愛你恨你的背後—邊緣性人格患者的人際親密能力

Love You or Hate You – Interpersonal Intimacy Competence in the Patients with Borderline Personality

邊緣性人格疾患者為臨床上最常見的人格疾患種類，其中一項明顯的臨床特徵為不良社會互動與人際關係，他們可能因過去的不安全依附關係導致有較多人際關係破裂危機，對人際關係有較多負向解讀，無法避免人際關係中較多的激烈衝突。本研究之目的為探討憂鬱情緒、同理心及情緒覺察對人際親密能力的影響程度，邊緣性人格疾患患者與正常控制組是否會有不同的影響模式，而此不同的影響模式是否正是邊緣性人格疾患患者的人際親密表現不佳的可能相關因素。本研究以30位經由醫學中心精神科醫師診斷且符合邊緣性人格量表高分之邊緣性人格疾患者與30位正常控制組配對，進行人際親密能力、憂鬱情緒、同理心和情緒覺察的評估。人際親密能力評估包括主動、負向決斷、自我坦露、情緒支持及衝突處理五個向度，而同理心包括角色置入、觀點取替、同理感受與個人受苦感四個向度。研究結果發現邊緣性人格患者在同理心、情緒覺察、憂鬱情緒和人際親密關係能力的分數均低於正常控制組。迴歸分析後結果顯示邊緣性人格患者組，與正常控制組不同，其同理心中的觀點取替對人際親密中的衝突處理具有較大解釋力，因此若能協助邊緣性人格患者從不同角度看待人際間之互動，將能有效改善其人際關係。

Borderline personality disorder (BPD)， the most common type of personality disorder encountered in clinical practice， manifests in impairment of social interactions and interpersonal relationships. Past insecure attachments may cause interpersonal relationships to break down and negative interpretations to develop， which in turn may lead to more severe conflicts. The aim of the present study is to assess the factors of depression， empathy， and emotional awareness that affect interpersonal intimacy in patients with BPD as compared to controls， and to explore whether different patterns of factors cause the impairments of interpersonal intimacy in patients with BPD. Thirty patients diagnosed with BPD by psychiatrists and thirty healthysubjects in the comparison group participated in the study. Subjects were assessed with the assessment of separation–individual inventory， interpersonal competence questionnaire (ICQ)， Beck Depression Inventory (BDI-II)， interpersonal reactivity index (IRI)， and levels of emotional awareness scale (LEAS). The ICQ includes five subscales: initiation， negative assertion， disclosure， emotional support， and conflict management. The IRI includes four subscales: perspective taking (PT)， fantasy (FS)， personal distress (PD)， and empathic concern (EC). The results showed that scores on empathy， emotional awareness， depression， and interpersonal intimacy were lower in patients than in controls. Regression analysis showed that lower performance in PT may explain the impairment of interpersonal intimacy in patients with BPD. Thus， our results suggest that strengthening the ability of perspective taking may help to improve the interpersonal relationships of patients with BPD.