Benazzi Franco
Hecker Psychiatry Research Center, a University of California at San Diego, USA.
Prog Neuropsychopharmacol Biol Psychiatry. 2006 Jan;30(1):68-74. doi: 10.1016/j.pnpbp.2005.06.010. Epub 2005 Jul 14.
The relationship between borderline personality disorder (BPD) and bipolar disorders, especially bipolar-II disorder (BP-II), is unclear. Several reviews on the topic have come to opposite conclusions, i.e., that BPD is a bipolar spectrum disorder or instead that it is unrelated to bipolar disorders. Study aim was to find which items of BPD were related to BP-II, and which instead had no relationship with BP-II.
An outpatient psychiatry private practice, more representative of mood disorders usually seen in clinical practice in Italy. INTERVIEWER: A senior clinical and mood disorder research psychiatrist.
A consecutive sample of 138 BP-II and 71 major depressive disorder (MDD) remitted outpatients. ASSESSMENT INSTRUMENTS: The Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version (SCID-CV) was used for diagnosing, the SCID-II Personality Questionnaire was used by patients to self-assess borderline personality traits. Interview methods: Patients were interviewed with the SCID-CV to diagnose BP-II and MDD. The questions of the Personality Questionnaire relative to borderline personality were self-assessed by patients. As clinically significant distress or impairment of functioning was not assessed by the questionnaire, a diagnosis of borderline personality disorder could not be made, but borderline personality traits (BPT) could be assessed (i.e., all DSM-IV BPD items but not the impairment criterion).
BPT items were significantly more common in BP-II versus MDD. The best combination of sensitivity and specificity for predicting BP-II was found by using a cutoff number of BPT items > or =5: specificity was 71.4%, sensitivity was 45.9%. BPT (defined by > or =5 items) was present in 29.5% of MDD and in 46.3% of BP-II (p=0.019). Logistic regression of BP-II versus BPT items number found a significant association. Principal component factor analysis of BPT items found two orthogonal factors: "affective instability" including unstable mood, unstable interpersonal relationships, unstable self-image, chronic emptiness, and anger, and "impulsivity" including impulsivity, suicidal behavior, avoidance of abandonment, and paranoid ideation. "Affective instability" was associated with BP-II (p=0.010), but "impulsivity" was not associated with BP-II (p=0.193). Interitem correlation was low. There was no significant correlation between the two factors.
Study findings suggest that DSM-IV BPD may mix two sets of unrelated items: an affective instability dimension related to BP-II, and an impulsivity dimension not related to BP-II, which may explain the opposite conclusions of several reviews. A subtyping of BPD according to these dimensions is supported by the study findings.
边缘型人格障碍（BPD）与双相情感障碍，尤其是双相II型障碍（BP-II）之间的关系尚不清楚。关于该主题的几项综述得出了相反的结论，即BPD是一种双相谱系障碍，或者它与双相情感障碍无关。研究目的是找出BPD的哪些项目与BP-II相关，哪些与BP-II无关。
一家门诊精神科私人诊所，更能代表意大利临床实践中常见的情绪障碍。访谈者：一位资深的临床和情绪障碍研究精神科医生。
138例BP-II型和71例缓解期重度抑郁症（MDD）门诊患者的连续样本。评估工具：使用《精神疾病诊断与统计手册》第四版轴I障碍临床定式访谈量表（SCID-CV）进行诊断，患者使用SCID-II人格问卷自我评估边缘型人格特质。访谈方法：用SCID-CV对患者进行访谈以诊断BP-II和MDD。患者对人格问卷中与边缘型人格相关的问题进行自我评估。由于问卷未评估具有临床意义的痛苦或功能损害，因此无法做出边缘型人格障碍的诊断，但可以评估边缘型人格特质（BPT）（即所有《精神疾病诊断与统计手册》第四版BPD项目，但不包括损害标准）。
与MDD相比，BPT项目在BP-II中显著更常见。通过使用BPT项目数≥5的临界值，发现预测BP-II的敏感性和特异性的最佳组合：特异性为71.4%，敏感性为45.9%。BPT（定义为≥5项）在29.5%的MDD患者和46.3%的BP-II患者中存在（p=0.019）。BP-II与BPT项目数的逻辑回归发现存在显著关联。BPT项目的主成分因子分析发现两个正交因子：“情感不稳定”，包括情绪不稳定、人际关系不稳定、自我形象不稳定、长期空虚和愤怒，以及“冲动性”，包括冲动、自杀行为、避免被抛弃和偏执观念。“情感不稳定”与BP-II相关（p=0.010），但“冲动性”与BP-II无关（p=0.193）。项目间相关性较低。两个因子之间无显著相关性。
研究结果表明，《精神疾病诊断与统计手册》第四版BPD可能混合了两组不相关的项目：一个与BP-II相关的情感不稳定维度，以及一个与BP-II无关的冲动性维度，这可能解释了几项综述得出相反结论的原因。研究结果支持根据这些维度对BPD进行亚型分类。
