ヒステリー反応を伴った境界性人格障害に対する作業療法の一経験

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A 17-year-old male student with suspected hysterical conversion reaction has been involved in occupational therapy to improve his psychological adjustment and his concentration. He was referred to the psychiatric clinic by an ophthalmologist, who failed to find any abnormality to explain his fluctuating visual difficulties, Psychiatric interviews and clinical observation of his stormy behavior and manipulative interpersonal dealings indicated borderline personality disorder (BPD: DSM Ⅲ-R). After one year of a multidisciplinary team approach, he was enrolled in a highschool program for the visually handicapped, and he continues with regular psychotherapy and occupational therapy. The following are findings of therapeutic value in occupational therapy for BPD at the early stages of psychiatric intervention. 1. The nonverbal occupational therapy approach and the verbal psychotherapy complement one another to enhance the therapeutic effectiveness. 2. Real life situations simulated by the occupational therapy program provide nonverbal limit setting for the BPD, ensuring a secure structure to overcome his tremendous feelings of inadequate self control. 3. Various activities serve to facilitate free and satisfying self expression on a more or less somato-sensational level: a carefully guided acting out in a safe environment. 4. The objects created by the patient have emotional significance as transitional objects.However, craft activities are rarely chosen due to the possible emotional threat to his fragile ego should he fail.

ヒステリー反応を伴った境界性人格障害に対する作業療法の一経験

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