Witt O, Brücher K, Biegel G, Petermann F, Schmidt S
Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen.
Fachkrankenhaus für Psychiatrie, Psychotherapie und Psychosomatik, AMEOS-Klinikum Dr. Heines, Bremen.
Fortschr Neurol Psychiatr. 2014 Jun;82(6):337-45. doi: 10.1055/s-0034-1366242. Epub 2014 Jun 5.
The present study focuses on selected symptom criteria to distinguish between attention deficit/hyperactivity disorder (ADHD) in adults and borderline personality disorder (BPD). A sample of n = 158 subjects was examined, consisting of BPD patients (n = 37), ADHD patients (n = 58), comorbid BPD/ADHD patients (n = 19), a clinical group of patients fulfilling the diagnostic criteria of a depressive disorder (DEP; n = 22) and a non-clinical control group (KG; n = 22). Selected symptom criteria were investigated by using the German scales "Skala zur Erfassung der Impulsivität und emotionalen Dysregulation der Borderline-Persönlichkeitsstörung" (IES-27), "ADHS-Screening für Erwachsene" (ADHS-LE), "Fragebogen zu dissoziativen Symptomen" (FDS) and a scale for the assessment of paranoid and dichotomous thinking (PADI). Multivariate analyses of variance revealed that BPD patients differed significantly with respect to self-mutilating behaviour, suicidality, dissociation, paranoia and dichotomy from all other groups. The same effect was found for affect regulation. Furthermore BPD patients differed significantly from ADHD patients by a more severe impulsiveness (IES-27), but not through disturbed impulse control and disinhibition overall. Regarding mean differences between ADHD and BPD patients for attentional control, ADHD patients revealed higher scores which just missed significance. For hyperactivity no significant group differences were found which is assumed to be influenced by symptom overlap like restlessness and aversive tension. The findings suggest that BPD-specific criteria, a stronger affective dysregulation and a higher tendency for autoaggressive impulsive reactions are more selective for differential diagnosis than the core symptoms of adult ADHD. Only attentional control might be a useful criterion for differential diagnosis, which should be examined in future studies.
本研究聚焦于用于区分成人注意力缺陷多动障碍（ADHD）和边缘型人格障碍（BPD）的特定症状标准。对n = 158名受试者组成的样本进行了检查，其中包括BPD患者（n = 37）、ADHD患者（n = 58）、BPD/ADHD共病患者（n = 19）、符合抑郁症诊断标准的临床患者组（DEP；n = 22）以及非临床对照组（KG；n = 22）。通过使用德国量表“边缘型人格障碍冲动性和情绪失调量表”（IES - 27）、“成人ADHS筛查量表”（ADHS - LE）、“分离症状问卷”（FDS）以及偏执和二分性思维评估量表（PADI）对选定的症状标准进行了调查。多变量方差分析显示，BPD患者在自我伤害行为、自杀倾向、分离、偏执和二分性思维方面与所有其他组存在显著差异。在情绪调节方面也发现了同样的效果。此外，BPD患者在冲动性方面（IES - 27）比ADHD患者显著更严重，但总体上并非通过冲动控制障碍和脱抑制来体现。关于ADHD和BPD患者在注意力控制方面的平均差异，ADHD患者得分较高，但未达到显著水平。对于多动，未发现显著的组间差异，这被认为是受不安和厌恶紧张等症状重叠的影响。研究结果表明，BPD特定标准、更强的情感失调以及更高的自我攻击冲动反应倾向在鉴别诊断中比成人ADHD的核心症状更具选择性。只有注意力控制可能是鉴别诊断的一个有用标准，这一点应在未来研究中进行检验。
