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

边缘性人格障碍(BPD)是一种以情绪不稳定和动荡的人际关系为特征的精神状态[1]。与健康的人和有其他精神健康状况的人相比，被诊断为BPD的人有更多的以重大变化或终止为特征的关系[2，3]，BPD特征与夫妇内部受到和犯下的虐待有关[4]。对于许多被诊断患有BPD的人--其中超过三分之一处于长期的浪漫关系[5]--配偶和浪漫伴侣是主要的护理提供者[6]。最近的研究强调了人际关系的质量和BPD特征的严重性之间的相互关系[7]。此外，与其他精神疾病患者的照顾者相比，BPD患者的照顾者承受着更高的照顾者负担[8，9]，这反过来又对关系质量和稳定性产生负面影响。这种疾病典型的关系动态的变化，以及与BPD特征的相互依赖和伴侣-照顾者的角色，导致了一个复杂的人际环境，这还有待定性研究。对BPD夫妇可用的干预措施是有限的，主要由理论模型提供信息，而不是基于夫妇的经验[10]。深入了解照顾伴侣和在恋爱关系中被诊断患有BPD的人的经历，将为根据夫妇的需求建立以关系为中心的干预措施、改善临床结果和总体幸福感提供必要的经验基础。考虑到心理治疗是BPD的一线治疗[11]，而且这种疾病在普通人群中的患病率为1.6%[11]，这一领域的研究尤其相关。BPD的核心临床领域是一个强化和维持紊乱情绪的因素[12]。具体地说，情绪调节困难、缺乏耐受性、意识和注意力冲动是这种情况的核心和相互关联的特征，并极大地导致人际问题[13]。相反，稳定的婚姻关系和短期有效的恋爱关系似乎是导致功能改善、减少愤怒、更高就业率和改善性功能的保护性因素[14-16]。重要的是，新出现的定量研究表明，随着时间的推移，关系质量和BPD症状之间的相关性具有动态和波动的性质[7]，这是包括诊断本身在内的许多其他障碍特征的典型特征[17]。BPD特征和关系质量之间的相关性在频繁互动的伴侣(如恋爱关系)中最重要[7]。BPD症状与夫妻关系中的互动障碍有关，导致婚姻满意度较低，依恋不安全感更高，更多的需求-退缩沟通问题，以及更高水平的亲密暴力比非临床夫妇[4]。有趣的是，这两个伴侣(不仅仅是患有BPD的一方)采取了类似程度的功能障碍行为，这同样会导致负面互动[18]。总而言之，对于照顾伴侣和由他们的伴侣照顾的BPD患者的相互交织的经历，还没有一个全面的理解。到目前为止，还没有研究捕捉到这些人际体验的流动性和波动性，这些体验代表了BPD的核心领域，因此应该为有效的心理干预提供信息。要理解这一方面，定性地研究这一点是基本的--因为人际关系反映了一个关键的背景，是互惠的，随着时间的推移而变化。它还需要一种具体的、整体的和深入的方法，如解释性现象学分析(IPA)-因为它具有深刻的个人化。

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.