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表演型人格障碍心理咨询-给力心理
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发表时间:2015-02-06 14:39:53 263 0 0

李某,男,26岁,工人,汉族,已婚。因喜表现自己,感情用事,易激惹13年入院。
     病人于13年之前,不明原因逐渐表现爱模仿戏装演员的动作,身着戏装或其姐的红毛衣,头扎鲜花,抹口红,打扮自己,行为举止女性化。同时容易发脾气,自己的愿望如不能得到满足,就烦躁,甚至打人。变得非常自私,把家里电视机和洗衣机搬至自己的房间,不许别人使用,并常紧锁门户,防止他人进入。爱听表扬的话,与人谈话时,总想让别人谈及自己如何有能力,亲戚如何有地位,自己外貌如何出众等,如果别人谈及别的话题,病人常常千方百计地将话题转向自己,而对别人的讲话内容则心不在焉。因此病人常与家庭地位、经济情况、个人外貌等不如他的人交往,而对强于他的人常常无端抵毁。病人常常感情用事,以自己高兴与否判断事物的对错和人的好坏,对别人善意的批评,即使很婉转,也不能虚心接受,不但不领情,还仇视别人,迫使别人不得不远离他。因此许多人说他不知好歹。与别人争论问题时,总要占上风,即使自己理亏,也要编造谎言,设法说服别人。病人常到火车站站口或公共汽车上帮助检票、售票。有时对人过分热情,但若别人稍违于他,就与别人吵架,从而导致关系破裂,几乎无亲密朋友。近几年来,与人发生纠纷次数有所增加,给家庭带来许多麻烦。于1992年3月25日入院。患病13年来,病情从未缓解过,但饮食、睡眠、大小便基本如常。

     平素体健,无高热、抽搐、昏迷史,无中毒、肝炎、结核等病史,无服用成瘾物质病史。

     母孕期健康,足月顺产,幼年发育正常。7岁上学,学习成绩较好,初中毕业后参加工作,从事一般体力劳动。姐弟3人与2个姐姐为同母异父,因此父母对其特别溺爱、娇惯。任性,不让人,听不得批评意见。

     精神状态检查:意识清,仪表整洁,自行步入病房,年貌相符,接触主动合作,对周围环境不感陌生,定向力完整,饮食、睡眠好,生活可自理。未发现感、知觉障碍和思维联想障碍。言语流畅,语量稍多。注意、记忆、计算无明显障碍,智能正常。自知力不完整,对自己易烦躁、发脾气,认为属病态,但对自己自私、爱表现等无正确认识。情感反应协调,但强烈而多变,谈及戏装或某人长相时,表现很大兴趣,面带笑容,表情夸张,谈及人际关系时则又抱怨别人,带有敌视情绪。以医护人员对他的态度好坏来评判对方长相是否漂亮。否认身着戏装时有性快感。言谈举止富有女性色彩。行为幼稚,有时故意尖声怪叫,以引起病友注意。

     辅助检查:血常规、肝功能化验正常。心电图正常。脑电图呈界限性脑电图。染色体显带分析未见异常。MMPI测查不合作,回答均为“是”,测图无效。

     【病例讨论】

     表演型人格障碍,又称癔症型人格障碍或寻求注意型人格障碍,或心理幼稚型人格障碍。从这些同义术语的字面含义中即可看出,此型人格障碍以人格的过分感情化,以夸张言行吸引注意力及人格不成熟为主要特征。关于癔症型人格与癔症的关系,过去认为二者是一脉相承的。但临床观察发现,癔症病人的病前人格为表演型的仅为20%,一些明显的表演型人格病人可终生不发生癔症,此情况表明表演型人格虽有癔症有关,但并非必然联系。因此,现在普遍倾向于使用“表演型”而回避“癔症型”,以达到将“癔症人格”与“癔症”分开之目的。

       国外报道本病在成人人群中的患病率为2.2%,妇女高于男性2倍。本病的病因主要是幼年创伤性体验,家庭因素、文化影响等。较多发生于少年期后阶段,随着年龄的增长,人格逐渐趋向成熟,至中年达到明显缓解。

 

 

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