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Yıl:2019; Cilt: 10; Sayı: 4>> Özet
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Psikiyatri Hemşireliği Dergisi; 2019;10(4):309-316
Sınır kişilik bozukluğunda psikodinamik formülasyon: Olgu sunumu
P Tunç, N Eren
Arel Üniversitesi, İstanbul
Psikodinamik vaka formülasyonu, hastanın belirtilerinin nasıl ortaya çıktığını araştırarak, nesne ilişkilerinin düzeyini, ego gücünü, zihinselleştirme kapasitesini, çekirdek çatışmalarını açıklamayı, tedaviyi planlama ve prognozu öngörmeyi sağlaması açısından klinisyenlere oldukça yararlı bir rehber oluşturur. Sınır kişilik bozukluğu (SKB) olguları dramatik yaşam öyküsü, dürtüsellik, ilişki sorunları, istikrarsız duygu durum ve davranışlar ile karakterize belirtiler sergilerler. Bu değişken ve çoklu belirtiler bozukluğun klinik görünümünü ve tedavi yanıtını ciddi derecede etkiler. Aynı zamanda SKB gösteren bireyler yoğun aktarım ve karşıaktarım tepkileri oluşturarak, sağlık çalışanları ve yataklı servislerde bu hastalarla en fazla vakit geçiren hemşireler tarafından, sıklıkla ‘zor hasta’ olarak algılanırlar. Bu açılardan sınır kişilik bozukluğu (SKB) olgularında psikodinamik formülasyon hastayı daha iyi anlama ve tedavi süreçlerini yönetebilmede özellikle gerekli ve yararlıdır. Bu makalede sunulan olgu, hızlı duygu değişimleri, boşluk duygusu, okula gidememe, aşırı para harcama, öfke patlamaları, kendine zarar verme davranışları, intihar düşünceleri ve girişimleri gibi şikâyetler ile başvurmuştur. Tedaviden beklentisini, öfkesini kontrol etmek, kendini ifade etmek, ikili ilişkilerde güçlü olmak, normal bir insan olmak şeklinde tarif etmiştir. Süpervizyon eşliğinde psikodinamik formülasyon yapılmış ve olgunun SKB tanısı gösterdiği düşünülmüştür. SKB vakaları psikodinamik açıdan formüle edildiğinde, olguların düşünce, his ve aynı zamanda davranışları hakkında da daha fazla bilgi sahibi olunabilir. Bu çalışmada, psikodinamik görüşme tekniği ile elde edilen bilgilerden yola çıkarak SKB tanılı olgunun, dürtü, duygulanım, mizaç özelikleri, savunma mekanizmaları, kendilik, nesne ilişkileri ve üst benlik durumu tartışılmıştır.
Psychodynamic formulation in borderline personality disorder: A case study
Psychodynamic case formulation examines how symptoms of the patient appeared and constitutes a useful guideline for clinicians because it examines the level of object relations, ego strength, mental capacity, and core conflict, plans the treatment, and predicts prognosis. Borderline personality disorder (BPD) cases display symptoms characterized by dramatic life history, impulsivity, relationship problems, and unstable moods and behaviors. These unstable and multiple symptoms affect the clinical appearance and treatment response of the disorder. People with BPD build up intense transference and countertransference responses and are often perceived as “difficult patients” by healthcare professionals and nurses who spend the most time with these patients in inpatient services. Therefore, psychodynamic formulation is particularly necessary and useful in BPD cases to understand the patient better and manage the treatment processes. The case presented here reported complaints including mood swings, feelings of emptiness, inability to go to school, bursts of rage, self-injurious behaviors, and suicidal thoughts and attempts. Her expectations from treatment were to control her anger, express herself, be strong in bilateral relationships, and be a normal person. A psychodynamic formulation was done in company with the supervision and the case was diagnosed with BPD. Formulating BPD cases in terms of a psychodynamic perspective may provide more information on thoughts, emotions, and behaviors of the patients. In this study, through the information obtained using psychodynamic interview techniques, impulse, affectivity, mood characteristics, defense mechanisms, selfdom, object relations, and superego of the BPD diagnosed case are discussed.

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