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Stop Walking on Eggshells:境界型人格障害の人を家族に持つ方々へ(1)

 なんだか長いタイトルだなあ、と思ったのですが、これしか思いつかなくて。

 今日からしばらくは、大人が抱える精神的な問題で最も難しいものを取り上げようと思います。

 それは、境界型人格障害(Borderline Personality disorder:BPD)と大人のアスペルガー症候群の2つです。アスペルガーについてご紹介する前に、先にBPDを取り上げておきたいと思います。それは、この2つに共通する部分が多いからです。

 病院では、来院された患者さんと直接お会いするのがほとんどですが、民間のカウンセリング研究所では、問題を持つ当人でなく、ご家族の方の相談を受ける機会がときどきあります。私は発達障害児の育児相談なども引き受けていますが、割合的には多くなく、むしろ引きこもりの相談が最近は増えています。

 ここ数日、家族からの相談が連続して3件ありました。しかし、発達障害でも引きこもりでもなく、とにかく問題のある本人とどう関わっていいか分からないというものでした。

 みな、境界型人格障害(以下BPDと略します)を配偶者や家族に持っている方々です。

 BPDとは、未だに議論の多い人格障害の1つです。DSM-IVでは10種類の人格障害が掲載されていますが、いずれも2軸に属する疾患で、主な精神疾患とは異なるカテゴリーにあるとだけ言えば十分です。人格障害を病気とみるかどうかでまだもめているようですが、個人的にはやはり精神疾患に含まれるべきだと思っています。

 BPDは人格障害の中で、臨床現場では比較的よく見られるものです。しかし、他の精神疾患との区別が難しく、大抵はうつ病などの気分障害や不安障害と診断されることが多いです。しかしBPDを持つ方は、抑うつや不安などの症状が薬物治療などでもなかなか改善せず、慢性化していることがほとんどで、症状だけでは人格障害の存在を見つけることが難しいです

 BPDは、簡単に言うと、極端な行動化、不安定な自己・他者評価、気分の不安定さの3つを特徴とします。DSM-IVによれば、次の9項目のうち5項目以上を満たせばBPDということになるようです。


①見捨てられる事を極端に恐れ、そのために多大な労力を費やす
②他人を極端に理想化したと思うと、最低のひどい人間だと評価したり、両極端で不安定な人間関係のパターンをもっている。
③極端で常に不安定な自己イメージや自己感を持っている。(自分がないというか、自分が何者か、どういう方向へ進みたいかが分からない)
④浪費、性行為、薬物乱用、無謀な運転、過食のうち、少なくとも2つの領域にわたり衝動的で自己破壊的な行為を繰り返す
⑤自殺をほのめかす、自殺を試みる、あるいは自分を傷つける行為(リストカットなど)を繰り返す
⑥2~3時間から2、3日にわたって、気分の激しい変動や不安、いらいらなどが続く
⑦慢性的に空しさを感じている
⑧ささいなことにひどく腹を立て、怒りをコントロールできない
⑨一時的に妄想的(現実にありえないことを考える)になったり、重度の解離症状が見られることがある

 通常、BPDは女性に多いのではないかと言われているのですが、私が相談を受けた3例は、いずれも男性でした。女性の方が、うつ症状などで病院を受診するチャンスが多いからではないかと思います。男性のBPDの場合、自らが病院へ行くということは非常に少ないような気がします。

 BPDといっても、それぞれに症状や抱える問題が少しずつ違っています。私の個人的な心証ですが、感情を激しく出してくるタイプと、怒りなどをきちんとぶつけられず、acting out(行動化)するタイプがあるように感じます。

 BPDの人は、とにかく考えも行動も極端です。英語では"I hate you, don't leave me."と言うのですが、嫌いなのに頼る、安定した関係を望みながら、うまくいきそうになると自分から関係を壊してしまう所があるのです。病院に通っているケースでは、主治医と安定した関係が持てないので、頻繁に病院を変えたり、複数の病院から同時に薬をもらっていることも少なくありません。

 BPDの人には、それぞれに独特な人間観、世界観があるように思います。白か黒かの両極端な価値観を持つため、悪いニュースに関しては極度に悲観的になるし、いいことでもその裏を見ようとする所があります。BPDに詳しい専門家たちはその背後にはかなり根強い人間そのものに対する不信感があるのではないか、と述べています。

 しかし、社会的な場面では他人にとても気を遣い、こまやかな気配りを見せたりすることもあり、仕事面ではストレスをためやすい傾向はありますが、条件が整っていれば能力を発揮できる人も少なくないです。残念なことに、不安定な人間関係は身近な人との間で起こりやすく、外部の人には全く普通にしか見えないことも少なくないので、「外と内とで全然態度が違っている」という言葉をよく耳にします。特に怒りなどの感情は、出しやすい人にぶつけられ、ぶつけられる方はどうにか我慢してじっと聞いているか、相手を怒らせないように言葉や態度に気を遣っていることがほとんどです。

 男性のBPDでは、しばしばDVに発展していることもあります。また、感情は激しくぶつけない代わりに、短期の家出を繰り返す例もときどき見られます。いずれにしてもBPDの感情はジェットコースターのように変動するので、家族やパートナーはそれにふりまわされることになるのです。

(続きます)

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初めまして。このブログのタイトルで呼びかけられている人間です。何人かの精神科の医師とお話ししましたが、彼らでもなかなかにお目にかかれるものではないとも聞きました。たぶん、BPD、また依存強化型人格障害と呼ばれることのあるもの、そして自己同一性乖離について、実際の状況がどういうものかを教えて差し上げられると思いますよ。

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