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2009 | OriginalPaper | Hoofdstuk

8 Visies op het borderlineconcept: verleden, heden en toekomst

Identiteitsdiffusie of complex geheel?

Auteurs : Jurrijn Koelen, Patrick Luyten, Liesbeth Eurelings-Bontekoe

Gepubliceerd in: Handboek persoonlijkheidspathologie

Uitgeverij: Bohn Stafleu van Loghum

Samenvatting

Volgens Michael Stone (1987) is het ziektebegrip ‘borderline’ vaag en elke poging om het begrip nauwkeuriger te definiëren zou tegen de (linguïstische) natuur van de definitie ingaan en het zelfs als diagnostische categorie uitroeien.

vorige hoofdstuk 7 Categoriale classificatie, epidemiologie en comorbiditeit

volgende hoofdstuk 9 Beschrijvende diagnostiek van DSM-IV-TR-persoonlijkheidsstoornissen

Het zal duidelijk zijn dat dit voor schizoïde en schizotypische borderline patiënten (Stone, 1983) niet of nauwelijks geldt. Patiënten met sterk schizoïde of schizotypische trekken kenmerken zich immers door sociale anhedonie, affectieve vervlakking, teruggetrokkenheid en een voorkeur voor solistische activiteiten.

Belangrijk is hier te vermelden dat we nu het bipolaire type II½ van Akiskal (2004) buiten beschouwing laten. Eveneens laten we nu subklinische vormen van affectieve stoornissen (Akiskal, 1981) onbesproken, wat verhindert dat een mogelijk grotere verwantschap tussen affectieve stoornissen en borderline stoornissen aan het licht kan komen.

Een term ontleend aan Kohut (1971). Interessant in dit verband is dat Drew Westen en collega’s (Golomb e.a., 1994) in een exploratieve empirische studie hebben aangetoond dat moeders van borderline patiënten ertoe neigden hun kind op zeer egocentrische wijze te bejegenen.

De ideeën van Fonagy omtrent de moeite die borderline patiënten ermee hebben te komen tot een realistische, gedifferentieerde representatie van (significante) anderen, vooral in de context van hechtingsrelaties (mentalisatie), hebben geleid tot de ontwikkeling van een psychodynamische behandelvorm specifiek voor de behandeling van de borderline persoonlijkheidsstoornis, namelijk Mentalization-Based Treatment (MBT; Fonagy & Bateman, 2006a; Bateman & Fonagy, 2004, 2006). Zie hoofdstuk 15 voor meer informatie over deze behandelvorm.

Borderline patiënten scoren hoog op neuroticisme (bijv. Saulsman & Page, 2004).

Personen die in hoge mate de persoonlijkheidstrek perfectionisme bezitten zouden voornamelijk veel stress ervaren als ze met falen in aanraking (dreigen te) komen, terwijl personen die hoog scoren op afhankelijkheid selectief en sterk reageren op verlating of veronderstelde dreigingen daarvan. Naast deze modererende invloed gaat er van deze persoonlijkheidseigenschappen ook een mediërende invloed uit: deze trekken zijn ook betrokken bij het induceren van stress, vooral in interpersoonlijke context (Luyten, Corveleyn & Blatt, 2005).

Hyperreactiviteit van de amygdala is door Donegan e.a. (2003) recent in verband gebracht met borderline pathologie (zie ook Herpertz e.a., 2001).

Zoals eerder vermeld is slechts in 33% van de gevallen het gedragspatroon op elfjarige leeftijd in overeenstemming met het temperament, zodat high-reactiveness en inhibition niet altijd hand in hand gaan. Interessant in dit verband is echter dat Pukrop (2002) vond dat patiënten met BPS hoger scoorden op inhibitedness (DAPP) dan zowel de normale populatie als patiënten met andere DSM-IV-persoonlijkheidsstoornissen, in combinatie met verhoogde scores op neuroticism (FFM) en emotional dysregulation (DAPP) (stressreactiviteit).

Widiger en Samuel (2005) merken terecht op dat de term ‘co-occurrence ’ hier de voorkeur verdient, omdat hiermee niet de indruk wordt gewekt dat we spreken over verschillende ziektebeelden. Mogelijk zijn de verschillende persoonlijkheidsstoornissen (in DSM-IV) uitdrukking van gemeenschappelijke etiologische factoren (multifinaliteit), zoals genetische (bijv. temperament), neurobiologische (verstoorde cognitief-affectieve regulatie ten gevolge van vroege ‘life stress’), ontwikkelings- of persoonlijkheidsfactoren (zie ook Jongedijk, 2001; Luyten & Vliegen, 2005).

Volgens de APA (1994) dienen persoonlijkheidstrekken – om te kunnen spreken van een persoonlijkheidsstoornis – inflexibel en onaangepast te zijn, en bovendien te leiden tot significante ondermijning van het functioneren of tot subjectief leed.

Uit een studie van Pukrop (2002), waarin de borderline persoonlijkheidsstoornis werd beschreven met verscheidene dimensionale modellen, bleek inderdaad dat deze persoonlijkheidsstoornis samenhangt met verhoogde scores op Emotional dysregulation , meer dan andere persoonlijkheidsstoornissen.

Lenzenweger en collega’s (2004) vonden inderdaad dat borderline patiënten lager scoorden op Nonaffective Constraint dan een controlegroep.

Blatt en Levy (2003), bijvoorbeeld, koppelen duidelijk de karakterstijl los van de persoonlijkheidsorganisatie (complexiteit). Zo onderscheiden zij binnen het anaclitische en het introjectieve cluster verschillende niveaus van complexiteit. Ze maken daarbij gebruik van de hechtingstheorie.

Voorbeelden van positieve persoonlijkheidstrekken zijn: zorgzaam, consciëntieus, netjes en betrouwbaar. Voorbeelden van negatieve persoonlijkheidstrekken: lusteloos, afhankelijk, onhandig, onbeschaamd, lomp, hardvochtig (voor meer voorbeelden zie Stone, 1993a, 1994).

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Titel: 8 Visies op het borderlineconcept: verleden, heden en toekomst
Auteurs: Jurrijn Koelen
Patrick Luyten
Liesbeth Eurelings-Bontekoe
Uitgeverij: Bohn Stafleu van Loghum
Boek: Handboek persoonlijkheidspathologie
Print ISBN: 978-90-313-6112-0

Elektronisch ISBN: 978-90-313-6821-1

Copyright: 2009
DOI: https://doi.org/10.1007/978-90-313-6821-1_8

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