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边缘性人格障碍 Borderline Personality Disorder

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<P><FONT color=#333333><FONT face=Verdana>Borderline Personality Disorder (BPD) is one of the most controversial diagnoses in psychology today. Since it was first introduced in the DSM, psychologists and psychiatrists have been trying to give the somewhat amorphous concepts behind BPD a concrete form. </FONT></FONT></P>
<P><FONT color=#333333><FONT face=Verdana></FONT></FONT> </P>
<P><FONT color=#333333><FONT face=Verdana>Kernberg's explication of what he calls <A href="http://www.palace.net/~llama/psych/bpd.html#kern" target=_blank><FONT color=#800080>Borderline Personality Organization</FONT></A> is the most general, while <A href="http://www.palace.net/~llama/psych/bpd.html#gund" target=_blank><FONT color=#800080>Gunderson,</FONT></A> though a psychoanalyst, is considered by many to have taken the most scientific approach to defining BPD. </FONT></FONT></P>
<P><FONT color=#333333><FONT face=Verdana></FONT></FONT> </P>
<P><FONT color=#333333><FONT face=Verdana>The Diagnostic Interview for Borderlines and the <A href="http://www.palace.net/~llama/psych/bpd.html#dibr" target=_blank><FONT color=#800080>DIB-Revised</FONT></A> were developed from research done by Gunderson, Kolb, and Zanarini. Finally, there is the "official" <A href="http://www.palace.net/~llama/psych/bpd.html#dsmiv" target=_blank><FONT color=#800080>DSM-IV</FONT></A> definition. </FONT></FONT></P>
<P> </P>
<P><FONT color=#333333><FONT face=Verdana></FONT></FONT><FONT color=#333333><FONT face=宋体>边缘人格障碍</FONT></FONT><FONT color=#333333><FONT face=Verdana>(BPD)</FONT></FONT><FONT color=#333333><FONT face=宋体>是当今心理学中最有争议的一个诊断。自从首次被介绍于</FONT></FONT><FONT color=#333333><FONT face=Verdana>DSM</FONT></FONT><FONT color=#333333><FONT face=宋体>中，心理学家和精神病学家一直试图在具体的形式背后</FONT></FONT><FONT color=#333333><FONT face=宋体>给予一些不定型的概念。</FONT></FONT></P>
<P> </P>
<P><FONT color=#333333><FONT face=Verdana>Kernberg</FONT></FONT><FONT color=#333333><FONT face=宋体>关于什么是边缘性人格障碍的解释是最普遍的，同时，</FONT></FONT><FONT face=Verdana>Gunderson, </FONT><FONT face=宋体>尽管是精神分析家，认为应根据大量的科学方法来定义</FONT><FONT face=Verdana>BPD。</FONT></P>
<P><FONT face=Verdana></FONT> </P>
<P> <FONT color=#333333><FONT face=Verdana>Gunderson, Kolb, and Zanarini</FONT></FONT><FONT color=#333333><FONT face=宋体>提出了诊断标准和修订标准。最终，有了一个官方的精神疾病《诊断与统计手册》第四版的定义。</FONT></FONT><FONT color=#333333><FONT face=Verdana></FONT></FONT></P>
最后编辑清舞飞扬 最后编辑于 2009-10-08 14:06:40
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回复: 边缘性人格障碍 Borderline Personality Disorder

    Some researchers, like Judith H erman, believe that BPD is a name given to a particular manifestation of post-traumatic stress disorder: in Trauma and Recovery, she theorizes that when PTSD takes a form that emphasizes heavily its elements of identity and relationship disturbance, it gets called BPD; when the somatic (body) elements are emphasized, it gets called hysteria, and when the dissociative/deformation of consciousness elements are the focus, it gets called DID/MPD. Others believe that the term "borderline personality" has been so misunderstood and misused that trying to refine it is pointless and suggest instead simply scrapping the term.     有些研究者，如Judith Herman，认为BPD是给早年创伤后精神障碍的特殊表现的一个名称。在《创伤与康复》中，她认为，创伤后应激障碍带来的一种形式，以着重强调身份因素和关系的紊乱，得名为边缘性人格障碍；当躯体因素被强调了，得名为歇斯底里，当潜意识的各因素分离和失真成为焦点，得名为DID/MPD(宝贝们，俺没弄明白这是什么的缩写55555)。其他人认为“边缘人格”一词已经被相当的误解和误用了，以致于试图提炼是无意义的，并建议简化该词。
最后编辑清舞飞扬 最后编辑于 2008-02-02 21:14:22
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回复：边缘性人格障碍 Borderline Personality Disorder

DID：DIISSOCIATIVE IDENTIFICATION DISORDER  分离性身份障碍 MPD：MULTIPLE PERSONNALITY DISORDER  多重人格障碍
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回复：边缘性人格障碍 Borderline Personality Disorder

爱心是一盏灯,越是黑暗的地方就被照的越光明.
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回复：边缘性人格障碍 Borderline Personality Disorder

谢谢船长的注解，还有许多还没来得及翻译呢，请朋友们等待阿。
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回复: 边缘性人格障碍 Borderline Personality Disorder

What causes Borderline Personality Disorder? 什么导致了边缘人格障碍？    It would be remiss to discuss BPD without including a comment about Linehan's work. In contrast to the symptom list approaches detailed below, Linehan has developed a comprehensive sociobiological theory which appears to be borne out by the successes found in controlled studies of her Dialectical Behavioral Therapy.   讨论BPD而不包括Linehan 的工作是不负责任的。与下列接近的症状列表比较，Linehan 拓展了一个 被其辩证行为治疗的对照研究成果证实了的 社会生物学理论。     Linehan theorizes that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak "higher" emotionally on less provocation and take longer coming down. In addition, they were raised in environments in which their beliefs about themselves and their environment were continually devalued and invalidated. These factors combine to create adults who are uncertain of the truth of their own feelings and who are confronted by three basic dialectics they have failed to master (and thus rush frantically from pole to pole of):
  • vulnerability vs invalidation
  • active passivity (tendency to be passive when confronted with a problem and actively seek a rescuer) vs apparent competence (appearing to be capable when in reality internally things are falling apart)
  • unremitting crises vs inhibited grief.
DBT tries to teach clients to balance these by giving them training in skills of mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation.   Linehan 认为边缘性人格障碍是随着先天的生物倾向而产生的，对较低水平的压力比其他人更容易起反应，且需要更长的时间恢复。他们会因很少的刺激而情绪化的高涨，并且花较长时间平复。另外，在其自身行为和环境持续被贬低和否定的环境中，他们会膨胀。这些因素结合起来，形成了这样的人，后者不相信他们自身感觉的真实性，并且为三个他们无法控制的基本对立（理解为：“冲突” 是不是更好些？ ） 所困扰。（ 并因此从一个极端奔入另一个极端）。         1. 攻击和无效性     2.行为的被动性（面对问题时的被动倾向和主动寻找求助）和外显的能力（当现实  中内在的事件不能区分的时候，表现出是有能力的）。     3.不间断的危机和受约束的忧虑 DBT（CBT—认知行为疗法， DBT--? 听过，可我忘了 ）试图依靠提供给他们的记忆力、人际关系效力、痛苦耐力和情绪管理等技能训练，来教会来访者平衡这些方面。
最后编辑清舞飞扬 最后编辑于 2008-02-09 16:13:40
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t T

回复：边缘性人格障碍 Borderline Personality Disorder

上述的三个对立面，翻译得很别扭，请朋友们指正。
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t T

回复：边缘性人格障碍 Borderline Personality Disorder

根据可靠情报，以及原文比对，DBT----Dialectical Behavioral Therapy  辩证行为治疗 哦耶~~~~~~~~~~~~~
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回复: 边缘性人格障碍 Borderline Personality Disorder

Kernberg's Borderline Personality Organization   Kernberg的边缘人格结构       Diagnoses of BPO are based on three categories of criteria. The first, and most important, category, comprises two signs:
  • the absence of psychosis (i.e., the ability to perceive reality accurately)
  • impaired ego integration - a diffuse and internally contradictory concept of self. Kernberg is quoted as saying, "Borderlines can describe themselves for five hours without your getting a realistic picture of what they're like."
边缘人格结构的诊断基于三种条件。首先，也是最重要的种类，包含2个征象：   l不存在精神疾病（也就是说有精确的现实认知能力） l自我同一性受损---自我的泛化和内在的矛盾观念。据Kernberg 说，“如果你没有一个关于他们像什么样儿的栩栩如生的图像，边缘人格的人会描绘他自己足足5个钟头。”      The second category is termed "nonspecific signs" and includes such things as low anxiety tolerance, poor impulse control, and an undeveloped or poor ability to enjoy work or hobbies in a meaningful way.   其次，是“非特异性征象”和包括这类如：焦虑耐受力低，冲动控制力差，和以易于理解的方式 享受工作或业余爱好的能力 不发达或欠缺。     Kernberg believes that borderlines are distinguished from neurotics by the presence of "primitive defenses." Chief among these is splitting, in which a person or thing is seen as all good or all bad. Note that something which is all good one day can be all bad the next, which is related to another symptom: borderlines have problems with object constancy in people -- they read each action of people in their lives as if there were no prior context; they don't have a sense of continuity and consistency about people and things in their lives. They have a hard time experiencing an absent loved one as a loving presence in their minds. They also have difficulty seeing all of the actions taken by a person over a period of time as part of an integrated whole, and tend instead to analyze individual actions in an attempt to divine their individual meanings. People are defined by how they lasted interacted with the borderline.     Kernberg 认为，边缘人格是靠“原始防御”的存在来区别于神经症的。其中主要的是分离，而此时的人或者事看起来是完全好或者完全坏的。其解释是那些某一天看起来极好的事儿，可能在次日变得极糟；并且与其他症状有关：边缘人格在人的目标稳定性上有问题，他们用自己的生活来理解人的每一个行为，就好像没有以前的内容一样。对于生活中的人和事儿，他们不能够有一个持续的、连贯的感觉。当他们的意识中有爱存在的时候，他们很少去体验这样一个虚渺的爱。他们也很难看见经过一段时间以后的人的所有行为，就像是一个整体的片断一样，且容易以猜测个体想法的方式代之以分析个体行为。   Other primitive defenses cited include magical thinking (beliefs that thoughts can cause events), omnipotence, projection of unpleasant characteristics in the self onto others and projective identification, a process where the borderline tries to elicit in others the feelings s/he is having. Kernberg also includes as signs of BPO chaotic, extreme relationships with others; an inability to retain the soothing memory of a loved one; transient psychotic episodes; denial; and emotional amnesia. About the last, Linehan says, "Borderline individuals are so completely in each mood, they have great difficulty conceptualizing, remembering what it's like to be in another mood."     其他的原始防御包括，不可思议的想法（思想会导致事件的信念）、万能、自我中不愉快的特性投射与别人，投射的身份，边缘人格试图在别人身上找出他/她有的感觉的过程。Kernberg也涵盖了边缘人格结构与他人无序的、偏激的关系；无力保留爱情的甜蜜记忆；短暂的精神病发作；否定；情绪健忘症。关于后者，Linehan 说，“边缘人格个体在每一个情绪中是非常完全的，对于在另一个情绪中是什么样儿，他们很难有概念和记忆。”   （待续。。。。。。 ）
最后编辑清舞飞扬 最后编辑于 2008-02-09 16:28:59
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t T

回复：边缘性人格障碍 Borderline Personality Disorder

DBT:辨证行为治疗 是基于CBTf发展出来的一种现代心理治疗，称为认知治疗的第三浪潮。
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t T

回复: 边缘性人格障碍 Borderline Personality Disorder

谢谢老师，我们慢慢了解，逐步学习。
最后编辑清舞飞扬 最后编辑于 2008-03-26 21:04:31
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t T

回复: 边缘性人格障碍 Borderline Personality Disorder

Gunderson's conception of BPD Gunderson有关边缘人格障碍的概念      Gunderson, a psychoanalyst, is respected by researchers in many diverse areas of psychology and psychiatry. His focus tends to be on the differential diagnosis of Borderline Personality Disorder, and Cauwels gives Gunderson's criteria in order of their importance:     Gunderson ，被许多学科 如心理学和精神病学的研究者 所敬重的一位精神分析学家。他的焦点在于边缘人格障碍不同的诊断上，并且 Cauwels 按照其重要性将Gunderson'的标准依次排列：
  • Intense unstable relationships in which the borderline always ends up getting hurt. Gunderson admits that this symptom is somewhat general, but considers it so central to BPD that he says he would hesitate to diagnose a patient as BPD without its presence.
  • 强烈的不稳定的关系，在其中边缘人格者总是中止关系免受伤害。Gunderson承认这个症状稍微有点一般化，但认为是BPD的核心，以致他说当没有它的存在时他会在诊断BPD的时候犹豫不决。
  • Repetitive self-destructive behavior, often designed to prompt rescue.
  • 反复的自伤行为，经常计划实施自救
  • Chronic fear of abandonment and panic when forced to be alone.
  • 长期的离弃恐惧感和当迫于孤独时的痛苦感。
  • Distorted thoughts/perceptions, particularly in terms of relationships and interactions with others.
  • 被歪曲的想法/感知觉，特别是在和其他人的关系和互动上。
  • Hypersensitivity, meaning an unusual sensitivity to nonverbal communication. Gunderson notes that this can be confused with distortion if practitioners are not careful (somewhat similar to Herman's statement that, while survivors of intense long-term trauma may have unrealistic notions of the power realities of the situation they were in, their notions are likely to be closer to reality than the therapist might think).
  • 高敏感性，意指一种对非语言沟通的异常的敏感。Gunderson注意到，如果从业者不小心的话，这容易与歪曲相混淆（有些类似于Herman的陈述，当紧张万分的长期外伤的生还者，对他们所处状态的实际力量有不切实际的看法的时候，他们[这里指边缘人格者]的看法似乎比临床医学家想象的更接近实际）。
  • Impulsive behaviors that often embarrass the borderline later.
  •   常常在事后使边缘人格者困窘的冲动行为。
  •   Poor social adaptation: in a way, borderlines tend not to know or understand the rules regarding performance in job and academic settings.
  • 社会适应差：某种程度上，边缘人格者不善于知道或理解工作程序的规则和学院式的设置。
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最后编辑清舞飞扬 最后编辑于 2008-02-11 21:16:24
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2008-02-16 17:54 |只看楼主 16#
t T

回复: 边缘性人格障碍 Borderline Personality Disorder

The Diagnostic Interview for Borderlines, Revised 边缘人格的诊断性面谈（DIB），修订。   Gunderson and his colleague, Jonathan Kolb, tried to make the diagnosis of BPD by constructing a clinical interview to assess borderline characteristics in patients. The DIB was revised in 1989 to sharpen its ability to differentiate between BPD and other personality disorders. It considers symptoms that fall under four main headings:     Gunderson与其同事Jonathan Kolb 试图通过评估患者边缘人格特征的临床面谈的结构，来诊断BPD。边缘人格的诊断性面谈（DIB）于1989年修订，以突出其区分边缘人格障碍和其他人格障碍的能力。它认为以下四个主要题目的症状。
  • Affect 影响 （感觉这里指对情绪的影响）
    • chronic/major depression
　　慢性/严重的抑郁
    • helplessness　 无助
    • hopelessness 绝望
    • worthlessness 无价值
    • guilt 内疚
    • anger (including frequent expressions of anger) 愤怒（包括经常的愤怒的表情）
    • anxiety 兴奋
    • loneliness 孤独
    • boredom厌倦
    • emptiness 空虚
  • Cognition 认知
    • odd thinking 希奇古怪的想法
    • unusual perceptions 不同寻常的领悟力
    • nondelusional paranoia 无妄想的偏执狂
    • quasipsychosis 类精神病
  • Impulse action patterns 冲动行为方式
    • substance abuse/dependence 药物滥用/依赖
    • sexual deviance 性变态
    • manipulative suicide gestures 自杀意念
    • other impulsive behaviors 其他冲动行为
  • Interpersonal relationships人际关系
    • intolerance of aloneness 孤独的不耐受
    • abandonment, engulfment, annihilation fears
    • 离弃感，吞没感，灭绝恐惧
    • counterdependency 反依赖
    • stormy relationships 激烈的人际关系
    • manipulativeness 善于操纵摆布
    • dependency 依赖
    • devaluation 无价值感
    • masochism/sadism 受虐/施虐
    • demandingness 苛求
    • entitlement 权利欲
    The DIB-R is the most influential and best-known "test" for diagnosing BPD. Use of it has led researchers to identify four behavior patterns they consider peculiar to BPD: abandonment, engulfment, annihilation fears; demandingness and entitlement; treatment regressions; and ability to arouse inappropriately close or hostile treatment relationships.     修订后的DIB 是诊断边缘人格最有影响力和最为人们熟知的“测试”。它的应用使研究者们能够将边缘人格分类为四种特有的行为方式：1.离弃感，吞没感，灭绝恐惧；2.苛求和权利欲；3.治疗衰退；4. 唤起不恰当亲近或者敌对的治疗关系的能力。
最后编辑清舞飞扬 最后编辑于 2008-02-16 22:28:38
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2008-03-24 21:12 |只看楼主 17#
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回复: 边缘性人格障碍 Borderline Personality Disorder

DSM-IV criteria 精神疾病《诊断与统计手册》第四版 标准   The DSM-IV gives these nine criteria; a diagnosis requires that the subject present with at least five of these. In I Hate You -- Don't Leave Me! Jerold Kriesman and Hal Straus refer to BPD as "emotional hemophilia; [a borderline] lacks the clotting mechanism needed to moderate his spurts of feeling. Stimulate a passion, and the borderline emotionally bleeds to death."   精神疾病《诊断与统计手册》第四版给出了九条标准，诊断需具备其中至少五项。在《我恨你，别离开我》一书中，Jerold Kriesman 和 Hal Straus 把边缘人格看成是“情绪血友病”，一个边缘人格障碍者缺乏凝血机制来缓和其情绪的迸发。激发一份强烈的情感，边缘人格者情绪化的宣泄致死。
最后编辑清舞飞扬 最后编辑于 2008-03-24 21:15:34
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2008-03-24 21:13 |只看楼主 18#
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回复: 边缘性人格障碍 Borderline Personality Disorder

Traits involving emotions: 与情绪有关的特性：    Quite frequently people with BPD have a very hard time controlling their emotions. They may feel ruled by them. One researcher (Marsha Linehan) said, "People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement."   边缘人格障碍很常见的人很难有控制他们的情绪的时候。他们可以感到被自己束缚了。一个研究者（Marsha Linehan）说，“边缘人格障碍者就像是身体的90%三度烧伤的人，缺乏情绪皮肤，在极轻微的触摸和运动时，感到极度痛苦。” 1.Shifts in mood lasting only a few hours.   心境的转换仅仅一点点时间 2.Anger that is inappropriate, intense or uncontrollable.   不合时宜的、强烈的或者控制不了的愤怒
最后编辑清舞飞扬 最后编辑于 2008-03-24 21:14:03
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2008-03-26 21:03 |只看楼主 19#
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回复: 边缘性人格障碍 Borderline Personality Disorder

Traits involving behavior: 与行为相关的特性： 3.Self-destructive acts, such as self-mutilation or suicidal threats and gestures that happen more than once 自毁行为，如发生了一次以上的自伤或者自杀威胁和姿态。 4.Two potentially self-damaging impulsive behaviors. These could include alcohol and other drug abuse, compulsive spending, gambling, eating disorders, shoplifting, reckless driving, compulsive sexual behavior. 两种自我损害的冲动行为。包括酒精和其他药物滥用，难以控制的花费，赌博， 进食障碍，商店内行窃，不顾一切的驾驶，难以控制的性行为。
最后编辑清舞飞扬 最后编辑于 2008-03-26 21:06:18
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2008-04-04 20:32 |只看楼主 20#
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回复: 边缘性人格障碍 Borderline Personality Disorder

Traits involving identity 与同一性相关的特性 5.Marked, persistent identity disturbance shown by uncertainty in at least two areas. These areas can include self-image, sexual orientation, career choice or other long-term goals, friendships, values. People with BPD may not feel like they know who they are, or what they think, or what their opinions are, or what religion they should be. Instead, they may try to be what they think other people want them to be. Someone with BPD said, "I have a hard time figuring out my personality. I tend to be whomever I'm with."   无常的、至少两个方面的、明显而持续的同一性失衡。这些方面包括自我形象、性倾向，职业选择或者其他长期目标，友情、价值。边缘人格障碍者可能不愿意知道他们是谁，他们想些什么，他们的观点是什么，他们应该有什么信仰。取而代之，他们试图做其他人希望的那种人。一位边缘人格障碍者说：“我很难弄明白我的性格，不管谁给我在一起，我都容易成为他的样子。” 6.   Chronic feelings of emptiness or boredom. Someone with BPD said, "I remember describing the feeling of having a deep hole in my stomach. An emptiness that I didn't know how to fill. My therapist told me that was from almost a "lack of a life". The more things you get into your life, the more relationships you get involved in, all of that fills that hole. As a borderline, I had no life. There were times when I couldn't stay in the same room with other people. It almost felt like what I think a panic attack would feel like."         长期的空虚或者厌倦感。一些边缘人格者说，“我记得描述我的胃内有一个深洞的感觉。一种我不知道怎样填满的空虚感。我的治疗师告诉我那就是‘缺乏生活’。越多的事儿带入你的生活，你涉及的关系就越多，所有这些就会填满那洞穴。当边缘时，我没有生活。有时不能和其他人共处一室。几乎就像我认为的惊恐发作的感觉。”
最后编辑清舞飞扬 最后编辑于 2008-04-04 20:33:05
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