Fonagy Peter, Luyten Patrick, Allison Elizabeth, Campbell Chloe
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
Borderline Personal Disord Emot Dysregul. 2017 Apr 11;4:11. doi: 10.1186/s40479-017-0061-9. eCollection 2017.
This paper sets out a recent transition in our thinking in relation to psychopathology associated with personality disorder, in an approach that integrates our thinking about attachment, mentalizing (understanding ourselves and others in terms of intentional mental states) and epistemic trust (openness to the reception of social communication that is personally relevant and of generalizable significance) with recent findings on the structure of both adult and child psychopathology and resilience. In this paper - the first of two parts - we review evidence suggesting that a general psychopathology or p factor underlies vulnerability for psychopathology. We link this p factor to a lack of resilience using Kalisch and colleagues' positive appraisal style theory of resilience (PASTOR). We argue that vulnerability for (severe) psychopathology results from impairments in three central mechanisms underlying resilience - positive situation classification, retrospective reappraisal of threat, and inhibition of retraumatizing triggers - which in turn result from a lack of flexibility in terms of social communicative processes. We suggest that, from this perspective, personality disorders, and borderline personality disorder (BPD) in particular, can be considered to be the prototype of disorders characterized by a lack of resilience. Part 2 proposes an evolutionary developmental psychopathology account linking this inflexibility in social communication to problems with the development of epistemic trust - that is, an evolutionary pre-wired social communication system that normally facilitates resilience through salutogenesis, that is, the capacity to learn and derive benefit from the (social) environment.
本文阐述了我们在与人格障碍相关的精神病理学思维方面的近期转变,采用的方法是将我们对依恋、心理化(根据意向性心理状态理解自己和他人)和认知信任(对与个人相关且具有普遍意义的社会交流持开放态度)的思考与关于成人和儿童精神病理学及复原力结构的最新研究结果相结合。在本文(分为两部分的第一篇)中,我们回顾了证据,这些证据表明一种普遍的精神病理学或p因素是精神病理学易感性的基础。我们使用卡利施及其同事的复原力积极评估风格理论(PASTOR)将这个p因素与复原力的缺乏联系起来。我们认为,(严重)精神病理学的易感性源于复原力所依赖的三个核心机制的损害——积极的情境分类、对威胁的回顾性重新评估以及对再次创伤触发因素的抑制——而这些损害反过来又源于社会交流过程缺乏灵活性。我们认为,从这个角度来看,人格障碍,尤其是边缘型人格障碍(BPD),可以被视为以缺乏复原力为特征的障碍的原型。第二部分提出了一种进化发展精神病理学解释,将这种社会交流中的不灵活性与认知信任发展中的问题联系起来——也就是说,一种进化预先设定的社会交流系统,通常通过健康生成(即从(社会)环境中学习并从中受益的能力)来促进复原力。