Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland.
Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Geneva, Switzerland.
Psychiatry Res. 2017 Oct;256:334-341. doi: 10.1016/j.psychres.2017.06.087. Epub 2017 Jun 30.
Emotion dysregulation and interpersonal hardships constitute core features of borderline personality disorder (BPD). Research has established the link between these core dysregulations and fluctuations in the capacity to appreciate the mental states that underlie behavior (mentalizing, operationalized as reflective functioning (RF)). As emotion dysregulation and interpersonal hardships also characterize adults with attention deficit hyperactivity disorder (ADHD), this study sought to examine the potential RF impairments affecting this population. 101 adults with ADHD, 108 with BPD and 236 controls were assessed using the RF questionnaire (RFQ), evaluating how individuals employ information about mental states to better understand their own and others' behaviors. The RFQ comprises two dimensions, certainty (RF_c) and uncertainty (RF_u) about mental states. RF scores helped distinguish ADHD from controls, but also from BPD (F = 48.1; p < 0.0001 for RF_c and F = 92.5; p < 0.0001 for RF_u). The ADHD group showed intermediary RF scores compared to the controls (b = -0.70; p < 0.0001 and b = 0.89; p < 0.0001 for RF_c and RF_u) and BPD group (b = 0.44; p = 0.001 and b = -0.56; p = 0.001 for RF_c and RF_u). Lower RF scores correlated with poor anger control and high levels of impulsivity. Higher severity of ADHD (more attentional and hyperactive/impulsive symptoms) was correlated with RF impairments. In conclusion, RF may constitute an important process underlying attentional, hyperactive/impulsive as well as emotional symptoms in ADHD; it should therefore be considered in the assessment of these patients.
情绪调节障碍和人际关系困难是边缘型人格障碍（BPD）的核心特征。研究已经确立了这些核心失调与理解行为背后心理状态的能力波动（心理化，操作化为反思功能（RF））之间的联系。由于情绪调节障碍和人际关系困难也存在于注意力缺陷多动障碍（ADHD）的成年人中，因此本研究旨在检查影响该人群的潜在 RF 损伤。使用 RF 问卷（RFQ）评估了 101 名 ADHD 成年人、108 名 BPD 成年人和 236 名对照者的 RF，该问卷评估个体如何利用关于心理状态的信息来更好地理解自己和他人的行为。RFQ 由两个维度组成，即对心理状态的确定性（RF_c）和不确定性（RF_u）。RF 分数有助于区分 ADHD 与对照组，但也与 BPD 区分（RF_c：F = 48.1；p < 0.0001；RF_u：F = 92.5；p < 0.0001）。与对照组相比，ADHD 组的 RF 分数处于中间水平（RF_c：b = -0.70；p < 0.0001；RF_u：b = 0.89；p < 0.0001），与 BPD 组相比（RF_c：b = 0.44；p = 0.001；RF_u：b = -0.56；p = 0.001）。较低的 RF 分数与愤怒控制能力差和冲动水平高相关。ADHD 的严重程度越高（注意力和多动/冲动症状越多），RF 损伤越严重。总之，RF 可能是 ADHD 中注意力、多动/冲动和情绪症状的一个重要过程；因此，在评估这些患者时应考虑到这一点。
