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SWAP-200によるパーソナリティ障害の理解
75 ᯓឭคɟ≝⁅⁉″⁂‟․•• ↚↷↺⇷∞⇣⇰∐⇬⇉ᨦܹ↝ྸᚐ ᄂᆮ⇴∞⇮‒ ଐஜܖܖٻኔᙲ‒ ᇹ ‣… ӭ≋․•‣‧≌‒ SWAP-200 ↚↷↺⇷∞⇣⇰∐⇬⇉ᨦܹ↝ྸᚐ ≝DSM-IV II ᠆↗↝Ⴛᢌ↗ଐஜ↝࣎ྸᐮ↧↝ᢘဇ↝ӧᏡࣱ ᯓឭ‒ คɟ‒ 1 ஜᆜ↞ Westen and Shedler (1999)ⅻ˺ↆ Shedler and Westen Assessment Procedure (SWAP-200)↚↷↺⇷∞⇣⇰∐⇬⇉ᨦܹ↝ྸᚐ⇁⅚DSM-IV II ᠆↝↻↗ൔ᠋ↆ↙ⅻ↸ኰʼↈ↺ↂ ↗⇁Ⴘႎ↗ↆ↕ⅳ↺⅛ↂↂ 20 ࠰˷⅚⇷∞⇣⇰∐⇬⇉ᨦܹྸᚐ↝σᡫᚕᛖ↗ↆ↕්ࠋↆ↕ⅼ DSM-IV II ᠆↚↞ወᚘႎ↞ࣱ࢘ڲ᭗ⅳⅻ⅚ᐮႎᚇ↝↗ݑᨠ↹ⅻⅱ↹⅚ၲ↚ࢫ↚ᇌ↙ⅳ⅚ ၏ྸ↝ྸᚐⅻᡶ↭↙ⅳ↗ⅳ→٣ⅻɥⅻ→↕ⅳ⅛↝ᨠ↹↝Ҿ⅚↞↕ↆ↗׆ӷɟ↝ᘮᚮૺᎍ ↚ᙐૠ↝ᚮૺӸⅻ↓ⅳ↕ↆ↭ⅵ↗ⅳⅵӓளࣱࡰКࣱ↝բ᫆⅚ଏ↝܍ᚮૺؕแ⇁⇮⇩⇽⇦⇌∙ႎ↚ ࢘↕↞↰↕ↆ↭ⅵↀ↖⅚ૼↆⅳႆᙸⅻӒପↄ↻↙ⅳЎඥ↝բ᫆⅚ᚮૺ⇽∓⇡⇟↚ⅹⅳ↕⅚ϋ Ⴞⅻഎↀⅻ←↙ᘮᚮૺᎍ↝ᐯࠁဎԓⅻΟέↄ↻⅚ᐮܼ↝ᧉݦႎ↙ᚇݑⅻᨊↄ↻↕ↆ↭→↕ⅳ ↺բ᫆↙↘ⅻਦઇↄ↻↕ⅼ↕ⅳ↺⅛DSM ↞⅚ወᚘႎ↙̮↳ࣱ࢘ڲࣱ᫂↚ؕ↔ⅳܲᚇࣱ⇁ࢍᛦↈ ↺Ⅴᅹ↝ܖჷⅥ⇁᭗↰↺↰⅚̾⅝ʴ↝ᐯࣱ⇁ྸᚐↈ↺ज़ᙾ⅚ⅳ↾↵↺Ⅴᐮ↝ჷⅥ⇁བྷཌ↚ ↆ↗ↂ↼ⅻⅱ↹⅚ମ࠰⅚Ј༿ↄ↻ DSM-V ↖↱⅚⇷∞⇣⇰∐⇬⇉ᨦܹ↚᧙ↆ↕↝ↂ↻↸↝բ᫆ ↞சᚐൿↄ↻↕ⅳ↙ⅳ⅛ɟ૾⅚SWAP-200 ↞⅚ᧉݦဇᛖ⇁̅↾↉੨ⅺ↻⇷∞⇣⇰∐⇬⇉ཎࣱ 200 Ⴘ⇁ Q ⇣∞⇮ඥ↖Ўↈ↺ↂ↗↖⇷∞⇣⇰∐⇬⇉ᨦܹ⇁ਵ↸ⅷ↸↻↺↷ⅵ˺ↄ↻↕ⅳ↺⅛ ↂ↝ 200 Ⴘ↞ DSM ↙↘ଏ↝ࡇݿ⇮∙∇⇟⇡⇈↝܍ᚡᡓ⇁ؕ↚˺↸↻⅚ↄ↸↚ဇↆᐮܼ ⅺ↸↝⇻⇉∞⇯⇶⇩⇕⇁↱↗↚࠹ࡇⅺોᚖⅻ↙ↄ↻↕ⅼ≋ϋܾႎ↝ࣱ࢘ڲਃ̬≌ ⅛ӓளႎ∝ࡰК ႎ↱↕ↆ᧙↚ࣱ࢘ڲᜂ↚↖ↈ↖ٳᄩᛐ↚ↄ↻↕ⅹ↹⅚⇁ឭⅷ↕̅ဇӧᏡ↗⇈⇡⇟∇∙⇮↳ᢅ ᆉᄂᆮ↚̅↾↻↕ⅼ↕ⅳ↺⅛ӷಮ↚ଐஜ↖↱ဇⅻӧᏡ↖ⅱ↺↗࣬↾↻↺ⅻ⅚↝ᨥ↚↞Ⴘϋ ܾⅻଐஜʴ↝⇷∞⇣⇰∐⇬⇉ཎࣱ↳ͼӼ⇁ᢘЏ↚ਵⅷ↸↻↕ⅳ↺ⅺ౨᚛ↈ↺࣏ᙲⅻⅱ↺⅛↭ SWAP-200 ↞∂⇮∆⇈⇩⇽ႎ↚ⅳ↾↵↺Ⅴᐮ↝ჷⅥ⇁Ӓପↈ↺↷ⅵ↚˖↕↻ↄⅳ↺ⅻ⅚↻ ↞ↈ↙↾←⅚ᐮܼ↝͞ᙸ↚↱ࢨ᪪⇁Ӗↀ↕ↆ↭ⅳ↳ↈⅳ↗ⅳⅵↂ↗↱ॖԛↆ↕ⅳ↺⅛ଐஜ↚ SWAP ⇁ݰλↈ↺ᨥ↞⅚ᐮܼⅻᢘЏ↚ɫ↓јௐႎ↚⇕∏⇊⇎∙⇮↝МႩ↚↙↺↷ⅵ⅚SWAP-200 ⇁ဇ↖ⅼ↺↷ⅵ↙⇛∃∞⇮∝⇝⇟⇬∆ⅻૢⅷ↸↻↺ↂ↗ⅻஓ↭↻↺⅛ äääääääääääääääääääää‒ ⇓∞∕∞⇯‒ ääääääääääääääääääää SWAP-200‒ DSM-IV II ᠆‒ ⇷∞⇣⇰∐⇬⇉ᨦܹ ‒ ‒ ․•‣… ࠰ உ ․‥ ଐӖྸ‒ Introduction of the SWAP-200 as a new language to understand personality disorders in Japanese clinical psychology *1 Junichi TORIGOE ଐஜܖܖ⇪∞⇈∑∏⇿∐ܖٻᢿ‒ 76 ଐஜܖܖٻኔᙲ‒ ᇹ ‣… ӭ≋․•‣‧≌‒ ⢭⚄⛉་ࡸࡢ⫋✀ࢫࢱࢵࣇඹ㏻ゝㄒࡋ࡚ 㸯ࡣࡌࡵ ࠼ࡿࠊ㸦㸱㸧ከ㍈デ᩿࣭㔜」デ᩿ࡀྍ⬟ࠊ㸦㸲㸧 ◊✲⏝ࡼ࠸ࠊ 㸦㸳㸧ᅜ㝿ⓗ㏻⏝ࡍࡿࠊ 㸦㸴㸧⤒ ᮏ✏ࡣࠊࣃ࣮ࢯࢼࣜࢸ㞀ᐖࡢࢭࢫ࣓ࣥࢺ࣭ ࢶ ࣮ ࣝ ࡛ ࠶ ࡿ Shedler-Westen Assessment Procedure㸦௨ୗ SWAP-200㸧ࡢ⤂ࢆ┠ⓗࡋ ࡚࠸ࡿࠋSWAP-200 ࡣࠊ⢭⚄ᝈࡢデ᩿࣭⤫ィ࣐ ࢽࣗࣝ 㸦௨ୗ DSM㸧➨ 4 ∧㸦⡿ᅜ⢭⚄་Ꮫ㸧 II ㍈ࡢ௦᭰ࢭࢫ࣓ࣥࢺ࣭ࢶ࣮ࣝࡋ࡚ Shedler Westen (1999ab)ࡼࡗ࡚సᡂࡉࢀࠊ⌧ᅾࡲ࡛ Ḣ⡿ㅖᅜࢆ୰ᚰ 12 ࢝ᅜࡢゝㄒ⩻ヂࡉࢀ࡚ ࠸ࡿࠋ DSM ࡸ ICD 㸦 International Statistical Classification of Diseases and Related Health Problems ୡ⏺ಖᶵ㛵㸧ࡢࡼ࠺࡞デ᩿ࡢୡ⏺ᇶ ‽ࢆసࡿࡇࡣࠊࡇࡇ༙ୡ⣖㛫ࠊ⢭⚄་⒪ࡀྲྀࡾ ⤌ࢇ࡛ࡁࡓㄢ㢟࡛࠶ࡾࠊ SWAP-200 ࡶࡑ࠺ࡋࡓ ືྥࡢ୍ࡘࡢᙧ࡛࠶ࡿࠋ࠸ࡎࢀࡶࠊྠ୍ᝈ⪅ᑐ 㦂ࡀὸࡃ࡚ࡶ࠼ࡿࠊ࡞ࡀᣲࡗ࡚࠸ࡿࡀࠊࡑࡢ ୍᪉࡛ḞⅬࡋ࡚ࠊ㸦㸯㸧⣽ࡍࡂ࡚☜ㄆᡭ㛫 ࡀࡿࠊ㸦㸰㸧⣽ࡍࡂ࡚ࡕࡻࡗࡢᕪ࡛㐪ࡗ ࡓྡ࡞ࡿࠊ㸦㸱㸧⒪ᙺ❧ࡓ࡞࠸ࠊᝈ⪅⌮ ゎࡀ㐍ࡲ࡞࠸ࠊ㸦㸲㸧⢭⚄⌮ࡢ⌮ゎࡀ㐍ࡲࡎࠊ ᮏ㉁ࡀศࡾࡃ࠸ࠊ㸦㸳㸧⛉ࡢ་ᖌࡸࡢ⫋ ✀ࡢࢫࢱࢵࣇࢃࡽ࡞࠸ࠊ㸦㸴㸧ᨵゞࡼࡗ࡚ デ᩿ྡࡀኚࢃࡿࠊ࡞ࡀᣲࡗ࡚࠸ࡿࠋࠕᐈほᛶࡸ ಙ㢗ᛶࡀ㧗࠸ࠖࡶ㛵ࢃࡽࡎࠊᑡࡋࡢᕪ࡛㐪࠺ ྡ࡞ࡗࡓࡾࠊ⒪ᙺ❧ࡓ࡞ࡗࡓࡾࠊ⢭⚄ ⌮ࡢ⌮ゎࡀ㐍ࡲ࡞࠸࠸࠺ࡢࡣࠊ⤫ィⓗࡣጇᙜ ࡛࠶ࡿࡀࠊ⮫ᗋⓗࡣጇᙜ࡛ࡣ࡞࠸࠸࠺ࡇ࡛ ࠶ࡾࠊࡇࡢឤぬࡢ㝸ࡓࡾࡣ࣐ࢽࣗࣝࡋ࡚ࡣ ࡞ࡾ῝้࡞ၥ㢟࡛࠶ࡿࠋ ࡇ࠺ࡋࡓṍ࡞≧ែࡢ⌧ࢀࡢ୍ࡘࠊ㛗ᖺ㆟ㄽࡉ ࡋ࡚ࠊሙᡤࢆၥࢃࡎࠊ୍㈏ࡋࡓ⢭⚄་⒪ࢧ࣮ࣅࢫ ࢀ࡚࠸ࡿ DSM ࡼࡿ㐣デ᩿ࡢၥ㢟ࡀ࠶ࡿࡀ ࢆᥦ౪ࡍࡿࡇࢆ┠ⓗࡋ࡚࠸ࡿࠋ 㸦ୖグࡢ DSM ➨୍ࡢ᮰ⓗ࣭ᘚูⓗጇᙜᛶࡢၥ ࡋࡋࠊDSM-IV II ㍈ࡣ௨ୗࡢࡼ࠺࡞ጇᙜᛶ ࡢၥ㢟ࡀᣦࡉࢀ࡚࠾ࡾࠊฟ∧ࡉࢀࡓᙜึࡽඹ ㏻ゝㄒࡋ࡚ࡢホ౯ࡀồࡵࡽࢀ࡚ࡁࡓࠋ➨୍ࠊ ྠࡌ⿕デ᩿⪅ከࡃࡢࣃ࣮ࢯࢼࣜࢸ㞀ᐖࡢデ ᩿ྡࡀࡘ࠸࡚ࡋࡲ࠺࠸࠺᮰ᛶࡸᘚูᛶࡢၥ 㢟 (1)ࠊ➨ࠊ≧ࡢࠕ࠶ࡿࠖࠕ࡞ࡋࠖࡢ⪅ᢥ ୍ࡼࡿ࢝ࢸࢦ࣮ࣜศ㢮ἲࡀࣃ࣮ࢯࢼࣜࢸࡢ デ ᩿ 㐺 ษ ྰ ࠸ ࠺ ၥ 㢟 (DSM-IV-TR p.655, Trull & Widiger, 2013)ࠊࡑࡋ࡚➨୕ࠊ デ᩿ࣉࣟࢭࢫࡀࠊ⿕デ᩿⪅ࡢ⮬ᕫ⏦࿌ጤࡡࡽࢀ ࡚࠾ࡾࠊ⿕デ᩿⪅ෆ┬ࡍࡿຊࠊὝᐹࡍࡿຊࡀ࠶ ࡿࡇࢆ๓ᥦࡋ࡚࠸ࡿ࠸࠺ၥ㢟࡛࠶ࡿ 㸦Westen & Shedler,1999ab㸧ࠋ㸦2㸧 ࡇࢀࡽࡢၥ㢟ࡣಶࠎ⊂❧ࡋ࡚࠸ࡿ࠸࠺ࡼ ࡾࠊ┦㛵ࡋ࡚࠾ࡾࠊデ᩿ᚰ⌮⮫ᗋࡢᐇ㊶ ࡢ㛫ወጁ࡞㐪ឤࢆసࡾࡔࡋ࡚ࡁࡓࠋࡓ࠼ࡤࠊ 㧗ᶫࡽ㸦2001㸧ࡀ⾜ࡗࡓ⢭⚄⛉་ࢆᑐ㇟ࡋࡓ DSM-IV ࡘ࠸࡚ࡢㄪᰝ࡛ࡣࠊDSM ࡢⅬࡋ ࡚㸦㸯㸧ಙ㢗ᛶࡸᐈほᛶࡀ㧗࠸ࠊ㸦㸰㸧Ꮫὴࡢ 㢟㛵㐃㸧 ࠊࡇࡢཎᅉ㛵ࡋ࡚ࠊ㔝㸦2014㸧ࡣ DSM ࡢᵓᡂࡑࢀ⮬య࠸࠺ࡼࡾࡶከ㍈デ᩿ࢆ ࠸ࡇ࡞ࡏ࡚࠸࡞࠸ᑓ㛛ᐙ㸦デ᩿⪅ഃ㸧࠶ࡾࠊᶵ ⬟㞀ᐖࢆ㐺ษホ౯ࡏࡎࠊ≧ࡢ᭷↓ࡔࡅࡢุ᩿ ࡛デ᩿ࢆ⾜ࡗ࡚࠸ࡿࡓࡵࡔᣦࡋ࡚࠸ࡿࠋᐇ㝿ࠊ ᶵ⬟㞀ᐖࡢホ౯ࡢᚲせᛶࡣࡇࢀࡲ࡛ࡶከࡃࡢ ⮫ᗋᐙࡀᙇࡋ࡚࠸ࡿࡀ㸦Westen & Shedler, 1999ab㸧ࠊࡇࡢၥ㢟ࢆࣄ࣮࣐࢚࣮ࣗࣥࣛࡋ࡚∦ ࡅࡿࡣၥ㢟ࡀゎỴࡋ࡞࠸ᮇ㛫ࡀ࠶ࡲࡾࡶ 㛗㐣ࡂࡿࠋࡶࡋࣄ࣮࣐࢚࣮ࣗࣥࣛࢆၥ㢟ࡍࡿࡢ ࡛࠶ࢀࡤࠊࡑࢀࢆྵࡵࡓୖ࡛ࡢ DSM ࡢᵓᡂࡢぢ ┤ࡋࡀ࠶ࡗ࡚ࡋࡿࡁ࡛࠶ࡿࠋ≉ࠊᮏ✏ࡀࢱ ࣮ࢤࢵࢺࡋ࡚࠸ࡿࣃ࣮ࢯࢼࣜࢸ㞀ᐖࡣࠊࡑࡢ ᴫᛕࡀฟ࡚ࡁࡓ㡭ࡼࡾࠊࠕ㞀ᐖࠖࠕಶᛶࠖࢆ ࡢࡼ࠺༊ูࡍࡿࡢ࠸࠺ၥ㢟ࡀ⧞ࡾ㏉ࡋ㆟ ㄽࡉࢀ࡚ࡁ࡚࠾ࡾࠊᶵ⬟ࡢホ౯ࡀ㛗ᖺồࡵࡽࢀ࡚ ࡁࡓࠋࡑࢀࡶ㛵ࢃࡽࡎࠊDSM ࡣࡑࢀᑐࡋ࡚ ࡲࡔ༑ศ࡞ゎỴࢆ࿊♧࡛ࡁ࡚࠸࡞࠸㸦➨ࡢศ㢮 ἲࡢၥ㢟㛵㐃㸧 ࠋ 77 ᯓឭคɟ≝⁅⁉″⁂‟․•• ↚↷↺⇷∞⇣⇰∐⇬⇉ᨦܹ↝ྸᚐ ࡋࡋࣃ࣮ࢯࢼࣜࢸࡢࠕ㞀ᐖࠖࡢᴫᛕ㛵ࡋ ᐃࡢ㌟యⓗ≧ែࢆᫎࡋ࡚࠸ࡿࡢ࡛ࡣ࡞ࡃ㸦ᐇ ࡚ࡣࡼࡾ」㞧࡞ၥ㢟ࡀ࠶ࡿࠋDSM-IV-TR ࡣࣃ࣮ ⓗ࡛ࡣ࡞ࡃ㸧ࠊ ࠕᖾࡔࠖ㏙ࡿࡇࡑࡢࡶࡢ ࢯࢼࣜࢸ㞀ᐖࡢデ᩿࠶ࡓࡗ࡚ࠊࠕࡑࡢேࡀᒓ 㔜せ࡞♫ⓗᶵ⬟ࡀ࠶ࡾ㸦ᐇ㊶ⓗ࡛࠶ࡾ㸧Ɇᚰ⌮ ࡍࡿᩥࡽᮇᚅࡉࢀࡿࡶࡢࡽⴭࡋࡃ೫ࡗࡓࠊ ⏝ㄒࡀࡑࢀᑐᛂࡍࡿᚰ⌮≧ែࢆ᭷ࡋ࡚࠸ࡿ ᗈ⠊ࡘᰂ㌾ᛶࡢ࡞࠸ࠊᣢ⥆ⓗ࡞ෆⓗ࠶ࡿ࠸ࡣ⾜ ࠸࠺๓ᥦࡣࡲࡗࡓࡃࡢㄗࡾ࡛࠶ࡿᙇࡋ࡚࠸ ືࡢᵝᘧࡼࡗ࡚ࠊⱞ③ࡲࡓࡣ㞀ᐖࢆᘬࡁ㉳ࡇࡋ ࡿࠋࡑࡢୖ࡛ Gergen ࡣࠊ⤖ᯝࡋ࡚་⒪ࡢᑓ㛛 ࡚࠸ࡿࠖ㸦p.651㸧ࡇࢆᚲせ᮲௳ᣲࡆ࡚࠸ࡿࠋ ᐙࡣᑓ㛛⏝ㄒࢆసࡾࠊ࠸ࠊࡉࡲࡊࡲ࡞ᚰ⌮≧ែ ࡋࡋࠊㄡࡽぢ࡚ࡢࠕ೫ࡾࠖ࡞ࡢ࡛࠶ࢁ࠺㸦➨ ࢆᚰ⌮࣭ᑓ㛛ࡍࡿࡇࡼࡗ࡚ໃຊࢆᣑࡋ ୕ࡢデุ᩿࣭᩿ࡢయ⪅ࡢၥ㢟㛵㐃㸧ࠋ⿕デ᩿ ࡚ࡁࡓㄽࡌ࡚࠸ࡿࠋࡇࡢ Gergen ࡢᚰ⌮ゝㄝ ⪅ࡢࠕ೫ࡾࠖࡣࠊ➨୕⪅࡛࠶ࡿ⮫ᗋᐙࡢุ᩿ࡍࡿ 㛵ࡍࡿ⌮ㄽࡣࠊඛࡢ㔝ࡢㄝ᫂ࡣࡲࡗࡓࡃ␗࡞ ࠕ೫ࡾࠖ࡞ࡐྠࡌゝ࠼ࡿࡢࡔࢁ࠺ࠋデ᩿ࢆ ࡗ࡚࠸ࡿࡀࠊDSM ࡀ⿕デ᩿⪅ࡢ⏦࿌ࢆࡲࡉ ཷࡅࡿேࡢほⓗయ㦂デ᩿ࢆࡍࡿேࡢほⓗ ⌮ࡢᐇࡋ࡚ཷࡅྲྀࡿࡇࡽጞࡲࡿࡇࢆ య㦂ࠊࡉࡽࠊඹ㏻ゝㄒࡋ࡚ᢅ࠺ࡢ࡛࠶ࢀࡤࠊ ⪃࠼ࡿࠊ㐣デ᩿ࡀቑ࠼࡚࠸ࡿ࠸࠺⌧㇟ࢆࠊ ࡑࡢࡢ㛵ಀ⪅࡞࠶ࡽࡺࡿேࡢయⓗయ㦂ࡀ ࠶ࡿ࠸ࡣࠊ㧗ᶫࡽࡢㄪᰝ࡛ฟ࡚ࡁࡓࡼ࠺࡞⤫ィⓗ ྠࡌ࡛࠶ࡿࡇࢆ๓ᥦࡋ࡞ࡅࢀࡤࠊࡇࢀࡽࡣᮏ ⤖ᯝ⮫ᗋⓗឤぬࡢᕪ␗ࢆㄝ᫂ࡍࡿ୍ࡘࡢどᗙ ᮶ᡂ❧ࡋ࡞࠸㆟ㄽ࡛࠶ࡿࠋ ࡛࠶ࡿࡼ࠺ᛮ࠺ࠋ ࡇ࠺ࡋࡓᐈၥ㢟ࡣࡇࡇ࡛ᢅ࠺ࡣ࠶ࡲࡾ ᮏ✏ࡀ⤂ࢆ┠ⓗࡋ࡚࠸ࡿ SWAP-200 ࡣࠊ ࡶࡁ࡞ࢸ࣮࣐࡛࠶ࡾࠊᮏ✏ࡢ┠ⓗࡶࡎࢀ࡚ࡋ DSM ྠᵝࠊᑓ㛛ᐙ㛫ࡢඹ㏻ゝㄒࢆసࡿࡇࢆ┠ ࡲ࠺ࡓࡵࠊ῝ࡃྲྀࡾᢅ࠺ࡇࡣࡋ࡞࠸ࡀࠊᅇࡣ ᣦࡋ࡚࠸ࡿࡀࠊDSM ࡢ┬ࡽ⏕ࡲࢀ࡚ࡁࡓ ࡇࡢ✀ࡢၥ㢟ࡢ⫼ᚋ࠶ࡿᛮࢃࢀࡿ୍ࡘࡢほ ࢭࢫ࣓ࣥࢺ࣭ࢶ࣮࡛ࣝ࠶ࡿࡔࡅࠊࡑࡢデ᩿᪉ Ⅼࡋ࡚ࠊGergen ࡢᚰ⌮ゝㄝㄽᑡࡋゐࢀ࡚࠾ ἲࡶ DSM ࡣኚ␗࡞ࡗ࡚࠸ࡿࠋୖグࡢၥ㢟Ⅼ ࡁࡓ࠸ࠋGergen㸦1994㸧ࡣࠊすὒᩥ࡛ࡣほ 㛵ࡋ࡚୧⪅ࢆẚ㍑ࡋ࡞ࡀࡽࠊ⢭⚄་⒪㡿ᇦ࠾ ⓗ≧ែࡢㄝ᫂ࡣ⪅ඹ᭷࡛ࡁࡿ⪃࠼࡚࠾ࡾࠊ ࡅࡿ SWAP ά⏝ࡢព⩏ࢆ࿊♧ࡋࡓ࠸ࠋ ᚰ⌮ゝㄒࡣᚰ⌮≧ែࢆᐇࡋ࡚࠸ࡿࢃ࡞࠸ ᣦࡋ࡚࠸ࡿࠋࡍ࡞ࢃࡕࠊ⚾ࡀᖾࡔゝ࠼ࡤࠊ ⚾ࡢᖾ࠶࡞ࡓࡢᖾࡣ㐪ࡗ࡚࠸࡚ࡶࠊ୧⪅ࡣ 㸰6:$3 సᡂࡢ⫼ᬒ㸸⢭⚄ศᯒ࠾ࡅࡿ ᐇド◊✲ࡢᢈุ ࡑࢀࡒࢀࡀྠࡌ“ᖾ”ࢆ᭷ࡋ࡚࠸ࡿಙࡌ࡚ࡋ ࡲ࠺࠸࠺ࠋ᪥ᮏᩥࡶࠊእⓎࡏࡽࢀࡓゝⴥ ࡀ⌧ᐇⓗ㇟࡞ࡗ࡚ᙳ㡪ࢆཬࡰࡍ࠸࠺ゝ㟋 ಙ௮ࡀ࠶ࡗࡓ㸦࠶ࡿ࠸ࡣࠊᮍࡔᏑᅾࡍࡿ㸧ࡇ ࢆ⪃࠼ࡿࠊ࠶࡞ࡀࡕすὒᩥ≉᭷ࡢၥ㢟ࡣゝ ࠸㞴࠸ࠋᐇ㝿⚾ࡓࡕ᪥ᮏேࡶⱞ③ࡸᝒယ࡞ࡢᚰ ⌮≧ែࢆ≀㇟ࡋࠊ࠶ࡓࡶᐇᅾࡍࡿఱࡘ࠸ ࡚ㄝ᫂ࢆࡋ࡚࠸ࡿࡼ࠺࡞㘒ぬࢆᢪࡁࡸࡍ࠸ഴྥ ࡀ࠶ࡿࡼ࠺ᛮ࠺ࠋGergen ࡣࠊᚰ⌮ゝㄒࡣᚰⓗ ≧ែࢆᐇࡍࡿࡶࡢ࡛ࡣ࡞ࡃࠊヰࡋᡭ⪺ࡁᡭࡢ ┦స⏝ࢆᘬࡁ㉳ࡇࡍᐇ㊶ⓗ࡞ࡶࡢ࡛࠶ࡿㄽ ࡌ࡚࠾ࡾɆࡍ࡞ࢃࡕࠊ ࠕ⚾ࡣᖾࡔࠖゝ࠺ࡁࡢ ࠕᖾࡔࠖ࠸࠺ゝⴥࡣࠊࢽ࣮ࣗࣟࣥࡢ≧ែࡸ≉ SWAP-200 ࡣ DSM-IV II ㍈ࡢ௦᭰ࢭࢫ࣓ࣥ ࢺࡋ࡚ㄌ⏕ࡋ࡚࠸ࡿࡀࠊసᡂࡣࡶ࠺୍ࡘูࡢ ⫼ᬒࡀ࠶ࡿࠋSWAP-200 ࡣࡑࡢ⌮ㄽⓗ⫼ᬒ⢭⚄ ศᯒ⌮ㄽࢆ᭷ࡋ࡚࠾ࡾࠊࡇࢀࡲ࡛ࡶ⢭⚄ศᯒ ⒪ࡢຠᯝ◊✲ࡸࣉࣟࢭࢫ◊✲ࡶά⏝ࡉࢀ࡚ࡁ ࡓࠋ㏆ᖺࡣ㉁ⓗ◊✲ࡀྎ㢌ࡋ࡚ࡁࡓࡇࡶ࠶ࡾࠊ ⢭⚄ศᯒࡀᚑ᮶ྲྀࡾ⤌ࢇ࡛ࡁࡓክࠊ㌿⛣ࠊᢠࠊ 㜵⾨࠸ࡗࡓほⓗయ㦂ࡢ◊✲ࡶ᫇ẚࠊࡣࡿ Ꮫ⾡ⓗチᐜࡉࢀࡿࡼ࠺࡞ࡗ࡚ࡁࡓࡀࠊࡑ ࢀ࡛ࡶ࡞࠾ࠊ⤫ィⓗࢹ࣮ࢱࡀ⛉Ꮫࢆࡅࡍࡿ ࠸࠺ᩘᑐࡍࡿಙ㢗ࡣࡁ࠸ࠋᐇ㝿ࠊ⢭⚄ศᯒࡢ 㡿ᇦࡣࠊㄆ▱⾜ື⒪ἲࡢ◊✲ࡢࡼ࠺࡞⤫ィࢆ 78 ଐஜܖܖٻኔᙲ‒ ᇹ ‣… ӭ≋․•‣‧≌‒ ࡗࡓ㔞ⓗᐇド◊✲ࡀᅽಽⓗᑡ࡞ࡃࠊࡑࢀࢆ⌮⏤ Ⅼࢆᙜ࡚ࡿࡇࡀ࡛ࡁࡿ၏୍↓ࡢ᪉ἲ࡛࠶ࡿ ⢭⚄ศᯒࡢ⌮ㄽࡸ⒪ࡣጇᙜᛶࡀ☜ㄆ࡛ࡁ࡞ ࠸࠺ᙇࡀ࠶ࡾ㸦ࡓ࠼ࡤ Brenner 1982, Pine ࠸ࡉࡲࡊࡲ࡞ᢈุࡀ࡞ࡉࢀ࡚ࡁࡓࠋ⤫ィⓗ࢚ࣅ 1998㸧ࠊࡑࢀᨾࠊ 㸦⢭⚄ศᯒຎࡿ㸧ࡢ᪉ἲ࡛ ࢹࣥࢫࡀồࡵࡽࢀࡿ♫ⓗ≧ἣࡣࡉࡽࡁ࡞ ࡢ ᳨ ド ࡣ ᚲ せ ࠸ ࠺ ࡶ ࡢ ࡛ ࠶ ࡿ ࠋ Shedler ᙳ㡪ࢆࡶࡓࡽࡋ࡚࠾ࡾࠊ⡿ᅜ࡛ࡣ⢭⚄ศᯒ⒪ἲࡣ 㸦2002㸧ࡣࡇࡢ❧ሙࡀᘬࡁ㉳ࡇࡍၥ㢟ࡋ࡚ࠊᏛ ಖ㝤ࡢᑐ㇟እࡉࢀ࡚࠸ࡿࡇࡀከࡃࠊྛᕞࡀබ ὴ㛫ࡢ⌮ㄽⓗ㝸ࡓࡾࡢゎỴኻᩋࡋ࡚ࡁࡓࡇ ㄆࡍࡿ࢝࢘ࣥࢭ࣮ࣛࡢ㈨᱁ヨ㦂ࡶ⢭⚄ศᯒ㡿 ࢆᣦࡋ࡚࠸ࡿࠋศᯒᐙࡢ⌮ㄽⓗಙᛕࡣࠊ࢚ࣅࢹ ᇦࡽฟ㢟ࡉࢀࡿ࠸࠺ࡇࡣࡰ࡞࠸ࡼ࠺࡛ ࣥࢫࡼࡾࡶࠊྛ⮬ࡀᡤᒓࡍࡿࣥࢫࢸࢸ࣮ࣗࢺ ࠶ࡿࠋࡑ࠺ࡋࡓព࡛ࡶࠊ⤫ィⓗࣃ࣮ࢯࢼࣜࢸ ࡸࠊカ⦎ศᯒᐙࠊࢫ࣮ࣃ࣮ࣦࢨ࣮ࡽࡢྠ୍ ഴྥࢆฟࡋ࡚࠸ࡿ SWAP-200 ࡣ⢭⚄ศᯒ◊✲ ࡼࡗ࡚ࡼࡾ☜ᅛࡓࡿࡶࡢ࡞ࡗ࡚࠸ࡿࡼ࠺ ࡗ࡚ࡶࡁ࡞㈉⊩࡞ࡿࡼ࠺ᛮࢃࢀࡿࠋ ࡛ࠊ⮫ᗋ◊✲ࡣ⮬Ꮫὴࡢඃᛶࢆ♧ࡍࡓࡵ᭩ ࡋࡋࠊ⢭⚄ศᯒࡢ㡿ᇦ࡛ࡣࡇ࠺ࡋࡓ⤫ィⓗ࡞ ࢀ࡚࠸ࡿࡇࡶከ࠸࠸࠺ࠋࡇࡢᏛὴࡢྠ୍ ᐇド◊✲ࡣᚲࡎࡋࡶཷࡅධࢀࡽࢀ࡚࠸ࡿࢃࡅ࡛ ࡣᗘࠎၥ㢟࡞ࡗ࡚ࡁࡓࠋࡓ࠼ࡤ Kernberg ࡣ࡞࠸ࠋᐇ㝿ࠊࡇࢀࡲ࡛ࡶ Core Conflictual 㸦1996㸧ࡣ⢭⚄ศᯒࡢ㛢㙐ⓗ࡛ࠊ⼥㏻ᛶࡢ࡞࠸カ Relationship Theme㸦Lubosky, 1977㸧࡞ࠊ⣔ ⦎㐣⛬ࡀೃ⿵⏕ࡢ⬟ຊࡸྍ⬟ᛶࢆྎ↓ࡋࡋ࡚ ⤫❧࡚࡚⢭⚄ศᯒ⒪ࢆ᳨ドࡋࡼ࠺࠸࠺ヨࡳ ࡋࡲ࠸࠺ࡿࡇࢆ⓶⫗ࡲࡌࡾ③Ⅿᢈุࡋ࡚ ࡣ࠸ࡃࡘ⾜ࢃࢀ࡚ࡁࡓࠋࡋࡋࠊࡑ࠺ࡋࡓᐇド ࠸ࡿࠋࡲࡓ⢭⚄ศᯒࡢ⮫ᗋ◊✲࡛ࡋࡤࡋࡤ┠ ◊✲ࡀ⌧ᅾᗈࡃά⏝ࡉࢀ࡚࠸ࡿ࠸࠺ヰࢆ⪥ ࡍࡿࡢࡣࠊ⣲ᮦࢆ࢚ࣅࢹࣥࢫࡓࡽࡋࡵ࡚࠸ࡿࡶ ࡋ࡞࠸ࡢࡶࡲࡓᐇ࡛࠶ࡿࠋࡑࢀࡣࡉࡲࡊࡲ࡞ ࡢࡣࠊ⮬Ꮫὴࡢศᯒᐙࡀᇳ➹ࡋࡓㄽᩥࡢᘬ⏝࡛࠶ ⌮⏤ࡀ⪃࠼ࡽࢀࡿ㸦ࡓ࠼ࡤࠊ⢭⚄ศᯒᐙࡣ⒪ ࡾࠊ᭷ຊ࡞ⴭྡேࡢᙇࢆ᰿ᣐࡋ࡚࠸ࡿࡇࡀ ⪅ࡋ࡚ࡢカ⦎ࡀ㛗࠸ࡓࡵ◊✲⪅ࡋ࡚ࡢカ⦎ ከ࠸ࠋ100 ᖺ௨ୖ๓ࡢ Sigmund Freud ࡢㄽᩥࡀ ࡲ࡛⾜࠺వ⿱ࡀ࡞࠸ࠊ࡞㸧ࡀࠊᮏ㉁ⓗ࡞ၥ㢟 ᮍࡔࠊ࠶ࡓࡶ᰿ᣐࡋ࡚ᘬ⏝ࡉࢀࡿࡢࡣࡑࡢ ࡋ࡚ࡣࠊ⢭⚄ศᯒᐙ⮬㌟ࡀᐇド◊✲ᑐࡋ࡚ྰᐃ ᆺⓗ࡞࡛࠶ࡿࡀࠊࡇ࠺ࡋࡓၥ㢟ࡣ᪥ᮏ࡛ࡶぢ ⓗ࡛࠶ࡾࠊ㑊ࡅ࡚ࡁࡓࡇࢁ࠶ࡿࠋ ⪺ࡁࡍࡿࡇࢁ࡛࠶ࡿࠋ Shedler㸦2002㸧ࡣࠊ⢭⚄ศᯒ࠾ࡅࡿᐇド◊ ୕ࡘ┠ࡢࠕ↓㛵ಀࠖ࠸࠺ࡢࡣࠊᐇド◊✲࠸ ✲ᑐࡍࡿࡼࡃ࠶ࡿᢈุࡀࠊ ࠕྍ⬟ࠖࠊ ࠕᚲせࠖࠊ ࠺᪉ἲࢆ㐺⏝࡛ࡁ࡞࠸࠸࠺ᢈุ࡛࠶ࡾࠊࡑࡢ௦ ࠕ↓㛵ಀࠖࡢ 3 ✀㢮ศ㢮ࡉࢀࡿࡲࡵ࡚࠸ࡿࠋ ⾲ⓗ࡞ᙇࡋ࡚ࡣࠊ⢭⚄ศᯒࡣゎ㔘ᏛࡢᏛၥ࡛ ᭱ึࡢࠕྍ⬟ࠖ࠸࠺ࡢࡣࠊ⢭⚄ศᯒࡢᵓᡂᴫ ࠶ࡾ⛉Ꮫ࡛ࡣ࡞࠸࠸࠺ࡶࡢ࡛࠶ࡿࠋGill㸦1994㸧 ᛕࢆ㔞ࡋࡼ࠺ࡍࡿࠊ࠺ࡋ࡚ࡶ▸ᑠࡸṍ ࡣࠕ┦ᑐ⩏ࡢពㄒࡣᐇド⩏࡛࠶ࡿࠋᚋ⪅ࡣ ᭤ࡣ㑊ࡅࡽࢀࡎࠊศᯒⓗពࡢ࠶ࡿ◊✲ࡣ࡛ ほᐹ⪅ḟ➨࡛ࡣ࡞࠸ᐇ࠸࠺ࡶࡢࢆᐃࡋ࡚ ࡁ࡞࠸࠸࠺ᖐ⣡⩏ᑐࡍࡿᢈุ࡛࠶ࡾࠊ࠾ࡑ ࠸ࡿࠋ၏୍ࡢ┿ࡢ⟅࠼ࡀ࠶ࡿࡢࡔࠋ࠸ࢃࡤほᐹ⪅ ࡽࡃ᭱ࡶぢཷࡅࡽࢀࡿᙇ࡛࠶ࡿࠋࡋࡋ◊ ࡣせᅉࡽእࡋ࡚ࡶࡼ࠸ࡉࢀࡿࠋ㸦୰␎㸧ࣈࣛ ✲࡛࠶ࡗ࡚ࡶࠊ▸ᑠࡸṍ᭤ࡀ⏕ࡌ࡞࠸࠸࠺ ࣥࢡ࣭ࢫࢡ࣮ࣜࣥࡋ࡚ࡢศᯒᐙ࠸࠺ぢ᪉ࡣࠊ ࡇࡣ࠶ࡾ࠼࡞࠸ࡋࠊࡑࡶࡑࡶᅛ᭷ᛶࢆྎ↓ࡋ ศᯒᐙࢆ㛵ࡍࡿせᅉࡽ㝖እࡋ࠺ࡿࡍࡿࠊࡍ ࡋ࡚ࡋࡲ࠺ྰࡣ᪉ἲㄽࡢၥ㢟࡛࠶ࡿࠋ ࡞ࢃࡕศᯒᐙࡢほᐹࡶゎ㔘ࡶศᯒᐙ⮬㌟ࡢಶᛶ ࡘ┠ࡢࠕᚲせࠖ࠸࠺ࡢࡣࠊศᯒ⌮ㄽࢆ⏕ ࡢᐤࢆචࢀ࡚࠸ࡿࡍࡿㄗࡗࡓಙᛕࡢᆺ࡛ ࡳฟࡋࡓࡾࠊಟṇࡋࡓࡾࠊྫྷ࡛ࡁࡓࡾࡍࡿࡢࡣࠊ ࠶ࡿࠖ㸦p.24㸧㏙ࠊᐇド⩏ᇶ࡙ࡃ◊✲ࢆ ศᯒⓗ᪉ἲࡢࡳ࡛࠶ࡿ࠸࠺ᚠ⎔ㄽࡼࡗ࡚⏕ ᢈุࡋ࡚࠸ࡿࠋ⢭⚄ศᯒࡣࠊ≉ 1950 ᖺ௨㝆ࠊ ࡌ࡚࠸ࡿࠋ⢭⚄ศᯒࡣ⢭⚄⏕άࡢ㔜せ࡞ഃ㠃↔ ㏫㌿⛣ࡀ⿕ศᯒ⪅ࡢ⌮ゎࡁ࡞㈉⊩ࢆࡶࡓࡽ 79 ᯓឭคɟ≝⁅⁉″⁂‟․•• ↚↷↺⇷∞⇣⇰∐⇬⇉ᨦܹ↝ྸᚐ ࡋ࠺ࡿ࠸࠺ぢ᪉ࡀᗈࡃཷࡅධࢀࡽࢀࡿࡼ࠺ ᐇ㝿ࠊDSM-III ࡀసᡂࡉࢀࡓ㝿ࠊ⢭⚄ศᯒࡀᅉ ࡞ࡗ࡚௨᮶ࠊศᯒᐙ⿕ศᯒ⪅ࡢ㛫࡛ᵓᡂࡉࢀࡿ ࡋ࡚ᐃࡋ࡚ࡁࡓⴱ⸨ࡸጇ༠ᙧᡂ࠸࠺ᴫᛕ ࠕពࠖࡢ⌮ゎດࡵ࡚ࡁࡓࠋࡑࡢࡓࡵ Freud ࡣࠊ᭕࡛ࠊホᐃ⪅㛫ࡢ୍⮴ࡀ㞴ࡋ࠸࠸࠺⌮⏤ ࡢࣈࣛࣥࢡ࣭ࢫࢡ࣮ࣜࣥࡢᴫᛕࡀᢈุࡢⓗ࡞ࡗ ࡛㝖ࡉࢀࡓࡀࠊศᯒᐙࡸศᯒᣦྥࡢ⮫ᗋᐙࡣࠊ ࡚ࡁࡓࡢࡣࡼࡃ▱ࡽࢀ࡚࠸ࡿࠋࡋࡋࠊᐇド⩏ ࡑࡢ᭕ࡸ☜ࣞࢵࢸࣝࢆ㈞ࡽࢀࡓࡇࢁ 㸻ࣈࣛࣥࢡ࣭ࢫࢡ࣮࡛ࣜࣥࡣ࡞࠸ࠋ┦ᑐ⩏ࡢ ࠊከࡃࡢࠕ⮫ᗋࡢ▱ࠖࢆぢ࡚࠸ࡓࠋ ᑐᴫᛕࡣ⤯ᑐ⩏࡛࠶ࡾࠊᐇド◊✲࠾࠸࡚ࡣ ࡋࡋࠊࡍ࡚ࡢᐇド◊✲ࡀྠࡌࡼ࠺ࡢ Gill ࡀ㏙ࡿࡼ࠺ほᐹ⪅ࢆ㝖ࡍࡿࡇࡀồ ᅛ᭷ᛶࡸࠕ⮫ᗋࡢ▱ࠖࢆ㝖ࡍࡿࢃࡅ࡛ࡣ࡞࠸ࠋ ࡵࡽࢀ࡚࠸ࡿࢃࡅ࡛ࡣ࡞࠸ࠋᐇド◊✲࡛ࡣ┤᥋ⓗ DSM ྠᵝࠊSWAP-200 ࡶᐇド◊✲ࡼࡗ࡚⏕ࡳ ࡞⤒㦂ࡸほᐹࢆ㏻ࡋ࡚▱㆑ࢆᵓ⠏ࡍࡿ◊✲࡛࠶ ฟࡉࢀࡓࢭࢫ࣓ࣥࢺ࣭ࢶ࣮࡛ࣝ࠶ࡾࠊDSM ྠ ࡾࠊࡑࢀࡣ㔞ⓗศᯒ࡛ࡶ㉁ⓗศᯒ࡛ࡶᵓࢃ࡞࠸ࡶ ᵝࠊSWAP-200 ࡶ⮫ᗋᐙ㛫ࡢඹ㏻ゝㄒࢆసࡿࡇ ࡢ࡛࠶ࡿࠋShedler㸦2002㸧ࡶᣦࡋ࡚࠸ࡿࡇ ࢆ┠ⓗࡋ࡚࠸ࡿࡀࠊࡑࡢసᡂ᪉ἲࡣ DSM ࡣ ࡛ࡣ࠶ࡿࡀࠊ⢭⚄ศᯒࡢࡍ࡚ࢆᐇドⓗ◊✲ࡋ Ỵᐃⓗ␗࡞ࡗ࡚࠸ࡿࠋDSM ࡢ┬ࡽࠊ⮫ ࡞ࡅࢀࡤ࡞ࡽ࡞࠸࠸࠺ࢃࡅ࡛ࡣ࡞ࡃࠊᐇドⓗ ᗋⓗほᐹࢆ㔜どࡍࡿࡼ࠺ࠊゝ࠺࡞ࢀࡤࠊࠕ⮫ᗋࡢ ◊✲࡛ࡁࡿࡇࢁࢆᐇドⓗ◊✲ࡍࢀࡤࡼ࠸ࡢ ▱ࠖࢆయ⌧࡛ࡁࡿࡼ࠺సࡽࢀࡓࡢ࡛࠶ࡿࠋ௨ୗࠊ ࡛ࡣ࡞࠸ࡔࢁ࠺ࠋ≉ࠊࣃ࣮ࢯࢼࣜࢸ㛵ࡋ ࡑࡢ㐪࠸ࡘ࠸࡚⤂ࡍࡿࠋ ࡚ࡣࠊ⒪⪅ࡼࡗ࡚ᕥྑࡉࢀࡿ㢮࠸ࡢࡶࡢ࡛ࡣ ࡞࠸ࠋࡇࢀࡲ࡛ࡶࣃ࣮ࢯࢼࣜࢸࡢ≉ᛶࡸഴྥ 㛵ࡋ࡚ࡣࠊᚑ᮶ࡽ㢮ᆺࡀ⾜ࢃࢀ࡚ࡁ࡚࠾ࡾ 㸱㸯ᑓ㛛ᐙࡢ⮫ᗋⓗほᐹࢡ࢚ࣛࣥࢺࡢ⮬ ᕫሗ࿌ 㸦Reich, 1933 ; MacWilliams, 1994/ 2005㸧ࠊඹ ᭷࡛ࡁࡿ⌮ゎࡀ࠶ࡿࡇࡣᗈࡃ▱ࡽࢀ࡚࠸ࡿ DSM ࡀᐈほᛶࢆᢸಖࡍࡿࡓࡵ⤫ไࡋࡓࡢࡣࠊ ࡇࢁ࡛࠶ࡿࠋ デ᩿ࡍࡿ⒪⪅ࡢほⓗุ᩿࡛࠶ࡗࡓࠋDSM ࡀ ᐇド◊✲ࡣ᪉ἲࡢ୍ࡘ࡛࠶ࡾࠊࡑࢀࢆ᭱ึࡽ సᡂࡉࢀࡿ௨๓ࡣࠊྠ୍ᝈ⪅␗࡞ࡿ་ᖌࡼࡗ ཷࡅධࢀ࡞࠸࠸࠺㛢㙐ⓗ࡞ᛮ⪃࣭ጼໃࡣ⢭⚄ศ ࡚␗࡞ࡿデ᩿ࡀࡘࡅࡽࢀ࡚࠸ࡓࡓࡵࠊホᐃ⪅㛫ࡢ ᯒࡢⓎᒎࡢࡓࡵࡶぢ┤ࡉࢀ࡚ࡋࡿࡁ࡛࠶ ୍⮴ࡣᮇᚅ࡛ࡁ࡞࠸ࡉࢀ࡚࠸ࡓࠋ⢭⚄ศᯒⓗぢ ࡿࡼ࠺ᛮ࠺ࠋSWAP ࡀࡑࡢ⌮ㄽⓗ⫼ᬒ⢭⚄ศ ❧࡚࡛ࡶࠊⴱ⸨ཎᅉࢆồࡵࡿ⪅ࡶ࠸ࢀࡤ㸦ḧື ᯒࢆ᭷ࡍࡿ࠸࠺ࡢࡣࠊࡇ࠺ࡋࡓ⢭⚄ศᯒࡢᐇド ㄽ㸧ࠊᑐ㇟㛵ಀၥ㢟ࢆồࡵࡿ⪅ࡶ࠾ࡾ㸦ᑐ㇟㛵 ◊✲ᑐࡍࡿጼໃࡢ┬ࡢ⾲ࢀ࡛ࡶ࠶ࡿࠋ ಀㄽ㸧ࠊఱࡀḞᦆࡋ࡚࠸ࡿࡇࢆᙇࡍࡿ⪅ࡶ ࠸ࡓ㸦Ḟᦆㄽ㸧 ࠋࡲࡓࠊFreud ࡀ⚄⤒ࡢ௦⾲ⓗ 㸱 ࠕ⮫ᗋࡢ▱ࠖࡢయ⌧ ᝈ⪅ࡋ࡚♧ࡋࡓࣥࢼ࣭O Ꮉࡣࠊቃ⏺Ỉ‽ ࡛࠶ࡗࡓࡾ㸦Bolkosy, 1982; Meissner, 1979㸧ࠊ ⮫ᗋᚰ⌮Ꮫࡢ㡿ᇦ࡛ࡣࠊᐈほᛶࡸᬑ㐢ᛶࢆᙉㄪ ⢭⚄Ỉ‽࡛࠶ࡗࡓࡾ㸦Goshen, 1952; Reichard, ࡍࡿࠕ⛉Ꮫࡢ▱ࠖࡔࡅ࡛ࡣ࡞ࡃࠊேࡀసࡾฟࡍࡉ 1956; Bram, 1965㸧ࡍࡿࠋࡑࡇ࡛ DSM ࡣ➨㸱∧ ࡲࡊࡲ࡞ၥ㢟ࡢᅛ᭷ᛶࢆ⌮ゎࡍࡿࠕ⮫ᗋࡢ▱ࠖࡀ ồࡵࡽࢀ࡚ࡁࡓࠋ≉⢭⚄ศᯒࡣ Freud ࡢ㡭ࡼ ࡾ◊✲ࡀࡓࡿ◊✲᪉ἲ࡛࠶ࡾࠊ ࠕ⮫ᗋࡢ▱ࠖ ࢆ῝ࡵࡿࡇࡀ➨୍⩏࡛࠶ࡗࡓࠋࡑࡢࡓࡵୖグࡢ ࡼ࠺࡞⌮⏤࡛ᐇド◊✲ࡀ≉᭷ࡢពࢆᦆࡡ ࡚ࡋࡲ࠺ࡇࡢᠱᛕࡀᙉ࠸ࡇࡣ⌮ゎ࡛ࡁࡿࠋ ௨㝆ࠊᅉㄽⓗ࡞デ᩿ศ㢮࡛ࡣ࡞ࡃࠊ⾲⌧ࢀ࡚ ࠸ࡿ≧ᇶ࡙࠸࡚ศ㢮ࡍࡿ᪉ἲ㌿ࡋࡓࠋ ␗࡞ࡿࣂࢵࢡࢢࣛ࢘ࣥࢻࢆࡶࡘࡉࡲࡊࡲ࡞⮫ᗋ ᐙࡸ◊✲⪅ࡀඹ㏻ㄆ㆑ࢆ᭷ࡍࡿࡓࡵࡣࠊ᭕࡞ ᅉࠊ≉࣓ࢱࣇ࣮ࡀከࡃࠊព㆑ࡉࢀ࡞࠸」㞧 ࡞ᚰ⌮࣓࢝ࢽࢬ࣒ࢆ௬ᐃࡍࡿ⢭⚄ศᯒࡢᴫᛕࡸ 80 ଐஜܖܖٻኔᙲ‒ ᇹ ‣… ӭ≋․•‣‧≌‒ ⏝ㄒࡣ㒔ྜࡀᝏࡗࡓࡢ࡛࠶ࡿࠋ⤖ᯝࠊデ᩿⪅㛫 ࡀࡑࡢ௦ൾࡋ࡚ᡶࡗ࡚ࡁࡓ⮫ᗋᐙࡢᝈ⪅ࢆ ࡢ୍⮴⋡ࡣୖࡀࡾࠊඹ㏻ゝㄒࡋ࡚ DSM ࡣࡁ ேⓗほᐹࡍࡿຊࡢ᳨ウࡀồࡵࡽࢀ࡚࠸ࡿࡢ ࡞ᡂຌࢆ࠾ࡉࡵࡓࡢࡼ࠺ぢ࠼ࡓࠋ ࡛࠶ࡿࠋ ࡇࢁࡀࠊᅉࡢ⪃ᐹࡣࠊᑓ㛛ᐙࡢ⮫ᗋⓗほᐹ ᐇ㝿ࠊDSM ࡀ⤫ィⓗಙ㢗ᛶࢆ㧗ࡵࡿࡓࡵ㢗 ࡀᫎࡉࢀࡿሙ࡛ࡶ࠶ࡗࡓࡓࡵࠊDSM ࡛ࡢデ᩿ ࡗ࡚ࡁࡓࢡ࢚ࣛࣥࢺࡢ⮬ᕫሗ࿌ࡶ㝈⏺ࡀ࠶ ࡣࠊ⒪⪅ࡢ⮫ᗋⓗឤぬࡽ㞳ࢀ࡚ࡋࡲ࠺࠸࠺ ࡿࡇࡀከࡃᣦࡉࢀ࡚ࡁ࡚࠸ࡿࠋࡓ࠼ࡤࠊ ࠕᢚ ၥ㢟ࡀ⏕ࡌ࡚ࡁࡓ㸦Westen & Shedler, 1999ab㸧ࠋ ࠺ࡘⓗ࡛࠶ࡿࠖ࠸ࡗࡓෆ㠃ⓗ≧ἣࡣッ࡞ࡾ SCID-II 㸦 Structured Clinical Interview for ࡸࡍ࠸ࡇࡽࡶデ᩿㠃᥋࡛ࡣሗ࿌ࡋࡸࡍ࠸ DSM-IV Axis II Personality Disorders㸧ࡣࠊ ࡛࠶ࡿࡀࠊࠕᛣࡾࡸࡍ࠸ࠖ࠸ࡗࡓᨷᧁᛶࡣ♫ DSM-IV II ㍈ࡢデ᩿ࢆࡼࡾṇ☜⾜࠺ࡓࡵ ⓗᐜㄆࡉࢀࡃ࠸ឤ࡛࠶ࡿࡇࡽྰㄆ ࢃࢀࡿᵓ㐀㠃᥋࡛࠶ࡾࠊࢡ࢚ࣛࣥࢺ┤≧ ࡉࢀ࡚࠸ࡿࡇࡀከࡃࠊ┤᥋ࠊ⿕デ᩿⪅ᑜࡡ࡚ ἣࢆᑜࡡࠊࡑࡢᅇ⟅ࡽࣃ࣮ࢯࢼࣜࢸ㞀ᐖࡢࢱ ࡶ࠶ࡲࡾពࡀ࡞࠸ࡇࡶከ࠸ࠋ௬ᨷᧁⓗ࡛࠶ ࣉࢆ≉ᐃ࡛ࡁࡿࡼ࠺సࡽࢀ࡚࠸ࡿࠋࡇࡢ㠃᥋ ࡿ࠸࠺⮬ᕫㄆ㆑ࡀ࠶ࡗࡓሙྜ࡛ࡶࠊ⪅ࡽ ࣉ࣮ࣟࢳࡣ DSM ࡢデ᩿ᚲ㡲࡛ࡣ࡞࠸ࡀࠊከ ࠺ぢࡽࢀࡓ࠸ࡼࡗ࡚ሗ࿌ࡢ᭷↓ᕪࡀฟ࡚ ࡃࡢ᭩⡠ࡸᩥ⊩࡛ᙉࡃ᥎ዡࡉࢀ࡚࠾ࡾࠊDSM ࡢ ࡃࡿྍ⬟ᛶࡀ㧗࠸ࠋࡢࡼ࠺⮬ᕫࢆ࿊♧ࡍࡿ デ᩿᪉ἲࡢ≉ᚩࢆࡼࡃ⾲ࡋ࡚࠸ࡿࠋࡓ࠼ࡤࠊ⮬ ࡣ♫⏕άࢆႠࡴ⚾ࡓࡕࡣ㠀ᖖ㔜せ࡞ၥ㢟 ᕫឡᛶࣃ࣮ࢯࢼࣜࢸ㞀ᐖ㛵ࡍࡿ㉁ၥ࡛ࡣࠕ࠶ ࡛࠶ࡾࠊ⒪ሙ㠃࡛࠶ࡗ࡚ࡶࠊ㠃᥋⪅ࡀ⏨ᛶዪ ࡞ࡓࡣࠊ≉ู࡞ᢅ࠸್ࡍࡿே㛫ࡔᛮ࠸ࡲࡍࠖ ᛶࠊⱝ࠸ᖺ㓄ࠊዲࡳࡑ࠺࡛ࡣ࡞࠸ࠊᏳ ࠸ࡗࡓࡼ࠺࡞㉁ၥࢆ࠸ࡃࡘࡶ⾜࠸ࠊᙜ࡚ࡣࡲࡿ ᚰࡋ࡚ヰࡏࡑ࠺ྰࠊ࡞ࡼࡗ࡚㛤♧ࡉࢀࡿ 㡯┠ࡀከ࠸ࠊࡑࡢேࡣ⮬ᕫឡᛶࣃ࣮ࢯࢼࣜࢸ ෆᐜࡀᕥྑࡉࢀࡿࡇࡣീ㞴ࡃ࡞࠸ࠋࡋࡋ 㞀ᐖࢆ᭷ࡋ࡚࠸ࡿุ᩿ࡉࢀࡿࠋ㔝㸦2014㸧ࡣ DSM ࡢ࠸࠺“≧”ࡣࠊࡑ࠺ࡋࡓືᶵ࡙ࡅࡢࡼ࠺ ࡇ࠺ࡋࡓ DSM ࡢデ᩿ᇶ‽ࡀᑟධࡉࢀࡓࡇ࡛ࠊ ࡞⾲㠃ぢ࠼࡞࠸ࡇࡣ࠶ࡲࡾ⪃៖ࡉࢀ࡚࠸࡞ ་ᖌࡸ◊✲⪅㛫࡛ࡢデ᩿ࡢಙ㢗ᛶࡀྥୖࡋࠕ⚾ࡓ ࠸ࠋඛࡶ㏙ࡓࡼ࠺ࠊᇶᮏⓗ DSM ࡛ࡣࣃ ࡕࡣࡼ࠺ࡸࡃᏛၥⓗ࣭⮫ᗋⓗ㆟ㄽࢆࡍࡿඹ㏻ゝㄒ ࣮ࢯࢼࣜࢸࡣᐈయࡋ࡚Ꮡᅾࡋ࡚࠾ࡾɆ࠶ࡿ࠸ ࢆ㌟ࡅࡓࡢ࡛࠶ࡿࠖ㸦p.49㸧㏙࡚࠸ࡿࠋ ࡣࠊᚰⓗ≧ែࡀ≀㇟ࡉࢀ࡚࠾ࡾɆࢡ࢚ࣛࣥࢺ ࡋࡋྠࠕ⢭⚄⛉་ࡀ┬ࢆࡋ࡞ࡅࢀࡤ࡞ࡽ ࡢሗ࿌࣭ゝⴥࡣྛ⮬ࡢᚰⓗ≧ែࢆᐇⓗᥥࡋ ࡞࠸ࡇࢁࡔ⚾ࡣ⪃࠼ࡿࡀࠊ࠺ࡋ࡚ࡶ⢭⚄⛉ ࡚࠸ࡿࡇࢆ ๓ᥦࡋ࡚࠸ࡿࡢ࡛࠶ࡿ ࠋ㔝 ་࡞࠸ࡋࡣ⢭⚄་⒪ᚑ⪅ࡣࠊ≧┠ࢆྥࡅࡓ 㸦2014㸧ࡣ⢭⚄་⒪ࡢデ⒪ࡣࠊᝈ⪅ࡀࡁࡕࢇ ࡃ࡞ࡿࠋࡑࢀࡀ࠸ࡁࡍࡂࡿࠊࡑࡢேࢆྲྀࡾࡲࡃ ≧ࡸᝎࡳࢆッ࠼ࡿ࠸࠺ᛶၿㄝ❧ࡗ࡚࠸ࡿࡓ ⎔ቃࡸ♫ⓗ≧ἣ࣭ே㛫㛵ಀ࡞ከ㠃ⓗ࡞ഃ㠃 ࡵ DSM ࡀᑟධࡉࢀࡿ๓࡛ࡣბ࠺ࡀぢ◚ࢀ ࡽࡑࡢேࢆ⌮ゎࡍࡿࠊ࠸࠺ࡇࡀ࡛ࡁ࡞ࡃ࡞ࡗ ࡞ࡗࡓ㏙ ࡚࠸ࡿࡀࠊࡇࡢ┿ྰࡢ ၥ㢟ࡣ ࡚ࡋࡲ࠺ࠋ≧ࡔࡅࡀࡑࡢே࡛ࡣ࡞࠸ࠋࡑࡢேࡢ DSM ࡢᑟධࡢ᭷↓㛵ࢃࡽࡎࠊGergen ࡢᣦ ᣢࡗ࡚࠸ࡿຊࠊࡑࡢேࢆྲྀࡾࡲࡃ⎔ቃࠊࡑࡢேࡢ ࡍࡿࡼ࠺࡞ゝⴥࡢᐇ⌮ㄽࡢၥ㢟ࡀ๓ᥦ࠶ࡿ Ꮡᅾࢆ⥲ྜⓗุ᩿ࡍࡿᚲせࡀ࠶ࡿࠋࡋࡋࠊデ 㝈ࡾ㸦ゝⴥࡢ♫ⓗᶵ⬟ࢆ⪃៖ࡋ࡞࠸㝈ࡾ㸧ᮏ㉁ ᩿ࡢಙ㢗ᛶࢆ㧗ࡵࡿ࠸࠺ࡇࠊேࡋ࡚ࡢ⢭ ⓗኚࢃࡿࡇࡣ࡞࠸ࠋ ⚄≧ⱞࡋࡴேࢆ⌮ゎࡍࡿ࠸࠺ࡇࡢ㊥㞳 ࡑࡇ࡛ࠊSWAP-200 ࡣࡇ࠺ࡋࡓ DSM ࡢၥ㢟ࢆ ࢆࠊ⚾ࡓࡕࡣࡲࡔᇙࡵࡁࢀ࡚࠸࡞࠸ࠖ㸦p.50㸧 ⪃៖ࡋࠊDSM ࡀデ᩿⪅ࡢほⓗぢ❧࡚ࢆ㝖ࡋ ⌧≧ࡢၥ㢟ࢆࡶᣦࡋ࡚࠸ࡿࠋࡍ࡞ࢃࡕࠊ⤫ィⓗ ࡓࡢᑐࡋ࡚ࠊSWAP-200 ࡣከ⩏ᛶࡀ࠶ࡾΰࢆ ࡞ಙ㢗ᛶࢆ㧗ࡵࡿࡓࡵࠊ⢭⚄་⒪ࡸ⮫ᗋᚰ⌮Ꮫ ᣍࡁࡸࡍ࠸ᑓ㛛⏝ㄒࢆ㝖ࡋ࡞ࡀࡽࠊデ᩿ࡍࡿ⪅ 81 ᯓឭคɟ≝⁅⁉″⁂‟․•• ↚↷↺⇷∞⇣⇰∐⇬⇉ᨦܹ↝ྸᚐ ࡢほⓗぢ❧࡚ࢆ✚ᴟⓗάࡍᕤኵࢆ⾜ࡗࡓࠋ ┠㧗࠸Ⅼᩘࡀࡘࡃࡼ࠺࡛࠶ࢀࡤࠊ⿕デ᩿⪅ࡣ࠸ 㐣ཤࠊᝈ⪅」ᩘࡢデ᩿ྡࡀࡘࡁࠊၥ㢟ࡢᮏ㉁ࢆ ࢃࡺࡿศ splitting ࢆࡗ࡚࠸ࡿࡢࡔࢁ࠺᥎ ྠᐃ࡛ࡁ࡞ࡗࡓࡢࡣࠊᑓ㛛ᐙࡢ⮫ᗋⓗ࡞ほᐹ ᐹࡉࢀࡿࠋࡇࡢࡼ࠺ࠊ」ᩘࡢ㡯┠㸦」ᩘࡢほᐹ㸧 ၥ㢟ࡀ࠶ࡗࡓ࠸࠺ࡼࡾࡶࠊࡑࢀࢆඹ᭷ࡍࡿゝㄒ ࢆ⥲ྜⓗุ᩿ࡍࡿࡇࡼࡗ࡚ࠊࡇࢀࡲ࡛ᑓ㛛 ၥ㢟ࡀ࠶ࡗࡓࡓࡵ⪃࠼ࡓࡢ࡛࠶ࡿࠋࡓ࠼ࡤࠊ ⏝ㄒ୍ࡘ࡛⾲ࡑ࠺ࡋ࡚ࡁࡓ⮫ᗋⓗ࡞ᴫᛕࡸ⌧ ࠕᢞᙳྠ୍ࠖ࠸࠺ᑓ㛛⏝ㄒࡣ⢭⚄ศᯒᣦྥࡢ ㇟ࢆᢕᥱ࡛ࡁࡿࡼ࠺సࡽࢀ࡚࠸ࡿࠋ ⒪⪅ࡣ㠀ᖖ㥆ᰁࡳ῝࠸ࡀࠊᏛὴࡼࡗ࡚ᣦ ࡋ♧ࡍࡇࢁࡢពࡀ␗࡞ࡗ࡚ࡃࡿࠋྂࣇࣟ ࢹࣥࠊྂࢡࣛࢽࣥࡣࠕᢞᙳࠖྠࡌព 㸱㸰ࢺࢵࣉࢲ࢘ࣥⓗデ᩿࣎ࢺ࣒ࢵࣉⓗデ ᩿ ࡛⏝ࡍࡿࡢᑐࡋ࡚ࠊᑐ㇟㛵ಀㄽ⪅ࡸ⌧௦ࢡ ࣛࢽࣥࡣᢞᙳྠ୍ࡣᢞᙳࡢᴫᛕࡣྵ ࡲࡓࠊDSM SWAP ࡣࡑࡢデ᩿ᵓ㐀ࡶ ࡲࢀ࡚࠸࡞࠸ࠊ⪅ࢆືࡍᚰⓗᅽຊࢆෆໟࡍࡿ ࡁ࡞㐪࠸ࡀ࠶ࡿࠋDSM-IV ࡛ࡣࣃ࣮ࢯࢼࣜࢸ㞀 ࡢぢゎࢆ♧ࡋ࡚࠸ࡿࠋࡉࡽࠊᑐே㛵ಀㄽ⪅ࡢ ᐖࡀ᪤㢮ᆺࡉࢀࡓ≧ែ࡛ᥖ㍕ࡉࢀ࡚࠾ࡾࠊࡑ ୍㒊㸦Eagle, 2000㸧ࡣࡇࡢᚰⓗᅽຊ࠸࠺⪃࠼ ࡢデ᩿ᇶ‽ࡀ᫂♧ࡉࢀ࡚࠸ࡿࠋ⮫ᗋᐙࡣࡑࡢᇶ‽ ၥࢆ࿊ࡋࠊ ࠕ㸦ᢞᙳྠ୍ࡼࡗ࡚㸧ᝈ⪅ື ⿕デ᩿⪅ࡢ≧ἣࡀྜ࠺࠺ࠊࡍ࡞ࢃࡕࡑࡢ ࡉࢀࡓࠖᙉㄪࡍࡿࡇࡣ⒪⪅ࡢయᛶࡢᙳ ᇶ‽࠶ࡆࡽࢀࡓ≉ᛶࡢ᭷↓ࢆ⪅ᢥ୍ⓗุ 㡪ࢆ⪃៖ࡋ࡚࠸࡞࠸ࡇࡢ⌧ࢀ࡛࠶ࡾࠊ⌧௦∧ࡢ ᩿ࡋࠊࢺࢵࣉࢲ࢘ࣥⓗྛ࢝ࢸࢦ࣮ࣜศ㢮ࡍࡿ ࣈࣛࣥࢡ࣭ࢫࢡ࣮ࣜࣥࡔᢈุࡋ࡚࠸ࡿࠋࡇࡢࡼ ࡇࡀồࡵࡽࢀࡿࠋࡋࡋࡇࡢ᪉ἲࡣࠊྲྀࡾୖ ࠺ྠࡌゝⴥ࣭⾲⌧࡛࠶ࡗ࡚ࡶࠊࡑࡇྵࡲࢀࡿ ࡆࡽࢀࡿ᪤Ꮡࡢ≉ᛶࡀ㝈ᐃࡉࢀࡿࡓࡵࠊ᪂ࡋ࠸Ⓨ ពࡣࠊṔྐⓗ࣭Ꮫὴⓗ⌮ㄽ⫼ᬒࡼࡗ࡚ᚲࡎࡋ ぢࡸࡢᅛ᭷ᛶࢆᫎࡉࡏࡿᶵࡀ࡞ࡃே ࡶ୍⮴ࡋ࡚࠸ࡿࡣ㝈ࡽ࡞࠸ࠋࡋࡋࠊࡑࢀ࡛ࡶ ⓗ࡞⌮ゎࡀ㞴ࡋࡃ࡞ࡗ࡚ࡋࡲ࠺࠸࠺ၥ㢟ࡀ࠶ ⮫ᗋ⌧㇟ࡢㄝ᫂࠸࠺ほⅬࡽࡇࢀࡽࡢ⏝ㄒࢆ ࡿࠋWesten and Shedler㸦1999ab㸧ࡣࠊDSM-IV ⪃࠼ࡓࡁɆࡓ࠼ࡤࠕᢞᙳྠ୍ࠖࡣᑐே㛵ಀ ࡢ II ㍈ࡀྛࣃ࣮ࢯࢼࣜࢸ㞀ᐖࡢᇶ‽ࢆ 7㹼10 㛫ࡢᙳ㡪ࢆ♧၀࡛ࡁࡿᩘᑡ࡞࠸ᴫᛕࡢ୍ࡘ࡛࠶ 㝈ᐃࡍࡿࡇࡼࡗ࡚ࠊデ᩿ᇶ‽ࡢෆⓗᩚྜᛶ ࡾɆᑐே㛵ಀࡢ㉁ࡸ⮬ᕫࡢ࠶ࡾ᪉ࢆ᳨ウࡍࡿࡣ ࢆ㧗ࡵࠊ㞀ᐖ㛫ࡢ┦㛵ࢆῶࡽࡑ࠺㸦ᘚูⓗጇᙜᛶ ኚ᭷┈࡛࠶ࡿࠋ ࢆ㧗ࡵࡼ࠺㸧ࡋࡓࡓࡵࠊ⮫ᗋ࠾ࡅࡿࢭࢫ࣓ ࡑࡇ࡛ SWAP ࡣデ᩿᭷┈࡞⮫ᗋ⌧㇟ࡢㄝ᫂ ࣥࢺ㐣⛬ࢆ࡛ᫎࡁ࡞ࡃ࡞ࡗ࡚࠸ࡿࡇࢆᣦ ࢆᖹ᫆࡞ゝⴥ࡛ྲྀࡾධࢀࠊ⌧㇟ࡢᮏ㉁ⓗ㒊ศࡣṧ ࡋ࡚࠸ࡿࠋࡓ࠼ࡤࠊ♫ᛶࣃ࣮ࢯࢼࣜࢸ㞀 ࡍࡀࠊࡑࢀࢆᴫᛕࡍࡿᑓ㛛⏝ㄒࢆࢃ࡞࠸࠸ ᐖࡢேࡣࠊ⪅ࡢඹឤࡀⴭࡋࡃḞዴࡋ࡚࠸ࡿ ࠺᪉ἲࢆࡗࡓࠋࡓ࠼ࡤࠊศ splitting ࡶࠊ ࡇ ࡀ ᣦ ࡉ ࢀ ࡚ ࡁ ࡚ ࠸ ࡿ ࡀ (Hare & Hart, ⢭⚄ศᯒࡢᩥ⊩ࡸ◊✲࡞࡛ࡣࡼࡃ┠ࡍ 1995)ࠊDSM-IV ࡛ࡣ⮬ᕫឡᛶࣃ࣮ࢯࢼࣜࢸ㞀 ࡿゝⴥ࡛࠶ࡿࡀࠊSWAP ࡢ୰࡛ࡇࡢゝⴥࢆࡗ࡚ ᐖࡢᘚูⓗጇᙜᛶࢆ㧗ࡵࡿࡓࡵࠕඹឤᛶࡢஈࡋ ࣃ࣮ࢯࢼࣜࢸࢆグ㏙ࡋ࡚࠸ࡿ㡯┠ࡣ࡞࠸ࠋ௦ࢃ ࡉࠖࡣデ᩿ᇶ‽ࡢ୰ࡣධࡗ࡚࠸࡞࠸ࠋࡑࡢ ࡾ“Tends to idealize certain others in unre- ࡶࠊቃ⏺ᛶࣃ࣮ࢯࢼࣜࢸ㞀ᐖࠊ₇ᢏᛶࣃ࣮ࢯࢼ alistic ways; sees them as ‘all good’to the ex- ࣜࢸ㞀ᐖࠊዶᛶࣃ࣮ࢯࢼࣜࢸ㞀ᐖ clusion of commonplace human defects”(item 㸦DSM-IV-TR㸧ࡸゎ㞳ᛶࣃ࣮ࢯࢼࣜࢸ㞀ᐖ 45)“Tends to see certain others as ‘all bad,’ 㸦McWilliams, 1994㸧ࡢከࡃࡢ㢮ఝᛶࡀᣦ and loses the capacity to perceive any positive ࡉࢀ࡚࠸ࡿࡀࠊࡇࢀࡽࡢ㞀ᐖࡶᘚูᛶࢆ㧗ࡵࡿ qualities the person may have”(item 79)ࡢ୧㡯 ࡓࡵࠊ㔜」ࡍࡿࡼ࠺࡞≉ᚩࡣ♫ᛶࣃ࣮ࢯࢼࣜ 82 ଐஜܖܖٻኔᙲ‒ ᇹ ‣… ӭ≋․•‣‧≌‒ ࢸ㞀ᐖࡢデ᩿ᇶ‽ࡣධࡗ࡚࠸࡞࠸ࠋ⤖ᯝࠊᘚ paranoid ഴྥࡀࡢࡼ࠺࡞ࡗ࡚࠸ࡿࡢࠊഴ ูⓗጇᙜᛶࢆ㧗ࡵࡿࡓࡵ⾜ࡗࡓᕤኵ࡛࠶ࡗࡓ ྥࡢᙉᙅࡀᩘ್࡛▱ࢀࡿࡼ࠺࡞ࡗ࡚࠾ࡾࠊಶࠎ ࡀࠊ⓶⫗࡞ࡇࠊ࠶ࡽࡺࡿデ᩿ᇶ‽ࠊ⿕デ᩿ ␗࡞ࡿ⮫ᗋീࡀᥥࡅࡿࡼ࠺࡞ࡗ࡚࠸ࡿࠋ ⪅ࡢ≉ᚩࢆ⾲ࡍ≉ᛶࡀᩓぢࡉࢀࡿ࠸࠺≧ἣ ࡲࡓࡇࡢ 200 㡯┠ࡢෆᐜⓗጇᙜᛶ㛵ࡋ࡚ࡣࠊ ࡞ࡾࠊ୍ேࡢ⿕デ᩿⪅」ᩘࡢデ᩿ྡࡀࡘ࠸࡚ࡋ DSM ࡢ┬Ⅼ࡛࠶ࡿࠊデ᩿⤖ᯝ⮫ᗋほᐹࡀ୍ ࡲ࠺࠸࠺ែࡀ⏕ࡌ࡚࠸ࡿࠋࡋࡋࠊ୍᪉࡛᪤ ⮴ࡋ࡞࠸࠸࠺Ⅼࢆ㋃ࡲ࠼ࠊ≉ᛶᥥࢆ DSM-IIIࠊ Ꮡࡢศ㢮ࢆᨵゞࡋ࡚࠸ࡃࡢࡶ㞴ࡋ࠸ࠋ࡞ࡐ࡞ࡽࠊ DSM-IVࠊࣃ࣮ࢯࢼࣜࢸࡸࣃ࣮ࢯࢼࣜࢸ㞀ᐖ ࡓ࠼⤒㦂ⓗ᪂ࡋ࠸ࣃ࣮ࢯࢼࣜࢸ≉ᛶࡀᚓ 㛵ࡍࡿᩥ⊩࡞ࡽᖜᗈࡃᢳฟࡋࡓୖ࡛ࠊ࠾ࡼ ࡽࢀࡓࡋ࡚ࡶࠊ᪤Ꮡࡢศ㢮↷ࡽࡋྜࢃࡉࢀࠊ ࡑ 200 ྡࡢ⮫ᗋᐙࡽࡢࣇ࣮ࢻࣂࢵࢡ㸦ࠕ࠶࡞ 㧗࠸┦㛵ࡀฟ࡞ࡅࢀࡤࠊ࠶ࡿ࠸ࡣࠊࡍ࡛ࡢ㞀 ࡓࡢᝈ⪅ࡘ࠸࡚ᚰ⌮Ꮫⓗ㔜せࡔᛮࢃࢀࡿ ᐖࡢ࢝ࢸࢦ࣮ࣜධࡗ࡚࠸ࢀࡤ㝖ࡉࢀࡓࡾ↓ ࡶࡢࢆᥥ࡛ࡁ࡚࠸ࡲࡍ㸽ࠖ࠸࠺㉁ၥᑐࡍ どࡉࢀࡓࡾࡍࡿྍ⬟ᛶࡀ࠶ࡿࡽࡔ㸦 Westen ࡿᅇ⟅㸧ࢆᇶಟṇࡀ㔜ࡡࡽࢀ࡚ࡁࡓ㸦Shedler and Shedler, 1999a㸧ࠋ and Westen, 1998; Shedler, 2002㸧ࠋ⤖ᯝࠊᚓⅬ ௨ୖࡢࡼ࠺࡞┬Ⅼࢆ㋃ࡲ࠼࡚ࠊ SWAP ࡣ ࡢ㧗࠸㡯┠ࡢ≉ᛶᥥࢆࡘ࡞ࡆࡿࡇ࡛ࠊࡢ⮫ DSM ࡣ␗࡞ࡿࣉ࣮ࣟࢳࢆࡿࡇࡼࡗ࡚ࠊ ᗋᐙࡀ⌮ゎࡋࡸࡍ࠸ࡼ࠺࡞⮫ᗋീࡀᙧᡂࡉࢀࡿ ࣃ࣮ࢯࢼࣜࢸࡢໟᣓⓗ࡞⌮ゎࢆ┠ᣦࡋࡓࠋලయ ࡼ࠺࡞ࡗ࡚࠾ࡾࠊ⮫ᗋࡸ◊✲࡛ά⏝ࡉࢀ࡚࠸ࡿࠋ ⓗࡣࠊࢭࢫ࣓ࣥࢺࢆ⾜࠺⮫ᗋᐙࡣࣃ࣮ࢯࢼࣜ ࡲࡓࠊDSM ࡢูࡢၥ㢟࡛࠶ࡿᘚูⓗጇᙜᛶ࣭ ࢸ≉ᛶࡀ᭩ࢀࡓ 200 㡯┠ࡢࣥࢹࢵࢡࢫ࣭࢝ ᮰ⓗጇᙜᛶ㛵ࡋ࡚ࡣࠊィ 797 ྡࡢ⮫ᗋᐙ㸦4㸧ࡢ ࣮ࢻࢆࠊQ ࢯ࣮ࢺἲ࡛ࠕ᭱ࡶᙜ࡚ࡣࡲࡿ㸦most ࠺ࡕࠊ530 ྡᐇ㝿ࡢᝈ⪅㸦actual patients㸧 descriptive㸧ࠖࡢ 7 Ⅼࡽࠊ ࠕࡃᙜ࡚ࡣࡲࡽ࡞࠸ࠖ ࡘ࠸࡚ࡢホ౯ࢆࠊṧࡾࡢ 237 ྡྛࠎࡀᛮ࠸ᥥࡃ ࡢ 0 Ⅼࡢ㸶ࡘࡢỈ‽ศ㢮ࡍࡿࡇࡀồࡵࡽࢀ 㞀ᐖࡢ⮫ᗋീ㸦hypothetical, prototypical pa- ࡿࠋ ࣃ࣮ࢯࢼࣜࢸ㞀ᐖࡢศ㢮ࡣ DSM ࡢࡼ࠺ tients㸧ࢆホ౯ࡋ࡚ࡶࡽ࠸ࠊࡘࡢ⮫ᗋീࡢ┦㛵 ඛᏑᅾࡋ࡚࠸ࡿࢃࡅ࡛ࡣ࡞࠸ࡓࡵࠊ⮫ᗋᐙࡣ ࢆồࡵࡿࡇࡼࡗ࡚୧ጇᙜᛶࡢ☜ㄆࢆ⾜ࡗ࡚ ࡑࡢ 200 㡯┠ࢆ⮬ᕫࡢほᐹᚑࡗ࡚㑅ᢥ᳨࣭ウࡍ ࠸ࡿɆࡍ࡞ࢃࡕࠊྠ㞀ᐖ㸦ࡓ࠼ࡤࠊparanoid㸧 ࡿࡇࡀ࡛ࡁࡿࡼ࠺࡞ࡗ࡚࠸ࡿࡢࡀ≉ᚩ࡛࠶ 㛵ࡋ࡚ࠊᐇᝈ⪅ࡢホ౯௬ᝈ⪅ࡢホ౯ࡢ┦㛵 ࡿࠋデ᩿ࡣࠊDSM-III DSM-IV ࡽ᥇⏝ࡋ ࡀ㧗ࡅࢀࡤ᮰ⓗጇᙜᛶࡀ㧗࠸ุ᩿ࡋࠊ␗࡞ࡿ ࡓ paranoidࠊschizoidࠊschizotypalࠊantisocialࠊ 㞀ᐖ㛫㸦ࡓ࠼ࡤࠊparanoid borderline㸧ࡢ borderlineࠊhistrionicࠊnarcissisticࠊavoidantࠊ ホ౯㛫ࡢ┦㛵ࡀపࡅࢀࡤᘚูⓗጇᙜᛶࡀ㧗࠸ dependent ࠊ obsessive ࠊ passive-aggressive ࠊ ุ᩿ࡋ࡚࠸ࡿɆ⤖ᯝࠊྠ㞀ᐖ㛵ࡍࡿ୧⪅ࡢ┦㛵 self-defeatingࠊsadisticࠊdepressive ࡢ 14 ✀㢮 ࡣ 0.79 ࡽ 0.93 㸦ᖹᆒ 0.83㸧㧗࠸⤖ᯝࢆ♧ࡋࠊ ࡢ㞀ᐖ DSM-IV ࡢ V ㍈࡛᥇⏝ࡉࢀ࡚࠸ࡿᶵ⬟ ␗࡞ࡿ㞀ᐖ㛵ࡍࡿ୧⪅ࡢ┦㛵ࡢᖹᆒࡣ 0.25 ࡢ య ⓗ ホ ౯ ࢆ ぢ ࡿ Global Assessment of ప࠸⤖ᯝࢆ♧ࡋࡓ㸦Westen & Shedler, 1999ab㸧ࠋ Functioning 㸦 GAF ᑻ ᗘ 㸧 ┦ 㛵 ࡀ 㧗 ࠸ SWAP ࡣ⌮ㄽࡸᴫᛕࡽࢺࢵࣉࢲ࢘ࣥⓗデ high-functioning ࡢᣦᶆࡀࢃࢀࡿࠋ⤖ᯝࡣࡕࡻ ᩿ࢆࡍࡿࡢ࡛ࡣ࡞ࡃࠊ⮫ᗋ⌧ሙࡢኌࢆάࡋ࡞ࡀ ࠺ M.M.P.I.ࡢࡼ࠺࡞ᢡࢀ⥺ࢢࣛࣇ࡛⾲ࡉࢀࠊྛ ࡽࠊෆᐜⓗጇᙜᛶࠊ᮰ⓗ࣭ᘚูⓗጇᙜᛶࢆ㧗ࡵ 㞀ᐖࡢഴྥࡀ୍┠࡛ᢕᥱ࡛ࡁࡿࡼ࠺࡞ࡗ࡚࠾ ࡚࠸ࡃ࠸࠺ࠊ࠸ࢃࡤࠊ࣎ࢺ࣒ࢵࣉⓗ࡞ࢭࢫ ࡾࠊ㞀ᐖࡢ᭷↓࡛ࡣ࡞ࡃࠊഴྥࢆ▱ࡿࡇࡀ࡛ࡁ ࣓ࣥࢺ࡞ࡗ࡚࠾ࡾࠊྠࡌࡼ࠺࡞≉ᛶࡀᥥ࡛࠶ ࡿࡼ࠺సࡽࢀ࡚࠸ࡿࠋࡓ࠼ࡤࠊborderline ഴ ࡗ࡚ࡶ DSM ࡣ㉁ⓗࡁࡃ␗࡞ࡗ࡚࠸ࡿࡇ ྥ ࡀ ᙉ ࡃ ฟ ࡚ ࠸ ࡿ ே ࡛ ࡶ ࠊ schizoid ഴ ྥ ࡸ ࡀศࡿࠋ 㸦3㸧 83 ᯓឭคɟ≝⁅⁉″⁂‟․•• ↚↷↺⇷∞⇣⇰∐⇬⇉ᨦܹ↝ྸᚐ 㸱㸱 ࣃ࣮ࢯࢼࣜࢸ㞀ᐖ࠾ࡅࡿᶵ⬟ホ౯ ࢼࣜࢸ㞀ᐖ㛵ࡋ࡚ࠊࡑࢀࡒࢀࡢ㸦㸯㸧ḧືࠊ ືࠊẼ㉁㸦㸰㸧㜵⾨㐺ᛂࡢ㐣⛬ࠊ㸦㸱㸧ᑐ㇟ DSM ࡣ≉ᐃࡢ⌮ㄽ೫ࡽ࡞࠸࠸࠺᪉ἲࢆ 㛵ಀࠊ 㸦㸲㸧⮬ᕫࠊ 㸦㸳㸧㌿⛣㏫㌿⛣ࢆ♧ࡋ࡚࠾ ࡿࡇ࡛ඹ㏻ ゝㄒࡋ࡚ࡢ㉁ࢆᢸಖࡋ ࡓࡀࠊ ࡾࠊࡢ⛬ᗘ㞀ᐖࡉࢀ࡚࠸ࡿࡢࠊࡲࡓࡑࡢ㞀ᐖ SWAP ࡣᇶᮏⓗ⢭⚄ຊືⓗ࡞⌮ゎࢆ⫼ᬒ⌮ㄽ ࡀࡢࡼ࠺⮬ᕫࡸ࿘ᅖᙳ㡪ࢆཬࡰࡍ࡞ࠊ ࡋ࡚᭷ࡋ࡚࠾ࡾࠊඹ㏻ゝㄒࡋ࡚ࡢ㉁ࡣࠊᑓ㛛 㞀ᐖࡢᶵ⬟ⓗ࡞ศᯒࡢ㔜せᛶࡀᙉㄪࡉࢀ࡚࠸ࡿࠋ ⏝ㄒࢆࢃࡎࠊᖹ᫆࡞᪥ᖖ⏝ㄒ࡛≉ᛶࢆ⾲⌧ࡍࡿ ࡲࡓࠊSperry㸦2003/2012㸧ࡣࣃ࣮ࢯࢼࣜࢸ㞀 ࡇ ࡛ ᢸ ಖ ࡋ ࡚ ࠸ ࡿ ࠋ Westen and Shedler ᐖࡢ⒪࠾࠸࡚ࡣࠊၥ㢟࡞ࡿ≉ᛶࡀ㞀ᐖỈ‽ 㸦1999b㸧ࡣࠊデ᩿࣐ࢽࣗࣝࡣࠊࡢࡼ࠺࡞⌮ ࡽ≉ᛶỈ‽࡛ᶵ⬟࡛ࡁࡿࡇࡀ┠ᶆࡉࢀࡿ ㄽⓗ࢚࢜ࣜࣥࢸ࣮ࢩࣙࣥࢆ᭷ࡍࡿேࡶ࠼࡞ ࡁ࡛࠶ࡿㄽࡌ࡚࠸ࡿࠋ ࡅࢀࡤ࡞ࡽ࡞࠸ࡋࡓ DSM ࡢጼໃࢆホ౯ࡋ࡞ࡀ ࣃ࣮ࢯࢼࣜࢸ࠸࠺ᴫᛕ⮬యࠊ≉ᛶࡢ೫ࡾࢆ ࡽࡶࠊ⌮ㄽࢆᤞ࡚ࡓࡓࡵࣃ࣮ࢯࢼࣜࢸࡀࡢ ๓ᥦࡋ࡚࠸ࡿࡓࡵࠊ೫ࡾࡀ࠶ࡿࡇ⮬యࡀ㞀ᐖ ࡼ࠺ᶵ⬟ࡋ࠺ࡿࡢ࠸࠺ᡭᘬࡁࡶྠኻ ࡛ࡣ࠶ࡾ࠼ࡎࠊఱࡀࠊࡢࡼ࠺ࠊࡢ⛬ᗘࠊ೫ ࡗ࡚ࡋࡲࡗࡓ㏙࡚࠸ࡿࠋࡓ࠼ࡤࠊዶᛶࣃ ࡗ࡚࠸ࡿࡢࡀၥ㢟࡞ࡗ࡚ࡃࡿࠋࡉࡽࠊࡑࡇ ࣮ࢯࢼࣜࢸ㞀ᐖࡣࠊDSM-IV ࡛ࡣࠕேࡢືᶵ ࡣࠊࡑࡢே࡞ࡾࡢ⏕ࡁ᪉ࡀᫎࡉࢀ࡚࠸࡞ࡅࢀ ࢆᝏពࡢ࠶ࡿࡶࡢゎ㔘ࡍࡿ࠸ࡗࡓࠊᗈ⠊ᅖ࡞ ࡤࠊఱࡀࡢࡼ࠺ၥ㢟࡞ࡾ࠺ࡿࡢࡀศࡽ ࠸῝ࡉࡀᡂேᮇ᪩ᮇࡲ࡛ጞࡲࡾࠊ✀ࠎ ࡎࠊデ᩿ࡣᙧ㧁ࡋ࡚ࡋࡲ࠸ࡡ࡞࠸ࠋ ࡢ≧ἣ࡛᫂ࡽ࡞ࡿࠖ㸦A ᇶ‽㸧ㅻࢃࢀࠊே SWAP-200 ࡛ࡣࠊ᭱⤊ⓗ⤫ィⓗ࡞ฎ⌮ࡀ࡞ࡉࢀࠊ ࡀ⮬ศࢆ⏝ࡍࡿࠊ༴ᐖࢆຍ࠼ࡿࠊࡔࡲࡍ࠸࠺ ⿕デ᩿⪅ྛࣃ࣮ࢯࢼࣜࢸ≉ᛶࡀࡢ⛬ᗘഛ ࠸ࢆࡶࡘࠊ࡞ලయⓗ࡞㸵ࡘࡢ≧ἣࡢ࠺ࡕ㸲ࡘ ࢃࡗ࡚࠸ࡿࠊࡍ࡞ࢃࡕࠊ㞀ᐖỈ‽ࡽ≉ᛶỈ‽ ௨ୖࡢヱᙜࢆࡶࡗ࡚ࠊࡇࡢᇶ‽ࡀ‶ࡓࡉࢀࡿࡋ ࡢࢫ࣌ࢡࢺ࣒ࣛࡀ⌮ゎ࡛ࡁࡿࡼ࠺࡞ࡗ࡚࠸ ࡚࠸ࡿࠋࡋࡋࠊࡑ࠺ࡋࡓ៏ᛶⓗ࡞ಙឤࡀࡢ ࡿࠋࡑࡢࡓࡵࠊ≉ᛶࡢ᭷↓ࡢሗࡋᚓࡽࢀ࡞ ࡼ࠺ᶵ⬟ࡋ࡚࠸ࡿࠊࡲࡓࠊዶᛶࣃ࣮ࢯࢼࣜ ࡗࡓ DSM ࡣ␗࡞ࡾࠊྛ≉ᛶࡀࡢࡼ࠺ᙳ㡪 ࢸ㞀ᐖࢆ᭷ࡍࡿேࡀࡢࡼ࠺⪅㛵ಀࢆ ࡋྜࡗ࡚࠸ࡿࡢࠊఱࡀ⏕άࡢᶵ⬟ࢆᘬࡁ㉳ సࡾࠊ⮬ศࢆᤊ࠼ࠊࡢࡼ࠺♫⏕άୖࡢᅔ㞴 ࡇࡍཎᅉ࡞ࡗ࡚࠾ࡾࠊࡢ≉ᛶࡀ⒪ࡼࡗ࡚ ࢆࡾ㉺࠼࡚࠸ࡿ࡞ࡘ࠸࡚ࡣゝཬࡉࢀ࡚ ⦆ࡋࠊ௦ࢃࡾࡢࡼ࠺࡞≉ᛶࡀ⥭㏕ࡋ࡚ࡁࡓ ࠸࡞࠸ࠋ ࠊ࡞ࢆ௬ㄝ❧࡚ࡿ᭷┈࡞㐨ල࡞ࡾ࠺ࡿࠋḢ Westen㸦1995, 1998㸧ࡣୖグࡢࡼ࠺࡞ DSM ࡢ ⡿ㅖᅜ࡛ᗈࡲࡾࡘࡘ࠶ࡿ SWAP ࡣࠊ᪥ᮏ࡛ࡶᚰ 㢮ᆺᑐࡍࡿ┬ࢆࡶࠊࢣ࣮ࢫࣇ࢛࣮࣑ࣗ ⌮⮫ᗋࢆࡼࡾ㇏࡞ࡶࡢࡍࡿࢶ࣮ࣝࡋ࡚ ࣮ࣞࢩࣙࣥࢆ⾜࠺㝿ࡣḟࡢ㸱ࡘࡢၥྲྀࡾ⤌ ࢃࢀࡿࡇࡀᮇᚅࡉࢀࡿࠋ ࡲ࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࡋ࡚࠸ࡿ㸸㸦㸯㸧ࡑࡢேࡣ ఱࢆᮃࡳࠊఱࢆᛧࢀࠊࡑࡋ࡚ࠊࡢ⛬ᗘࠊࡑ࠺ࡋ 㸲 ࠾ࢃࡾ ࡓ㢪ᮃᜍᛧࡀⴱ⸨ⓗࠊ࠶ࡿ࠸ࡣ↓ព㆑ⓗ㸽 㸦㸰㸧ࡑࡢேࡣࠊෆⓗ࣭እⓗせồࢆ‶ࡓࡍࡓࡵࠊ ࡢࡼ࠺࡞ᚰ⌮ⓗ㈨※—ㄆ▱ࠊືࠊ⾜Ⅽ—ࢆ ࠺ࡇࡀ࡛ࡁࡿ㸽㸦㸱㸧ࡑࡢேࡣ⮬ᕫࡸ⪅ࢆ ࡢࡼ࠺▱ぬࡋయ㦂ࡍࡿࠊࡑࡋ࡚ࠊ᭷┈࡛ᚰ ᆅࡼ࠸㛵ಀᛶ ࢆ⥔ᣢࡍࡿࡇࡀࡢ⛬ ᗘྍ⬟ 㸽ྠࡌࡃ McWilliams㸦1994㸧ࡶ 9 ࡘࡢࣃ࣮ࢯ ᮏ✏࡛ࡣࠊ⢭⚄ศᯒ㡿ᇦ࠶ࡿᐇド◊✲ࡢ㢼 ₻ࠊDSM-IV II ㍈ࡢデ᩿ᵓ㐀ࢆᢈุⓗࣞࣅࣗ ࣮ࡍࡿࡇ࡛ࠊ⢭⚄ศᯒⓗ࡞ᐇド◊✲ᇶ࡙࠸ࡓ ࣃ࣮ࢯࢼࣜࢸ 㞀ᐖࡢ⌮ゎࡢྲྀࡾ⤌ࡳ ࡛࠶ࡿ SWAP-200 ࢆ⤂ࡋࡓࠋḢ⡿ㅖᅜ࡛ࡣࠊDSM-IV II ㍈௦ࢃࡿࡶࡢࡋ࡚ SWAP-200 ࢆ⏝࠸ࡓ◊ 84 ଐஜܖܖٻኔᙲ‒ ᇹ ‣… ӭ≋․•‣‧≌‒ ✲ࡸ⮫ᗋሗ࿌ ࡀฟጞࡵ࡚࠸ࡿࡀ㸦ࡓ ࠼ࡤࠊ ࡢ㈨᱁᪥ᮏࡢ⮫ᗋᚰ⌮ኈࡢ㈨᱁ࡢ୧᪉ࢆ᭷ࡋ Marin-Avellan, McGauley, Campbell & Fonagy ࡚࠾ࡾᚰ⌮Ꮫࡸ⢭⚄་Ꮫࡢ⏝ㄒ⢭㏻ࡋ࡚࠸ࡿ 2005㸧ࠊ᪥ᮏ࡛ࡣࡲࡔᗈࡃ▱ࡽࢀ࡚ࡣ࠸࡞࠸ࠋ➹ ⃝ᬛᜨᵝࡣከࡃࡢࡈ༠ຊࢆ㡬࠸࡚࠸ࡿࠋࡇࡇ ⪅ࡣࠊ⌧ᅾࠊSWAP-200 ࡢ᪥ᮏㄒ∧ࡢసᡂࡑࡢ ῝࠸ឤㅰࢆ⏦ࡋୖࡆࡓ࠸ᛮ࠺ࠋ ጇᙜᛶࡢ᳨ド◊✲ࢆ⾜ࡗ࡚࠾ࡾࠊSWAP-200 ࡢస ‒ ᡂ⪅ࡢ୍ே࡛࠶ࡿ Dr. Shedler ᪥ᮏㄒ∧ࡢ㏫ⱥ ヂ㸦back-translation㸧ࢆࢳ࢙ࢵࢡཷࡅ࡞ࡀࡽྍ ⬟࡞㝈ࡾཎᩥࡢពᅗࢆ㐺ษ࡛ᫎࡁࡿࡼ࠺ດ ࡵ࡚࠸ࡿ᭱୰࡛࠶ࡿࡀࠊࡑࡢ㐣⛬࡛⪃࠼ࡽࢀࡿ ᚋࡢㄢ㢟ࢆᣲࡆ࡚ᮏ✏ࢆ⥾ࡵࡃࡃࡾࡓ࠸ᛮ࠺ࠋ ➨୍ࠊ㡯┠ෆᐜ㛵ࡍࡿၥ㢟ࡀ࠶ࡿࠋ᪥ᮏㄒ సᡂ㐣⛬࡛ⴭసඖࡽࡋࡤࡋࡤࠕࡇࡢᴫᛕࡣ᪥ᮏ ᩥ࠶ࡿ㸽ࠖᑜࡡࡽࢀࡿࡇࡀ࠶ࡿࠋࡇࢀ ࡲ࡛ࡢࡇࢁࠊ࠸ࡃࡘ⾲⌧ࡋࡃ࠸ⱥㄒ⾲⌧ࡸ ⡿ᅜ≉᭷ࡢࢹ࣒࢜ࡣ࠶ࡗࡓࡀࠊ᪥ᮏㄒ࡛ࡃ ㄝ࡛᫂ࡁ࡞࠸࠸࠺㡯┠ࡣ࡞࠸ࠋࡋࡋࠊࣃ࣮ࢯ ὀ (1) DSM-IV II ㍈ࡢ㡯┠ࡣࡋࡤࡋࡤࢡࣛࢫࢱ࣮ศᯒ ࡸᅉᏊศᯒࡽᐇドⓗ࡞ࢹ࣮ࢱᇶ࡙࠸࡚࡞࠸ ࡢᣦࡀ࠶ࡾࠊ≉ࡢ㞀ᐖࡢేᏑ⋡ࡢ␗ᖖ࡞㧗 ࡉ㸦ᘚูᛶࡢጇᙜᛶ㸧ၥࡀ࿊ࡉࢀ࡚ࡁࡓ㸦Blais 1997, Clark 1992, Harkness 1992, Morey 1988, Bell & Jackson 1992, Oldham, Skodol, Kellman, Hyler, Rosnick & Davies 1992㸧 (2) 2013 ᖺ DSM-V ࡀฟ∧ࡉࢀࠊከ㍈デ᩿ࡀ࡞ࡃ࡞ ࡿ࡞యࡢᵓᡂࡣኚ᭦ࡀ࠶ࡗࡓࡀࠊࣃ࣮ࢯࢼࣜ ࢸ㞀ᐖ㛵ࡋ࡚ࡣࠊDSM-II ㍈ࡽ I ㍈⛣ࡉࢀ ࡓࡇ௨እࠊᇶᮏⓗࡣఱࡶኚࢃࡗ࡚࠸࡞࠸ࠋᮏ✏ ࡛ࡣ DSM-IV II ㍈࡛ᣦࡉࢀ࡚ࡁࡓၥ㢟ࡣ DSM-V ࡀฟ∧ࡉࢀࡓ⌧ᅾ࡛ࡶᮍゎỴ࡛࠶ࡿㄆ㆑ࡋࡓୖ ࡛㆟ㄽࢆ㐍ࡵࡿࠋ ࢼࣜࢸࡀᩥࡁࡃᙳ㡪ࢆཷࡅ࡚࠸ࡿࡇ ࢆ⪃៖ࡍࡿ⡿ᅜᩥ࡛ၥ㢟ࡋ࡚ྲྀࡾୖࡆࡽ ࢀࡿ≉ᛶ᪥ᮏ࡛ྲྀࡾୖࡆࡽࢀࡿࡁ≉ᛶࡣ 㐪࠸ࡀ࠶ࡗ࡚ࡶᛮ㆟࡛ࡣ࡞ࡃࠊ≉ Marmarosh et al.㸦2010㸧ࡀ♧၀ࡋ࡚࠸ࡿࡼ࠺ࠊ ᩥ᰿ᕪࡋࡓᕪูࡸ೫ぢࡀࡢࡼ࠺⤖ᯝ ᙳ㡪ࢆ࠼ࡿ࠸࠺ၥ㢟ࡣᚋ≉᳨ウࡋ࡚ ࠸ࡃᚲせࡀ࠶ࡿࡼ࠺ᛮࢃࢀࡿࠋ➨ࠊ⾜ࡢ ၥ㢟ࡀ࠶ࡿࠋGuide to SWAP-200 Interpretation ࡼࡿࠊ⒪⪅ࡣ⿕デ᩿⪅ࡢࡇࢆࡼࡃ▱ࡗ࡚ ࠸࡞ࡅࢀࡤ࡞ࡽࡎࠊ᭱ప࡛ࡶ 6 ᅇ௨ୖࡢ㠃᥋ࡀᮇ ᚅࡉࢀࡿࠋ ࡲࡓᡤせ㛫ࡣࠊ ⇍▱ᗘࡼࡗ࡚ 20 㹼 45 ศ⛬ᗘࡀぢ㎸ࡲࢀࡿࠋࡢࡼ࠺࡞デ᩿㸭ࢭ ࢫ࣓ࣥࢺ࣭ࢶ࣮ࣝࢆ࠺ሙྜࡶゝ࠼ࡿࡇ࡛࠶ ࡿࡀࠊSWAP ࢆ᪥ᮏ࡛ά⏝ࡍࡿሙྜࠊ㐺ษୟࡘ ຠᯝⓗࢡ࢚ࣛࣥࢺࡢ┈ࡘ࡞ࡆࡽࢀࡿࠊ ⏝ࡍࡿ⮫ᗋᐙࡢࢧ࣏࣮ࢺ࣭ࢩࢫࢸ࣒ࡢᵓ⠏ࡶ ᳨ウࡋ࡚࠸ࡃᚲせࡀ࠶ࡿࡼ࠺ᛮࢃࢀࡿࠋ グ㸸ᮏ◊✲ࡣ JSPS ⛉◊㈝ 25780425 ࡢຓᡂࢆ ཷࡅࡓࡶࡢ࡛࠶ࡿࠋᮏ⩻ヂࡢ back-translation ࡚ࠊ⩻ヂᐙࡢᘯ୰‶బᏊᵝࠊ⡿ᅜࡢ࢝࢘ࣥࢭ࣮ࣛ (3) ᭱ࡶᙜ࡚ࡣࡲࡿࡢࠕ7ࠖⅬࡣ 8 㡯┠ࠊḟࡼࡃ ࠶࡚ࡣࡲࡿࠕ6ࠖⅬࡣ 10 㡯┠ࠊ ࠕ5ࠖⅬࡣ 12 㡯 ┠ࠊ ࠕ4ࠖⅬࡣ 14 㡯┠ࠊ ࠕ3ࠖⅬࡣ 16 㡯┠ࠊ ࠕ2ࠖ Ⅼࡣ 18 㡯┠ࠊ ࠕ1ࠖⅬࡣ 22 㡯┠ࡀࡾࡽࢀࠊ ᭱ᚋࡢ᭱ࡶᙜ࡚ࡣࡲࡽ࡞࠸ࡣ 100 㡯┠ࡀධࡿࡇ ࡞ࡗ࡚࠸ࡿࠋࡍ࡞ࢃࡕࠊ1 ࡽ 7 ࡾࡽࢀ 100 㡯┠ࡀᐇ㉁ࠊࣃ࣮ࢯࢼࣜࢸ㞀ᐖࢆ≉ᐃࡍࡿࡓ ࡵࢃࢀࡿࡇ࡞ࡿࠋྛỈ‽ࡾࡽࢀࡿ㡯 ┠ࡢᩘࡀỴࡲࡗ࡚࠸ࡿᅛᐃ㓄⨨ fixed distribution ࡣᚰ⌮ ᐃୖࡢ࣓ࣜࢵࢺࡀ࠶ࡾࠊᶆ‽ᆺࡢࢸࢫࢺ 㸦ࡍ࡚ࡢ㡯┠ࡀࠕ᭱ࡶ࡞࠸ࠖࡽࠕ᭱ࡶ࠶ࡿࠖࡢ ⠊ᅖ࡛ᆒ➼ᅇ⟅ࡀ㑅ࡿࡶࡢ㸧ẚ࡚ࠊ ᐃ࢚ ࣮ࣛࢆ࡞ࡾῶࡽࡍࡇࡀྍ⬟࡛࠶ࡿ㸦Block, 1976㸧 (4) ⫋✀㸸⢭⚄⛉་ 32.2%ࠊᚰ⌮ኈ 67.8%ࠋᛶู㸸⏨ ᛶ 63.6%, ዪᛶ 36.4%ࠋᖹᆒ⮫ᗋ⤒㦂ᖺᩘ:18.14 ᖺ (SD=9.80)ࠋ࢚࢜ࣜࣥࢸ࣮ࢩࣙࣥࡢෆヂ㸸⢭⚄ຊື ⒪ἲ 48.6%, ᢡ⾺⒪ἲ 29.4%, , ㄆ▱⾜ື⒪ἲ 14.4% ⏕≀Ꮫⓗ⒪ἲ 4.8%, ࢩࢫࢸ࣒⒪ἲ 2.0% ᩥ⊩ Bell, E. and Jackson, D.:1992, The structure of personality disorders in DSM-III, Acta Psychiatrica Scandinavica. 85:279-287. 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Edited by Barron, J., Washinton, D.C.: American Psychological Association Press, pp. 111-138 86 ଐஜܖܖٻኔᙲ‒ ᇹ ‣… ӭ≋․•‣‧≌‒ Introduction of the SWAP-200 as a new language to understand personality disorders in Japanese clinical psychology Junichi TORIGOE≍1 ⁅⁛‒ This paper aims to introduce The Shedler and Westen Assessment Procedure (SWAP-200), a new personality disorder taxonomy, as an alternative to the DSM. For the past two decades, the DSM-IV Axis II has been largely used as the world-standard language to understand personality disorders. However, at the same time, it has been often said to be of no help in understanding these disorders and providing treatments: For example, the comorbidity of axis II disorders is too high. A client often receives four to six out of a possible 10 diagnosis. The taxonomy of axis II artificially dichotomizes diagnostic criteria into present or absent in top-down fashion, which risks excluding potential new understanding of personality traits. In the diagnostic process, the client’s self-report comes first before the clinician’s professional observations, although clients with personality disorders often lack self-awareness. In other words, the DSM has sacrificed so-called “clinical knowledge,” representing a way to understand the uniqueness of the individual, to enhance “scientific knowledge,” representing objectivity based on statistical validity and reliability. Although the DSM-V was published last year, these problems were not resolved. On the other hand, the SWAP-200 was designed to capture personality disorders by sorting out 200 items describing personality traits without jargon. In addition, the descriptions have been revised several times based on feedbacks from clinicians in order to properly reflect their professional observations. The SWAP-200 has enhanced the convergent and discriminant validity in different ways from the DSM, and those validities have been confirmed in several different countries. It can be also utilized in Japan as a new common language to understand clients with personality disorders holistically. However, as long as personality depends on culture, it must be examined whether its items can properly describe Japanese personality traits and tendencies. In addition, the bottom-up type of assessment tool such as the SWAP-200 can well reflect “clinical knowledge” but it means that the result of assessment is likely to be influenced by the clinician’s bias. In using the SWAP-200 in Japan, it will be desirable and necessary to set up systems to support clinician to use it properly and effectively for the client’s benefit. äääääääääääääääääääää‒ Key words‒…………………………………………………… SWAP-200, DSM-IV Axis II, personality disorders Ფ1 Faculty of Liberal Arts Nihonbashi Gakkan University NIHONBASHI GAKKAN UNIVERSITY Bulletin No.14