Couple relationships and Borderline Personality Disorder: examining the interpersonal experience of caregiving partners and people diagnosed with BPD

边缘型人格障碍（BPD）是一种以情绪不稳定和人际关系动荡为特征的精神状态。与健康个体和其他精神疾病患者相比，被诊断为BPD的人有更多以重大改变或终止为特征的关系[2,3]，并且BPD特征与夫妻中接受和实施的虐待有关[10]。对于许多被诊断为bpd的人来说——其中超过三分之一的人处于长期的恋爱关系中——配偶和恋人是主要的照顾提供者。最近的研究强调了人际关系质量与BPD特征严重程度之间的相互关系。此外，BPD患者的照顾者比其他精神疾病患者的照顾者承受更高的照顾负担[8,9]，这反过来又对关系质量和稳定性产生负面影响。该障碍的典型特征是对关系动态的不断变化的看法，以及它与BPD特征和伴侣-照顾者角色的相互依存关系，导致了一个复杂的人际关系背景，尚未进行定性研究。对BPD夫妇可用的干预措施是有限的，而且主要是由理论模型提供信息，而不是基于夫妇的经验。深入了解照顾伴侣和恋爱关系中被诊断患有BPD的人的经历，将为基于夫妻需求的以关系为中心的干预建模提供必要的经验基础，从而改善临床结果和总体幸福感。考虑到心理治疗是BPD的一线治疗方法，而且这种疾病在一般人群中的患病率为1.6%，研究这一领域尤为重要。BPD的核心临床领域是强化和维持紊乱影响[12]的因素。具体来说，调节情绪的困难、缺乏宽容、意识和注意力冲动是这种情况的核心和相互关联的特征，并显著地导致人际问题[10]。相反，稳定的婚姻关系和短期有效的恋爱关系似乎是改善功能、减少愤怒、提高就业率和改善性功能的保护因素[14-16]。重要的是，新兴的定量研究表明，随着时间的推移，关系质量与BPD症状之间的相关性是动态和波动的，这是该疾病的许多其他特征的典型特征，包括诊断本身。在频繁互动的伴侣（如恋爱关系）中，BPD特征与关系质量之间的相关性最为重要。与非临床夫妻相比，BPD症状与夫妻关系中的功能失调互动有关，导致婚姻满意度降低，依恋不安全感增加，更多的要求-退缩沟通问题，以及更高程度的亲密暴力。有趣的是，双方（不仅仅是有BPD的一方）都采取了相似程度的功能失调行为，对负面互动的贡献相同。总之，对于照料者和被照料者照顾的BPD患者之间相互交织的经历，人们并没有一个全面的理解。迄今为止，还没有研究捕捉到这些代表BPD核心领域的人际体验的流动性和波动性，因此应该为有效的心理干预提供信息。为了理解这方面，对其进行定性研究是至关重要的——因为人际关系反映了一个关键的背景，是相互的，并且随着时间的推移而变化。它还需要一种具体的、整体的、深入的方法，比如解释现象学分析（IPA）——因为它是非常个人化的。

Borderline Personality Disorder (BPD) is a mental condition characterised by emotional lability and turbulent interpersonal connections [1]. People diagnosed with BPD have more relationships characterised by a major change or termination compared to healthy individuals and those with other mental health conditions [2, 3] and BPD features are associated with received and perpetrated abuse within the couple [4]. For many individuals diagnosed with BPD-more than a third of whom are in long-term romantic relationships [5]- spouses and romantic partners are the main providers of care [6]. Recent studies highlighted the reciprocal relationship between the quality of interpersonal relationships and the severity of BPD features[7]. Further, carers of people with BPD experience a higher carer burden than carers of people affected by other mental illnesses [8, 9] which, in turn, negatively impacts relationship quality and stability.The changing perception of relational dynamics that is typical of the disorder, along with its interdependence with BPD features and the role of the partner-caregiver, gives rise to a complex interpersonal context that is yet to be investigated qualitatively. The available interventions for BPD couples are limited and largely informed by theoretical models rather thangrounded on couples' experience [10]. Gaining insight into the experience of both caregiving partners, and people diagnosed with BPD in a romantic relationship will provide the experiential ground necessary to model relationship-centred interventions based on the couple's needs, improving clinical outcomes and general wellbeing. Researching this area is particularly relevant considering that psychotherapy is the first-line treatment for BPD [11] and that this disorder has a prevalence of 1.6% in the general population [11].The core clinical domains of BPD are a reinforcing and maintaining factor of disordered affect [12]. Specifically, difficulties regulating emotions, a lack of tolerance, awareness and attentional impulsiveness are central and interrelated featuresof the condition and contribute significantly to interpersonal problems [13]. Conversely, stable marital relationships and short-term functioning romantic relationships seem to act as protective factors leading to improved functioning, decreased anger, higher employment rates, and improved sexual functioning [14-16]. Importantly, emerging quantitative research shows the dynamic and fluctuant nature of the correlation between relationship quality and BPD symptoms over time [7] which is typical of many other features of the disorder including the diagnosis itself [17].The correlation between BPD features and relationship quality is most important among frequent-interaction partners (e.g. romantic relationships) [7]. BPD symptoms are associated with dysfunctional interactions within couple relationshipsleading to lower marital satisfaction, higher attachment insecurity, more demand-withdrawal communication problems, and higher levels of intimate violence than in non-clinical couples[4]. Interestingly, both partners (not only the one with BPD) adopt similar levels of dysfunctional behaviours contributing equally to negative interactions [18].In summary, there is not a comprehensive understanding of the intertwined experiences of caregiving partners and people with BPD cared for by their partners. No research, to date, has captured the fluid and fluctuant nature of these interpersonal experiences that represent a core domain of BPD and, therefore, should inform effective psychological interventions. To understand this aspect, it is fundamental to research this qualitatively - because interpersonal relationships reflect a key context, are reciprocal and shift over time. It also requires an idiographic, holistic, and in-depth approach like Interpretative Phenomenological Analysis (IPA) - because it is profoundly personal.