边缘型人格障碍的欲求-压力分析

目的:运用主题统觉测验(TAT)探索边缘型人格障碍(BPD)潜在的欲求-压力特点.方法:用人格诊断问卷(PDQ-4+)在3552名高校学生中筛出边缘型得分≥7者254人,由两名研究人员对他们进行人格障碍定式临床检查(SCID-Ⅱ)面谈,最后确诊BPD 62人,从中按边缘型得分由高到低选取30名愿意参与本研究的为BPD组,在边缘型得分<2的学生中由高到低选取30名为对照组,施测主题统觉测验,对照两组的欲求-压力得分.结果:(1)BPD组的欲求和、压力和均高于对照组[(32.6±5.1)vs.(29.8±5.0),(36.9±5.0)vs.(32.2±6.3);均P<0.05],且BPD组的压力和高于欲求和(P<0.05).(2)边缘型得分与欲求-压力系统的逐步回归方程:边缘型得分＝-0.315C成就欲求+0.36X情绪变化欲求+0.329X灾害压力+0.313X情感压力+0.234X联想压力+0.204X丧失支持压力,多元回归系数为0.817,方程拟合度为0.668.结论:运用主题统觉测验的欲求-压力系统可解释BPD患者的内心感受模式和临床行为的驱动因素.     

边缘型人格障碍大学生的客体关系特点

目的:运用主题统觉测验探索边缘型人格障碍(BPD)的客体关系特点。方法:对某师范大学新生施测PDQ-4+问卷,选取边缘型得分7分以上者进行SCID-Ⅱ结构化访谈,共确诊62人,从中按边缘型得分由高到低选取30名被试作为BPD组。从边缘型得分小于2的群体中,由低到高选取30名被试作为非BPD组,比较两组在社会认知和客体关系量表(SCORS)四个维度上的得分。结果:两组被试在客体关系表征复杂性、情感基调和社会归因三个维度上存在显著差异,情感投入与道德发展没有显著差异。情感基调这一变量能够预测边缘型得分。结论:BPD组大学生的客体关系四维度中,表征复杂性、情感基调和社会归因三个维度发展水平明显低于非BPD组大学生。     

边缘型人格障碍的欲求压力与沙盘主题相关分析

目的:采用沙盘游戏和主题统觉测验对边缘型人格障碍的潜在特点进行研究,探索其欲求-压力得分与初始沙盘主题得分的关系。方法:从62名确诊为边缘型人格障碍的大学生中随机选取30名为研究对象,称BPD组,在边缘性得分低于2分的大学生中随机选取30名为对照组,施测主题统觉测验和完成初始沙盘,对比两组的治愈-创伤主题,且对BPD组的欲求-压力与创伤-治愈进行相关分析。结果:①BPD组的创伤主题显著高于对照组(3.67±1.06/2.33±0.92,t=5.19,P0.01),治愈主题显著低于对照组(1.67±0.66/2.57±1.15,t=-3.68,P0.01),且BPD组的创伤主题显著低于其治愈主题(3.671.67,t=8.79,P0.01)。②BPD组的沙盘创伤主题与负性欲求成显著正相关,如三类攻击欲求、情绪变化欲求;与压力成显著正相关,如强迫压力、制约压力、被拒绝压力。沙盘治愈主题与成就欲求成显著正相关,与躯体反社会攻击欲求、反社会攻击欲求、情感性压力成显著负相关。结论:负性欲求、可感压力与创伤形成有关,而良性欲求与治愈力量有关。     

边缘型人格障碍大学生的童年期创伤经历特征

目的:探讨边缘型人格障碍(borderline personality disorder,BPD)大学生的童年期创伤经历特征。方法:用人格诊断问卷第四版(Personality Diagnosis Questionnaire-4+,PDQ-4+)从3227名二、三年级本科生中筛选出边缘型阳性者293例,用个性障碍晤谈手册第四版(Personality Disorder Interview,PDI-IV)半定式晤谈法进一步筛选出BPD患者(得分5分)31例。从PDQ-4+划界分阴性的大学生中按年龄和性别比随机选取114例为对照组。用童年期创伤经历问卷(Childhood Trauma Questionnaire,CTQ-SF)对两组进行测评。结果:①在PDQ-4+筛查中,总体的边缘型分量表分为(2.62±1.70);31例BPD患者中女18例,男13例,女性CTQ-SF不良环境因子得分高于男性[(13.63±4.54)vs.(9.83±1.95),P0.01]。②BPD组的CTQ-SF各因子分均高于对照组[如,情感虐待(2.11±0.77)vs.(1.66±0.49),P0.01]。结论:大学生边缘型人格障碍者均有不同程度的童年期创伤经历,而且这种创伤经历存在性别差异。     

大学生边缘型人格障碍患病率调查

目的:调查高校大学生边缘型人格障碍(BPD)的患病率.方法:用PDQ"从3227名大学生中筛选出边缘型划界分阳性者.以PDI-Ⅳ晤谈确定BPD的发病情况,使用CTQ对BPD被试做进一步测验.结果:3227名大学生中有31例(女18例)符合PDI-Ⅳ晤谈的评定标准.总患病率为0.96%,女性是男性的1.38倍;31名BPD被试合并其它常见五型人格障碍18例,男女各半,总共病率为58.00%;BPD被试的CTQ得分显著高于对照,CTQ中躯体忽视因子和情感虐待因子与BPD的症状呈显著正相关.结论:BPD在大学生人群中存在一定的发病率,与常见人格障碍存在较高的共病率;BPD患者多数存在一定程度的童年期创伤性经历,创伤的程度跟临床症状呈正相关.     

大学生边缘型人格障碍倾向与其家庭环境研究

目的探讨边缘型人格障碍患者(BPD)的家庭环境特点、BPD形成中家庭环境中起作用的相关因素以及相互之间的关系。方法以高校学生群体为研究对象,采用PDQ-4+人格障碍诊断问卷最新修订版中文版本和家庭环境量表中文版(FES-CV)调查的方法,得到PDQ-4+问卷的边缘型1项的得分,通过筛选高分组(7分以上包括7分)和低分组(1分和1分以下),并应用家庭环境量表对两组进行调查进而分析结果中的差异。结果大学生家庭环境的矛盾性、宗教道德性、家庭环境中的亲密度因素对边缘型人格障碍的形成有很大影响,是边缘型人格障碍的形成的重要因素。结论边缘型人格障碍的形成与家庭环境中的矛盾性和宗教道德观密切相关。     

边缘型人格障碍的住院式干预

边缘型人格障碍是一种严重、慢性、不稳定的精神疾病,临床上心理病理表现为深在的情绪的不稳定、强烈的极不稳定的人际关系、冲动及自毁、自杀行为、自我身份感的紊乱、对真正的或想象的被抛弃的恐惧和短暂的应激性的精神病性症状.本文在此基础上分析了边缘型人格障碍的住院式干预,为该类型的患者在住院时提供干预指导.     

边缘型人格障碍患者父母的养育方式

目的:了解边缘型人格障碍与父母养育方式.方法:对两组父母的一般情况进行调查,并以父母养育方式评估量表为工具,对50例边缘型人格障碍患者和50例正常对照进行父母教养方式评定,结果:结果发现,两组在除偏爱因子以外的父母养育方式的其他9个因子得分上均表现出显著的差异,病例组在父母的情感温暖、理解因子得分上明显低于对照组,在其他因子得分上明显高于对照组.结论:父母亲的情感温暖和理解可能在边缘型人格障碍的发生和发展中起重要的作用.     

边缘型人格障碍患者初始沙盘的典型特征

目的:以沙盘游戏为工具探讨边缘型人格障碍(borderline personality disorder, BPD)患者独特的内心世界,并尝试总结其初始沙盘具有诊断意义的特点.方法:某师范大学新生经人格障碍诊断问卷(DQ-4+)筛查和DSM-Ⅲ-R人格障碍临床定式检测(SCID-II)确诊,且自愿参加沙盘治疗的BPD大学生56例,另招募愿意参与本研究的非BPD大学生30名,对他们的初始沙盘作品进行多维度的对照研究.结果:(1)BPD组和非BPD组在初始沙盘的整体特征上存在差异,其中BPD组分裂项目的例数多于非BPD组(35.7%vs.0.0%,P<0.01),在整合上少于非BPD组(26.8%vs.66.7%,P<0.01);(2)在细节主题上,BPD组的创伤主题得分高于非BPD组[(2.5±1.1)vs.(1.3±0.9),P<0.01],而治愈主题得分低于非BPD组[(0.9±0.9)vs.(1.8±1.0), P<0.01],其中创伤主题中主要是隔离、威胁和限制的例数BPD组多于非BPD组(40.1%vs.20.0%,25.0%vs.6.7%,28.6%vs.10.0%;Ps<0.05),而治愈主题中主要是联结、新生和对话的例数BPD组少于非BPD组(7.1%vs.26.7%,23.2%vs.33.3%,12.5%vs.40.0%;Ps<0.05);(3)在沙具的非常规使用或摆放上,奇异呈现和边界问题两项BPD组的例数多于非BPD组(25.0%vs.3.3%,12.5%vs.0.0%;Ps<0.05).结论:BPD患者的初始沙盘中最典型的特征是分裂、奇异呈现和边界问题,经常出现的创伤性主题是隔离、限制和威胁;BPD的病理特点和防御机制可以在沙盘中很清晰地表现出来.     

边缘型人格障碍患者的认知特点研究

近年来，关于人格障碍的认知特点的研究越来越引起重视,许多研究认为边缘型人格障碍患者具有独特的认知风格，并存在显著的神经认知功能损害,特别是执行功能损害。本文回顾近年来关于边缘型人格障碍患者认知风格和神经认知功能的若干研究，以期为国内对该问题感兴趣者提供借鉴。     

Hypothesized mechanisms of change in cognitive therapy for borderline personality disorder

Preliminary evidence suggests that cognitive therapy (CT) is effective in treating borderline personality disorder (BPD). According to cognitive theory, BPD patients are characterized by dysfunctional beliefs that are relatively enduring and inflexible and that lead to cognitive distortions such as dichotomous thinking. When these beliefs are activated, they lead to extreme emotional and behavioral reactions, which provide additional confirmation for the beliefs. It is hypothesized that a change in dysfunctional beliefs is the primary mechanism of change associated with CT. However, additional mechanisms of change are likely also at work in CT, including enhancement of skills, reduction in hopelessness, and improvement in attitude toward treatment. Each of these mechanisms is discussed in light of cognitive theory, data from an open clinical CT trial, relevant literature, and therapeutic interventions. Findings from the CT trial support the role of cognitive change during therapy and its continuation after termination.     

Neuropsychological functioning in patients with borderline personality disorder

Although results have been variable, studies suggest that individuals with borderline personality disorder (BPD) exhibit cognitive deficits suggestive of frontal- and temporal-lobe dysfunction. Patients diagnosed with BPD (n = 18) using two structured interviews, and who were carefully screened for neurological and substance-use disorders, were compared to depressed patients (n = 18) and a nonpsychiatric control group (n = 18) on a series of neuropsychological tasks. The role of emotion on cognitive functioning was assessed by including emotional stimuli and interference on several of the tasks. Little support was found for the neurobehavioral hypothesis of BPD. The BPD group performance did not differ from the normal group on most tasks of executive functioning or memory, and the introduction of emotional stimuli did not impair performance. The depressed group performed less effectively than the other groups. Reasons for variable findings and factors affecting the cognitive functioning of patients with BPD are discussed. There may be considerable heterogeneity in the cognitive functioning of BPD patients, with those exhibiting significant cognitive deficits comprising only a subgroup.     

Interpersonal psychotherapy for borderline personality disorder: possible mechanisms of change

This article describes the rationale for applying interpersonal psychotherapy (IPT) to the treatment of patients who have borderline personality disorder and explains the adaptation of standard IPT to that end. The authors describe the preliminary stages of adapting IPT for a pilot study to test its feasibility and potential efficacy and speculate on potentially therapeutic mechanisms for IPT in treating patients who have borderline personality disorder.     

Neuropsychological function in borderline personality disorder

To evaluate the possibility of an underlying dimension of organicity in borderline personality disorder (BPD), a carefully diagnosed group of borderline patients was assessed across a wide range of neuropsychological functions and then was compared to an age-and education-matched non-patient control group. The BPD group had significantly lower Verbal, Performance, and Full Scale IQ scores on the WAIS-R. The BPD group also was impaired significantly on motor skills, figural memory, complex visuo-motor integration, social or interpersonal intelligence, and on a measure of susceptibility to interference. This pattern of deficits localized to the fronto-temporal regions and became more pronounced when a subgroup analysis was performed. This study suggests that subtle organic factors may be operative in some, but not all, BPD patients.     

Disinhibition and borderline personality disorder

We review different conceptions of inhibitory control that may be relevant to the regulatory problems featured in borderline personality disorder (BPD). These conceptions have often been framed with regard to personality traits of inhibitory control, but can also be related to cognitive measures of response suppression as well as affect regulation. Reactive behavioral inhibition is relatively unstudied in relation to BPD. A substantial amount of literature links executive function problems with BPD, but that literature has not isolated executive response inhibition nor been controlled for other personality disorder symptoms of antisociality, attention-deficit/hyperactivity disorder (ADHD), or depression, anxiety, or posttraumatic symptoms. We therefore conducted a study of this question looking at BPD symptoms in an adult sample with a small number of BPD subjects and other disorders. Results indicated that symptoms of BPD were correlated with response inhibition (measured by stop signal reaction time) even after controlling for the overlap of stop inhibition with ADHD, antisociality, and other Axis II disorder symptoms. We conclude by hypothesizing discrete developmental routes to BPD, based on different mechanism breakdowns, which would be amenable to empirical investigation at the cognitive or trait level of analysis.     

The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy

We address how Transference Focused Psychotherapy (TFP) conceptualizes mechanisms in the cause and maintenance of borderline personality disorder (BPD) as well as change mechanisms both within the patient and in terms of specific therapists' interventions that engender patient change. Mechanisms of change at the level of the patient involve the integration of polarized representations of self and others; mechanisms of change at the level of the therapist's interventions include the structured treatment approach and the use of clarification, confrontation, and "transference" interpretations in the here and now of the therapeutic relationship. In addition, we briefly review evidence from our group regarding the following hypothesized mechanisms of change: contract setting, integration of representations, and changes in reflective functioning (RF) and affect regulation.     

Psychotherapy for patients with borderline personality disorder: focusing on the mechanisms of change

A major development in the field of psychotherapy research is the growing recognition of the need for evidence on the mechanisms of change in psychotherapy. The empirical evidence that psychotherapy has a positive and significant effect must be amplified with data on the mechanisms of action in the various psychotherapies. This special issue is devoted to the articulation of putative mechanisms of change in the psychotherapy of patients with borderline personality disorder by leading researchers in this field.     

Cortical inhibition in alexithymic patients with borderline personality disorder

High levels of alexithymia, a personality trait closely associated with emotion dysregulation, have been found in several psychiatric disorders including borderline personality disorder (BPD). Both BPD and alexithymia have been related to impaired cortical inhibition; however, this relationship has not been tested directly. The aim of the present study was, therefore, to investigate whether cortical inhibition is modulated by alexithymia in BPD. Fifteen BPD patients with Toronto-Alexithymia Scale (TAS-20) scores ≥61, 14 BPD patients with TAS-20 <61, and 16 healthy controls were examined using different TMS paradigms. High-alexithymia patients showed a shortened cortical silent period (CSP) compared to low-alexithymia patients and controls. Additionally, a significant inverse correlation was found between the TAS-20, the left CSP and the left transcallosal conduction time. These findings indicate that alexithymia is associated with changes in GABAergic neurotransmission and facilitated transcallosal inhibition. The results highlight the importance of considering alexithymia in BPD.