LWL University Hospital, Department of Psychiatry, Psychotherapy and Psychiatric Preventive Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University Bochum, Germany
Evol Med Public Health. 2016 Feb 28;2016(1):52-66. doi: 10.1093/emph/eow002.
The term 'Borderline Personality Disorder' (BPD) refers to a psychiatric syndrome that is characterized by emotion dysregulation, impulsivity, risk-taking behavior, irritability, feelings of emptiness, self-injury and fear of abandonment, as well as unstable interpersonal relationships. BPD is not only common in psychiatric populations but also more prevalent in the general community than previously thought, and thus represents an important public health issue. In contrast to most psychiatric disorders, some symptoms associated with BPD may improve over time, even without therapy, though impaired social functioning and interpersonal disturbances in close relationships often persist. Another counterintuitive and insufficiently resolved question is why depressive symptoms and risk-taking behaviors can occur simultaneously in the same individual. Moreover, there is an ongoing debate about the nosological position of BPD, which impacts on research regarding sex differences in clinical presentation and patterns of comorbidity.In this review, it is argued that many features of BPD may be conceptualized within an evolutionary framework, namely behavioral ecology. According to Life History Theory, BPD reflects a pathological extreme or distortion of a behavioral 'strategy' which unconsciously aims at immediate exploitation of resources, both interpersonal and material, based on predictions shaped by early developmental experiences. Such a view is consistent with standard medical conceptualizations of BPD, but goes beyond classic 'deficit'-oriented models, which may have profound implications for therapeutic approaches.
“边缘型人格障碍”（BPD）这一术语指的是一种精神科综合征，其特征为情绪调节障碍、冲动、冒险行为、易怒、空虚感、自残和被遗弃的恐惧，以及不稳定的人际关系。BPD 不仅在精神科人群中很常见，而且在普通人群中的流行程度比以前认为的要高，因此是一个重要的公共卫生问题。与大多数精神疾病不同，即使没有治疗，BPD 相关的一些症状也可能随着时间的推移而改善，尽管社会功能受损和亲密关系中的人际干扰通常持续存在。另一个有违直觉且尚未解决的问题是，为什么抑郁症状和冒险行为可以同时出现在同一个人身上。此外，BPD 的分类位置问题仍存在争议，这影响了有关性别差异在临床表现和共病模式中的研究。在这篇综述中，作者认为，BPD 的许多特征可以用进化框架，即行为生态学来概念化。根据生活史理论，BPD 反映了一种病理性的极端或扭曲的行为“策略”，这种策略无意识地基于早期发育经验形成的预测，旨在立即利用人际和物质资源。这种观点与 BPD 的标准医学概念一致，但超越了经典的“缺陷”导向模型，这可能对治疗方法有深远的影响。
