Psychodynamic Implications of Self-mutilation in a Patient with Borderline Personality Disorder

邊緣型人格障礙患者自傷行為的精神動力學意涵

10.29478/TJP.200906.0010

楊屏生(Ping-Suen Yang)

自傷 ； 邊緣性人格障礙症 ； 人際關係 ； 精神動力心理治療 ； self-mutilation ； borderline personality disorder ； interpersonal relationships ； psychodynamic psychotherapy

台灣精神醫學

23卷2期（2009 / 06 / 01）

172 - 176

英文

目的：本文報告一位邊緣性人格障礙症患者以自傷方式來處理其人際衝突問題，並以精神動力學的觀點來探討自傷的成因及其潛意識中的意義。病例報告：一30歲已婚女性與先生發生衝突後，在忿怒之下開始出現以拳頭打頭和割腕的自傷行為。在接受兩年精神動力取向的心理治療過程中，她逐漸了解到她使用自傷來避免想到遭先生遺棄的恐怖念頭和希望藉此恢復與先生的關係，但果是適得其反。結論：此報告案例顯示精神動力取向的心理治療能幫助邊緣性人格障礙症患者察覺其之前面對人際衝突時，對使用自傷抱持不符合現實的幻想和動機，而不再重覆此行為，並進而採取更適當的人際溝通方式。

Objective: Borderline patients frequently have self-mutilation behavior to allay anxiety and to gratify certain wishes related to threats involving the breakdown of interpersonal relationships. In this case report, I present the psychodynamic implications of self-mutilation in a patient with borderline personality disorder who received psychodynamic psychotherapy. Case Report: A 30-year-old married female patient would hurt herself by cutting her wrists whenever she felt that she was going to be abandoned by her husband, and she experienced an immediate sense of relief after her self-mutilating behavior. After a two-year course of psychodynamic psychotherapy, the patient became more aware of the fact that self-mutilation was her way of trying to ward off terrifying fantasies of losing her beloved husband and was an attempt to restore her impaired relationship with him. But the actual results of her actions were contrary to the patient's wishes. Conclusion: This case report illustrates that the understanding of patients' unconscious motives and fantasies of self-mutilation can facilitate borderline patients' ability to effectively deal with their interpersonal difficulties.

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