边缘型人格障碍（BPD）解析：从概念到临床现实

Introduction

To comprehend Borderline Personality Disorder (BPD), it is essential to first understand the foundational concept of personality. In psychological research, the observable manifestations of an individual's mental activities—what we see, hear, and feel in daily life—are termed psychological phenomena. These phenomena are broadly categorized into two groups. The first is psychological processes, which encompass:

• Cognitive Processes: The acquisition and processing of information, including sensation, perception, memory, thinking, and imagination.
• Emotional Processes: The attitudes or experiences generated while cognizing objective things, such as satisfaction or pleasure.
• Volitional Processes: The conscious act of setting goals, overcoming difficulties, and striving to achieve them to fulfill certain needs.

The second category is individual characteristics, known in psychology as personality. In other words, due to differences in innate qualities, living environments, educational levels, and personal experiences, each individual gradually develops unique conscious tendencies and relatively stable psychological traits through the aforementioned processes. This constitutes a person's distinct personality. Personality is formed through various psychological processes and, once established, in turn constrains and influences these processes, manifesting in cognitive, emotional, and volitional differences among individuals. It is worth noting that the term "personality" originates from the Latin persona, meaning "mask."

要理解边缘性人格障碍（BPD），首先需要理解人格这一基本概念。在心理学研究中，个体在日常生活中“所见”、“所闻”及“所感”等心理活动的外在表现，被称为心理现象。这些现象大致可分为两类。第一类是心理过程，包括：

• 认识过程：信息的获取与加工处理，包括感觉、知觉、记忆、思维、想象等。
• 情感过程：在认识客观事物过程中产生的态度或体验，如满意、愉快等。
• 意志过程：为满足某种需要，自觉确定目的、克服困难、努力达成目标的过程。

第二类是个性特征，即心理学上所称的人格。换言之，由于先天素质、生活环境、教育水平及实践活动的差异，每个个体在经历上述心理过程时会逐渐形成独特的意识倾向性和相对稳定的个性心理特征，这就构成了一个人独特的人格。人格通过各种心理过程建立，而已形成的人格又会制约和影响心理过程，并在其中得到表现，导致个体在认知、情感和意志上表现出明显差异。值得一提的是，“人格”（personality）一词源于拉丁语“persona”，意为“面具”。

What is a Personality Disorder?

Personality can be understood as the sum of an individual's stable characteristics formed within a specific social environment. However, when personality traits significantly deviate from the norm, they can coalesce into persistent abnormal behavioral patterns that reflect an individual's lifestyle and interpersonal relationships. These patterns markedly deviate from the expectations of the individual's cultural background and general cognitive style, significantly impairing social and occupational functioning, leading to maladjustment, and sometimes even causing harm to society. This condition is termed a Personality Disorder.

Individuals with personality disorders typically do not have intellectual impairments and can manage daily life and work. However, they often experience conflicts in social interactions, suffer personal distress (sometimes without apparent cause), and may cause distress to others. The onset of personality disorders is usually not pinpointed to a specific time; they generally develop from childhood or adolescence and persist throughout life, with only a minority showing improvement in adulthood or old age. The etiology remains unclear and is generally considered the result of a complex interplay of biological, psychological, social, and cultural factors.

人格可被视为个体在特定社会环境中形成的稳定特征总和。然而，当人格特征明显偏离常态时，往往会形成反映个人生活风格和人际关系的一贯性异常行为模式。这种模式显著偏离特定文化背景和一般认知方式，明显损害个体的社会和职业功能，导致其适应不良，有时甚至对社会造成危害。这种现象被称为人格障碍。

人格障碍患者通常无智能障碍，能处理日常生活和工作，但在社会生活中常与他人发生冲突，感到痛苦（有时是无故的），也可能使他人感到困扰。人格障碍通常没有确切的起病时间，一般从童年或青少年期开始并持续终生，仅少数在成年或老年后有所改善。其形成原因尚不完全清楚，通常认为是生物、心理、社会及文化因素共同作用的结果。

Common Features and Classification of Personality Disorders

Personality disorders generally share the following characteristics:

1. A specific behavioral pattern.
2. The pattern is long-term and persistent.
3. The pattern is pervasive, leading to social maladjustment or significant occupational impairment.
4. The individual has normal intelligence but cannot learn from past conflicts or experiences.
5. The pattern begins in childhood, adolescence, or early adulthood, and the individual is currently aged 18 or above.
   (Note: Personality changes resulting from sudden cerebral disease, trauma, chronic alcoholism, or major life events in individuals with previously normal personality are termed "Personality Change," not Personality Disorder.)

Beyond these common features, manifestations vary. While classification systems are not entirely unified, major categories include:

• Paranoid Personality Disorder
• Schizoid Personality Disorder
• Antisocial Personality Disorder
• Impulsive/Aggressive Personality Disorder
• Histrionic Personality Disorder
• Obsessive-Compulsive Personality Disorder
• Anxious [Avoidant] Personality Disorder
• Dependent Personality Disorder
• ...and Borderline Personality Disorder.

人格障碍通常具有以下共同特点：

1. 特殊的行为模式。
2. 该模式是长期、持续的。
3. 该模式具有普遍性，导致患者社交适应不良或职业功能明显受损。
4. 患者智能正常，但无法从既往冲突经历中吸取教训。
5. 该模式始于童年、青少年或成年早期，且患者现年18岁以上。
   （注：若原人格正常，因脑病、脑外伤、慢性酒精中毒或重大生活事件后出现偏差，称为“人格改变”，而非人格障碍。）

除共同特点外，患者表现各异。分类尚未完全统一，但主要类别包括：

• 偏执性人格障碍
• 分裂样人格障碍
• 反社会性人格障碍
• 冲动性/攻击性人格障碍
• 表演性/癔症性人格障碍
• 强迫性人格障碍
• 焦虑性（回避性）人格障碍
• 依赖性人格障碍
• ……以及边缘性人格障碍。

The Evolution of the Borderline Concept

We now turn to Borderline Personality Disorder (BPD), a complex and severe mental disorder characterized by instability in emotions, interpersonal relationships, self-image, and impulsive behavior, often leading to significant impairment in social functioning. BPD is challenging to treat and is associated with a suicide mortality rate 10-50 times higher than that of the general population (Andrew E. et al., 2002).

The conceptualization of BPD has a rich history. In the late 19th and early 20th centuries, during the dominance of Freudian psychoanalysis in American psychiatry, clinicians observed patients who retained reality-testing abilities but exhibited behavioral dyscontrol, emotional distress, and sometimes moral or social transgressions. These patients were initially labeled with terms like "moral insanity," an early precursor to "psychopathic personality."

Other patients presented with fluctuating, difficult-to-diagnose symptoms, sometimes receiving multiple diagnoses. Kraepelin (1921) noted these "borderline" issues in psychiatry—atypical or borderline manifestations of conditions like schizophrenia. He described a vast, ill-defined territory between frank psychosis and normality. Psychoanalysis later contributed theories on character formation and pathology, coining the term "borderline state" and using descriptors like "pseudo-" or "as-if" to capture the instability and ambiguity of these presentations.

Debate continued on whether to classify "borderline" conditions under neurosis or psychosis until Schmideburg (1959) proposed that the borderline disturbance was essentially a disorder of character. This shifted the focus from psychotic symptoms to character structure. Stone (1980) further delineated the borderline spectrum as lying between schizophrenia and non-schizophrenia, and between neurosis and deeper disorganization. This evolution led to the concept of the "borderline syndrome" and the development of operational diagnostic criteria like the Diagnostic Interview for Borderlines (DIB, 1987), paving the way for the formal adoption of the terms "borderline personality" and "Borderline Personality Disorder."

现在，我们聚焦于边缘性人格障碍（BPD）。这是一种复杂且严重的精神障碍，以情感、人际关系、自我形象的不稳定及冲动行为为临床特征，常导致患者社会功能严重损害。BPD治疗困难，其自杀死亡率是普通人群的10-50倍（Andrew E. 等, 2002）。

BPD概念的演变历史丰富。19世纪末20世纪初，弗洛伊德的精神分析理论主导美国精神病学界时，临床医生发现一些患者保有检验现实的能力，但存在行为失控、情绪痛苦，有时在道德或社会层面越轨。这些患者最初被称为“悖德性疯癫”，是后来“病态人格”等概念的雏形。

另一些患者症状多变，难以诊断，甚至集多种诊断于一身。Kraepelin（1921）注意到了精神病学中的这些“边缘”问题——精神分裂症等疾病的不典型或边缘类型。他描述了一个介于明显精神病态与正常之间广阔而无明确标志的领域。精神分析学随后在性格形成和异常领域创建理论，用“边缘状态”及“类XX”、“假性XX”等词来描述这类患者“不稳定”和“似是而非”的表现。

关于将“边缘性”划归神经症还是精神病的争论持续着，直到Schmideburg（1959）提出边缘障碍实质上是一种性格障碍。这将对这类问题的理解重点从精神病理症状转向了性格结构。Stone（1980）进一步限定了边缘状态的范围，即介于精神分裂症与非精神分裂症之间，以及介于神经症与深度紊乱之间的状态。这一演变催生了“边缘综合征”的概念，并产生了《边缘性人格障碍诊断性访谈》（DIB, 1987）等操作性诊断标准，为正式采用“边缘人格”及“边缘性人格障碍”等术语铺平了道路。

Core Symptoms of Borderline Personality Disorder

The clinical description of BPD has undergone refinement. Its hallmark is a pervasive pattern of instability. The core symptoms can be summarized into six key domains:

1. Profound Emotional Instability: Intense, rapidly shifting moods (e.g., anger, anxiety, dysphoria) often triggered by interpersonal stressors.
2. Intense and Unstable Interpersonal Relationships: Relationships characterized by alternating between extremes of idealization and devaluation ("splitting").
3. Impulsivity with Self-Damaging Behaviors: Impulsive actions in areas such as spending, sex, substance abuse, reckless driving, binge eating, coupled with recurrent suicidal behavior, gestures, threats, or self-mutilation.
4. Identity Disturbance: Markedly and persistently unstable self-image or sense of self.
5. Chronic Feelings of Emptiness.
6. Frantic Efforts to Avoid Real or Imagined Abandonment.
7. Inappropriate, Intense Anger or Difficulty Controlling Anger.
8. Transient, Stress-Related Paranoid Ideation or Severe Dissociative Symptoms.

BPD的临床描述历经演变。其核心特征是一种普遍的不稳定模式。主要症状可归纳为以下几个关键方面：

1. 深在的情绪不稳定：强烈且快速变化的情绪（如愤怒、焦虑、烦躁），常由人际压力引发。
2. 强烈而不稳定的人际关系：人际关系在极端理想化与贬低之间交替（“分裂”机制）。
3. 冲动及自毁行为：在消费、性行为、物质滥用、鲁莽驾驶、暴食等方面的冲动行为，以及反复的自杀行为、姿态、威胁或自残。
4. 自我身份感紊乱：显著且持续不稳定的自我意象或自我感。
5. 慢性的空虚感。
6. 竭力避免真实或想象的被抛弃。
7. 不恰当的、强烈的愤怒或难以控制的愤怒。
8. 短暂的、与应激相关的偏执观念或严重的分离症状。

(Due to length constraints, the detailed analysis of etiological factors and prevention will be covered in a subsequent section. The following provides a brief transition.)

Etiology and Early Prevention: A Glimpse

The formation of BPD is multifactorial, closely linked to disturbances in early developmental stages. Key perspectives include:

• Early Caregiver-Child Interactions: Maladaptive interactions during the symbiotic and separation-individuation phases (per Mahler's theory) can lead to developmental arrests, impairing the child's ability to develop a stable sense of self and self-soothing capacities.
• Object Relations Theory: Recurrent self-harm or suicidal behavior in BPD can be understood as a manifestation of internalized, conflicted early attachment relationships—a simultaneous struggle against the regressive pull towards fusion with a caregiver and the desire for separation and autonomy.
• Adverse Childhood Experiences: Early neglect, separation, abuse, and unstable or conflict-ridden family environments are strongly correlated with the development of BPD and other psychological issues in adulthood.

These insights point toward the importance of early prevention, emphasizing the establishment of secure parent-child attachments, consistent parental care as the cornerstone of healthy personality development, and the maintenance of a balanced family system.

BPD的成因众多，与早期发展阶段的失调密切相关。主要观点包括：

• 早期照料者-儿童互动：共生期与分离-个体化期（基于马勒理论）的不良互动可能导致发展停滞，损害儿童形成稳定自我感和自我安抚能力。
• 客体关系理论：BPD中反复的自伤或自杀行为，可被理解为内化的、冲突性早期依恋关系的表现——一种既对抗退行性地与照料者融合的拉力，又渴望分离和自主的矛盾斗争。
• 不良童年经历：早期的忽视、分离、虐待以及不稳定或充满冲突的家庭环境，与BPD及成年后其他心理问题的发生密切相关。

这些观点提示了早期预防的重要性，强调建立安全的亲子依恋、将稳定的父母关爱作为健康人格发展的基石，以及维持平衡的家庭系统。

This post has outlined the foundational concepts of personality and personality disorders, traced the historical evolution of the borderline diagnosis, and summarized its core clinical features. A deeper exploration of the complex biopsychosocial etiological models and evidence-based treatment approaches for BPD will be the focus of a future discussion.

本文概述了人格及人格障碍的基本概念，追溯了边缘性诊断的历史演变，并总结了其核心临床特征。关于BPD复杂的生物-心理-社会病因模型及循证治疗方法的深入探讨，将是未来文章的重点。

References / 参考资料

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• Ma Xin, Zhao Xudong. Medical Psychology [M]. 3rd ed. Beijing: People's Medical Publishing House, 2018: 57, 130-131.
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• Yang Can, Shi Qijia. A Descriptive Study of the Adult Attachment Style and Parental Rearing Behavior of Borderline Personality Disorder [J]. Shanghai Archives of Psychiatry, 2006, 018(006):327-329,332.