[48주차] Disorders of Personality: 19. Unstable Styles, Borderline Types, Cyclophrenic Disorders: The UBC Spectrum(pp. 927-932)

Self-Destructive Cyclophrenic Personality Disorder

• In a manner similar to the petulant borderline, self-destructive subtypes are unable to ‘‘get hold of themselves’’ and unable to find a comfortable niche with others.
• 차이점은 보다 intropunitive하다는 것. depressive or masochistic traits을 지닐 수 있음.
• This social propriety cloaked deep and increasingly intense, but suppressed antagonisms. To control these oppositional tendencies, there was a struggle to maintain a self-restraint and a self-sacrificial affability. <- Discouraged와의 차이를 잘 모르겠음
• They may have become high-strung and moody, straining to express attitudes contrary to their inner feelings of tension, anger, and dejection. To avoid these discomforts, they may have become overly sensitive to the moods and expectations of others.
• Although viewing themselves as self-sacrificial and submissive, the extreme other-directedness utilized in the service of achieving approval has resulted in an increasingly unstable lifestyle. <-- petulant borderline과 유사하다고 하면서 극도로 타인지향적이라 하니 개념의 혼란이 옴.
• growing sense of personal impotence and social dependency.
• resentments toward those to whom they have sacrificed themselves begin to emerge.
• 극도로 분노하고 다시 죄책감 느끼며 순종하고 우울한 negativism에 빠짐. 2-4 code 같은 느낌.
• 보여주고자 하는 자기이미지와 실제로 보여진 모습 간의 불일치가 커짐. 또한 근면이나 순종에 대한 인정을 받지 못할 뿐만 아니라 부당하게 대우받은 데 대한 쓰라린 양가감정이 지속되며 신체적 증상으로 발현되기 쉬움.
• 여기서도 감정이 내면으로 향하면서 self-destructive해짐. 자살시도의 가능성이 언제나 존재함.

Co-Morbid Disorders and Syndromes

Axis II Co-Morbidities

• Most notably, the borderline level overlaps to a considerable extent with the negativistic (DRN) and masochistic (AAM) spectrum types. To a lesser degree, and reflecting the more impulsive and hostile features of certain borderlines, we see conjunctions with the antisocial (ADA), sadistic (ADS), and histrionic (SPH) disorders. Signifying the more introversive and intropunitive characteristics of certain UBC types is their tendency to be associated with the melancholic (DFM), avoidant (SRA), and schizotypal (ESS) spectrum personality disorders, the latter overlap also reflecting their common level of structural defect.
• Anxiety Syndromes(ANX)
  • generalized anxiety
  • panic disorder -> brief psychotic disorder
• Somatoform Syndromes(SOM)
  • Overdetermined, they reflect a compromise solution that blends several emotions and coping aims. Thus, a paralyzed arm may not only control an angry impulse but also may attract social sympathy, as well as discharge the patient’s self-punitive and guilt feelings.
• Dissociative Syndromes(DIS)
  • psychogenic fugue: Repressed resentments occasionally take this form and erupt into the open when these patients have felt trapped and confused or betrayed.
  • brutalize themselves
  • more prolonged psychotic disorder로 발전할 여지 있음
• Mood Syndromes(MOOD)
  • A major form of anger control is to turn feelings of resentment inward into hypochondriacal disorders and mild depressive episodes.
  • 자기 경멸과 thinly veiled suicidal threats: 환자가 지닌 분노의 표출인 동시에(다른 사람이 죄책감 느끼게 하고 다른 사람의 분노를 유발하기도 하지만) 다른 사람의 용서와 위로를 바라는 마음이 있음.
    • 용서를 구하고 구원을 얻기 위해 마음 속의 contrary impulses(타인에 대한 resentment and anger)를 숨기고 그것을 자신에게 분출함.
  • As evident from the preceding, UBCs succumb frequently to major depressions. In the more retarded form of depression, they gain some measure of control over their inner conflicts and hostile impulses.
  • 불안과 긴장이 커지면서 다른 사람의 도움으로도 진정이 안 되고, hostile depressive complaints and a demanding and querulous irritability를 보이는 때가 있음
  • UBCs are especially prone, however, to agitated depressions.
    • Their habitual style of acting out their conflicts and ambivalent feelings becomes more pronounced at these times and results in vacillations between bitterness and resentment, on the one hand, and intropunitive self-deprecation, on the other.
  • 일부 UBCs의 경우 양극성 장애나 분열정동 장애와 비슷할 수 있으나, 두 장애 중 어느 경우든지 간에 심각도의 정도에 따라 사고/정동의 와해 정도가 다르게 나타남
• Schizophrenic Clinical Syndromes(SCH)
  • Without external support and lacking a core of inner competence, UBCs may disintegrate into what has been labeled a schizoaffective disorder.
• Substance Use Syndromes(SUB)
  • but appears to signify the patient’s desire to experience varied forms of reality and an effort to search for an identity that may give structure to divergent impulses and confusions. Hence, UBCs are inclined to be abusers of many different substances, including alcohol, cocaine, speed, and crack.