Meissner W W
Int J Psychoanal Psychother. 1982;9:3-49.
It is argued that the borderline personality organization as now conceived embraces a spectrum of differentiable diagnostic groupings. Lumping these diagnostic clusters under a single descriptive heading contributes to continuing conceptual ambiguities and theoretical confusion in the understanding of borderline psychopathology. A potential differentiation of borderline entities on clinical grounds is suggested. The bases for discrimination of higher-order borderline conditions versus lower-order conditions are explored. Current accounts of borderline pathology tend to focus on lower-order pathology as characteristic, but do not account for the full range of the borderline spectrum. Other potential discriminations between an hysterical continuum and an obsessional-schizoid continuum are explored. Differential diagnoses suggested include pseudoschizophrenia, psychotic character, borderline personality, and primitive hysteric in the hysterical continuum; schizoid personality, false-self organization, and as-if personality in the schizoid continuum. The syndrome of identity diffusion is also suggested as part of the borderline spectrum.
有人认为,目前所构想的边缘性人格组织包含一系列可区分的诊断分组。将这些诊断集群归在一个单一的描述性标题下,导致在理解边缘性精神病理学方面持续存在概念上的模糊性和理论上的混乱。本文提出了基于临床理由对边缘性实体进行潜在区分的方法。探讨了区分高阶边缘性状况与低阶状况的依据。目前对边缘性病理学的描述往往侧重于将低阶病理学视为特征,但并未涵盖边缘性谱系的全部范围。还探讨了癔症连续体与强迫性-分裂样连续体之间的其他潜在区分。建议的鉴别诊断包括癔症连续体中的假性精神分裂症、精神病性人格、边缘性人格和原始癔症;分裂样连续体中的分裂样人格、虚假自我组织和类人格。身份扩散综合征也被认为是边缘性谱系的一部分。