Hospital de Saúde Mental Professor Frota Pinto, Fortaleza, Brazil.
Hospital de Saúde Mental Professor Frota Pinto, Fortaleza, Brazil.
Psychiatry Res. 2018 Apr;262:70-77. doi: 10.1016/j.psychres.2018.01.043. Epub 2018 Feb 1.
Although sexual abuse (SA) is known to be frequent among borderline personality disorder (BPD) patients, few reviews evaluating that relationship have been published. This systematic review aimed to investigate SA (including adulthood) as a predictor of BPD diagnosis, clinical presentation and prognosis. Studies written in English or Portuguese from January 1997 until January 2017 were identified by searching the following keywords in three international databases: "borderline personality disorder" OR "borderline disorder" AND "sexual abuse" OR "sexual violence" OR "sexual victimization" OR "sexual assault" OR "rape". Forty articles met the eligibility criteria. Overall, SA was found to play a major role in BPD, particularly in women. Childhood sexual abuse (CSA) is an important risk factor for BPD. Adult sexual abuse (ASA) rates are significantly higher in BPD patients compared with other personality disorders (PDs). SA history predicts more severe clinical presentation and poorer prognosis. Suicidality has the strongest evidence, followed by self-mutilation, post-traumatic stress disorder (PTSD), dissociation and chronicity of BPD. Future research should study more ASA and include more males, milder BPD patients and documented or corroborated SA cases. The impact of other traumatic experiences (e.g., emotional abuse) on BPD must also be systematically reviewed.
虽然性虐待（SA）在边缘型人格障碍（BPD）患者中较为常见，但很少有研究对这种关系进行评估。本系统评价旨在探讨 SA（包括成年期）作为 BPD 诊断、临床表现和预后的预测因子。通过在三个国际数据库中搜索以下关键词，检索了 1997 年 1 月至 2017 年 1 月间发表的英文或葡萄牙文研究：“边缘型人格障碍”或“边缘障碍”以及“性虐待”或“性暴力”或“性受害”或“性侵犯”或“强奸”。有 40 篇文章符合入选标准。总体而言，SA 在 BPD 中起重要作用，尤其是在女性中。儿童期性虐待（CSA）是 BPD 的重要危险因素。与其他人格障碍（PDs）相比，BPD 患者的成年期性虐待（ASA）发生率显著更高。SA 史预示着更严重的临床表现和更差的预后。自杀行为的证据最强，其次是自残、创伤后应激障碍（PTSD）、解离和 BPD 的慢性化。未来的研究应更多地研究 ASA，并纳入更多的男性、病情较轻的 BPD 患者和有记录或证实的 SA 病例。还必须系统地审查其他创伤性经历（如情感虐待）对 BPD 的影响。
