Kaplan Cynthia, Tarlow Naomi, Stewart Jeremy G, Aguirre Blaise, Galen Gillian, Auerbach Randy P
Department of Psychiatry, Harvard Medical School; Center for Depression, Anxiety and Stress Research, McLean Hospital.
Department of Psychiatry, Harvard Medical School; Center for Depression, Anxiety and Stress Research, McLean Hospital.
Compr Psychiatry. 2016 Nov;71:86-94. doi: 10.1016/j.comppsych.2016.08.016. Epub 2016 Sep 5.
Borderline personality disorder (BPD) is characterized by greater engagement in non-suicidal self-injury (NSSI) and suicidality. The aim of the study is to test whether the occurrence of child abuse contributes to these high-risk behaviors in BPD youth.
BPD female youth aged 13-21years with (n=29) and without (n=29) a history of child abuse were administered clinical interviews assessing diagnostic history, child abuse, NSSI and suicidality (i.e., ideation, plans, and attempts). NSSI and suicidality were subsequently reevaluated at the 1- and 2-month follow-up assessments.
Several findings emerged. First, relative to BPD youth without abuse, the abuse group reported greater past NSSI; however, no significant differences emerged in the follow-up period. Second, the occurrence of child abuse was associated with a 5-fold increase in the rate of lifetime suicide attempts relative to the no abuse group and additionally, prospectively predicted suicide ideation (but not attempts). Last, exploratory analyses indicated that the co-occurrence of physical and sexual abuse was associated with greater past NSSI and suicidality as compared to the no abuse and sexual abuse only participants.
As a whole, child abuse - particularly co-occurring physical and sexual abuse - increases risk for NSSI and suicidality among BPD youth, which may have important treatment implications in this high-risk population.
边缘型人格障碍（BPD）的特征是更频繁地出现非自杀性自伤行为（NSSI）和自杀倾向。本研究的目的是检验儿童期受虐经历是否会导致BPD青年出现这些高风险行为。
对年龄在13 - 21岁、有（n = 29）和无（n = 29）儿童期受虐史的BPD女性青年进行临床访谈，评估诊断史、儿童期受虐情况、NSSI和自杀倾向（即想法、计划和尝试）。随后在1个月和2个月的随访评估中对NSSI和自杀倾向进行重新评估。
得出了几个研究结果。首先，相对于无受虐经历的BPD青年，受虐组报告的既往NSSI更多；然而，在随访期间未出现显著差异。其次，与无受虐组相比，儿童期受虐经历使终生自杀未遂率增加了5倍，此外，还前瞻性地预测了自杀想法（但不是自杀未遂）。最后，探索性分析表明，与无受虐组和仅遭受性虐待的参与者相比，身体虐待和性虐待同时发生与更多的既往NSSI和自杀倾向相关。
总体而言，儿童期受虐——尤其是身体虐待和性虐待同时发生——会增加BPD青年出现NSSI和自杀倾向的风险，这可能对这一高风险人群的治疗具有重要意义。
