十種人格障礙

According to DSM-5, a personality disorder can be diagnosed if there are significant impairments in self and interpersonal functioning together with one or more pathological personality traits. In addition, these features must be (1) relatively stable across time and consistent across situations, (2) not better understood as normative for the individual’s developmental stage or socio-cultural environment, and (3) not solely due to the direct effects of a substance or general medical condition.

根據 DSM-5，如果一種或多種病態人格障礙對個體以及人際關係功能產生顯著損害，那麼就可以診斷為具有某種人格障礙。另外，這些特徵必須：

（1）在時間和空間上相對穩定、一致，

（2）客觀上不符合該個體的發育階段或社會文化環境的標準和規範，

（3）並非僅因某種物質或生理疾病的直接影響而導致。

The DSM-5 lists 10 personality disordersand allocates each to one of three groups or "clusters": A, B, or C.

DSM-5列出了10種人格障礙，並將其歸納為三組：A、B、C

Cluster A(Odd, bizarre, eccentric)/A組（離奇古怪，不合常規）

· Paranoid PD/妄想型人格障礙

· Schizoid PD/類精神分裂人格障礙

· Schizotypal PD/精神分裂型人格障礙

Cluster B(Dramatic, erratic)/B組（戲劇化、行為乖張）

· Antisocial PD/反社會人格障礙

· Borderline PD/邊緣型人格障礙

· Histrionic PD/表演型人格障礙

· NarcissisticPD/自戀型人格障礙

Cluster C(Anxious, fearful)/C組（焦慮、恐懼）

· Avoidant PD/逃避型人格障礙

· Dependent PD/依賴型人格障礙

· Obsessive-compulsivePD/強迫性人格障礙

Before going on to characterize these 10 personality disorders, it should be emphasized that they are more the product of historical observation than of scientific study, and thus that they are rather vague and imprecise constructs. As a result, they rarely present in their classic "textbook"form, but instead tend to blur into one another. Their division into three clusters in DSM-5 is intended to reflect this tendency, with any given personality disorder most likely to blur with other personality disorders within its cluster. For instance, in cluster A,paranoid personalityis most likely to blur with schizoid personality disorder andschizotypal personality disorder.

在詳述這10種人格障礙之前，應先強調，他們更多是基於歷史觀察，而非科學研究，因此它們的結構相當模糊、不精確。所以實際生活中，人們很少嚴絲合縫完全符合其官方描述症狀，它們通常界限模糊。DSM-5手冊將其歸類為3組，目的是為了反映出這一傾向，因為任何一種人格障礙都極可能帶有同組其他人格障礙的一些特徵。例如，在A組中，妄想型人格障礙極可能也帶有類精神分裂型以及精神分裂型人格障礙的特徵。

1. Paranoid personality disorder

妄想型人格障礙

Cluster A is comprised ofparanoid, schizoid, and schizotypal personality disorders.Paranoid personality disorderis characterized by a pervasive distrust of others, including even friends, family, and partners. As a result, thisperson is guarded,suspicious, and constantly on the lookout for clues or suggestions to validate his fears. He also has a strong sense of personal rights: He is overly sensitive to setbacks and rebuffs, easily feels shame andhumiliation, and persistently bears grudges. Unsurprisingly, he tends to withdraw from others and to struggle with building close relationships. The principal ego defense in paranoid PD isprojection, which involves attributing one’s unacceptable thoughts and feelings to other people. A large, long-term twin study found that paranoid PD is modestly heritable, and that it shares a portion of its genetic and environmental risk factors with schizoid PD and schizotypal PD.

A組人格障礙包括：妄想型、類精神分裂型和精神分裂型。

妄想型人格障礙的特徵為：對他人普遍不信任，這其中甚至包括對朋友、家人和愛人。因此，這類人防禦心極強，多疑，而且總是不斷在尋找各種線索或跡象來證明其所擔憂恐懼之事。他們通常還具有強烈的個人權利感：對挫折和反駁過度敏感，很容易感到羞恥和受辱，而且一直記仇。因此，自然而然，他們會遠離他人，並難以建立親密關係。妄想型人格障礙的主要防禦機制是“投射”，即，將一個人自己不可接受的想法和感受投射到其他人身上。一項大規模長期雙胞胎研究發現，妄想型人格障礙具有一定的遺傳性，而在其遺傳與環境風險因素中，有一部分是與類精神分裂型以及精神分裂型人格障礙共有的。

類精神分裂型人格障礙

The term "schizoid"designates a natural tendency to directattentiontoward one’s inner life and away from the external world. A person with schizoid PD is detached and aloof and prone to introspection andfantasy. He has no desire for social or sexual relationships, is indifferent to others and to social norms and conventions, and lacksemotional response. A competing theory about people with schizoid PD is that they are in fact highly sensitive with a rich inner life: They experience a deep longing for intimacy, but find initiating and maintaining close relationships too difficult or distressing, and so retreat into their inner world. People with schizoid PD rarely present to medical attention, because despite their reluctance to form close relationships, they are generally well functioningand quite untroubled by their apparent oddness.

“類精神分裂”是指將注意力集中於個人內部世界，而非外部世界。該類人群性情冷漠孤僻，而且易於自我審視和幻想。他們對社交關係或性關係無慾望。對他人、社會規範和傳統等，毫不在乎，而且缺乏情緒回應。而對於類精神分裂型人群，另一種不同的理論則認為，他們實際上高度敏感，而且內在生活豐富：他們對親密感有著深切的渴望，但又覺得建立並維護親密關係太難，或者太令人煩惱，因此他們撤回自己內心世界。此類型人群極少就醫，因為儘管他們不願意建立親密關係，他們通常行為正常，而且他們明顯的怪異行為也並沒有給他們自身帶來困擾。

內向無罪——內向、害羞、社交焦慮，三者有何區別？

3. Schizotypal disorder

精神分裂型人格障礙

Schizotypal PD is characterized by oddities of appearance, behavior, and speech, unusual perceptual experiences, and anomalies of thinking similar to those seen inschizophrenia. These latter can include odd beliefs,magical thinking(for instance, thinking that speaking of the devil can make him appear), suspiciousness, and obsessive ruminations. People with schizotypal PD oftenfearsocial interaction and think of others as harmful. This may lead them to develop so-called ideas of reference —that is,beliefs or intuitions that events and happenings are somehow related to them. So whereas people with schizotypal PD and people with schizoid PD both avoid social interaction, with the former it is because they fear others, whereas with the latter it is because they have no desire to interact with others or find interacting with others too difficult. People with schizotypal PD have a higher than average probability of developing schizophrenia, and the condition used to be called "latent schizophrenia."

精神分裂型人格障礙以類似於精神分裂症症狀的怪異外表、行為和言語，不正常的認知體驗以及思維的異常為特徵。這其中思維異常包括：怪異的理念、神奇思維（例如，覺得提到魔鬼，就能讓魔鬼出現）、猜疑、強迫性窮思竭慮等。此類型人格障礙人群通常懼怕社交互動，並認為他人對自己有害。這可能會導致他們形成所謂的“牽連觀念”——即，認為或直覺上感覺所有事件都與他們有關。因此，儘管精神分裂型與類精神分裂型人群均避免社交互動，前者是因為他們懼怕他人，而後者則是因為他們沒有與他人互動的慾望，或是發現與他人互動很難。精神分裂型人格障礙人群患精神分裂症的可能性要高於均值，而且該病症曾被稱為“潛伏精神分裂症。”

*牽連觀念和牽連錯覺，是指一個個體在經歷無害或巧合事件時，認為它們與自己有極強烈關聯。“認為自己所看到的這個世界上的一切都與自己命運有關”，而且通常是做出負面和有敵意的解讀。

*強迫性窮思竭慮（Obsessive rumination），顧名思義，患者的痛苦來自自身的內心思維，這些思維反覆出現，難以自拔，這些思維的內容往往令人不快或並沒有什麼實際意義，患者本身對此很清楚，並試圖作出抵制(並非都是如此)，但往往是徒勞的。

4.Antisocial personalitydisorder

反社會人格障礙

Cluster B is comprised of antisocial, borderline, histrionic, and narcissistic personality disorders.Until psychiatrist Kurt Schneider (1887-1967) broadened the concept of personality disorder to include those who "suffer fromtheir abnormality," personality disorder was more or less synonymous with antisocial personality disorder. Antisocial PD is much more common in men than in womenand is characterized by a callous unconcern for the feelings of others. The person disregards social rules and obligations, is irritable and aggressive, acts impulsively, lacksguilt, and fails to learn from experience. In many cases, he has no difficulty finding relationships — and can even appear superficially charming (the so-called "charming psychopath") — but these relationships are usually fiery, turbulent, and short-lived. As antisocial PD is the mental disorder most closely correlated with crime, he is likely to have a criminal record or a history of being in and out of prison.

B組包含反社會、邊緣、表演型和自戀型人格障礙。

在精神病症學家 Kurt Schneider 擴展人格障礙概念，納入“因自身異常而受到折磨的人群”之前，人格障礙一詞幾乎是與反社會人格障礙等同的。反社會人格障礙在男性中更多見，特徵是：對他人感受麻木冷漠。這類人群無視社會準則和義務、易怒、具有攻擊性、行為衝動、缺乏內疚感、且無法吸取經驗教訓。在很多情形下，他們在建立感情關係方面並不困難，而且甚至可能還會看起來非常有魅力（所謂的“富有魅力的精神病態者”）——但這些感情關係通常如烈火湍流，而且並不長久。由於反社會人格障礙是與犯罪最密切相關的一種精神障礙，該類患者很可能有犯罪記錄或入獄記錄。

5.Borderline personality disorder

In borderline PD (or emotionally unstable PD), the person essentially lacks a sense of selfand, as a result, experiences feelings of emptiness and fears of abandonment. There is a pattern of intense but unstable relationships, emotional instability, outbursts ofangerand violence (especially in response to criticism), and impulsive behavior.Suicidalthreats and acts ofself-harmare common, for which reason many people with borderline PD frequently come to medical attention. Borderline PD was so called, because it was thought to lie on the "borderline"betweenneurotic(anxiety) disorders andpsychoticdisorders, such as schizophrenia andbipolar disorder.It has been suggested that borderline personality disorder often results fromchildhoodsexual abuse, and that it is more common in women, in part because women are more likely to suffer sexual abuse. However, feminists have argued that borderline PD is more common in women, because women presenting with angry and promiscuous behavior tend to be labeled with it, whereas men presenting with similar behaviour tend instead to be labeled with antisocial PD.

在邊緣型人格障礙（或情緒不穩定人格障礙）中，該類人群從根本上缺乏一種自我意識，從而會產生空虛感，並害怕被拋棄。常表現為強烈但不穩定的感情關係、情緒不穩定性、爆發型憤怒和暴力（尤其在受到批評時）、以及衝動行為。自殺威脅以及自我傷害行為也常見，這也是很多邊緣型人格障礙人群就醫的原因所在。

之所以被稱為邊緣型人格障礙，是因為它被視為處於神經（焦慮）障礙和精神障礙（諸如精神分裂症和雙相情感障礙/躁鬱症）的交界處。有人稱邊緣型人格障礙常常源於童年時期的性虐待，而且在女性中更常見，部分是因為女性更易於受到性虐待的傷害。但女權者們卻認為，邊緣型人格障礙之所以更多見於女性，是因為易怒且性關係混亂的女性通常會被被歸屬於該人格障礙範疇內，而表現出同樣行為的男性則常被歸屬於反社會人格障礙範疇內。

邊緣型人格障礙（Borderline Personality Disorder）

6.Histrionic personality disorder

表演型人格障礙

People with histrionic PD lack a sense ofself-worthand depend on attracting the attention and approval of others for their wellbeing. They often seem to be dramatizing or "playing a part"in a bid to be heard and seen. Indeed, "histrionic"derives from theLatinhistrionicus, "pertaining to the actor." People with histrionic PD may take great care of their appearance and behave in a manner that is overly charming or inappropriately seductive. As they crave excitement and act on impulse or suggestion, they can place themselves at risk of accident or exploitation. Their dealings with others often seem insincere or superficial, whichin the longer termcan adversely impacttheir social andromantic relationships. This is especially distressing to them, as they are sensitive to criticism and rejectionand react badly to loss or failure. A vicious circle may take hold in which the more rejected they feel, the more histrionic they become —and the more histrionic they become, the more rejected they feel. It can be argued that a vicious circle of some kind is at the heart of every personality disorderand, indeed, every mental disorder.

表演型人格障礙人群缺乏自我價值感，將自身快樂維繫在吸引注意力、獲得別人認可上。他們通常會採用戲劇化行為或“表演某個角色”的行為，試圖讓自己吸引別人目光和注意力。“表演型”的英文 Histrionic 源於拉丁語 histrionicus，意為“與演員有關的”。表演型人格障礙人群可能會極度呵護自己的外表，而且舉止之間或是過於迷人，或是表現出不妥的引誘行為。由於他們渴望興奮，並且會因衝動或別人暗示而行事，他們可能會有遭遇事故或被剝削利用的風險。

他們與別人之間的交往通常看起來虛情假意或流於表面，長此以往，會對他們的社交和感情關係帶來負面危害。這對他們是非常痛苦的，因為他們對批評和拒絕很敏感，而且不擅應對損失或失敗。這樣就可能形成一種惡性循環：他們越受到拒絕，他們就越“表演”；他們越表演，他們就感到自己越受到拒絕。也可以說，在每種人格障礙，以及，每種精神障礙的中心，都存在著某種類型的惡性循環。

“戲精”的專業解讀——表演型人格障礙

7.Narcissistic personality disorder

自戀型人格障礙

In narcissistic PD, the person has an extreme feeling of self-importance, a sense of entitlement, and a need to be admired. He isenviousof others and expects them to be the same of him. He lacksempathyand readily lies andexploits othersto achieve his aims. To others, he may seem self-absorbed, controlling, intolerant, selfish, or insensitive. If he feels obstructed or ridiculed, he can fly into a fit of destructive anger andrevenge. Such a reaction is sometimes called "narcissistic rage"and can have disastrous consequences for all those involved.

自戀型人格障礙人群認為自己極度重要、有一種特權感，而且需要被崇拜仰慕。他們嫉妒他人，並覺得別人也會嫉妒他們。他們缺乏同理心，而且隨時隨地會通過撒謊或利用他人的方式實現個人目的。在他人看來，自戀型人群可能看起來以自我為中心、具有控制慾、不寬容、自私或麻木。如果他們感到受到阻礙或被嘲笑，他們可能會爆發出一陣具有破壞性的憤怒和復仇行為。這種反應有時也被稱為“自戀者之怒”，對所有相關者都可能會帶來災難性的後果。

自戀型母親以及三種子女類型

三句之內必談“我”的談話自戀者們

8.Avoidant personality disorder

逃避型人格障礙

Cluster C is comprised of avoidant, dependent, and anankastic personality disorders.People with avoidant PD believe that they are socially inept, unappealing, or inferior, and constantly fear being embarrassed, criticized, or rejected. They avoid meeting others unless they are certain of being likedand are restrained even in their intimate relationships. Avoidant PD is strongly associated with anxiety disorders, and may also be associated with actual or felt rejection by parents or peers in childhood. Research suggests that people with avoidant PD excessively monitor internal reactions, both their own and those of others, which prevents them from engaging naturally or fluently in social situations. A vicious circle takes hold in which the more they monitor their internal reactions, the more inept they feel; and the more inept they feel, the more they monitor their internal reactions.

C組包含逃避型、依賴性以及強迫性人格障礙。

逃避型人格障礙人群認為他們不善交際、毫無魅力或低人一等，而且一直恐懼被置於尷尬境地、被批評或被拒絕。他們會逃避與他人見面，除非他們確信對方會喜歡他們，他們即使在親密關係中也拘謹剋制。該類型人格障礙與焦慮障礙密切相關，而且可能也與童年時期被父母或同伴拒絕（無論是真實發生或只是感到被拒絕）相關。研究顯示，該類型人群會過度監測自己和他人的內在反應，這就讓他們無法自然流暢地參與社交互動。這樣就會形成一種惡性循環：他們越密切監控內在反應，他們就感到自己越不善交際，他們越感到自己不善交際，就越進一步監控彼此內在反應。

9.Dependent personality disorder

依賴型人格障礙

Dependent PD is characterized by a lack ofself-confidenceand an excessive need to be looked after. Thisperson needs a lot of help in making everyday decisions and surrenders important life decisions to the care of others. He greatly fears abandonment and may go through considerable lengths to secure and maintain relationships. A person with dependent PD sees himself as inadequate and helpless, and so surrenders his personal responsibility and submits himself to one or more protective others. He imagines that he is at one with these protective other(s), whom he idealizes as competent and powerful, and towards whom he behaves in a manner that is ingratiating and self-effacing. People with dependent PD often end up with people with a cluster B personality disorder, who feed on the unconditional high regard in which they are held. Overall, people with dependent PD maintain a naïve and child-like perspectiveand have limited insight into themselves and others. This entrenches their dependency, leaving them vulnerable to abuse and exploitation.

依賴型人格障礙的特徵是：缺乏自信、過度需要被照顧。該類人群在日常決策制定中需要大量幫助，而且將重大人生決策付諸他人手中。他們深深恐懼被拋棄，而且可能會想方設法千方百計維護感情關係。該類人群認為自己不夠好、且無助，因此將個人責任以及其自身完全交付於一位或多位保護者手中。他們感覺自己與“保護者”之間如若一體，他們理想化地認為對方非常強大，而且對對方逢迎討好且謙卑恭順。依賴型人格障礙人群通常會於B組人格障礙人群在一起，B組人格障礙人群很享受這種無條件的愛戴崇敬。整體而言，依賴型人格障礙看待事物的視角天真幼稚，且對自己和他人理解有限。這強化了他們的依賴性，並讓他們易於受到不公平對待和剝削利用。

10. Anankastic (obsessive-compulsive) personality disorder

強迫性人格障礙

Anankastic PD is characterized by an excessive preoccupation with details, rules, lists, order, organization, or schedules;perfectionismso extreme that it prevents a task from being completed; and devotion to work andproductivityat the expense of leisure and relationships. A person with anankastic PD is typically doubting and cautious, rigid and controlling, humorless, and miserly. His underlying anxiety arises from a perceived lack of control over a world that eludes his understanding,and the more he tries to exert control, the more out of control he feels. As aconsequence, he has little tolerance for complexity or nuance, and tends to simplify the world by seeing things as either all good or all bad. His relationships with colleagues, friends, and family are often strained by the unreasonable and inflexible demands that he makes upon them.

強迫性人格障礙的特徵是：對細節、規則、清單、順序、組織或安排過度糾結；極度的完美主義，以至於阻礙了任務的完成；對工作和效率過度投入，以至於影響到休閒時間和感情關係。

該類人群通常會充滿懷疑、謹慎警戒、死板且有控制慾、無幽默感而且吝嗇。他們底層的焦慮來源於他們發現自己對超出他們理解範圍之外的世界缺乏控制力，而且，他們越試圖去加以控制，就越感到難以控制。因此，他們難以忍受複雜性或細微差別，易於通過非好即壞的視角來簡化世界。他們與同事、朋友和家人之間的關係通常因他們不可理喻、不可變通的苛求而處於緊繃狀態。

Closing remarks

結語

While personality disorders may differ from mental disorders, like schizophrenia and bipolar disorder, they do, by definition, lead to significant impairment. They are estimated to affect about 10 percent of people, although this figure ultimately depends on where clinicians draw the line between a "normal"personality and one that leads to significant impairment. Characterizing the 10 personality disorders is difficult, but diagnosing them reliably is even more so. For instance, how far from the norm must personality traits deviate before they can be counted as disordered? How significant is "significant impairment"? And how is "impairment"to be defined?

儘管人格障礙可能與精神分裂症或雙相情感障礙等精神障礙不同，按照官方定義，他們的確也會導致巨大危害。據估計，有約10%的人存在人格障礙，儘管該數值最終取決於臨床醫生如何界定正常人格以及帶來顯著危害人格之間的界限。界定出這10項人格障礙的特徵，已屬不易，但正確診斷它們，更加困難。例如，性格特徵要多麼偏離常規，才算是“障礙”？“顯著危害”怎麼量化？“危害”又該如何定義？

Whatever the answers to these questions, they are bound to include a large part of subjectivity. Personal dislike,prejudice, or a clash of values can all play a part in arriving at a diagnosis of personality disorder, and it has been argued that the diagnosis amounts to little more than a convenient label for undesirables and social deviants.

無論對上述問題的答案是什麼，它們都難以避免地包含很大的主觀性。個人喜好、偏見以及價值觀衝突等都可能會對人格障礙診斷結果產生影響，而且有人稱，這些診斷結果不過是為方便起見，對一些不受喜歡的行為以及離經叛道者貼上的標籤而已。