心理动力学诊断与治疗：边缘型人格障碍.pptVIP

“ ” BORDERLINE PERSONALITY DISORDER 边缘型人格障碍 DESCRIPTIVE VERSUS DYNAMIC对比描述性和动力性 SYMPTOMATOLOGY症状学 Beginning with early adulthood :Pervasive instability: affects, self image, relations, impulsivity 始于成人早期；广泛的不稳定性：情感、自我意象、关系、冲动性 Fears of Abandonment 害怕被抛弃 Idealization/devaluation 理想化/贬低 Identity disturbance 认同障碍 Impulsivity 冲动性 Affect instability, anger, fights 情感不稳定、愤怒、争执 Suicidal behavior/gestures 自杀行为/自杀姿态 Emptiness 空虚 Transient psychosis 暂时性的精神病 DEMOGRAPHICS AND COURSE 人口学特征和病程 General population : 0.7% – 1.8 % 一般人群流行率：0.7% – 1.8 % Clinical population: 15% - 25% 临床人群流行率： 15% - 25% Woman men 女性高于男性 Most patients do well 大部分病人预后良好 PSYCHODYNAMIC UNDERSTANDING精神动力学理解 Early theories: Maternal overinvolvement versus neglect 早期理论：母亲过度干涉对比母亲的忽视 Contemporary theories 当代理论 Maternal relationship: conflicted, distant, uninvolved 母亲的关系：冲突、疏远、不参与 Father’s absence 父亲的缺失 Disturbed relationship with both parents 与父母双方的关系困扰 Sexual abuse, childhood trauma 性虐待，儿童期创伤 MENTALIZATION 心智化 BPD associated with preoccupied or unresolved/disorganized subtypes of insecure attachment 边缘型人格障碍与不安全依恋的先占或未解决/紊乱的亚型相关 NEUROBIOLOGY神经生物学 HPA axis 肾上腺轴 Left amygdala activation; negatively interpret neutral faces 左侧杏仁核活化；负面地解释中性面部表情 Reading the facial expression 读取面部表情 MRI: reduced hippocampus, amygdala volumes 核磁共振成像：海马体、杏仁核体积减少 Decreased left orbitofrontal volumes 左侧视额叶体积减少 BPD HAS A MULTIFACTORIAL ETIOLOGY !边缘型人格障碍有多种病因！ Traumatic home environment 创伤性家庭环境 Biologically based vulnerable temperament 生物学基础的易感气质 Triggering events 诱发事件 PHARMACOTHERAPY COMBINED WITH PSYCOTHERAPY药物合并心理治疗 BASIC PRINCIPLES OF PSYCHOTHERAPY心理治疗的基本原则 Maintain flexibility 保持弹性 Establish conditions that make therapy viable建立使治疗可行的情景 Avoid passive stance 避免被动的立场 Allow transformation into bad object 允许被转化为坏的客体 Empathize with the pain that is under the anger 共情病人愤怒之下的痛苦 Promote mentalization 促进心智化 BASIC PRINCIPLES OF PSYCHOTHERAPY心理治疗的基本原则 Set Limits when