Soloff Paul H, Feske Ulrike, Fabio Anthony
University of Pittsburgh, USA.
J Pers Disord. 2008 Jun;22(3):221-32. doi: 10.1521/pedi.2008.22.3.221.
A history of childhood sexual abuse (CSA) increases the risk of suicidal behavior and the lifetime number of suicide attempts in adults with BPD. Despite a strong association, specific variables mediating the relationship between CSA and adult suicidal behavior in BPD have not been identified. This study examined risk factors for suicidal behavior as potential mediators of the relationship between CSA and suicide attempts in 151 men and women with BPD. Diagnostic, clinical, and psychosocial risk factors, as well as CSA, and suicidal behaviors, were assessed by standardized interviews or self-rated measures. Psychotic and schizotypal symptoms, and poor social adjustment, were associated with both CSA and suicidal behavior, and partially mediated the relationship between CSA and attempter status. Psychotic and schizotypal symptoms in BPD define a vulnerability to cognitive and perceptual distortions under stress. They increase the likelihood of suicidal behavior in BPD, especially in the absence of mitigating social support. A theoretical model for suicidal behavior in BPD is presented which integrates direct, mediated, and moderated pathways between childhood sexual abuse and temperament, adolescent and adult risk factors, and suicidal behavior.
童年期性虐待（CSA）史会增加边缘型人格障碍（BPD）成年患者自杀行为的风险以及终生自杀未遂次数。尽管存在密切关联，但尚未确定介导CSA与BPD成年患者自杀行为之间关系的具体变量。本研究调查了151名BPD男性和女性自杀行为的风险因素，这些因素可能是CSA与自杀未遂之间关系的潜在中介因素。通过标准化访谈或自评量表评估诊断、临床和社会心理风险因素，以及CSA和自杀行为。精神病性和分裂样症状以及社会适应不良与CSA和自杀行为均相关，并部分介导了CSA与自杀未遂状态之间的关系。BPD中的精神病性和分裂样症状表明在压力下易出现认知和感知扭曲。它们增加了BPD患者自杀行为的可能性，尤其是在缺乏缓解性社会支持的情况下。本文提出了一个BPD患者自杀行为的理论模型，该模型整合了童年期性虐待与气质、青少年和成年风险因素以及自杀行为之间的直接、中介和调节途径。
