Trappler B, Backfield J
Department of Psychiatry, State University of New York, Health Science Center at Brooklyn, Box 1203, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
Psychiatr Q. 2001 Spring;72(1):29-40. doi: 10.1023/a:1004805919123.
This case study investigation considers typical and potentially unique characteristics of older (> 50 years) Borderline Personality Disorder (BPD) patients and describes their impact on an inpatient psychiatric unit encompassing a therapeutic milieu setting and multidisciplinary treatment teams. The somatization of symptoms, in particular, and the associated therapeutic, medical, and psychopharmacological interventions, result in prolonged and elaborate treatments that undermine clinical and personal boundaries, clash with managed care directives, and engender frustrating and elusive transferential and countertransferential reactions. Moreover, the guilt-inducing nature of somatization and physical frailty in older individuals, combined with the well-documented ability of BPD patients, regardless of age, to incite stormy and 'split' relationships, are linked characteristics that may describe a diagnostic subtype of BPD. Rather than suggesting a diminution of psychopathology as BPD patients age, the results of this investigation indicate that their persistent difficulties may only be altering in content and in pathological adaptation to changing needs.
本案例研究调查考虑了年龄较大（>50岁）的边缘型人格障碍（BPD）患者的典型及潜在独特特征，并描述了这些特征对一个包含治疗性环境设置和多学科治疗团队的住院精神科病房的影响。特别是症状的躯体化以及相关的治疗、医疗和心理药物干预，导致了冗长而复杂的治疗，这些治疗破坏了临床和个人界限，与管理式医疗指令相冲突，并引发了令人沮丧且难以捉摸的移情和反移情反应。此外，躯体化的内疚诱导性质以及老年人的身体虚弱，再加上BPD患者（无论年龄大小）引发激烈和“分裂”关系的能力已得到充分证明，这些相关特征可能描述了BPD的一种诊断亚型。本调查结果并非表明随着BPD患者年龄增长精神病理学有所减轻，而是表明他们持续存在的困难可能只是在内容以及对不断变化的需求的病理适应方面发生了改变。
