Winsper C, Marwaha S, Lereya S T, Thompson A, Eyden J, Singh S P
Division of Mental Health and Wellbeing,Warwick Medical School, University of Warwick,Coventry CV4 7AL,UK.
Department of Psychology,University of Warwick,Coventry CV4 7AL,UK.
Psychol Med. 2015 Aug;45(11):2237-51. doi: 10.1017/S0033291715000318. Epub 2015 Mar 24.
While there is a growing body of research on borderline personality disorder (BPD) in children and adolescents, controversy remains regarding the validity and diagnosis of the disorder prior to adulthood.
MEDLINE, EMBASE, Psych INFO and PubMed databases were systematically searched for articles pertaining to the clinical and psychosocial outcomes (i.e. predictive validity) of BPD first diagnosed in childhood or adolescence (i.e. prior to 19 years of age). All primary empirical studies were included in the review. A narrative synthesis of the data was completed.
A total of 8200 abstracts were screened. Out of 214 full-text articles, 18 satisfied the predetermined inclusion criteria. Quality assessment indicated that most studies had high risk of bias in at least one study domain. Consistent with the adult literature, the diagnostic stability of BPD prior to the age of 19 years was low to moderate, and mean-level and rank-order stability, moderate to high. Individuals with BPD symptoms in childhood or adolescence had significant social, educational, work and financial impairment in later life.
Studies indicate that borderline pathology prior to the age of 19 years is predictive of long-term deficits in functioning, and that a considerable proportion of individuals continue to manifest borderline symptoms up to 20 years later. These findings provide some support for the clinical utility of the BPD phenotype in younger populations, and suggest that an early intervention approach may be warranted. Further prospective studies are needed to delineate risk (and protective) factors pertinent to the chronicity of BPD across the lifespan.
虽然关于儿童和青少年边缘型人格障碍（BPD）的研究越来越多，但对于该障碍在成年前的有效性和诊断仍存在争议。
系统检索MEDLINE、EMBASE、Psych INFO和PubMed数据库，查找与首次在儿童期或青少年期（即19岁之前）诊断的BPD的临床和心理社会结局（即预测效度）相关的文章。所有原发性实证研究均纳入本综述。完成了数据的叙述性综合分析。
共筛选了8200篇摘要。在214篇全文文章中，18篇符合预定的纳入标准。质量评估表明，大多数研究在至少一个研究领域存在高偏倚风险。与成人文献一致，19岁之前BPD的诊断稳定性为低到中度，平均水平和等级顺序稳定性为中到高度。童年或青少年期有BPD症状的个体在晚年有显著的社会、教育、工作和经济损害。
研究表明，19岁之前的边缘型病理可预测长期功能缺陷，相当一部分个体在20年后仍表现出边缘型症状。这些发现为BPD表型在年轻人群中的临床实用性提供了一些支持，并表明可能有必要采取早期干预方法。需要进一步的前瞻性研究来确定与BPD在整个生命周期中的慢性病程相关的风险（和保护）因素。
