本篇翻譯：CL 校對：Salvador 排版：醬紫
根據 《精神障礙診斷與統計手冊》（DSM5）中邊緣型人格障礙的條目，BPD的估計平均患病率在1.6%到5.9%之間。病情在青年時期最為嚴重，之後會隨時間衰減，進入三四十歲後在人際關係和職業功能方面都會變得更加穩定。參加治療性干預的患者多在第一年內就得到改善，接下來的隨訪顯示就醫10年之後，半數患者不再有符合BPD的診斷標準的行為模式。
由傑洛德·克雷斯曼（Jerold Kreisman）和哈爾·斯特勞斯(Hal Straus)共同執筆，介紹邊緣型人格障礙（BPD）的暢銷書《我討厭你，別離開我！()》中譯《邊緣型人格障礙》，群言出版社)廣為人知。關於邊緣型人格障礙，這本書向患者和醫療人士提供了遠超診療標準的解讀。
The book “I hate you, don’t leave me” is a widely known bestseller about Borderline Personality Disorder written by Jerold Kreisman and Hal Straus. It is a book that is written for both mental health professionals and patients and provides an understanding of this difficult disorder that by far exceeds the clinical diagnostic criteria.
這次Psych2go有幸能採訪到克雷斯曼先生來解答有關BPD的各方面問題。希望你也能從中收穫需要的答案。
Mr. Kreisman kindly agreed to give Psych2go an interview about some questions regarding complicated details about BPD. Hopefully, you can find some answers that help you.
Psych2go(P):克雷斯曼博士，感謝您接受我們的採訪。您和您的合作者哈爾·斯特勞斯共同執筆的作品《我討厭你，別離開我！》在患者和醫療人士中廣受好評。您當初為何想要成為BPD方面的專家呢？
Psych2go(P2g): Dr. Kreisman, thank you so much for agreeing to do this interview with us. Your book “I hate you, don’t leave me”, that you wrote together with your colleague Hal Straus, is widely known among therapists and patients. Why did you choose to become an expert for Borderline Personality Disorder (BPD)?
克雷斯曼(克): 在我學習的階段，BPD才剛剛被分類並定義下來。我的很多同行都認為這些病人很麻煩，並敬而遠之。而我發現很多患者非常有趣且勇敢。
Jerry (J): During my training, the diagnosis was just being understood and defined.Many of my colleagues recognized these patients to be troublesome and avoided them.I found many of them to be intriguing and brave.
《我討厭你，別離開我！(I hate you, don't leave me) 》中譯《邊緣型人格障》
P: BPD是受到過最多科學性研究的人格障礙。雖然很多部分已經被研究透徹，但是依然存有很多讓人困惑的部分。有沒有哪個問題是還沒有被研究透徹的？
P2g: BPD is the most scientifically researched personality disorder. Much is known and yet, a lot is still confusing. Is there a question that has not been answered yet by research?
克:我們依然在研究這個疾病的先天/後天因素。我認為在接下來的10年裡，應該能發現更多基因上和生物上的病因。
J: We are still trying to figure the nature/nurture configuration.I believe the next decades will uncover more genetic and biological information.
(注：想獲取這方面更多信息，請閱讀克雷斯曼博士在Psychology Today上的文章: https://www.psychologytoday.com/blog/i-hate-you-dont-leave-me/201408/nature-and-nurture-and-bpd)
https://www.psychologytoday.com/blog/i-hate-you-dont-leave-me/201408/nature-and-nurture-and-bpd)
“長期研究顯示大部分患者的病情會隨時間好轉”
“Long-term studies demonstrate that over time the vast majority of patients get better”
P: 很多心理醫生糾結於該不該向BPD患者吐露實情。當你告訴一個患者他患有BPD時，他會有怎樣的反應？當患者第一次被告知患有BPD時，有沒有什麼建設性的方法來應對他將遇到的衝擊？
P2g: Therapists struggle to tell the Borderline patient their actual diagnosis. When you tell a patient, what are the reactions? What is a constructive way of coping with the first time you get this diagnosis?
克:很多專家建議直接向患者實話實說。但我更傾向於考慮周全，對不同的患者採取不同的方案。對於部分患者來說，對於自己現狀，是知道的越多越好。但是對於很多患者來說，BPD是個令人沮喪的標籤，或是一個將不合理行為合理化的免罪金牌，使病人失去改變自身的動機。
J: Many experts recommend telling patients immediately.I prefer to be more circumspect, depending on the patient.Some benefit from learning as much as they can about their issues.But for many, it becomes a label that is discouraging or a badge that is passively accepted as a rationality for irrational behavior, without motivation to change.
P: BPD患者可能會覺得自己的病永遠不會好。你能解釋下BPD的長期預後和心理治療後的預期效果嗎？
P2g: BPD patients might feel that they will never get better. Could you explain the lifetime prognosis and prognosis during psychotherapy?
克：BPD的長期研究表明，絕大部分患者都會好轉。其中的大部分將好轉到無法被BPD確診標準認定的程度。
J: Long-term studies demonstrate that over time the vast majority of patients get better, most to a point where they no longer exhibit symptoms that would satisfy a formal diagnosis of BPD.
P: BPD患者的家庭常常是混亂且充滿衝突的。患者從配偶和親屬那裡真正需要的是什麼？
P2g: Families of BPD patients often are chaotic and have many conflicts. What does a BPD patient really need from partners and relatives?
克: 理解與忍讓。在矛盾中保持耐心與支持。目前我在寫一本新書（明年上市），內容上會在已經出版的兩本書中提出的範例做進一步擴展。
J: Understanding and Perseverance. Staying patient and supportive during times of conflict.I am currently engaged with a new book (to be published next year) that enlarges on the SET-UP paradigm I describe in the first two books.
P: 患者要如何抑制自己的破壞性衝動？
P2g: What can patients do to take control over their destructive impulses?
克: 認識到觸發自己破壞性衝動的導火索。找些別的事幹，比如運動，冥想，等等。
J: Recognize triggers that lead to destructive impulsivity.Find alternatives, such as exercise, meditating, etc.
P: 慢性自殺想法的BPD患者可以如何自我救贖？
P2g: How can a BPD patient suffering from a long-term wish to commit suicide work through this chronic suicidality?
克: 自殺想法是患者對自身病情的逃避而非解決，試圖以“治療之路困苦艱辛，不如就此撒手人寰”的悲鳴來伸張自己迴避治療的想法的正當性。心理治療或是藥物治療可以幫助患者減退自殺的念頭。一段時間以後，自殺想法就會隨風消逝。
J: Suicidal ideation can serve as a kind of distraction from trying to get better.Instead of trying to work on problems, it is tempting to justify avoiding the work by a kind of, “Oh well, I guess I’ll just kill myself.”Psychotherapy and, sometimes, medication can help motivate.Over time, suicidal thoughts usually subside.
P: 分裂（spliting）是一種什麼樣的感受？患者如何才能意識到自己分裂的狀態？如何才能讓患者接受“灰色地帶”而不是隻有非黑即白的想法？
P2g: In which ways can you experience splitting and how can a patient understand that he or she is splitting? What can a patient do to be able to tolerate “shades of gray”, instead of only black and white?
克: 分裂是對同一件事或同一個人持有極端相反的兩種看法。對於普通人來說，從孩童時期“好人和壞人”故事中宣揚的非黑即白的觀念中脫胎，接受“正面事物帶會有瑕疵”這種觀念也並非易事。而BPD患者在這方面更花時間。
J: Splitting is recognized when the individual can see the extreme contradictory reactions to the same person or situation.Merging the positives with the flaws is a task all adults struggle with when they have evolved past the “good guys-bad-guys” dichotomies of childhood stories.In BPD it may take longer to get there.
“很多BPD患者對他人非常敏感且極富同情心”
“Many individuals with BPD are extremely sensitive and empathetic to others.”
P: BPD患者常常是眾多精神疾患患者中最慈悲為懷，關愛他人和富有同情心的。患者該如何運用這些特點來改善自身？他們該如何將自己的敏感性運用於人際交流中？
P2g: BPD patients are regularly among our most loving, caring and sympathetic patients. How can they use those traits as resources? How can they use their sensitivity for other persons’ emotions to make interactions easier?
克: 很多BPD患者十分敏感並富有同情心。而過度的敏感可能導致對他人的誤讀。重要的是要訓練出一定的心理強度，並能夠通過確認或者否定這個情緒信息來甄別它們。
J: Many individuals with BPD are extremely sensitive and empathetic to others.But this sensitivity can result in misinterpretation.It is important to develop the fortitude to “check out” emotional impressions by confirming or denying these impressions.
P: 《有時瘋狂(Sometimes I act Crazy)》，暫譯《有時瘋狂：與邊緣型人格障礙共處》，找了下似乎暫無中譯本) 是一本講述BPD患者日常生活中的種種困難並給與各種建議的書。您還有別的書推薦嗎？
P2g: “Sometimes I act crazy” is a book looking at the day-to-day-struggles in the lives of BPD-patients and giving practical tips to cope with problems. Is there another book you can recommend?
克: 在過去的20年中，確實湧現了有很多面向患者或是患者身邊的人的書。我覺得哪本書對自己有幫助，是因人而異的。我建議大家多瞄幾本然後從中選出自己感觸最深的。
J: Over the last 20 years, many books have been published by those with BPD or those living with someone with the diagnosis.I think finding what is helpful is a personal choice.I recommend that people look through several books and pick out those that resonate with them.
《有時瘋狂(Sometimes I act Crazy)》
P: BPD這個話題很廣。您覺
得還有沒有哪些我沒有問到的點？
P2g: The topic of BPD is wide. However, is there anything you wish I had asked?
克: 我非常欣賞你在問題中所表現出的對BPD的理解。再問更多問題的話我就需要再多寫一本書了！
J: I appreciate your understanding of BPD that is reflected in your questions.Responding to more questions would require a separate book!
P: 感謝您。 (採訪者 Laura, Psych2go)
Thank you so much for your time!
Kind regards, Laura (Psych2go)
以上是psych2go對克雷斯曼博士的採訪。
簡而言之，是可以治好的。
Don’t worry, be happy!
Never give up!
