40주차 피드백
보더라인의 학자 간 개념 차이와 현대 이전의 역사적 선구 개념을 짚어주니 DSM-V의 경계선 성격장애보다 폭넓은 조망에서 경계선 개념을 이해하는 데 많은 도움이 됐습니다. 특히 경계선이 신경증적인 면모와 정신병적인 면모 사이의 일시적 상태가 아니라 a habitual level of behavior, a durable pattern of troubled functioning 임을 강조하는 부분이 그렇고요. 이와 비슷하게 밀론이 경계선을 말할 때는 a stable and moderately severe level of functioning that encompasses a variety of different personality subtypes 을 의미한다는 것도 중요해 보입니다. 밀론이 DSM-III의 보더라인 진단기준을 딤섬에 비유하면서 겉만 번지르르한 잡탕이라는 식으로 시니컬하게 표현한 부분도 재미있었고요.
Intro
DSM-III의 다른 성격장애 진단기준과 달리 Borderline은 개념적 혼선을 일으키는 작명이며, 축I과 축II의 증상들이 공존하는 불분명함이 특징적이다. (딤섬에 비유) a level of personality organization(컨버그)이나 a degree of personality severity(밀론)를 포착하지 못한다. 개념적 특성을 너무 좁게 한정시킴으로써 broad borderline group(ex. borderline schizophrenia, pseudoneurotic schizophrenia, latent psychoses)를 포함시키지 못한다.
As noted previously, the spectrum ranges from mild (normal) style to severe (clinical) disorder variants. The moderate (abnormal) type to the severe level are often advanced dysfunctional variants of the less structurally defective dependent, histrionic, narcissistic, antisocial and, in particular, negativistic (passive-aggressive) personalities. The subvarieties of the unstable style (mild), borderline type (moderate), and cyclophrenic disorder (severe) personalities are thereby more clearly differentiated and their frequently mixed symptom pictures clarified.
borderline이 neurosis인지 psychosis인지 판단이 서지 않을 때 사용하는 wastebasket일 때도 있었으나 밀론이 보기에 It is currently conceived as a meaningful designation that reflects a real rather than a spurious or incongruous state of affairs: an advanced and moderately serious level of maladaptive personality functioning. Moreover, the label borderline need not represent a transitory state between normality and severe pathology—a way station leading inevitably to more severe illness. The label signifies a habitual level of behavior, a durable pattern of troubled functioning that can stabilize for substantial periods of time. Only if matters persist or get worse can the person further deteriorate into the severe level of cyclophrenia.
borderline에 대한 학자 간 개념 차이가 크다.
- a level of personality cohesion midway between neurotic and psychotic levels.
- biologically oriented researchers -> it is best considered as a set of personality variants within an affective disorders spectrum (ex. Akiskal)
- an incipient precursor or inchoate substrate for schizophrenia
- a stable and moderately severe level of functioning that encompasses a variety of different personality subtypes (ex. 밀론)
HISTORICAL ANTECEDENTS
Aretaeus(고대 그리스 의사) says "It appears to me that melancholia is the commencement(시작) and a part of mania."
It was Kahlbaum, however, who, in 1882, clearly imprinted the current belief in the fixed covariation of mania and melancholia. (중략) He termed the milder variant of the illness, notable for its frequent periods of normality, cyclothymia. A more severe and chronic form of the same pattern was designated vesania typica circularis. Both terms correspond to the designations cycloid and cyclophrenia coined in this author’s 1969 Modern Psychopathology text.
Kraepelin (1921) identified four temperament variants disposed to clinical manic-depressive disease. The irritable temperament, elsewhere described by Kraepelin as the ‘‘excitable personality,’’ was conceived as a ‘‘mixture of the fundamental states.’’ It parallels the DSM borderline concept closely, (중략) Of special note is the extent to which Kraepelin’s description encompasses the central diagnostic criteria of the DSM-IV borderline, especially the impulsivity, unstable relationships, inappropriate and intense anger, affective instability, and physically self-damaging acts.
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