Beck Emma, Sharp Carla, Poulsen Stig, Bo Sune, Pedersen Jesper, Simonsen Erik
Psychiatric Research Unit, Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark.
Child and Adolescent Psychiatric Department, Region Zealand, Smedegade 16, 4000 Roskilde, DK Denmark.
Borderline Personal Disord Emot Dysregul. 2017 Nov 24;4:23. doi: 10.1186/s40479-017-0074-4. eCollection 2017.
Insecure attachment is a precursor and correlate of borderline personality disorder. According to the mentalization-based theory of borderline personality disorder, the presence of insecure attachment derails the development of the capacity to mentalize, potentially resulting in borderline pathology. While one prior study found support for this notion in adolescents, it neglected a focus on peer attachment. Separation from primary caregivers and formation of stronger bonds to peers are key developmental achievements during adolescence and peer attachment warrants attention as a separate concept.
In a cross-sectional study, female outpatients (M 15.78=, SD = 1.04) who fulfilled DSM-5 criteria for BPD ( = 106) or met at least 4 BPD criteria ( = 4) completed self-reports on attachment to parents and peers, mentalizing capacity (reflective function) and borderline personality features. Our findings suggest that in a simple mediational model, mentalizing capacity mediated the relation between attachment to peers and borderline features. In the case of attachment to parents, the mediational model was not significant.
The current study is the first to evaluate this mediational model with parent and peer attachment as separate concepts and the first to do so in a sample of adolescents who meet full or sub-threshold criteria for borderline personality disorder. Findings incrementally support that mentalizing capacity and attachment insecurity, also in relation to peers, are important concepts in theoretical approaches to the development of borderline personality disorder in adolescence. Clinical implications are discussed.
不安全依恋是边缘型人格障碍的先兆且与之相关。根据边缘型人格障碍的基于心理化的理论，不安全依恋的存在会使心理化能力的发展偏离正轨，可能导致边缘型病理状态。虽然之前的一项研究在青少年中为这一观点找到了支持，但它忽略了对同伴依恋的关注。与主要照顾者分离并与同伴形成更强的纽带是青少年时期关键的发展成就，同伴依恋作为一个独立的概念值得关注。
在一项横断面研究中，符合DSM - 5边缘型人格障碍标准（n = 106）或至少满足4条边缘型人格障碍标准（n = 4）的女性门诊患者（M = 15.78，SD = 1.04）完成了关于对父母和同伴的依恋、心理化能力（反思功能）以及边缘型人格特征的自我报告。我们的研究结果表明，在一个简单的中介模型中，心理化能力介导了同伴依恋与边缘型特征之间的关系。在对父母的依恋方面，中介模型不显著。
本研究首次将父母依恋和同伴依恋作为独立概念来评估这一中介模型，也是首次在符合边缘型人格障碍全部或亚阈值标准的青少年样本中进行评估。研究结果逐步支持了心理化能力和依恋不安全感（包括与同伴相关的）在青少年边缘型人格障碍发展的理论方法中是重要概念这一观点。文中还讨论了临床意义。
