Zanarini Mary C, Temes Christina M, Magni Laura R, Fitzmaurice Garrett M, Aguirre Blaise A, Goodman Marianne
McLean Hospital, Belmont, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Personal Ment Health. 2017 Aug;11(3):150-156. doi: 10.1002/pmh.1378. Epub 2017 May 28.
The validity of borderline personality disorder (BPD) in children and adolescents has not been studied in a rigorous manner reflecting the criteria of Robins and Guze first detailed in 1970. This paper and the others in this series address some aspects of this multifaceted validation paradigm, which requires that a disorder has a known clinical presentation, can be delimited from other disorders, 'runs' in families, and something of its aetiology, treatment response and course is known.
Three groups of subjects were studied: 104 adolescent inpatients meeting the Revised Diagnostic Interview for Borderlines and DSM-IV criteria for BPD, 60 psychiatrically healthy adolescents and 290 adult inpatients meeting the Revised Diagnostic Interview for Borderlines and DSM-III-R criteria for BPD.
Adolescents with BPD had significantly higher prevalence rates of 22 of the 24 symptoms studied than psychiatrically healthy adolescents. Only rates of serious treatment regressions and countertransference problems failed to reach the Bonferroni-corrected level of 0.002. Adolescents and adults with BPD had only four symptomatic differences that reached this level of significance, with adolescents with BPD reporting significantly lower levels of quasi-psychotic thought, dependency/masochism, devaluation/manipulation/sadism and countertransference problems than adults with BPD.
Taken together, the results of this study suggest that adolescents report BPD as severe as that reported by adults. They also suggest that BPD in adolescents is not a tumultuous phase of normal adolescence. Copyright © 2017 John Wiley & Sons, Ltd.
儿童和青少年边缘型人格障碍(BPD)的有效性尚未按照1970年首次详细阐述的罗宾斯和古泽标准进行严格研究。本文及本系列中的其他文章探讨了这一多方面验证范式的一些方面,该范式要求一种疾病具有已知的临床表现,可与其他疾病区分开来,在家族中“遗传”,并且对其病因、治疗反应和病程有所了解。
对三组受试者进行了研究:104名符合《边缘型人格障碍修订诊断访谈》和DSM-IV标准的青少年住院患者,60名精神健康的青少年,以及290名符合《边缘型人格障碍修订诊断访谈》和DSM-III-R标准的成年住院患者。
患有BPD的青少年在所研究的24种症状中有22种的患病率显著高于精神健康的青少年。只有严重治疗退行和反移情问题的发生率未达到经邦费罗尼校正的0.002水平。患有BPD的青少年和成年人只有四个症状差异达到这一显著水平,患有BPD的青少年报告的准精神病性思维、依赖/受虐狂、贬低/操纵/施虐和反移情问题的水平显著低于患有BPD的成年人。
综合来看,本研究结果表明青少年报告的BPD与成年人报告的一样严重。这些结果还表明,青少年中的BPD并非正常青春期的一个动荡阶段。版权所有© 2017约翰威立国际出版公司。