[47주차] Disorders of Personality: 19. Unstable Styles, Borderline Types, Cyclophrenic Disorders: The UBC Spectrum(pp. 923-927)

• And second, even though we recognize that severe pathology does not fall into sharply defined subtypes, we have differentiated several structurally deteriorated patterns in accordance with their dominant predecompensated personality styles. <- 같은 심각한 구조적 deterioration 수준이라 하더라도 병전 성격에 따른 차이를 구분해야 한다는 것.
  • cyclophrenic의 핵심은 seeks to focus on the essential feature found among these patients—their psychic ambivalence, and their vacillation in mood, thought, and behavior.
• 분열정동장애가 cyclophrenic에 상응할 수 있음.
  • they display both a strong affective tone and a social relatedness that are not found in schizophrenic personalities.
• 사고 및 감정 조절의 심한 어려움. 환각이나 상동증적 행동이 발생할 수 있음. 자기돌봄의 심한 어려움.
  • 고통스러운 사고를 차단해 버림. 이는 slow and laborious responses를 설명함. 이것조차 괴로움을 감소시키는 데 도움이 안 될 시 사고가 와해될 수 있음.
  • 체계적이지 못한 망상, 환각이 드물지 않음. 자기경멸이나 죄책감이 망상의 주요한 정서일 수 있음.
  • Geared to turn to others for guidance and support, these cyclophrenics often are keenly aware of their aloneness and the frightening unfamiliarity of their surroundings. Most feel desperately removed and lost, perplexed and bewildered in a strange and unreal world.
• defective borderline과의 차이는 degrees of impairment. cyclophrenic에서는 특히 현실검증력의 상실을 비롯한 total disintegration of personality functioning
• schizophrenics와의 차이: cyclophrenics have shown a capacity to relate to others, although in an ambivalent fashion; their thoughts focus on their own inadequacies, conflicts, guilt, and self-deprecation; frequent periods of angry resentment and mood swings are notable. In contrast, schizophrenics have characteristically been detached, self-contained, and socially deficient; their cognitive processes have always been disjointed and somewhat autistic; affect has been either lacking or markedly apprehensive; periods of panic and bizarre impulses and feelings of alienation and depersonalization are notable.
• Subtypes
  • dependent-immature styles
    • Convinced of their unworthiness and the inevitability of abandonment and desertion, they crumble and sink into a state of utter hopelessness.
    • Though frightened by their separation from past sources of security, they quickly learn that they can gain a more consistent level of support in the ‘‘womb’’ of a totally nurtural hospital.
    • Here they can comfortably regress to a childlike dependency, to a limpetlike attachment to whoever supplies their needs for protection and nurture.
  • histrionic-theatrical styles
    • Their lifelong pattern of soliciting attention and approval reemerges periodically in displays ofmanic and irrational conviviality, often accompanied by garish clothes and ludicrous makeup.
    • During these brief but wild flights into euphoria, there is a gushing forth of frenetic conversation and a latching on to any and all passersby in a frantic effort to rekindle the human warmth they so desperately need.
    • But these bizarre and maniclike episodes usually are short lived, and the patient succumbs oncemore to a less agitated and more dolorous and downcast state
  • negativist-abrasive styles
    • Thewoebegone look has an air of tension; behaviors are more rigid and stereotyped and all sorts of mannerisms and grimaces may be displayed. On rare occasions, they may exhibit explosive outbursts of rage directed at unseen persecutors; at other times, they may assault themselves viciously. Many remain mute and unresponsive for long periods.
    • 다른 subtype에 비해 인지적 왜곡이 더 체계적으로 조직화된 양상
    • Most times, however, these patients are subdued and downcast, complaining in a quiet, almost unfeeling and automatic manner, as if by sheer habit alone.
    • Their sour pessimism, although now dissipated, still colors their attitudes and behaviors, making relationships with fellow patients and hospital workers difficult to sustain.
• Psychotic disorders and decompensated personality patterns share a common level of pathological severity; both lack reality awareness and emotional and cognitive control. The principaldistinction between them is the pervasiveness and relative permanence of these impairments among the decompensated personalities.

Discouraged Cyclophrenic Personality Disorder

• Discouraged cyclophrenics typically have been pliant and submissive individuals who shun competition, are lacking in initiative, and are frequently, chronically sad or depressed.
• These patients may have put all their eggs in one basket, a specific loved one towhomthey are excessively attached. But this attachment has not proved secure; their lifeline is connected to an unreliable anchor and their psychic equilibrium hangs on a thin thread and is in constant jeopardy.
• As can be expected from the preceding, the features just outlined demonstrate traits likely to be seen in mixed clinical pictures composed of deteriorated dependent and avoidant and structurally defective borderline personalities.
• Sometimes at the borderline level of disintegration they may try to reverse their habitual strategy and seek actively to solicit attention and security.
• Others may disown their submissive and acquiescent past and display explosive fury, brief outbursts of angry resentment...
• Some discouraged cyclophrenics appear to be extreme variants of the pathological compulsive and melancholic personalities.
• However, these personalities are less certain than their less disturbed counterparts that theywill receive support for compliant behaviors.
  • Try as they may, they no longer have confidence that diligence and acquiescence will forestall desertion, and that they will not be left adrift, alone, and abandoned evenwhen they submit and conform.

schizophrenics와의 차이점은 아무래도 양가성에 기인하는 감정적 부침이라는 점이 잘 이해가 되고요. 또한 schizophrenics와 달리 다른 사람과의 관계에 대한 갈망이 크고, 이러한 점은 borderline에서 cyclophrenic으로 발전하지 않을 수 있게 하는 브레이크 역할을 하기도 한다는 부분이 기억에 남아요.

 

cyclophrenic으로 발전했다 하더라도 하위 유형 세 가지 모두 다른 사람에게 상당한 역전이를 야기하게 되는 것 같고, 관계에 대한 borderline의 갈망이 구조적 결함이 심해진 이후에도 지속됨을 배웠습니다.

 

같은 cyclophrenic이라 하더라도 병전 성격에 따라 차이를 두어야 함을 강조하는 부분도 이번 챕터에서 중요했던 것 같아요.