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Tidlige tegn på Borderline Personlighedsforstyrrelse · PDF file Borderline Personlighedsforstyrrelse En teoretisk undersøgelse omhandlende muligheden for tidlig indsats belyst ud

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    Tidlige tegn på

    Borderline Personlighedsforstyrrelse

    En teoretisk undersøgelse omhandlende muligheden for tidlig indsats

    belyst ud fra en udviklingspsykologisk forståelsesramme

    Rapportens samlede antal tegn

    (med mellemrum & fodnoter): 184.188

    Svarende til antal normalsider: 76,74

    10. Semester, Psykologi

    Kandidatspeciale

    Anne Lyng Larsen, studienr. 2006-2799

    Vejleder: Mette Thuesen

    Aalborg Universitet

    28. Maj 2014

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    Underskrift

    ____________________________

    Anne Lyng Larsen

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    Abstract

    The main objective of this theoretical study: “Early signs of borderline personality

    disorder. A theoretical study regarding the possibility of early intervention under-

    stood on the basis of developmental psychology”, was to examine how early signs of

    borderline personality disorder can be understood and traced/identified through the

    understanding of theories from developmental psychology – and from this find out,

    which forms of early intervention could be useful.

    The study included three theoretical perspectives: The mentalization based perspec-

    tive as presented by Peter Fonagy and colleagues, the original attachment theory by

    John Bowlby and finally Daniel Stern’s theory about the development of the senses of

    self. The age of the target group was set at six year old children.

    Some of the findings in the study were as followed: Experienced expressions of the

    child, who is at risk of developing borderline personality disorder, could be pleasing

    behavior, vulnerability towards shifts in interaction with others, transgressive behav-

    ior, affective instability, failing impulse inhibition and deficits in attention. In the

    study it was discussed whether these early signs could indicate other common child-

    hood disorders such as ADHD. It was concluded, that early problems can lead to

    other disorders than borderline personality and therefore no causal relation can be

    determined.

    Two forms of early intervention were suggested in the study. The first example is

    group therapy sessions for the parents, which focuses on psychoeducation and on

    enhancing mentalization which will benefit the child by improving the relational en-

    vironment. The second example is an enhancement of the conditions regarding after

    school activities. By ensuring better staffing and more supervision by psychologists,

    there is a better chance that the neglected child experiences a grownup that sees and

    contains it, which in turn will enhance the child’s resilience.

    Furthermore it was considered whether even earlier intervention could be more effec-

    tive in preventing the child from developing a severe mental disorder such as border-

    line personality disorder, and the study suggested the mentalization-based program

    Minding the Baby as a useful intervention.

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    Indholdsfortegnelse

    1. INTRODUKTION ............................................................................................................................ 1

    1.1 PROBLEMFORMULERING OG AFGRÆNSNING ................................................................................. 3

    1.1.1 Teorivalg .............................................................................................................................. 3

    1.1.2 Aldersfokus .......................................................................................................................... 5

    1.2 LÆSEVEJLEDNING ........................................................................................................................ 5

    2. BORDERLINE PERSONLIGHEDSFORSTYRRELSE .............................................................. 7

    2.1 FORSTYRRELSENS PLACERING I DIAGNOSESYSTEMET SAMT KERNEVANSKELIGHEDER ................. 7

    2.1.1 Kernevanskeligheder ........................................................................................................... 8

    2.2 ÆTIOLOGISKE ANTAGELSER ....................................................................................................... 10

    2.2.1 Barndomstraumer .............................................................................................................. 11

    2.3 OPSAMLING ................................................................................................................................ 11

    3. MENTALISERING OG UDVIKLINGEN AF BORDERLINE ................................................ 13

    3.1 TEORIRAMMENS PLACERING....................................................................................................... 13

    3.2 TILKNYTNINGENS- OG HERUNDER MILJØET BETYDNING ............................................................. 14

    3.2.1 Mentalisering og den Interpersonelle Fortolkningsmekanisme ......................................... 15

    3.2.1.1 Præmentalisering i form af psykisk ækvivalensmodus samt forestillingsmodus ........................ 17

    3.3 SOCIAL BIOFEEDBACK: TEORI OM AFFEKTSPEJLING OG UDVIKLING AF SELVBEVIDSTHED OG

    SELVKONTROL .................................................................................................................................. 18

    3.4 FORLØBERE TIL UDVIKLINGEN AF BORDERLINE PERSONLIGHEDSFORSTYRRELSE ....................... 20

    3.4.1 Desorganiseret tilknytning og det fremmede selv .............................................................. 20

    3.4.2 Præmentaliseringsmodi og den manglende integration heraf ........................................... 21

    3.5 OPSAMLING ................................................................................................................................ 23

    4. TILKNYTNINGSTEORI .............................................................................................................. 25

    4.1 TEORIRAMMENS PLACERING....................................................................................................... 25

    4.2 TILKNYTNINGENS FUNKTION ...................................................................................................... 26

    4.2.1 En sikker base .................................................................................................................... 27

    4.2.2 Udviklingsstier ................................................................................................................... 28

    4.3 ARBEJDSMODELLER ................................................................................................................... 28

    4.4 PATOLOGISK UDVIKLING ............................................................................................................ 29

    4.4.1 Tilknytningsmønstre ........................................................................................................... 30

    4.4.1.1 Det desorganiserede tilknytningsmønster .................................................................................. 31

    4.5 OPSAMLING ................................................................................................................................ 32

    5. UDVIKLINGEN AF FORNEMMELSERNE FOR SELVET ................................................... 33

    5.1 TEORIRAMMENS PLACERING....................................................................................................... 33

    5.2 FORNEMMELSE FOR SELVET ....................................................................................................... 34

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    5.3 FORNEMMELSEN AF ET KERNESELV ............................................................................................ 35

    5.3.1 Selvet versus den anden ..................................................................................................... 36

    5.3.2 Selv sammen med den anden ............................................................................................. 37

    5.3.2.1 Moderskabskonstellationen ........................................................................................................ 37

    5.4 FORNEMMELSEN AF ET INTERSUBJEKTIVT SELV ......................................................................... 38

    5.4.1 Affektiv afstemning............................................................................................................. 38

    5.5 PATOLOGISK UDVIKLING ............................................................................................................ 39

    5.5.1 Kerneselvet ........................................................................................................................ 40

    5.5.2 Fornemmelsen af et intersubjektive selv og dannelsen af det falske selv ........................... 41

    5.6 OPSAMLING ................................................................................................................................ 42

    6. DISKUSSION ...................................................