PART I Adulthood
CHAPTER 1 Personality Syndromes P Axis
Level of Personality Organization (Severity of Disturbance)
Borderline Level of Organization
P-Axis Personality Syndromes
Paranoid Personalities
Individuals who are so recurrently or chronically paranoid that they have a diagnosable personality disorder are found mainly in the borderline and psychotic ranges. Paranoid psychologies are characterized by unbearable affects, impulses, and ideas that are disavowed and attributed to others, and are then viewed with fear and/or outrage. They occupy the introjective, self-definition end of Blatt’s continuum from relatedness to self-definition.
那些反复发作或长期偏执的人，他们有一个可诊断的人格障碍，主要发现在边缘和精神病的范围。偏执型心理学的特征是难以忍受的情感、冲动和想法，这些情感、冲动被否认并归于他人，然后被视为恐惧和/或愤怒。他们占据了布拉特从亲缘到自我定义的连续统一体的内向的、自我定义的末端。
Projected feelings may include hostility, as in the common paranoid conviction that one is being persecuted by hostile others; dependency, as in the sense of being deliberately rendered humiliatingly dependent by others; and attraction, as in the belief that others have sexual designs on the self or on the people to whom one is attached (e.g., in the common phenomenon of paranoid jealousy or the syndrome of erotomania). Other painful affects, such as hatred, envy, shame, contempt, disgust, and fear, may also be disowned and projected. Although paranoia is described in somewhat one-dimensional ways in the DSMs, persons with paranoid psychologies may have complex subjective experiences organized around their terror to trust.
投射出去的感觉可能包括敌意，就像人们普遍的偏执信念，认为自己正受到怀有敌意的他人的迫害;依赖，如被他人故意地描绘为丢人地依赖(他人);和吸引力，如相信别人对自己或对自己所依附的人有性设计(例如，偏执的嫉妒或性欲狂躁症的普遍现象)。其他痛苦的影响，如仇恨、嫉妒、羞耻、蔑视、厌恶和恐惧，也可能被否认和投射。虽然偏执在DSMs中以某种一维的方式进行描述，但患有偏执心理的人可能有复杂的主观体验，这些体验围绕着他们的对信任的恐惧组织起来。
Because pathologically paranoid individuals tend to have histories marked by felt shame and humiliation (Gilbert, Boxall, Cheung, & Irons, 2005; Meissner, 1978), they expect to be humiliated by others and may attack first in order to spare themselves the agony of waiting for the inevitable attack from outside. Their expectation of mistreatment creates the suspiciousness and hypervigilance for which they are noted— attitudes that tend to evoke the hostile and humiliating responses they fear. Their personality is defensively organized around the themes of danger and power (either the persecutory power of others or the megalomanic power of the self).
因为病态偏执的个体往往有以感到羞耻和羞辱为特征的历史(Gilbert, Boxall，张，& Irons, 2005;(迈斯纳，1978)，他们期望被他人羞辱，可能会先攻击，以避免等待不可避免的外部攻击的痛苦。他们对虐待的预期产生了一种值得注意的怀疑和高度警惕——这种态度往往会引起他们害怕的敌意和羞辱反应。他们的人格是围绕着危险和权力(要么是他人的迫害权力，要么是自我的妄自尊大权力)的主题进行防御组织的。
Paranoid patients tend to have more or less mild thought disorders and trouble conceiving that thoughts are different from actions—a belief that may stem from childhoods in which they were (or felt) criticized for their real or presumed attitudes, as if feelings are equivalent to action. Some clinical reports (Bonime, 1979; Stern, 1989) suggest that they have experienced a parent as seductive or manipulative and are consequently alert to the danger of being seduced and exploited by the therapist and others. They may exist in anxious conflict between feeling panicky when alone (afraid that they will be damaged by an unexpected attack, and/or afraid that their destructive fantasies will damage or have already damaged others) and anxious in relationships (afraid that they will be used and destroyed by the agendas of others). Finally, paranoid people have severe difficulties putting themselves in others’ shoes and examining experiences from such a perspective; that is, they have problems in “cognitive decentration” (Dimaggio & Semerari, 2004).
偏执狂患者倾向于或多或少有轻微的思维障碍，难以想象思维和行为是不同的。这种想法可能源于童年时期，他们(或感觉)因真实或假设的态度而受到批评，就好像感觉等同于行动一样。部分临床报道(Bonime, 1979;斯特恩(1989)认为，他们经历过父母的诱惑或操纵，因此对治疗师和其他人的诱惑和利用的危险保持警惕。他们可能存在于焦虑之间的冲突感到恐慌时独自(担心他们会受到意外的攻击,和/或担心他们的破坏性的幻想会损坏或已损坏)和焦虑的关系(担心他们将使用和被别人的议程)。最后，偏执型的人很难设身处地为他人着想，也很难从他人的角度审视自己的经历;也就是说，他们在“认知去中心化”方面存在问题(Dimaggio & Semerari, 2004)。
Clinical experience attests to the rigidity of the pathologically paranoid person (Shapiro, 1981). A therapist’s countertransference may be strong, mirroring feelings that the paranoid person disowns and projects, such as helplessness, fright, and a sense of being criticized when the patient expresses only the angry aspects of his or her emotional reaction and shows no fear or vulnerability. Such reactions also occur in other people interacting with paranoid individuals.
临床经验证明病态偏执狂的刚性(夏皮罗，1981)。治疗师的反移情可能是强烈的，反映出偏执者否认和投射出来的感觉，比如无助、恐惧，以及当病人只表现出他或她情绪反应中愤怒的一面而没有表现出恐惧或脆弱时的一种被批评的感觉。这种反应也会发生在与偏执的人互动的其他人身上。
The clinical literature emphasizes the importance of maintaining a patient, matter-of-factly respectful attitude; the communication of a sense of strength (lest a paranoid patient worry unconsciously that his or her negative affects could destroy the therapist); a willingness to respond with factual information when the patient raises questions (lest the patient feel evaded or toyed with); and attending to the patient’s private conviction that aggression, dependency, and sexual desire—and the verbal expressions of any of these strivings—are inherently dangerous. It is best not to be too warm and solicitous, as such attitudes may stimulate a terror of regression and fuel suspicions about why the therapist is “really” being so nice.
临床文献强调保持病人的重要性，实事求是的尊重态度;一种力量感的交流(以免偏执的病人无意识地担心他或她的负面影响会毁掉治疗师);当病人提出问题时，愿意提供真实的信息(以免病人感到逃避或被玩弄);关注病人个人的信念，即攻击性、依赖性、性欲望——以及任何这些挣扎的语言表达——本质上是危险的。最好不要过于热情和关怀，因为这样的态度可能会引发对回归的恐惧，并加剧人们对治疗师“真的”如此友善的怀疑。
KEY FEATURES
关键特性
Contributing constitutional–maturational patterns: Possibly irritable/aggressive.
促成体质成熟的模式:可能是易怒/好斗。
Central tension/preoccupation: Attacking versus being attacked by humiliating others.
主要紧张/专注:攻击还是被羞辱。
Central affects: Fear, rage, shame, contempt.
主要影响:恐惧、愤怒、羞耻、蔑视。
Characteristic pathogenic belief about self: "I am in constant danger."
自我的典型病态信念:“我总是处于危险之中。”
Characteristic pathogenic belief about others: "The world is full of potential attackers and users."
对他人特有的病态信念:“这个世界充满了潜在的攻击者和利用者。”
Central ways of defending: Projection, projective identification, denial, reaction formation.
防御的主要方式:投射，投射性认同，否认，反向形成。