throughout to provide an empirical foundation for the DBT theories and strategies that are discussed.     

Effectiveness of Psychodynamic Treatment in Patients with Borderline Personality Disorder

There is some evidence that the efficacy of four types of psychotherapeutic psychotherapy (mentalized-based treatment, transference-focused psychotherapy, psychoanalytic psychotherapy, and cognitive-analytic therapy), is superior to treatment-as-usual. More controlled and randomized studies are needed in order a) to confirm the results of the relatively few investigations that were available, b) to examine the therapeutic relevance and usefulness of correlates and predictors of improvement and remission in borderline patients, and c) to examine possible fruitful combinations with other types of treatment.     

Integrating Individual and Family Systems Psychotherapy to Treat Borderline Personality Disorder

This paper focuses on two areas. The first is the framework for psychotherapy integration used by Unified Therapy, a psychotherapy approach that is an integration of psychodynamic, cognitive–behavioral, and family systems therapy. The second is the use of this treatment paradigm in the psychotherapy of adults with borderline personality disorder. The theory posits that continuing and recurrent interpersonal behavior patterns within the patient's family of origin serve as behavioral triggers to typical acting-out behaviors. Therapy is geared toward planning strategies to alter these destructive patterns. A case example is presented to demonstrate the use of the therapy's theories and techniques.     

Emotion Differentiation as a Protective Factor Against Nonsuicidal Self-Injury in Borderline Personality Disorder

Evidence that nonsuicidal self-injury (NSSI) serves a maladaptive emotion regulation function in borderline personality disorder (BPD) has drawn attention to processes that may increase risk for NSSI by exacerbating negative emotion, such as rumination. However, more adaptive forms of emotion processing, including differentiating broad emotional experiences into nuanced emotion categories, might serve as a protective factor against NSSI. Using an experience-sampling diary, the present study tested whether differentiation of negative emotion was associated with lower frequency of NSSI acts and urges in 38 individuals with BPD who reported histories of NSSI. Participants completed a dispositional measure of rumination and a 21-day experience-sampling diary, which yielded an index of negative emotion differentiation and frequency of NSSI acts and urges. A significant rumination by negative emotion differentiation interaction revealed that rumination predicted higher rates of NSSI acts and urges in participants with difficulty differentiating their negative emotions. The results extend research on emotion differentiation into the clinical literature and provide empirical support for clinical theories that suggest emotion identification and labeling underlie strategies for adaptive self-regulation and decreased NSSI risk in BPD.     

Between Subjugation and Survival: Women, Borderline Personality Disorder and High Security Mental Hospitals

Women in high security mental health care are frequently diagnosed with borderline personality disorder. Such women commonly report histories of child abuse, in particular child sexual abuse, and the vast majority also self-harm. In this paper, we draw on social constructionist theory to develop a framework for understanding these women, the effects of abuse and the reasons they self-harm. We demonstrate how a social model of intervention provides a comprehensive framework for identifying and exploring relevant factors within therapy. We argue that diagnostic categorisation has limited utility in directing therapeutic work with this particular group of women, because it directs attention away from the social world to internal pathology. We demonstrate that it is with reference to women's past and current relationships that borderline behaviour can be understood to be meaningful and partially adaptive. We conclude that treatment is more usefully organised around and directed towards those factors, such as abuse and self-harm, that are implicated in women's ongoing relationship difficulties.     

The Relation between Mind‐mindedness in Mothers with Borderline Personality Disorder and Mental State Understanding in their Children

This study investigated relations between mind‐mindedness in mothers with borderline personality disorder (BPD) and mental state understanding in their children. Participants were 20 mothers with BPD and 19 mothers without personality disorder and their children, aged 39–61 months. Children's mental state understanding was examined via a battery of theory of mind and emotion labelling tasks. Maternal mind‐mindedness was assessed by mothers' use of mental state references to describe their children relative to other attributes. Maternal BPD was associated with fewer references to children's mental states as well as poorer levels of mental state understanding in their children. Findings lend some empirical support to recent theoretical suggestions that BPD is associated with a reduced capacity for mentalization, as well as reduced capacity for mental state understanding in children of mothers with BPD. Copyright © 2012 John Wiley & Sons, Ltd.     

Description of an Intensive Dialectical Behavior Therapy Program for Multidiagnostic Clients With Eating Disorders

The authors describe an intensive outpatient dialectical behavior therapy (DBT) program for multidiagnostic clients with eating disorders who had not responded adequately to standard, empirically supported treatments for eating disorders. The program integrates DBT with empirically supported cognitive behavior therapy approaches that are well established for the treatment of eating disorders. Attention is given to inclusion and exclusion criteria, how the program differs from standard treatments for eating disorders, and the application of specific DBT treatment components for multidiagnostic clients with eating disorders.     

Associations Between Symptoms of Borderline Personality Disorder,Externalizing Disorders,and Suicide-Related Behaviors

Borderline personality disorder and externalizing disorders are associated with suicide-related behaviors. The present study examined whether symptoms of borderline personality disorder mediate the relationship between externalizing disorders and suicide-related behaviors. Diagnostic interviews were administered to 344 participants (n = 233 women). Results indicated that symptoms of antisocial personality disorder, alcohol use disorders, and drug use disorders each were significantly associated with suicide threats and self-injurious behavior in women and symptoms of antisocial personality disorder were associated with suicide attempts in women. With the exception of the association between symptoms of alcohol dependence and self-injurious behaviors, borderline personality disorder symptoms mediated or partially mediated all associations between externalizing disorders and suicide-related behaviors in women. These results highlight the importance of assessment and treatment of borderline personality disorder symptoms in individuals with externalizing disorders, particularly in the presence of suicide-related behaviors.

The Relationship between Personality Disorder Features and Symptom Improvement at an Inpatient Treatment Program for Posttraumatic Stress Disorder

This study examined the association between personality disorder (PD) features and symptom improvement among adult survivors of childhood trauma in an inpatient program for posttraumatic stress disorder (PTSD). Participants completed questionnaires at admission, discharge, and six months following discharge. Multiple regression analyses were used to assess the combined effects of personality features on symptom improvement. Results indicated that improvement in trauma-related symptoms was not related to PD features. By contrast, the PD features were associated with change in other Axis I symptoms often comorbid with PTSD. Overall, results suggested that PD features do not impede improvement in trauma-related symptoms; however, specific accommodations might be needed to address comorbid disorders among individuals with PTSD.     

Relation Between Childhood Maltreatment and Severe Intrafamilial Male‐Perpetrated Physical Violence in Chinese Community: The Mediating Role of Borderline and Antisocial Personality Disorder Features

This study investigates the role of borderline personality disorder (BPD) and antisocial personality disorder (ASPD) features as mediators of the effects of childhood maltreatment on severe intrafamilial physical violence amongst Chinese male perpetrators. A cross‐sectional survey and face‐to‐face interview were conducted to examine childhood maltreatment, personality disorder features, impulsivity, aggression, and severe intrafamilial physical violence in a community sample of 206 abusive men in China. The results suggest that ASPD or BPD features mediate between childhood maltreatment and intimate partner violence perpetration in Chinese abusive men. These findings may yield clinical and forensic implications for assessing the psychopathology of abusive men, and may steer the intervention of intimate partner violence. Aggr. Behav. 38:64‐76, 2012. © 2011 Wiley Periodicals, Inc.