Kaess Michael, Fischer-Waldschmidt Gloria, Resch Franz, Koenig Julian
Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstraße 8, Heidelberg, 69115 Germany.
Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
Borderline Personal Disord Emot Dysregul. 2017 May 7;4:7. doi: 10.1186/s40479-017-0058-4. eCollection 2017.
Diagnostic standards do not acknowledge developmental specifics and differences in the clinical presentation of adolescents with borderline personality disorder (BPD). BPD is associated with severe impairments in health related quality of life (HRQoL) and increased psychopathological distress. Previously no study addressed differences in HRQoL and psychopathology in adolescents with subthreshold and full-syndrome BPD as well as adolescents at-risk for the development but no current BPD.
Drawing on data from a consecutive sample of = 264 adolescents (12-17 years) presenting with risk-taking and self-harming behavior at a specialized outpatient clinic, we investigated differences in HRQoL (KIDSCREEN-52) and psychopathological distress (SCL-90-R) comparing adolescents with no BPD (less than 3 criteria fulfilled), to those with subthreshold (3-4 BPD criteria) and full-syndrome BPD (5 or more BPD criteria). Group differences were analyzed using one-way analysis of variance with corrected contrasts or Chi-Square test for categorical variables.
Adolescents with subthreshold and full-syndrome BPD presented one year later at our clinic and were more likely female. Adolescents with subthreshold and full-syndrome BPD showed greater Axis-I and Axis-II comorbidity compared to adolescents with no BPD, and reported greater risk-taking behaviour, self-injury and suicidality. Compared to those without BPD, adolescents with subthreshold and full-syndrome BPD reported significantly reduced HRQoL. Adolescents with sub-threshold BPD and those with full-syndrome BPD did not differ on any HRQoL dimension, with the exception of . Similar, groups with sub-threshold and full-syndrome BPD showed no significant differences on any dimension of self-reported psychopathological distress, with the exception of .
Findings highlight that subthreshold BPD in adolescents is associated with impairments in HRQoL and psychopathological distress comparable to full-syndrome BPD. Findings raise awareness on the importance of early detection and question the diagnostic validity and clinical utility of existing cut-offs. Findings support a lower diagnostic cut-off for adolescent BPD, to identify those at-risk at an early stage.
诊断标准未考虑边缘型人格障碍（BPD）青少年的发育特点及临床表现差异。BPD与健康相关生活质量（HRQoL）的严重损害及精神病理痛苦增加有关。此前尚无研究探讨亚阈值和完全综合征型BPD青少年以及有发展为BPD风险但目前未患BPD的青少年在HRQoL和精神病理学方面的差异。
利用一家专门门诊连续收集的264名（12 - 17岁）有冒险和自我伤害行为青少年的数据，我们比较了无BPD（满足少于3条标准）、亚阈值（3 - 4条BPD标准）和完全综合征型BPD（5条或更多BPD标准）青少年在HRQoL（儿童生活质量量表 - 52）和精神病理痛苦（症状自评量表 - 90修订版）方面的差异。使用单因素方差分析及校正对比分析组间差异，分类变量采用卡方检验。
亚阈值和完全综合征型BPD青少年在我们诊所就诊时间晚一年，且女性居多。与无BPD青少年相比，亚阈值和完全综合征型BPD青少年显示出更高的轴I和轴II共病率，且报告有更高的冒险行为、自我伤害和自杀倾向。与无BPD青少年相比，亚阈值和完全综合征型BPD青少年报告的HRQoL显著降低。亚阈值BPD青少年和完全综合征型BPD青少年在任何HRQoL维度上均无差异，除了……。同样，亚阈值和完全综合征型BPD组在自我报告的精神病理痛苦的任何维度上均无显著差异，除了……。
研究结果表明，青少年亚阈值BPD与HRQoL损害及精神病理痛苦有关，与完全综合征型BPD相当。研究结果提高了对早期检测重要性的认识，并对现有临界值的诊断有效性和临床实用性提出质疑。研究结果支持降低青少年BPD的诊断临界值，以便早期识别有风险的个体。
