Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain.
Consorci Sanitari del Maresme. Department of Psychiatry, Hospital of Mataró, Mataró, Spain.
Clin Psychol Psychother. 2018 Jan;25(1):e30-e41. doi: 10.1002/cpp.2123. Epub 2017 Aug 17.
To ascertain the foundations for a schema-focused therapy model for the treatment of borderline personality disorder.
The sample consisted of 102 borderline personality disorder outpatients. Dimensional psychopathology was assessed using the Scale for Suicidal Ideation, the Aggression Questionnaire, and the Symptom CheckList Revised. Categorical psychopathology was measured using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders, Patient Edition. Stepwise linear/logistic multiple regression analyses were used to determine the predictive role of the schema domains tested by the Young Schema Questionnaire on both types of psychopathology. Receiver operating characteristic curves were calculated for those binary outcomes.
Regarding dimensional psychopathology, disconnection/rejection predicted greater suicidal ideation (β = .39, p = .002), physical/overt aggressiveness (β = .27, p = .05), and psychotic-like symptoms, such as paranoid ideation (β = .35, p = .003). Other-directedness predicted greater anger/inner aggressiveness (β = .22, p = .05) and internalizing symptoms, such as phobic anxiety (β = .39, p = .001). Regarding categorical psychopathology, disconnection/rejection significantly predicted the presence of lifetime comorbidities with eating disorders (adjusted odds ratio [AOR] = 1.12, 95% CI = 0.99-1.24) and posttraumatic stress disorder (AOR = 1.2, 95% CI = 1.04-1.3), resulting in a good balance of sensitivity/specificity, respectively (.97/.96 and .88/.89). Other-directedness significantly predicted the absence of lifetime comorbidity with substance-use disorders (AOR = .74, 95% CI = 0.57-0.95). These relationships remained significant after controlling for confounders (e.g., comorbidity with other personality disorders, clinical global severity).
Two schema domains, disconnection/rejection and other-directedness, were directly associated with dimensional and categorical psychopathology among borderline personality disorder patients. These findings provide further information about the foundations and target interventions when implementing schema-focused therapy on this population.
确定以图式为焦点的治疗模式治疗边缘型人格障碍的基础。
该样本包括 102 名边缘型人格障碍门诊患者。使用自杀意念量表、攻击问卷和症状检查表修订版评估维度性精神病理学。使用《精神障碍诊断与统计手册》第四版轴 I 障碍患者版的结构化临床访谈测量类别性精神病理学。使用逐步线性/逻辑多元回归分析来确定 Young 图式问卷测试的图式域对这两种精神病理学的预测作用。为这些二项结果计算了接收器工作特征曲线。
关于维度性精神病理学，疏离/拒绝预测更大的自杀意念（β=0.39，p=0.002）、身体/明显攻击性（β=0.27，p=0.05）和精神病样症状，如偏执意念（β=0.35，p=0.003）。他向性预测更大的愤怒/内在攻击性（β=0.22，p=0.05）和内化症状，如恐惧症焦虑（β=0.39，p=0.001）。关于类别性精神病理学，疏离/拒绝显著预测与饮食障碍（调整后的优势比 [AOR] = 1.12，95%置信区间 [CI] = 0.99-1.24）和创伤后应激障碍（AOR = 1.2，95%CI = 1.04-1.3）终生共病的存在，分别具有良好的敏感性/特异性平衡（分别为.97/.96 和.88/.89）。他向性显著预测与物质使用障碍终生共病的缺失（AOR = 0.74，95%CI = 0.57-0.95）。在控制混杂因素（例如，与其他人格障碍的共病、临床总体严重程度）后，这些关系仍然显著。
两个图式领域，疏离/拒绝和他向性，与边缘型人格障碍患者的维度性和类别性精神病理学直接相关。这些发现为在该人群中实施图式为焦点的治疗时提供了关于基础和目标干预的进一步信息。
