<br>寻求帮助的青少年边缘性人格障碍症状的异质性,Borderline Personality Disorder and Emotion Dysregulation

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寻求帮助的青少年边缘性人格障碍症状的异质性
Borderline Personality Disorder and Emotion Dysregulation ( IF 4.0 ) Pub Date : 2021-02-26 , DOI: 10.1186/s40479-021-00147-9
Marialuisa Cavelti ₁ , Stefan Lerch ₁ , Denisa Ghinea _{2,

3} , Gloria Fischer-Waldschmidt _{2,

3} , Franz Resch ₃ , Julian Koenig _{1,

4} , Michael Kaess _{1,

2,

3}

Affiliation

边缘性人格障碍（BPD）的异质性表现是一个临床挑战。关于异质性是否可以通过个体之间的定性（计算类别）或定量（维度）差异来最好地理解，科学界一直存在争论。本研究调查了青少年 BPD 的潜在结构。对 506 名年龄在 12 至 17 岁之间有冒险和/或自残行为的门诊患者进行了基线和一年随访评估。潜在类别分析（对应于分类方法）、因子分析（对应于维度方法）和因子混合模型（考虑到分类和维度方面）均应用于 DSM-IV BPD 标准。最佳拟合模型区分了对所有 BPD 标准具有高概率的多数类别（“边缘群体”）和仅对冲动和愤怒标准具有高概率的少数类别（“冲动群体”）。性别显着影响潜在阶级成员资格，潜在因素和年龄都解释了阶级内的变异性。边缘群体主要由女性组成，经常报告不良的童年经历，在情绪失调和抑制性人格特征方面得分较高，并且与内化精神病理学相关。相比之下，冲动组主要由男性组成，在不社会行为人格特质上得分较高，并且与外化精神病理学相关。一年后，两组表现出相似的临床改善。该研究为具有 BPD 特征的两个不同的青少年亚群提供了证据，这些特征类似于 ICD-10 情绪不稳定人格障碍的亚型。需要更多的研究来进一步调查两组随时间的诊断稳定性和潜在的差异化治疗适应症。

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Heterogeneity of borderline personality disorder symptoms in help-seeking adolescents

The heterogeneous presentation of borderline personality disorder (BPD) represents a clinical challenge. There is an ongoing scientific debate whether the heterogeneity can best be understood in terms of qualitative (categorical) or quantitative (dimensional) differences between individuals. The present study examined the latent structure of BPD in adolescents. Five-hundred and six outpatients aged 12 to 17 years with risk-taking and/or self-harming behavior were assessed at baseline and one-year follow-up. Latent class analysis (corresponding with the categorical approach), factor analysis (corresponding with the dimensional approach), and factor mixture models (allowing for both categorical and dimensional aspects) were applied to the DSM-IV BPD criteria. The best fitting model distinguished between a majority class with high probabilities for all BPD criteria (“borderline group”) and a minority class with high probabilities for the impulsivity and anger criteria only (“impulsive group”). Sex significantly affected latent class membership, and both a latent factor and age explained within-class variability. The borderline group primarily consisted of females, frequently reported adverse childhood experiences, scored high on the emotion dysregulation and inhibitedness personality traits, and was associated with internalizing psychopathology. In contrast, the impulsive group primarily consisted of males, scored high on the dissocial behavior personality trait, and was associated with externalizing psychopathology. After one year, the two groups showed similar clinical improvement. The study provides evidence for two distinct subgroups of adolescents with BPD features that resemble the subtypes of the ICD-10 emotionally unstable personality disorder. More research is needed to further investigate the diagnostic stability of the two groups over time and potential differential treatment indications.

更新日期：2021-03-15

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