Couple relationships and Borderline Personality Disorder: examining the interpersonal experience of caregiving partners and people diagnosed with BPD

夫妻关系和边缘性人格障碍：检查护理伙伴和诊断患有边缘性人格障碍的人的人际经历

• 批准号: 2862723
• 金额: --
• 依托单位: Birkbeck, University of London
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2862723
• 关键词: Couple; relationships; Borderline; Personality; Disorder

Borderline Personality Disorder (BPD) is a mental condition characterised by emotional lability and turbulent interpersonal connections [1]. People diagnosed with BPD have more relationships characterised by a major change or termination compared to healthy individuals and those with other mental health conditions [2, 3] and BPD features are associated with received and perpetrated abuse within the couple [4]. For many individuals diagnosed with BPD-more than a third of whom are in long-term romantic relationships [5]- spouses and romantic partners are the main providers of care [6]. Recent studies highlighted the reciprocal relationship between the quality of interpersonal relationships and the severity of BPD features[7]. Further, carers of people with BPD experience a higher carer burden than carers of people affected by other mental illnesses [8, 9] which, in turn, negatively impacts relationship quality and stability.The changing perception of relational dynamics that is typical of the disorder, along with its interdependence with BPD features and the role of the partner-caregiver, gives rise to a complex interpersonal context that is yet to be investigated qualitatively. The available interventions for BPD couples are limited and largely informed by theoretical models rather thangrounded on couples' experience [10]. Gaining insight into the experience of both caregiving partners, and people diagnosed with BPD in a romantic relationship will provide the experiential ground necessary to model relationship-centred interventions based on the couple's needs, improving clinical outcomes and general wellbeing. Researching this area is particularly relevant considering that psychotherapy is the first-line treatment for BPD [11] and that this disorder has a prevalence of 1.6% in the general population [11].The core clinical domains of BPD are a reinforcing and maintaining factor of disordered affect [12]. Specifically, difficulties regulating emotions, a lack of tolerance, awareness and attentional impulsiveness are central and interrelated featuresof the condition and contribute significantly to interpersonal problems [13]. Conversely, stable marital relationships and short-term functioning romantic relationships seem to act as protective factors leading to improved functioning, decreased anger, higher employment rates, and improved sexual functioning [14-16]. Importantly, emerging quantitative research shows the dynamic and fluctuant nature of the correlation between relationship quality and BPD symptoms over time [7] which is typical of many other features of the disorder including the diagnosis itself [17].The correlation between BPD features and relationship quality is most important among frequent-interaction partners (e.g. romantic relationships) [7]. BPD symptoms are associated with dysfunctional interactions within couple relationshipsleading to lower marital satisfaction, higher attachment insecurity, more demand-withdrawal communication problems, and higher levels of intimate violence than in non-clinical couples[4]. Interestingly, both partners (not only the one with BPD) adopt similar levels of dysfunctional behaviours contributing equally to negative interactions [18].In summary, there is not a comprehensive understanding of the intertwined experiences of caregiving partners and people with BPD cared for by their partners. No research, to date, has captured the fluid and fluctuant nature of these interpersonal experiences that represent a core domain of BPD and, therefore, should inform effective psychological interventions. To understand this aspect, it is fundamental to research this qualitatively - because interpersonal relationships reflect a key context, are reciprocal and shift over time. It also requires an idiographic, holistic, and in-depth approach like Interpretative Phenomenological Analysis (IPA) - because it is profoundly personal.

边缘性人格障碍（BPD）是一种以情绪不稳定和人际关系不稳定为特征的精神疾病[1]。与健康人和患有其他心理健康问题的人相比，被诊断为 BPD 的人有更多以重大变化或终止为特征的关系 [2, 3]，并且 BPD 特征与夫妇内部受到和实施的虐待有关 [4]。对于许多被诊断患有 BPD 的人（其中超过三分之一处于长期恋爱关系中 [5]）来说，配偶和浪漫伴侣是主要的护理提供者 [6]。最近的研究强调了人际关系质量与 BPD 特征严重程度之间的相互关系[7]。此外，边缘性人格障碍患者的照顾者比其他精神疾病患者的照顾者承受更高的照顾者负担 [8, 9]，这反过来又会对关系质量和稳定性产生负面影响。对关系动态的看法不断变化，这是这种疾病的典型特征以及它与 BPD 特征和伴侣照顾者角色的相互依赖性，导致了复杂的人际环境，尚有待定性研究。针对 BPD 夫妇的可用干预措施是有限的，并且很大程度上是基于理论模型，而不是基于夫妇的经验 [10]。深入了解护理伴侣和浪漫关系中被诊断患有边缘性人格障碍的人的经历，将为根据夫妻的需求建立以关系为中心的干预措施提供必要的经验基础，从而改善临床结果和总体福祉。考虑到心理治疗是 BPD 的一线治疗方法 [11]，并且这种疾病在普通人群中的患病率为 1.6% [11]，因此研究这一领域尤为重要。BPD 的核心临床领域是强化和维持因素紊乱的情感[12]。具体来说，情绪调节困难、缺乏宽容、意识和注意力冲动是该病症的核心和相互关联的特征，并且在很大程度上导致了人际关系问题[13]。相反，稳定的婚姻关系和短期有效的浪漫关系似乎可以作为保护性因素，从而改善功能、减少愤怒、提高就业率和改善性功能[14-16]。重要的是，新兴的定量研究表明，随着时间的推移，关系质量与 BPD 症状之间的相关性具有动态和波动的性质 [7]，这是该疾病的许多其他特征（包括诊断本身）的典型特征 [17]。BPD 特征与关系之间的相关性对于频繁互动的伴侣（例如恋爱关系）来说，质量是最重要的[7]。边缘性人格障碍症状与夫妻关系中功能失调的互动有关，导致婚姻满意度较低、依恋不安全感较高、需求撤回性沟通问题较多，以及亲密暴力程度高于非临床夫妻[4]。有趣的是，双方（不仅是边缘性人格障碍患者）都采取了相似程度的功能失调行为，同样导致了负面互动[18]。总之，对于护理伙伴和边缘性人格障碍患者所照顾的相互交织的经历，目前还没有一个全面的了解。他们的合作伙伴。迄今为止，还没有任何研究能够捕捉到这些代表 BPD 核心领域的人际经历的流动性和波动性，因此应该为有效的心理干预提供信息。要理解这一方面，定性研究至关重要 - 因为人际关系反映了关键背景，是互惠的，并且随着时间的推移而变化。它还需要像解释现象学分析（IPA）这样具体的、整体的和深入的方法——因为它是非常个人化的。