Glaser J-P, Van Os J, Mengelers R, Myin-Germeys I
Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, The Netherlands.
Psychol Med. 2008 Sep;38(9):1231-9. doi: 10.1017/S0033291707002322. Epub 2007 Nov 30.
Stress is postulated to play an essential role in the expression of core borderline symptoms. However, the phenomenology of stress reactivity in borderline personality disorder remains unclear. The current study investigated the phenomenology of stress sensitivity in borderline personality disorder in the flow of daily life and compared this with stress sensitivity in patients suffering from psychotic disorders, a group so far known to report the largest reactivity to stress.
A total of 44 borderline patients, 42 patients with psychotic disorder and 49 healthy controls were studied with the Experience Sampling Method (a structured diary technique assessing current context and mood in daily life) to assess: (1) appraised subjective stress related to daily events and activities; and (2) emotional reactivity conceptualized as changes in positive and negative affect.
Multilevel regression analysis revealed that subjects with borderline personality disorder experienced significantly more emotional reactivity to daily life stress compared with both patients with psychosis and healthy controls, as evidenced by a larger increase in negative affect and a larger decrease in positive affect following stress.
These results are the first to ecologically validate the incorporation of stress reactive symptoms in the diagnosis of borderline personality disorder. Borderline patients continually react stronger than patients with psychosis and healthy controls to small disturbances that continually happen in the natural flow of everyday life. Altered emotional stress reactivity may define borderline personality disorder.
压力被认为在边缘型人格障碍核心症状的表现中起关键作用。然而，边缘型人格障碍中压力反应的现象学仍不明确。当前研究调查了日常生活中边缘型人格障碍患者压力敏感性的现象学，并将其与精神障碍患者的压力敏感性进行比较，后者是目前已知对压力反应最大的一组人群。
采用经验抽样法（一种评估日常生活中当前情境和情绪的结构化日记技术）对44名边缘型人格障碍患者、42名精神障碍患者和49名健康对照者进行研究，以评估：（1）与日常事件和活动相关的主观压力评估；（2）被概念化为积极和消极情绪变化的情绪反应。
多水平回归分析显示，与精神障碍患者和健康对照者相比，边缘型人格障碍患者对日常生活压力的情绪反应明显更多，压力后消极情绪增加幅度更大，积极情绪减少幅度更大即证明了这一点。
这些结果首次从生态学角度验证了将压力反应性症状纳入边缘型人格障碍诊断的合理性。边缘型人格障碍患者对日常生活自然过程中持续发生的小干扰的反应始终比精神障碍患者和健康对照者更强烈。情绪压力反应的改变可能是边缘型人格障碍的特征。
