تبيين شدت نشانگان باليني اختلال شخصيت مرزي بر اساس روابط موضوعي اوليه و مكانيزم‌هاي دفاعي

Determining the Clinical Syndrome Severity of Borderline Personality Disorder Based on Primary Object Relations and Defense Mechanisms

زمينه و هدف: اختلال شخصيت مرزي اختلال شايع‌تر شخصيت در محيط‌هاي روان‌پزشكي است. اختلال شخصيت مرزي، يكي از مشكلات پيچيده مربوط به حيطهٔ سلامت روان است كه با مشخصه‌هايي چون هيجانات منفي شديد، اختلال در هويت، رفتارهاي تكانش‌گرانه و ناپايداري در روابط ميان‌فردي شناخته مي‌شود. هدف پژوهش حاضر، تبيين شدت نشانگان باليني اختلال شخصيت مرزي براساس روابط موضوعي اوليه و مكانيزم‌هاي دفاعي بود. روش‌بررسي: روش پژوهش حاضر از نوع همبستگي و مدل‌سازي معادلات ساختاري بود. جامعهٔ آماري اين پژوهش را تمامي مراجعه‌كنندگان به كلينيك‌هاي روان‌شناسي شهر تهران با تشخيص اختلال شخصيت مرزي، در سه‌ماههٔ پاياني سال 1397 تشكيل دادند. نمونهٔ آماري 300 نفر از مبتلايان به شخصيت مرزي (تشخيص روان‌پزشك) بود كه به‌صورت روش نمونه‌گيري هدف‌مند انتخاب شدند. داده‌ها با استفاده از پرسشنامه‌هاي روابط موضوعي اوليه و واقعيت‌آزمايي (بل و همكاران، 2005) و آزمون چندمحوري (ميلون، 1994) و مكانيزم‌هاي دفاعي (اندروز و همكاران، 1990) به‌دست آمد. تحليل داده‌ها ازطريق روش مدل‌سازي معادلات ساختاري و برازندگي الگوي پيشنهادي با نرم‌افزارهاي SPSS نسخهٔ 22 و ليزرل نسخهٔ 880 انجام پذيرفت. همچنين براي ارزيابي روابط واسطه‌اي از آزمون بوت‌استرپ استفاده شد. سطح معناداري آزمون‌ها در اين پژوهش، 0٫05 در نظر گرفته شد. يافته‌ها: نتايج نشان داد روابط موضوعي به‌عنوان متغير برون‌زا، به‌ترتيب بر مكانيزم دفاعي (0٫65=β و 0٫001>p) و شدت نشانگان باليني (0٫26=β و 0٫001>p) تأثير دارد؛ همچنين مكانيزم دفاعي بر شدت نشانگان باليني اثر مي‌گذارد (0٫40=β و 0٫001>p). نتيجه‌گيري: مي‌توان نتيجه گرفت كه روابط موضوعي اوليه با نقش ميانجي مكانيزم‌هاي دفاعي بر شدت نشانگان باليني در اختلال شخصيت مرزي اثر مي‌گذارد؛ بنابراين به‌طوركلي مي‌توان گفت كه مدل ادعا‌شده در اين پژوهش از برازش خوبي برخوردار است.

Background & Objectives: Borderline Personality Disorder (BPD) is a complex mental health condition. It is characterized by characteristics, such as severe negative emotions, identity disorder, impulsive behavior, and instability in interpersonal relationships. BPD manifests with numerous failures that arise in interpersonal relationships concerning self–concept, as well as behavioral, emotional, and cognitive aspects. Females constitute 75% of all BPD cases. Its onset is in adolescence, culminates in early adulthood, and decreases in middle–age. The present study aimed to determine the severity of the clinical syndrome of BPD based on primary objective relations and defense mechanisms. Methods: This was a correlational and structural equation modeling research. The statistical population of this study included all clients with BPD who were referred to psychology clinics in Tehran City, Iran in the last quarter of 2018. The study sample consisted of 300 patients with BPD (according to a psychiatrist’s diagnosis) who were selected by purposive sampling method. Then, the study participants completed the research questionnaires. In the sample size selection stage, 10 to 15 individuals were required for modeling and 300 individuals were selected by convenience sampling approach based on the available variables. The researchers observed all necessary ethical considerations for the present study. All study subjects received written information about the research and voluntarily participated in the research. The study participants were assured that all the obtained information remains confidential and will only be used for research purposes. The research participants' names and surnames were not recorded for privacy reasons. Besides, after the end of the study, more effective treatment was provided to the control group members. The required data were obtained using the Bell Object Relations and Reality Testing Inventory (Bell et al., 2005), Millon Clinical Multiaxial Inventory (Millon, 1992), and Defense Style Questionnaire (Andrews et al., 1993). Frequency tables and graphs, as well as central and dispersion indices, such as mean and standard deviation were employed for data expression. For the inferential analysis of structural equation modeling and proposed model fit based on Chi–squared index, Comparative Fit Index (CFI), Fit Goodness Index (GFI), Adjusted Fit Goodness Index (AGFI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Squared Residual (SRMR) were evaluated. The above–mentioned analyses were performed in SPSS and LISREL. The significance level of all studied tests was considered to be 0.05. Results: The present research results suggested that primary object relations, as an exogenous variable, affected the defense mechanisms (β=0.65, p<0.001) and the severity of clinical syndrome (β=0.26, p<0.001). The defense mechanisms also affected the severity of clinical syndrome (β=0.40, p<0.001). Primary object relations, as exogenous variables, and defense mechanisms, impacted the severity of the clinical syndrome. In the structural model, the significance of the path coefficient is determined by the T–value. In this study, the Bootstrap test was used to evaluate the mediating relationships. The hypothetical model indicated indirect and direct effects for the object–relations and defense mechanisms, respectively. The path of object relations to the severity of clinical syndrome was mediated by the defense mechanisms with a standard coefficient (β=0.26, p<0.001). In other words, a change in standard deviation highly reduced the standard deviation of the severity of clinical syndrome to 0.26. Conclusion: Primary object relations mediated by defense mechanisms affected the severity of clinical syndrome in BPD. In conclusion, the model claimed in this study was well–suited.