本篇翻译：CL 校对：Salvador 排版：酱紫
根据 《精神障碍诊断与统计手册》（DSM5）中边缘型人格障碍的条目，BPD的估计平均患病率在1.6%到5.9%之间。病情在青年时期最为严重，之后会随时间衰减，进入三四十岁后在人际关系和职业功能方面都会变得更加稳定。参加治疗性干预的患者多在第一年内就得到改善，接下来的随访显示就医10年之后，半数患者不再有符合BPD的诊断标准的行为模式。
由杰洛德·克雷斯曼（Jerold Kreisman）和哈尔·斯特劳斯(Hal Straus)共同执笔，介绍边缘型人格障碍（BPD）的畅销书《我讨厌你，别离开我！()》中译《边缘型人格障碍》，群言出版社)广为人知。关于边缘型人格障碍，这本书向患者和医疗人士提供了远超诊疗标准的解读。
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.
这次Psych2go有幸能采访到克雷斯曼先生来解答有关BPD的各方面问题。希望你也能从中收获需要的答案。
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，感谢您接受我们的采访。您和您的合作者哈尔·斯特劳斯共同执笔的作品《我讨厌你，别离开我！》在患者和医疗人士中广受好评。您当初为何想要成为BPD方面的专家呢？
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): 在我学习的阶段，BPD才刚刚被分类并定义下来。我的很多同行都认为这些病人很麻烦，并敬而远之。而我发现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.
《我讨厌你，别离开我！(I hate you, don't leave me) 》中译《边缘型人格障》
P: BPD是受到过最多科学性研究的人格障碍。虽然很多部分已经被研究透彻，但是依然存有很多让人困惑的部分。有没有哪个问题是还没有被研究透彻的？
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:我们依然在研究这个疾病的先天/后天因素。我认为在接下来的10年里，应该能发现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：想获取这方面更多信息，请阅读克雷斯曼博士在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)
“长期研究显示大部分患者的病情会随时间好转”
“Long-term studies demonstrate that over time the vast majority of patients get better”
P: 很多心理医生纠结于该不该向BPD患者吐露实情。当你告诉一个患者他患有BPD时，他会有怎样的反应？当患者第一次被告知患有BPD时，有没有什么建设性的方法来应对他将遇到的冲击？
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:很多专家建议直接向患者实话实说。但我更倾向于考虑周全，对不同的患者采取不同的方案。对于部分患者来说，对于自己现状，是知道的越多越好。但是对于很多患者来说，BPD是个令人沮丧的标签，或是一个将不合理行为合理化的免罪金牌，使病人失去改变自身的动机。
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患者可能会觉得自己的病永远不会好。你能解释下BPD的长期预后和心理治疗后的预期效果吗？
P2g: BPD patients might feel that they will never get better. Could you explain the lifetime prognosis and prognosis during psychotherapy?
克：BPD的长期研究表明，绝大部分患者都会好转。其中的大部分将好转到无法被BPD确诊标准认定的程度。
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乱且充满冲突的。患者从配偶和亲属那里真正需要的是什么？
P2g: Families of BPD patients often are chaotic and have many conflicts. What does a BPD patient really need from partners and relatives?
克: 理解与忍让。在矛盾中保持耐心与支持。目前我在写一本新书（明年上市），内容上会在已经出版的两本书中提出的范例做进一步扩展。
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坏性冲动？
P2g: What can patients do to take control over their destructive impulses?
克: 认识到触发自己破坏性冲动的导火索。找些别的事干，比如运动，冥想，等等。
J: Recognize triggers that lead to destructive impulsivity.Find alternatives, such as exercise, meditating, etc.
P: 慢性自杀想法的BPD患者可以如何自我救赎？
P2g: How can a BPD patient suffering from a long-term wish to commit suicide work through this chronic suicidality?
克: 自杀想法是患者对自身病情的逃避而非解决，试图以“治疗之路困苦艰辛，不如就此撒手人寰”的悲鸣来伸张自己回避治疗的想法的正当性。心理治疗或是药物治疗可以帮助患者减退自杀的念头。一段时间以后，自杀想法就会随风消逝。
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）是一种什么样的感受？患者如何才能意识到自己分裂的状态？如何才能让患者接受“灰色地带”而不是只有非黑即白的想法？
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: 分裂是对同一件事或同一个人持有极端相反的两种看法。对于普通人来说，从孩童时期“好人和坏人”故事中宣扬的非黑即白的观念中脱胎，接受“正面事物带会有瑕疵”这种观念也并非易事。而BPD患者在这方面更花时间。
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患者对他人非常敏感且极富同情心”
“Many individuals with BPD are extremely sensitive and empathetic to others.”
P: BPD患者常常是众多精神疾患患者中最慈悲为怀，关爱他人和富有同情心的。患者该如何运用这些特点来改善自身？他们该如何将自己的敏感性运用于人际交流中？
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患者十分敏感并富有同情心。而过度的敏感可能导致对他人的误读。重要的是要训练出一定的心理强度，并能够通过确认或者否定这个情绪信息来甄别它们。
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: 《有时疯狂(Sometimes I act Crazy)》，暂译《有时疯狂：与边缘型人格障碍共处》，找了下似乎暂无中译本) 是一本讲述BPD患者日常生活中的种种困难并给与各种建议的书。您还有别的书推荐吗？
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: 在过去的20年中，确实涌现了有很多面向患者或是患者身边的人的书。我觉得哪本书对自己有帮助，是因人而异的。我建议大家多瞄几本然后从中选出自己感触最深的。
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.
《有时疯狂(Sometimes I act Crazy)》
P: BPD这个话题很广。您觉
得还有没有哪些我没有问到的点？
P2g: The topic of BPD is wide. However, is there anything you wish I had asked?
克: 我非常欣赏你在问题中所表现出的对BPD的理解。再问更多问题的话我就需要再多写一本书了！
J: I appreciate your understanding of BPD that is reflected in your questions.Responding to more questions would require a separate book!
P: 感谢您。 (采访者 Laura, Psych2go)
Thank you so much for your time!
Kind regards, Laura (Psych2go)
以上是psych2go对克雷斯曼博士的采访。
简而言之，是可以治好的。
Don’t worry, be happy!
Never give up!
