338. 边缘型人格障碍（BPD）的心理学

这是iHeart播客《保证人性》。

This is an iHeart podcast, Guaranteed Human.

大家好，欢迎回到《二十岁的心理学》。

Hello, everybody, and welcome back to the psychology of Your 20s.

这档播客我们将探讨二十岁人生中一些重大的变化与转折，以及它们对心理的影响。

The podcast where we talk through some of the big life changes and transitions of our 20s and what they mean for our psychology.

大家好。

Hello everybody.

欢迎回到本节目。

Welcome back to the show.

欢迎回到本播客。

Welcome back to the podcast.

无论你是新听众还是老听众，无论你身在世界何处，都非常高兴你能回来收听这一期备受期待的节目，我们将深入剖析二十岁的心理学。

New listeners, old listeners, wherever you are in the world, it is so great to have you here back for another highly requested episode as we break down the psychology of our twenties.

所以，朋友们，今天我们要讨论的是边缘性人格障碍，简称BPD。

So guys, today we're going to talk about Borderline Personality Disorder or BPD.

也许你最近在网上看到过这个术语被频繁使用。

Maybe you have seen the term thrown around online, especially recently.

也许你看到过它被用来形容那些被他人认为是操纵性、情绪化甚至危险的人，而这些人其实并没有被真正了解，也没有人清楚BPD到底意味着什么。

Maybe you have seen it used to describe people who others think are manipulative or dramatic or even dangerous without really even knowing the whole story or what BPD actually means.

也许对于一些正在听节目的人来说，这个术语你已经亲身接触过。

Maybe for some of you listening you know this is a term that you have encountered more personally.

也许这正是你所获得的诊断。

Maybe this is a diagnosis that you've received.

也许你从小和患有BPD的父母一起长大，直到最近才真正理解它。

Maybe you grew up with a parent who had BPD and didn't really understand it until recently.

或者你今天第一次在这档播客中听到这个术语。

Or maybe you are hearing it for the very first time on this podcast.

我今天真正想做的，是为BPD患者的世界提供一个准确而真实的介绍。

What I really want to do today is give a proper and real introduction into the world of people with BPD.

介绍这种状况究竟意味着什么。

Into what this condition actually means.

而且可能更重要的是，它不是什么。

And probably more importantly what it doesn't.

因为我认为，就像许多精神障碍或人格障碍一样，真相往往被扭曲，被简化，最终变成一种刻板印象。

Because I think as is the case with a lot of mental health disorders or personality disorders the truth gets rather twisted and I think it gets made smaller until it becomes a bit of a stereotype.

边缘型人格障碍确实发生了这种情况。

This has definitely happened with borderline personality disorder.

从根本上说，这是一种情绪调节和依恋障碍。

At its heart, this is a condition, this is a disorder of emotional regulation and attachment.

这意味着它极大地影响了一个人的感受、情绪、人际关系、自我认知，以及他们对爱的看法——这是我们核心的人类体验之一。

Meaning it massively affects how someone feels, their mood, their relationships, how they see themselves, how they view love, one of our core human experiences.

我见过一些人将它描述为一种身份缺失。

Some of the ways that I've seen people describe it is basically like a lack of identity.

你会经历极度的愤怒和虚无感，感到彻底空虚，而第二天或下一分钟，你又会充满一种强烈的狂喜，觉得世界再也不会是邪恶的地方。

You get such intense feelings of anger and nihilism that you feel completely empty and then the next day or the next minute you will be filled with like such an intense ecstatic joy that you feel like the world could never be an evil place again.

不确定自己对同一情境的感受，也因此不确定自己是谁，这真的很可怕。

It's scary kind of not knowing how you feel about the same situation and therefore kind of not knowing who you are.

其他人也用情绪的摆动来形容这种状态，说是因为情绪太过强烈而不知所措，但同时又感到极度空虚，这两种感受竟然能同时存在。

Others have also described this emotional pendulum by saying it's like having so much emotion that you don't know what to do with it, but also at the same time feeling so empty and having both of these things exist at the same time.

你可以从深爱一个人，觉得没有对方就活不下去，突然转变为憎恨他们的一切。

You can go from loving a person so deeply you think, you know, you might die and then suddenly hating everything about them.

这是一种障碍，一种过山车式的障碍。

It is the disorder it is a roller coaster disorder.

这确实是描述它最贴切的方式。

That's really like the best way to put it.

这种情绪强度背后真正的原因是什么？

And what actually is behind this emotional intensity?

因为我认为你可能知道它的症状，了解人们通常对边缘型人格障碍患者的刻板印象，但我们真的了解它的根源吗？

Because I think you may know the symptoms, you may know the general character profile of what people assume people with BPD look like, but do we really know the origins?

我们了解这种障碍如何影响大脑吗？

Do we know how this disorder impacts the mind?

为什么它与依恋如此密切相关？

Why it is so linked to attachment?

我认为很多人并不了解。

I think a lot of people don't.

所以我今天真的很想谈谈这个话题。

So I really want to talk about it today.

我真的很想减少一些污名化，聊聊一些可能不为人知的事实和关于边缘型人格障碍的未经广泛传播的研究，这些内容你在抖音上看不到，日常讨论中也很难听到。

I really want to reduce a little bit of the stigma and just talk about some probably unknown facts and some unknown research about BPD that you might not see presented on TikTok and that you might not see in everyday discussions about this about this condition.

和以往一样，每次我们制作关于精神障碍的特定节目时，我都会强调：这并不是一个诊断工具。

As always, I say this every time with these specific episodes that we do on mental health disorders this is not a diagnostic tool.

它既不是用于自我诊断，也不能用来诊断他人，更不能替代治疗或现实中的专业干预。

It's not a diagnostic tool for yourself or to be used for someone else nor is it a substitute for therapy or real life intervention.

今天我们还将讨论一些与自杀、自杀意念和自伤有关的敏感话题。

We're also going to be talking about some sensitive topics today to do with suicide, suicidal ideation and self harm.

如果你对这些内容比较敏感，请考虑一下，这个节目是否是你今天需要听的。

So if that's something that you are sensitive towards just consider whether this episode is what you need to hear today.

它一个月后还在，一年后也还在，等你感觉准备好了，随时都可以回来听。

It will be here in a month, it will be here in a year, you can always come back to it when you feel more prepared.

我会在描述中留下一些链接，供你获取更多资源。

I will leave you some links in the description for further resources.

所以，如果你或你认识的人可能正在经历边缘性人格障碍，如果你认为他们可能正在经历边缘性人格障碍，如果这个视频让你感到不安，希望这些资源能帮助你找到当地所需的帮助，应对你正在经历的困境。

So if you or someone you know may be experiencing borderline, if you think they may be experiencing borderline, if this episode has left you distressed, hopefully those help you find the help that you need in your local area and for what you're going through.

所以在进入正题之前，我想先做个小小的说明。

So I just want to give that little disclaimer before we get into it.

这期节目可能会比我们平时的更沉重一些，但请照顾好自己，不多说了，让我们开始探讨边缘性人格障碍的心理学。

It probably will be a more heavy episode than we're used to but take care of yourself and without further ado let's dive into the psychology of borderline personality disorder.

我想先做一个小小的想象练习。

So I want to begin with a little bit of like an imagination exercise.

为了让你真正理解边缘性人格障碍患者体验的一小部分，这是人们常描述的方式。

To really get across even just a small part of the experience of someone with BPD this is how people describe it.

请想象一下，你今天或过去一周感受到的每一种情绪，此刻都同时存在于你身上。

Imagine for a moment that every emotion that you have felt today or in the last week, you are currently feeling right now.

全部同时感受到。

All at the same time.

你知道，你不仅仅是感到开心，而是感到极度的喜悦。

You know you don't just feel happy, you feel ecstatic joy.

你不仅仅是感到悲伤，而是感到无底的绝望。

You don't just feel sadness, you feel bottomless despair.

过去一周里你经历的每一刻愤怒、每一刻笑声、每一刻憎恨，你现在都在体验着。

Every moment of rage, every moment of laughter, every moment of hatred from the past week of your life, you're experiencing it right now.

我认为这些强烈的情绪，通常只在我们生命和日子的极小部分中出现，而患有边缘型人格障碍的人却始终在感受着它们。

These visceral emotions that I think are only usually available to us for a tiny portion of of our lives and of our days, people with BPD, they feel them all the time.

他们感受到这些情绪的频率更高，也更加鲜明。

They feel them much more often in much much higher definition.

现在想象一下，这些情绪被分成了正面和负面两类。

Now imagine that these emotions get split into positive and negative.

而你现在感受到的不再是所有情绪同时出现，而是非黑即白。

And now instead of just feeling all your emotions at once, you're feeling all or nothing.

你要么完全感到美好、被爱、快乐，要么完全陷入痛苦、抑郁和愤怒。

You're feeling either entirely good and loved and happy or entirely miserable and depressed and angry.

这种快速而强烈的情绪不稳定性，可能由我们许多人认为微不足道的小事触发。

And that rapid, effective or emotional instability can be triggered by something that many of us would consider really really tiny.

极其微小的事情。

Really really miniscule.

比如，一条短信回复延迟了。

You know a delayed reply to a text message.

一个特定的面部表情。

A certain facial expression.

某种轻微的冒犯或被拒绝的感觉。

A certain slight or perceived rejection.

不仅BPD患者的情绪深度被放大，而且已有研究表明，患有边缘型人格障碍的人可能实际上拥有更细腻的情感尺度。

Not only is the depth of feeling amplified for people with BPD and there have been studies that have shown that people who have Borderline Personality Disorder may actually have access to a more nuanced emotional scale.

但BPD患者情绪变化的速度也大大加快了。

But the rate at which these emotions is changing within someone with Borderline Personality Disorder is also accelerated.

这正是人们常说BPD是情绪不稳定的含义。

This is what people often mean when they describe BPD as emotional instability.

事实上，一些诊断手册正是这样称呼它的。

And in fact that's exactly what some diagnostic manuals call it.

在我们继续本集内容之前，这是一个非常重要的提醒。

This is a really important caveat before we get any further in the episode.

如果你来自澳大利亚或美国以外的地方，你可能对边缘性人格障碍有完全不同的认知。

If you are listening from somewhere outside of Australia or outside of The US, you might know borderline personality disorder as something entirely different.

在英国、欧洲部分地区以及亚洲部分地区，你可能会听到‘情绪不稳定型人格障碍’或EUPD这个术语，而不是边缘性人格障碍。

In The UK, in parts of Europe, in parts of Asia, you might hear the term emotionally unstable personality disorder or EUPD rather than borderline personality disorder.

我之所以在本集中使用BPD这个术语，显然因为我身处澳大利亚，而且从我的口音你可能也听出来了；此外，这也是DSM所使用的术语——我们之前多次在播客中提到过，DSM是几乎涵盖所有已知精神障碍的诊断与统计手册。

Now the reason I'm going to go with BPD for this episode is obviously I am in Australia and if you couldn't tell from my voice but also it is the term that is used, by the DSM which we've spoken about before many times on the podcast it is the diagnostic statistical manual of basically every single mental disorder known and categorized.

所以，如果我开始用‘情绪不稳定型人格障碍’代替‘边缘性人格障碍’，我想我可能会说错。

So you know if I was to start saying emotionally unstable personality disorder instead of borderline personality disorder I think I would kind of slip up.

因此，你可能曾听过这个障碍以不同的名称或方式被提及。

So you may have heard this as a different term as a different in a different way.

它们指的其实是同一件事。

They do mean the same things.

不过，它们被这样命名是有原因的。

There is a reason though that they are labeled differently.

‘边缘性’这个术语或前缀源自一种较旧的思维方式。

The term or the preface of borderline comes from kind of an older way of thinking.

在过去，临床医生认为患有边缘性人格障碍的人处于精神病与神经症的边缘。

Back in the day clinicians believed that people with BPD with this condition were on the borderline between psychosis and neurosis.

神经症也被称为焦虑。

Neurosis is also known as anxiety.

如今，大多数专家认为这种说法并不准确，这种描述已经过时了。

Today most experts agree that that is not actually what's happening, that description is outdated.

我们现在很少再使用‘神经症’这样的术语了。

We don't really use terms like neurosis anymore.

我应该说，‘情绪不稳定’更接近实际情况。

Emotional emotionally unstable I should say gets closer to the reality.

这种障碍的真正表现是，神经系统因被引发或被迫对情绪触发因素做出强烈且不可预测的反应。

What is really happening with this disorder is a nervous system that has been caused or forced to react intensely and unpredictably to emotional triggers.

我们来稍微谈一下患病率。

Let's talk about prevalence here for a little bit.

据估计，边缘型人格障碍在普通人群中的患病率介于0.7%至5.8%之间。

BPD is estimated to be prevalent in anywhere between zero point seven to five point eight percent of the general population.

这些数字真是非常具体。

Uber specific numbers right there.

我来告诉你为什么这些数字如此精确。

And I'll tell you why those numbers are so specific.

它们如此精确，是因为这是研究人员认为该病症可能出现的最低和最高范围。

They're so specific because that is the minimum and the maximum that researchers believe this condition could be present.

在考虑诸如诊断不足等因素时，尤其是在某些人群（如男性）或心理健康系统不发达的国家，那里对这种疾病的认识或诊断机会较少。

When considering factors like, a lack of diagnosis, especially in certain population groups like men or in certain countries with underdeveloped mental health systems where there isn't as much, I guess like knowledge of this or opportunities for diagnosis.

他们也在考虑是否存在过度诊断的情况；当人们试图估算某种疾病在全球的普遍程度时，往往会尽量涵盖最小和最大的可能性。

They're also considering if there is an over representation so times when people try and find these estimates of like how common is a disorder in the world, they like to go as small as possible and as big as possible.

所以当你听到5.8%这个数字时，不要以为每次上班、每次走在街上，每二十个人中就有一个患有边缘型人格障碍。

So when you hear five point eight percent, I don't want you to think that anytime you go into work, anytime you're walking down the street, one in every twenty people have borderline personality disorder.

这仅仅是所有最高值中的最高值。

Again, it's just like the max of all maxes.

现在我们来更深入地讨论一下。

Now let's talk about more more deeply.

让我们谈谈这种障碍实际上包含哪些内容。

Let's talk about what this disorder actually contains.

边缘型人格障碍的典型症状是什么？

What are the hallmark symptoms of BPD?

根据DSM-5，若要被诊断为边缘型人格障碍，必须满足几个条件。

So according to the DSM-five if you want to be diagnosed with borderline personality disorder, a couple of things have to be true.

首先，你必须经历以下症状中的一定数量。

Firstly, you have to experience a certain number of the following symptoms.

对被抛弃的强烈恐惧、不稳定的人际关系以及不稳定且混乱的自我形象。

An intense fear of abandonment, unstable relationships and unstable and stable self image.

因此，一会儿感觉棒极了，一会儿又糟糕透顶；冲动行为、反复出现的自杀行为或自伤行为、情绪不稳定、快速而强烈的情绪波动、长期的空虚感、与情境不相称的强烈愤怒，以及在极端压力下出现的偏执或解离。

So feeling amazing one minute terrible the next, impulsivity, recurrent suicidal behavior or self harm, emotional instability, rapid intense mood changes, chronic feelings of emptiness, intense anger inappropriate to the situation, and at the extreme stress related paranoia or dissociation.

我认为，截至今天，就在我录制这段内容的此刻，你必须在相当长的一段时间内、在多种情境下表现出这五种或更多的症状。

I think that as of today, as of right now, as I'm recording this, you need to have five or more of these symptoms present over a significant period of time and across various contexts.

你不能只是在和家人在一起时才感到空虚、冲动和强烈愤怒，而且只限于家人面前。

So you can't just feel emptiness, impulsivity, and intense rage when you're around your family and your family only.

也不能只是在你讨厌的工作中才经历这些情绪。

Or you can't just experience that when you're at the job that you hate.

它必须是一种不幸地超越了单纯环境或情境因素的东西，而是贯穿于你所有社会、生理和情感情境中的状态。

It has to be something that unfortunately isn't purely environmental or context based, but which sits with you throughout all social, physical, emotional context.

这正是被诊断为边缘型人格障碍需要跨越的门槛。

That is kind of the hurdle that you have to jump over to be diagnosed with BPD.

我们稍后会讨论其他几个门槛。

We're going to talk about a couple of the other hurdles later on.

别担心，我们会说到的。

Don't worry we'll get to it.

所以，当我们谈论不稳定时，这绝不仅仅是偶尔的情绪波动。

So clearly when we talk about instability, this isn't just having a few mood swings.

这些情绪波动是全身性的。

It these swings are full body.

它们影响身份认同和人际关系。

They affect identity, relationships.

它们影响我们与自己的关系。

They affect our relationship with ourself.

甚至有时影响我们对现实的认知。

Even sometimes how we see reality.

边缘型人格障碍最令人痛心的方面之一，就是它显著增加了自伤和自杀的风险。

One of the most devastating aspects of BPD is the way that it heightens risk for self harm and suicide.

这可以说是这个群体中一个广为人知却令人悲伤的秘密——那些承受并受困于这种状况的人。

And this is kind of a known very sad secret of the community of people who endure and suffer from this condition.

前几天我看到一个统计数据，我认为高达百分之七十的边缘型人格障碍患者在其一生中会尝试自杀。

I saw this statistic the other day that as many as seventy percent I believe of those with BPD will attempt suicide at some point in their lifetime.

这使得边缘型人格障碍成为与死亡风险相关的最严重的精神疾病诊断之一。

That makes borderline personality disorder one if not the most high risk psychiatric diagnosis when it comes to mortality.

我猜这仅次于厌食症。

I would assume it would be second only to anorexia.

这个统计数据的目的并不是要让你震惊，尽管它确实让我震惊了。

That statistic isn't necessarily meant to shock you although it definitely shocked me.

百分之七十是一个极高的数字，但它的目的只是想突出这种疾病对患者而言有多么剧烈和痛苦。

Seventy percent is a ridiculously high number but it's meant to just highlight how intense and painful this disorder can be for those who are living with it.

在这种情况下，许多承受这种疾病的人认为，他们唯一能做出的反应，唯一合适的回应，就是一种剧烈、毁灭性且永久性的做法。

Whereby the only response many of the people who are enduring this condition believe they can have, the only appropriate response is a drastic devastating and permanent one.

与边缘型人格障碍相关的另一个关键复杂性是，它很少单独存在。

Another key complexity to do with BPD is that it actually rarely exists alone.

我们之前谈过你需要跨越的那些障碍。

We talked about those hurdles you need to get across.

这是第二大障碍。

This is the second biggest hurdle.

获得诊断实际上相当困难，因为对于患有边缘型人格障碍的人来说，他们同时经历另一种共病精神健康问题的可能性非常高，甚至可以说更有可能如此。

Getting the diagnosis is actually quite difficult because for someone with BPD it is highly likely in fact it is more probable than not that they will also be experiencing another co occurring mental health condition.

关于这方面的研究有些不一致，但就与其他精神健康状况的共病率而言，患有边缘型人格障碍的人中，有63%到95%在确诊时同时存在另一种诊断。

The research in this is a little inconsistent but in terms of the rate of co occurrence with other mental health conditions anywhere between sixty three to ninety five percent of people with borderline personality disorder will also have another diagnosis at the time of their diagnosis.

这个数字——63%到95%——来自一项非常著名的2019年瑞典人群研究，该研究调查了近两百万名BPD患者。

Now that number, the sixty three to ninety five percent that was found in a very well known 2019 Swedish population study, which looked at almost two million people with BPD.

因此，我认为这个数字相当准确。

So I think that we can say that number is fairly accurate.

两百万人。

Two million people.

我认为，这是我们在播客中提到过的任何研究中样本量最大的一次。

I think that is the largest sample size of any study we have ever mentioned on the podcast before ever.

最常见的共病状况也是社会上普遍常见的那些，比如抑郁症、焦虑症、双相情感障碍，此外还有创伤后应激障碍、复杂性创伤后应激障碍（简称CPTSD）、物质使用障碍和进食障碍。

Some of the most common co occurring conditions are the ones that are obviously most common in society in general so depression, anxiety disorders, bipolar disorder but then also PTSD complex PTSD, CPTSD as it's called for short, substance use disorders and eating disorders.

尤其是进食障碍与BPD的共病情况非常普遍。

This one especially eating disorders and BPD are incredibly common.

特别是暴食症和暴食性进食障碍。

Especially bulimia and binge eating disorder.

这种重叠显然会让情况变得相当棘手。

Now this overlap obviously can make things quite tricky.

想象一下，你走进医生的办公室，你很清楚自己所有的症状都源于一个巨大的肿瘤，但他们不去治疗肿瘤，反而开始处理你腿上的伤口，开始为你治疗维生素缺乏症，还把你送到牙医那里接受牙齿治疗。

Imagine going into a doctor's office and you know really all your symptoms are coming from a large tumor but instead of treating the tumor they start treating a gash on your leg, and they start treating you for a vitamin deficiency, and they start treating they send you to the dentist to get, like, dental treatment.

而自始至终，你身上那个巨大的肿瘤才是所有问题的根源。

And all along, you have this big tumor that all of this stuff is coming from.

就像这样，有些人就是这样描述边缘型人格障碍的。

Like, that's how some people describe BPD.

这就像是你去就医，我不知道该怎么说，进入医疗系统，特别是心理健康系统，你有一个让你非常困扰却无法弄清楚的大问题。

It's like you're treating you go into, I don't know, the medical system, specifically the mental health system, and you have this big thing that is really bothering you that you can't figure out.

而为了获得最终诊断，所有这些其他小问题会先被处理或被贴上标签，而那个大问题却某种程度上未被察觉。

And as in order to get a final diagnosis, all these other little things get treated or get labeled first when the big thing kind of goes undetected.

我从听众那里听到过太多这样的故事，有些人甚至直到他们因进食障碍住院治疗五年后才第一次听说BPD这个词，或者他们在有人突然坐下来告诉他们可能患有此病之前，已经为抑郁和焦虑治疗了多年，而这就像一把打开门的钥匙。

I've heard so many stories of this from listeners, of people who you know they had not even heard of the term BPD until they were in an inpatient treatment for an eating disorder five years after they first developed said eating disorder or they've been treated for depression and anxiety for years before suddenly someone sits down and says you might have this and it's like the key that unlocks the door.

我认为这与你所知的ADHD和自闭症的晚期诊断类似，人们往往直到生命稍晚阶段才得到他们需要且能真正给出答案的诊断标签。

I think that's similar for you know in late stage diagnosis for ADHD and for autism often people don't get the label that they need and that they would would really give them an answer until a little bit later in in life.

那么，边缘型人格障碍到底从何而来？

So where does BPD actually come from?

心理学家和研究人员通常会借助生物社会模型来解释边缘型人格障碍的成因。

Psychologists, researchers they will often turn to the biosocial model to explain the origins of BPD.

生物社会模型最初由玛莎·林内汉在九十年代提出，我想是这样。

Now the biosocial model was originally proposed by Marsha Lyman in the nineties, I think.

她同时也是辩证行为疗法（DBT）的创始人，你可能在之前的播客中听说过这种疗法。

And she also is the creator of dialectical behavior therapy, DBT, which you have probably heard about on the podcast before.

我们稍后会再回到这一点。

We're going to circle back to that in a second.

但根据这个生物社会模型，边缘型人格障碍是由多种因素共同作用形成的，几乎像一场完美风暴。

But according to this biosocial model BPD develops from a combination of a couple of things almost like a perfect storm.

它并不是由单一因素造成的。

It is not a singular thing that creates it.

首先，必须存在一种生物易感性。

Firstly, there must be a biological vulnerability.

这意味着一个人天生就具有高度的情绪敏感性，某种特定的气质或情绪调节障碍。

Meaning a person is born, naturally born with a heightened emotional sensitivity, a certain specific kind of temperament or heightened emotional dysregulation.

在这种情况下，个体被认为天生就容易出现过度兴奋或过度反应的倾向。

An individual basically is seen in this case to have had a predisposition for either hyperarousal or hyperreactivity.

因此，由于他们的基因蓝图，他们的神经系统对情绪刺激的反应更强烈，且恢复到基线状态所需的时间更长。

So their nervous system reacts more strongly to emotional stimuli and takes longer to return to a baseline because of their genetic blueprint.

这还与环境无关。

It has nothing to do with environment yet.

关于这种过度兴奋或过度反应背后的生物学基础，有许多不同的理论和研究。

There's a lot of different theories and pieces of research looking at the specific biological basis behind this hyperarousal or hyper reactivity.

许多人通常会回到我们大脑中的一个结构——一个最小的结构，即杏仁核。

And what a lot of people typically come back to is this one structure in our brain, one of the smallest structures, which is the amygdala.

杏仁核位于我们所谓的旧脑中心位置。

Now the amygdala sits right in the center of what we call our old brain.

它负责检测威胁并触发情绪反应，如恐惧或愤怒，进而引发身体反应。

It is responsible for detecting threats and for triggering, an emotional response like fear or anger which will in turn also trigger a physical response.

对于患有边缘型人格障碍的人，当对他们进行功能性磁共振成像扫描时，研究者通常发现他们的杏仁核处于过度活跃状态。

Now in people with BPD when they do, fMRI scans of these people's brains, what they tend to find is that the amygdala is hyperactive.

这意味着，当发生一种相当普遍或微小的情感体验时，杏仁核的反应会与所谓的正常大脑或对照组大脑相比显得过度强烈——虽然我不太喜欢用‘正常’这个词。

Meaning that when a rather ubiquitous or small emotional experience occurs, it reacts in a disproportionate way compared to a so called, and I hate saying this, a so called normal brain or a control brain.

在这种情况下，大脑的警报系统会在 slightest 的拒绝或批评迹象出现时就启动，因为它无法区分只需要2%反应和需要200%反应的情境。

The brain's alarm system in this case goes off the slightest sign of rejection or criticism because it cannot distinguish between something that requires a 2% reaction and a 200% reaction.

这正是这种障碍背后强烈情绪反应的一部分原因。

That is part of the intensity behind this disorder.

另一方面，我们有前额叶皮层。

Now on the other side we have the prefrontal cortex.

前额叶皮层和杏仁核经常被一起讨论，因为它们就像……我该怎么形容呢？

Now the prefrontal cortex and the amygdala often get talked about together a lot because they are like How do I describe it?

它们就像天平的两端。

They're like on two sides of the balance beam.

前额叶皮层代表的是逻辑。

The prefrontal cortex she is logic.

她是调节。

She is regulation.

她是提供理性、执行功能并帮助我们平静下来的那部分。

She is the thing that provides reason, executive functioning, helps calm us down.

现在，如果杏仁核表现出过度反应，那么在边缘型人格障碍患者中，额叶则显示出活动减少或连接性降低。

Now if the amygdala shows hind reactivity, the frontal lobe shows reduced activity or reduced connectivity in people with BPD.

基本上，额叶内部的通路更少，快速通道更少，因此信息传递会稍慢一些。

Basically, are less roads, less path fast pathways running around the frontal lobe, so messages are a little bit slower.

所以你的大脑就像一个情感油门异常敏感、而刹车系统反应迟钝甚至失效的系统。

So you've got a brain where the emotional accelerator is extra sensitive and the braking system is less responsive slash doesn't really work.

这对任何人来说都是一个难以控制的大脑。

That's a hard mind to control for anybody.

当然，这具有遗传成分。

Of course, this does have a genetic component.

如果你的父母、兄弟姐妹或直系亲属患有边缘型人格障碍，你患上这种障碍的概率大约在40%到60%之间。

If you have a parent, if you have a sibling, if you have an immediate family member with BPD, the chances of you then developing that disorder sits around the forty to sixty percent mark.

它的遗传率大约在百分之四十到六十之间。

It's about forty to sixty percent heritable.

现在很难分辨，这是因为你在有障碍的环境中长大，导致那个人情绪极端且反应强烈，还是纯粹由基因决定的。

Now it's kind of hard to, kind of hard to detach whether it's because you've been raised in an environment where someone has a disorder that causes them to be quite polarizing and reactive or whether it is purely genetic.

我们最好的研究方法是双生子研究，结果显示这里既有遗传因素，也有环境因素。

The best way we can figure it out is through twin studies and it does seem to be that there is both a genetic and an environmental context here.

遗传方面，如果家族中有人拥有某种基因，或者具备易患边缘型人格障碍的特质，这种脆弱性可能在人的一生中或多年内完全处于休眠状态，直到被某些事件触发。

The genetic aspect of having a family member or having a certain genome or whatever it is that has been primed for BPD is that that vulnerability can actually lay completely dormant for somebody's whole life or for many many years until something triggers it.

这就引出了生物社会模型的第二部分——无效环境的作用。

And this is where we get to talk about the second part of the biosocial model which is the role of an invalidating environment.

这意味着，许多从小发展出边缘型人格障碍的人，很可能成长在一个从未教导他们如何管理情绪、没有提供安全空间来处理情绪的环境中，并且在童年时期经历过某种极其严重和极端的事件，而他们当时无法理解、无法控制，也没有得到支持去理解。

Meaning that a lot of people who go in to develop BPD from a young age probably existed in a world that didn't teach them how to manage their emotions, didn't give them a safe space to manage their emotions, and who probably experienced something very severe and extreme during their childhood that they couldn't grasp, they couldn't control, they weren't supported to understand as a child.

从那时起，他们所有的情绪都处于100分的强度。

And so from that point on all of their emotions were at level 100.

你们知道我的小秘密吗？当我研究一个想深入了解真实经历的节目时，我喜欢去Reddit浏览各种支持论坛。

You guys know my guilty secret is that if I'm researching an episode where I want I want to know more about lived experience, I love going into Reddit and reading through all like the, I guess, like the support boards.

在其中一个关于BPD的帖子中，我发现很多人谈论一种‘之前’和‘之后’的体验。

And in one of the ones for BPD, I found a lot of people talking about this experience of a before and after.

就像某个时刻，他们感觉自己的大脑——这个新的、患有BPD的大脑——突然被激活了。

Like a moment where they felt their brain, this new brain, their BPD brain, like, switch on.

这正是我们正在讨论的内容。

And this is exactly what we're talking about.

存在一种生物易感性，而某个环境经历就像突然打开了一个开关。

There's a biological vulnerability, a light switch that is suddenly switched on by an environmental experience.

那么，这种环境经历可能是什么呢？

Now what might that environmental experience be?

可能性很多，而且很多都相当糟糕，但通常是创伤，无论是微妙的还是明显的，都会加剧这些影响，从而形成我们现在所称的边缘型或情绪不稳定型人格障碍。

Well, are a lot of options, lot of really actually terrible options, but it's often trauma, either subtle or overt that adds to these effects and that creates the personality disorder or personality type we now call borderline or emotionally unstable.

2018年发表在《人格与心理健康杂志》上的一项研究，调查了一组13至17岁、因BPD而入住住院单位的青少年。

A 2018 study published in the journal for personality and mental health looked at a sample of of adolescents from 13 to 17 who were at an inpatient unit as a result of their BPD.

在这组患有BPD的儿童中，研究者还匹配了一组年龄相同但没有BPD的对照组。

And then of these people who of these children who had BPD, they also matched them with a sample of people of the same age who didn't have BPD.

另外还有290名成年住院患者，患有BPD。

And then a further two ninety adult imp inpatients with BPD.

他们让所有三组人——患有BPD的青少年、没有BPD的青少年，以及患有BPD的成年人——回答了一些关于童年经历的问题，特别是关于虐待或忽视的经历。

And they just got every single group, the teenagers with BPD, the teenagers without BPD, and the adults with BPD to answer a few questions about their childhood, specifically experiences of abuse or neglect.

研究发现，患有BPD的青少年描述的虐待经历明显多于心理健康的同龄人。

What the study found was that adolescents with BPD described significantly more abusive experiences than their psychologically healthy peers.

但通常他们是以一种相当冷漠的方式讲述的。

But often they did so in quite a detached way.

哦，你知道，我不太明白我为什么会这样，但接着他们会解释一些完全令人心理崩溃的事情。

Oh, you know, I don't really know why I'm like this but then they would go on to explain something that was just like absolutely psychologically crushing.

更有趣的是，他们对这些事件的回忆，以及创伤和情感或童年忽视的发生率，在成年组中也非常相似。

What's even more interesting is that that recall of those events and I guess that rate of trauma and emotional or childhood neglect was very similar in the adult group as well.

许多这些人发现，童年逆境的影响在成年后几乎更加显著。

And a lot of these people found that the impact of their childhood adversity was almost more pronounced in adulthood.

这或许是因为早期创伤的长期影响，以及他们在经历这些事件时无法自我调节，导致这些经历的影响不断累积。

Perhaps due to the prolonged effects of early trauma and the fact that the inability to regulate themselves through those experiences had meant that the impact of those experiences had just been allowed to compound.

创伤，尤其是与照顾者如何对待你有关的人际创伤，比如家人去世、社交排斥、社交痛苦或悲伤。

Trauma, especially when it's relational trauma to do with how your caregivers treated you, to do with maybe a death in the family, to do with social rejection or social pain or grief.

它还会加剧对被遗弃的恐惧，使建立信任变得困难，并强化对情绪压力的过度反应，这也是边缘型人格障碍的核心特征之一。

It also heightens a fear of abandonment and it makes trust in relationships a lot more difficult and it reinforces that hyperactivity to emotional stress which is another core element of BPD.

创伤不一定是那种你可以明确指出、回顾并说‘就是从这里开始的’重大事件。

Now trauma doesn't have to be this huge major thing that you can point to and reflect on and say this is where it began.

对于许多患有边缘型人格障碍的人来说，他们实际上会说：‘我的童年挺好的。’

For a lot of people with BPD, they actually say, know, my childhood was pretty good.

他们并不会回忆起自己经历过虐待的童年。

They don't recount having an abusive childhood.

但正如我们之前所说，当你让他们描述时，会发现父母虽然在物理上存在，会提供食物，却极度冷漠。

But as we said before, when you ask them to describe it, it's, you know, parents who are physically present, who put food on the table, but are deeply dismissive.

父母自身也可能患有边缘型人格障碍。

Parents who themselves had BPD.

因为这是孩子或这个人一生中唯一熟悉的照顾方式和父母之爱，对他们而言，这感觉就是正常的。

And because that's the only caregiving and parental love the child or the person has ever known that felt normal to them.

或者只是不被重视。

Or it's just not being valued.

是那些与孩子敏感性不匹配的环境。

It's environments that just didn't match the child's sensitivity.

在那里，他们觉得自己太过分了，或者太戏剧化了。

Where they felt like they were too much or too dramatic.

在那里，每当他们说‘不要抛弃我’时，别人真的会离开，或者觉得利用这些不安全感来开玩笑很有趣。

Where they felt like every time they said don't abandon me someone would or someone would think that it was funny to play into these insecurities.

我们在这里所指的，实际上是创伤如何与生物易感性相互作用，进而与情感否定或环境否定相互作用。

Really what we are pointing to here is how trauma interacts with biological vulnerability which then interacts with emotional invalidation or environmental invalidation.

这三者结合，造就了我所说的99%的边缘型人格障碍病例。

That is the trifecta that creates BPD in I would say ninety nine percent of cases.

它塑造了情绪调节、自我概念，当然还有我们的依恋模式。

And it's what shapes emotional regulation, self-concept and of course our attachment pattern.

明白了这一点后，我们即将短暂休息一下。

Now with that in mind, are going to take a short break.

但当我们回来时，让我们深入探讨这如何影响我们的关系。

But when we return, let's really talk about how this impacts our relationships.

因为我认为，这正是人们对边缘型人格障碍最感兴趣、或最初接触BPD的地方。

Because I think this is the space where people are most curious about BPD or often first introduced to BPD.

所以请继续关注我们。

So stay with us.

正如我之前提到的，BPD中一个非常关键的重点是人际关系的作用。

Something really critical and key with BPD as I mentioned before is the role of relationships.

它们承载了这种障碍的大部分负担，而且很多时候，我认为这也是BPD在日常生活中最明显、尤其对他人而言最显而易见的地方。

They carry so much of the disorder's weight and a lot of the times I think it is where BPD becomes most visible in everyday life especially to others.

如果你看过《女孩 Interrupted》、《致命吸引力》或《乌云背后的幸福线》。

If you have watched Girl Interrupted, Fatal Attraction, Silver Linings Playbook.

这些是我认为相当不错地向人们解释或展现这种体验强度的流行文化参考。

These are like pop culture references that I actually think are pretty good at explaining or showing the intensity of this experience to people.

我个人非常喜欢《乌云背后的幸福线》。

I personally, I love Silver Linings Playbook.

这是我有史以来最喜爱的电影之一，但如果你看过，就会感受到这部电影有一种奇特的方式，让你感到紧张和不安。

It is one of my all time favorite movies but if you've seen it, you will feel or you will notice that the movie has this weird way of making you feel stressed and making you feel on edge.

尤其是主角与他人的互动，有时会变得极其不稳定，你能从电影中明显感受到这种情绪。我本人并没有BPD，但有人告诉我，这部电影非常真实地展现了BPD患者内心的体验。

Especially from the main character like his interactions with people are so They become so volatile at times and you can feel that through the movie and I apparently See I don't have BPD but I've been told it is a very good depiction of how this feels inside the mind of someone with BPD.

情绪会突然高涨，下一刻却又完全陷入失望、愤怒或憎恨，仿佛一切都在失控中螺旋上升。

Like things are rising, things are like just spiraling and it's all joy the next one moment and it's all disappointment or anger or hate the next.

心理学家通常从依恋理论的角度来解释这种现象。

Psychologists often frame this through the lens of obviously attachment theory.

许多BPD患者表现出焦虑型迷恋或混乱型依恋风格。

Many people with BPD show what's called an anxious preoccupied or disorganized attachment style.

这意味着他们极度渴望亲密与连接，但与此同时，这种亲密感因为太过珍贵，反而让他们感到深深的威胁。

That means that they desperately crave closeness and connection, but at the same time that intimacy because it is something they desire so much feels deeply threatening.

当亲密对他们而言常常与痛苦、拒绝或不一致相伴时，情况就更加复杂。

When closeness for them has so often been paired with pain, rejection or inconsistency.

爱，成了他们最需要的东西，同时也是他们最害怕的东西。

Love becomes both the thing they need the most and the thing they fear the most.

他们害怕失去这份爱。

They fear the loss of that love.

他们害怕某人终究会离开自己，因此在内心和外部都竭尽全力阻止这种情况发生。

They fear that someone is just inevitably going to leave them and they fight very very hard internally and externally to prevent that from happening.

这体现为我们有时所说的推拉动态。

This plays out in what we sometimes call a push pull dynamic.

一方面，他们渴望这种纽带，渴望亲密，努力拉近关系；另一方面，他们又极度害怕受伤，于是将对方推开。

On one hand, they're craving this bond, they're craving intimacy, they are pulling it closer and on the other hand, they're so fearful of being hurt that they push away.

这就是退缩和愤怒的表现形式。

And that's what the withdrawal and the anger looks like.

有一个非常著名的说法描述这种状态，那就是‘我恨你，请不要离开我’。

There's a very famous phrase used to describe this which is I hate you, please don't leave me.

你可能听说过这句话。

You've probably heard of it.

这实际上是关于BPD最著名的书籍之一的书名，字面意思就是如此。

It is actually the name of one of the most well known books on BPD and it's exactly as it sounds.

我恨你，请不要离开我。

I hate you, please don't leave me.

我其实爱你。

I actually love you.

我们有时意识到，对他们而言，爱的感觉如此强烈，以至于常常与其他强烈的情绪混淆。

What we sometimes realize is that love for them feels so intense that sometimes it just gets confused with all other intense emotions.

或者你在对方离开之前就提前预感到痛苦，因此你是在回应或表现你对未来场景的想象——当这一切结束时，你会有何感受。

Or you start to anticipate the pain of someone leaving before it happens and so you're reacting or you are acting out this future imagination that you have of how it's gonna feel when this all comes to an end.

正如他们所描述的，关系确实像钟摆一样在理想化伴侣和贬低伴侣之间剧烈摇摆。

Relationships really do feel like as they described a pendulum swing between extremes of idealizing one's partner and then devaluing them.

在某一刻，你的伴侣是完美的。

At one moment, you know, your partner is perfect.

他们是你生命中发生过的最好的事。

They're the best thing that's ever happened to you.

他们美丽、善良，拥有你曾渴望的一切。

They are gorgeous and beautiful and kind and everything you've ever wanted.

而下一刻，由于某种被感知到的冒犯或失望，同一个伴侣可能会被看作是残忍或不可信的。

And the next, after some perceived slight or disappointment, that same partner might be seen as cruel or untrustworthy.

在那一刻，你感觉你再也不想见到他们，一切都毁了。

And in that moment it feels like you never want to see them again, it's ruined.

并不是患有边缘型人格障碍的人想要以这种非黑即白的方式看待事物，而是他们的情绪太过强烈，难以同时容纳好与坏的两面。

It's not that the person with BPD wants to see things in this black and white way, it's that their emotions are so overwhelming that it's hard to hold both the good and the bad in one mind at the same time.

这有一个名字。

This has a name.

它被称为分裂，本质上是无法同时持有对立的想法、感受或信念。

It's known as splitting and it's basically the inability to hold opposing thoughts, feelings, or beliefs all at once.

显然，没有人是完美的。

Obviously, no one is ever perfect.

要知道，即使某人真的是我们的灵魂伴侣、生命的挚爱，而且我们已经找到了他们，事情也还是会出错。

Know, even if someone is literally our soul mate and the love of our life and we've managed to find them, things do go wrong.

但对于患有边缘型人格障碍的人来说，为了应对内在的情绪波动，他们往往觉得直接做出明确的分类更容易一些。

But for someone with BPD, often to survive the internal emotional volatility, they do find it easier to make outright categorizations.

比如，这个人是邪恶的，或者这个人是天使。

Like, this person is evil or this person is an angel.

当一个人处于中间地带，处于灰色区域时，他们不能仅仅被视为一个有缺点、有矛盾、有正常人类反应的普通人。

And when someone sits in the middle, sits in the gray area, they cannot just be a normal person with flaws, with inconsistencies, with normal human reactions.

这使得日常的人际冲突、分歧和失望对患有这种障碍的人来说尤为困难。

That's what makes everyday relational conflict, disagreements, disappointments so difficult for someone with this disorder.

我读了一些关于BPD患者对此感受的报告，有些人描述的是，他们无法将对情境的负面情绪与情境中的人分开。

I read a few reports of what this felt like for people with BPD, and what some people describe is this inability to detach the bad feeling about the situation from the person in the situation.

显然，关系中的争吵是令人不适的，但同时也存在一种‘破裂与修复’的理念，即你有时确实需要摩擦和冲突，来增强关系的韧性，提升关系的深度，并向前发展。

Obviously, having arguments in a relationship is uncomfortable, but also there's this whole rupture and repair idea of you do need to sometimes have friction and conflict in order to build the muscle and build the volume of your relationship and to move forward.

因此，这实际上是正常的一部分。

And so it's kind of just a normal part of things.

即使现在感觉很糟糕，你仍然可以继续前进。

Even if it feels bad now, you can move forward.

患有BPD的人看到这种情况时，会认为：这正是我需要的所有证据，证明这个人将来会对我不好，我们的关系注定失败。

Someone with BPD sees that situation and is like, well, that's just all the evidence I need that this person is going to treat me poorly in the future, that our relationship is doomed.

因此，他们自然会做出相应的反应。

And so of course, they react accordingly.

他们要么防御性地回应，要么出于痛苦做出反应。

They react defensively or from a place of of pain.

你知道，你和朋友吵了一架，对吧？

You know, you have this fight with a friend, right?

气氛很激烈，很糟糕，很难受。

It's heated, it's rough, it's hard.

如果你有边缘型人格障碍，有时你可能会觉得，事后想：好吧，这段友谊结束了，算了。

And if you have BPD, sometimes you might feel like afterwards, okay, well that friendship is over, guess.

这听起来很傻。

Like that's that's dumb.

那个人是个糟糕的人。

That person is a terrible person.

他们再也不想见到我了。

They never want to see me again.

所以我会是第一个说再也不想见你的人，如果这说得通的话。

So I'll be the first one and never want to see them again first, if that makes sense.

但三天后，他们会给你发消息，想约你喝杯咖啡或者聊聊解决这件事。

And then three days later, you know, they'll text you wanting to grab a coffee or wanting to hang out and talk it through.

这种困惑就是：什么叫人可以这么复杂？

And it's this confusion of like, what do you mean people can be nuanced?

什么叫这根本不是终点？

What do you mean this wasn't the end?

你知道吗，我已经在情感上做好了和你断绝来往的准备。

You know, I'd already emotionally prepared to cut you off.

这到底是什么情况？为什么不是每个人都和我想的一样？

What what is this why doesn't everyone think the same way as me?

我读过一个特别深刻的帖子，讲的是一个在Reddit上的人，她和别人吵了一架，居然真的困惑对方为什么还想修复关系。

One account I read that was really profound was this person who, again, was on Reddit and was like genuinely seemed confused that someone who she had had an argument with wanted to repair the relationship.

她就说：什么意思？

She was like, what do you mean?

这 surely 就是我们需要的所有证据，足以证明这段友谊无法继续下去。

Surely this is all the evidence we need and that we require to know that this friendship isn't going to work out.

冲突是关系中的一部分。

Conflict is part of a relationship.

但如果你情绪不稳定，且过去曾经历过受伤或被辜负，那么要容忍这一切自然会困难得多。

But if you have this emotional instability and these previous experiences of being hurt or being let down, well of course it's going to be a lot harder to tolerate.

真正与边缘型人格障碍患者建立浪漫关系的人，常常报告说他们很难应对这种亲密与冲突的循环。

People who are actually the romantic partners of people with BPD often report really struggling sometimes with this cycle of closeness and conflict.

一会儿感到被深爱，下一刻却遭受痛苦的拒绝。

Feeling deeply loved one moment and painfully rejected the next.

2014年有一项研究专门探讨了这一点，对象是边缘型人格障碍患者的伴侣。

There was a 2014 study that looked at this specifically, the partners of people with BPD.

研究发现，许多这样的浪漫伴侣在争吵后都报告了更强的受伤感，以及更高的照顾者倦怠或照顾焦虑。

And what they found was that a lot of these romantic partners reported an increased sense of hurt in the aftermath of arguments and an increased sense of caregiver burnout or caregiving anxiety.

当你总是觉得自己对他人的情绪负有直接责任，而对方又难以预测甚至难以捉摸时，这种压力会逐渐侵蚀你，也会破坏整个关系的结构。

When you feel deeply personally responsible for someone else's emotions all of the time and that person is also you know a little bit difficult or impossible to predict that takes its toll, it takes its toll on the other person, it takes its toll on the structure of the relationship as a whole.

患有边缘型人格障碍的青少年或年轻人的父母也报告了这种感受。

Parents of, young adults or teenagers with BPD also report this feeling.

我记得2021年还有另一项研究，将他们视为边缘型人格障碍患者生活中的主要关系人。

There was another study I think in 2021 that looked at them as the main relationship in the life of someone with BPD.

同样地，这是一种奇怪的困境：既感到无助和内疚，又感到愤怒；既想设定界限，又想任由这个人掌控局面，因为这可能是处理这种情况的最佳方式。

And again, it's this weird it's this weird difficulty of feeling helpless and guilty, but also angry, wanting to set boundaries, but also wanting to let this person be in control because that might be the best way to manage the situation.

正因为如此，这些人中的许多——实际上是所有人——都无法控制这种被放大的情绪反应。

As a result of this, which again, a lot a lot of these people actually all of them, they cannot control this amplified emotional reaction.

但正因如此，边缘型人格障碍与孤独感之间存在极强的关联。

But as a result of it there is a huge link between BPD and loneliness.

由于患有此病症的个体与他人建立关系和互动的方式，边缘型人格障碍患者自我孤立的情况非常普遍，这成为他们对这些行为模式唯一恰当的反应——这些模式，第一，他们并不想要；第二，他们发现自己无法控制。

Because of how individuals with this condition relate and interact with others, it is really common for people with BPD to self isolate as the only appropriate reaction to these behavioral patterns that number one, they don't want but number two, they find themselves being unable to control.

他们实际上并不想伤害他人。

They don't actually want to hurt people.

他们实际上并不想陷入这种重复的关系模式：强烈地爱一个人，强烈地信任一个人，然后仅仅因为一件事出错，就感觉世界仿佛裂开。

They don't actually want to have this repetitive relational pattern of loving someone intensely, trusting someone intensely and then one thing going wrong and feeling like the world is splitting open.

因此，由于他们难以应对人际关系带来的情绪后果，便干脆避免所有关系。

And so because they find it difficult to manage the emotional consequences of relationships, they just avoid relationships in general.

研究表明，与普通人群相比，边缘型人格障碍患者更容易感到孤独，他们的社交网络通常更小、更多样性更低，也更不令人满意。

Research shows that not only are people with BPD more likely to be lonely compared to the general population, but their social networks are often, much smaller, much less diverse, also less satisfying.

也许我们甚至可以将这一点追溯到我们之前讨论过的自杀意念和行为。

And maybe we could even trace this back to what we were talking about before with the suicidal ideation and behavior.

孤独当然会是另一个因素。

Loneliness is of course going to be another factor.

你不仅无法控制自己的情绪状态，还缺乏社会支持——而这恰恰是你真正需要、而其他人通常都能获得的。

Not only can you not control your emotional state, you also don't get that same support socially that maybe you really need and that other people do receive.

你知道，我简直无法想象这种孤立感会有多强烈。

You know, I just I can't imagine how isolating that would feel.

你如此渴望爱，渴望与人相处，真心热爱关系中的深度、强度与美好，但同时你也知道，自己内心有一部分就是无法承受这一切，于是选择退出。

To want love and to want to be around people so badly and to really love the depth and the intensity and beauty of relationships, but also know that there's a part of you that just can't handle it and just deciding to opt out.

这简直是一种疯狂的牺牲和艰难的决定，人们却不得不做出。

Like that's a crazy sacrifice and a crazy decision that people have to make.

对于患有边缘型人格障碍的人来说，这里有一个刻板印象，认为他们爱人的能力是受损的，无法正常去爱。

And this is the thing for people with BPD, there is this stigma that their capacity to love is kind of broken, that they can't do it normally.

这并不正确。

That's not true.

他们的爱只是与恐惧紧密相连，而这种联系恐怕我们大多数人难以真正理解。

It's simply tethered to fear in a way that I guess a lot of us don't really understand.

除非我们亲身经历。

Unless of course we're in it.

除非我们正在经历它。

Unless we're experiencing it.

既然我们已经开始了这个话题，我们再来多聊聊关于边缘型人格障碍的污名化问题。

Let's talk some more about the stigma around BPD since we've kind of gotten started on that now.

因为我认为这是最受污名化的精神健康诊断之一。

Because I do think it's one of the most stigmatized mental health diagnoses out there.

这种污名化部分源于对边缘型人格障碍相关行为的误解，尤其是这些行为背后的意图。

Part of the stigma comes from a misunderstanding about the behaviors associated with BPD, particularly the intention of these behaviors.

表面上，一个人可能看起来是在寻求关注、操纵他人或表现得戏剧化。

Outwardly, someone might appear to be doing things to get attention, to be manipulative, to be dramatic.

伴侣可能会觉得，这个人会疯狂地给你打电话，或者有强烈的情绪爆发，你可能会认为这是一种控制手段。

A partner might, you know this person might frantically call you or have these very intense emotional outbursts and you might think that that's a control tactic.

那种‘我恨你，但别离开我’的体验，其实可能并不是操纵。

The I hate you don't leave me experience, it, you know, it might not be manipulation.

实际上，这很少是出于有计算目的的操纵。

It actually rarely is manipulation in a calculated sense.

这仅仅是患有BPD的人对情境所能做出的唯一恐慌反应。

It is just the only panicked way that someone with BPD can respond to a situation.

他们不具备普通人所拥有的那种情绪和人际调节能力。

They do not have the same emotional and interpersonal regulation skills that the, again, average person has.

所以他们并不会坐在那里想：‘如果我这样反应，就会得到某种回应。’

So they are not sitting there and thinking, well if I react this way I'm gonna get a certain response.

即使他们真的这样想，也不是因为有意要伤害别人。

And even if they are, it's not because they want to necessarily hurt someone.

他们只是想尽一切办法回到关系中的情感安全状态。

They're just doing anything to get back to a place of emotional safety within the relationship.

这是一种生存策略。

It's a survival strategy.

那种推拉感，我想靠近你，但我不知道该怎么做。

That push pull that I the I want to let you in, but I don't know how to.

我不希望感到失望。

I don't wanna be disappointed.

这导致他们做出一些在外人看来非常奇怪的行为，但对他们来说却完全合理，或者不合理，但他们觉得自己毫无控制力。

It does cause them to do things that outwardly might seem really strange, but for them make perfect sense or don't make sense, but they feel like they have no control.

当然，我认为文化表征只会让情况变得更糟。

Of course, I do think cultural representations only make matters worse.

我们已经讨论过一些好的表现方式。

We've talked about some good representations.

如今网上对边缘型人格障碍患者的许多刻画都缺乏教育性和信息性。

A lot of the stuff we see these days with the characterizations of people with BPD online are less educational, less informative.