Nurnberg H G, Raskin M, Levine P E, Pollack S, Siegel O, Prince R
Department of Psychiatry, Queens Hospital Center, Long Island Jewish Medical Center, Albert Einstein College of Medicine, Jamaica, NY 11432.
Am J Psychiatry. 1991 Oct;148(10):1371-7. doi: 10.1176/ajp.148.10.1371.
This study examines the comorbidity of DSM-III-R borderline personality disorder and the other axis II personality disorders. The extent and direction of overlap provides a measure of the clarity of its diagnostic boundaries and descriptive validity.
In 110 outpatients without concurrent major axis I conditions, axis II diagnoses were assessed in semistructured format and all DSM-III-R personality disorder criteria were rated. Multiple diagnoses were recorded.
Twenty-two patients (20%) met criteria for borderline personality disorder; 18 (82%) had at least one additional personality disorder diagnosis. Using measures of frequencies and intercorrelation coefficients, the authors found that overlap was extensive and not confined to any one of the three designated axis II clusters. Factor analysis revealed 1) a group containing borderline personality disorder with paranoid, histrionic, narcissistic, antisocial, and passive-aggressive personality disorders and 2) another grouping of schizoid, schizotypal, avoidant, obsessive-compulsive, and self-defeating personality disorders.
Borderline personality disorder appears to constitute a broad, heterogeneous category with unclear boundaries that embraces a general personality disorder concept. Both further refinement of the borderline personality disorder construct and investigation into alternative models to the DSM-III-R axis II classification system are suggested.
本研究探讨《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）中边缘型人格障碍与其他轴II人格障碍的共病情况。重叠的程度和方向为其诊断界限的清晰度和描述效度提供了一种衡量方式。
对110名无轴I主要共病情况的门诊患者，以半结构化形式评估轴II诊断，并对所有DSM-III-R人格障碍标准进行评分。记录多重诊断情况。
22名患者（20%）符合边缘型人格障碍标准；18名（82%）至少还有一项其他人格障碍诊断。通过频率和相互关联系数测量，作者发现重叠情况广泛，且不限于指定的三个轴II类别中的任何一个。因子分析显示：1）一组包括边缘型人格障碍与偏执型、表演型、自恋型、反社会型和被动攻击型人格障碍；2）另一组包括分裂样、分裂型、回避型、强迫型和自我挫败型人格障碍。
边缘型人格障碍似乎构成一个宽泛、异质性的类别，其界限不明确，涵盖了一个一般性的人格障碍概念。建议对边缘型人格障碍的结构进行进一步细化，并对DSM-III-R轴II分类系统的替代模型进行研究。
