Zanarini M C, Frankenburg F R, DeLuca C J, Hennen J, Khera G S, Gunderson J G
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Mass. 02478, USA.
Harv Rev Psychiatry. 1998 Nov-Dec;6(4):201-7. doi: 10.3109/10673229809000330.
The objective of this study was to identify the dysphoric states that best characterize patients meeting criteria for borderline personality disorder and distinguish them from those in patients with other forms of personality disorder. One hundred forty-six patients with criteria-defined borderline personality disorder and 34 Axis II controls filled out the Dysphoric Affect Scale, a 50-item self-report measure that was designed for this purpose and has good internal consistency and test-retest reliability. Twenty-five dysphoric states (mostly affects) were found to be significantly more common among borderline patients than controls but nonspecific to borderline personality disorder. Twenty-five other dysphoric states (mostly cognitions) were found to be both significantly more common among borderline patients than controls and highly specific to borderline personality disorder. These states tended to fall into one of four clusters: (1) extreme feelings, (2) destructiveness or self-destructiveness, (3) fragmentation or "identitylessness," and (4) victimization. In addition, three of the 25 more-specific states (feeling betrayed, like hurting myself, and completely out of control), when occurring together, were particularly strongly associated with the borderline diagnosis. Equally important, overall mean Dysphoric Affect Scale scores correctly distinguished borderline personality disorder from other personality disorders in 84% of the subjects. Taken together, the results of this study suggest that the subjective pain of borderline patients may be both more pervasive and more multifaceted than previously recognized, and that the overall "amplitude" of this pain may be a particularly good marker for the borderline diagnosis.
本研究的目的是确定最能表征符合边缘型人格障碍标准患者的烦躁不安状态，并将其与其他形式人格障碍患者的状态区分开来。146名符合标准定义的边缘型人格障碍患者和34名轴II对照组患者填写了烦躁情绪量表，这是一项为该目的设计的包含50个条目的自我报告测量工具，具有良好的内部一致性和重测信度。研究发现，25种烦躁不安状态（大多为情感方面）在边缘型患者中比对照组更为常见，但并非边缘型人格障碍所特有。另外25种烦躁不安状态（大多为认知方面）在边缘型患者中不仅比对照组更为常见，而且对边缘型人格障碍具有高度特异性。这些状态往往可分为四类：（1）极端情绪，（2）破坏性或自我破坏性，（3）分裂或“身份缺失”，以及（4）受害感。此外，25种更具特异性的状态中有三种（感觉被背叛、想伤害自己和完全失控）同时出现时，与边缘型人格障碍的诊断特别密切相关。同样重要的是，在84%的受试者中，烦躁情绪量表的总体平均得分能正确区分边缘型人格障碍和其他人格障碍。综合来看，本研究结果表明，边缘型患者的主观痛苦可能比之前认识到的更为普遍和多面，而且这种痛苦的总体“强度”可能是边缘型人格障碍诊断的一个特别好的指标。
