Rausch Juliane, Gäbel Andrea, Nagy Krisztina, Kleindienst Nikolaus, Herpertz Sabine C, Bertsch Katja
Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany.
Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
Psychoneuroendocrinology. 2015 May;55:116-27. doi: 10.1016/j.psyneuen.2015.02.002. Epub 2015 Feb 12.
Borderline personality disorder (BPD) is characterized by antagonism, negative affectivity, disinhibition, and impairments in interpersonal functioning, including enhanced impulsive aggression. Interpersonal dysfunctions may be related to alterations in endocrine systems. The current study investigated alterations in basal activity of the hypothalamus-pituitary-gonadal (HPG) reproductive and the hypothalamus-pituitary-adrenal (HPA) stress system in BPD patients and their association to anger-related aggression with a particular focus on effects of gender and comorbid conditions of depression and posttraumatic stress disorder (PTSD).
Saliva testosterone levels as well as cortisol awakening responses were assessed in 55 medication-free female and male patients with BPD and compared to 47 gender-, age-, and intelligence-matched healthy volunteers. In addition, analyses controlling for current depression and PSTD and bivariate correlations between testosterone and cortisol levels on the one hand and anger and aggressiveness on the other hand were performed.
The results revealed increased saliva testosterone levels in female and male patients with BPD as well as elevated cortisol awakening responses in female, but not male patients with BPD compared to healthy volunteers. Cortisol awakening responses were positively related to anger and aggressiveness in female patients with BPD, but no associations were found with testosterone levels.
In line with previous reports, the present results suggest endocrine alterations in BPD which may be associated with interpersonal impairments, such as increased anger-related aggressive behavior and could have implications for the development of new (psychopharmaco-) therapeutic interventions that may help to restore the alterations in the HPA and HPG systems.
边缘型人格障碍（BPD）的特征包括敌对性、消极情感、行为抑制解除以及人际功能受损，其中冲动攻击性增强。人际功能障碍可能与内分泌系统的改变有关。本研究调查了BPD患者下丘脑-垂体-性腺（HPG）生殖系统和下丘脑-垂体-肾上腺（HPA）应激系统的基础活动变化，及其与愤怒相关攻击行为的关联，特别关注性别以及抑郁和创伤后应激障碍（PTSD）共病情况的影响。
对55名未服用药物的BPD女性和男性患者进行唾液睾酮水平以及皮质醇觉醒反应评估，并与47名性别、年龄和智力匹配的健康志愿者进行比较。此外，还进行了控制当前抑郁和PTSD的分析，以及睾酮和皮质醇水平与愤怒和攻击性之间的双变量相关性分析。
结果显示，与健康志愿者相比，BPD女性和男性患者的唾液睾酮水平升高，BPD女性患者的皮质醇觉醒反应升高，但男性患者未升高。BPD女性患者的皮质醇觉醒反应与愤怒和攻击性呈正相关，但未发现与睾酮水平有关联。
与先前报告一致，目前的结果表明BPD存在内分泌改变，这可能与人际功能受损有关，如与愤怒相关的攻击行为增加，并且可能对开发新的（精神药物）治疗干预措施有启示，这些措施可能有助于恢复HPA和HPG系统的改变。
