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多重人际创伤是创伤后应激障碍和边缘型人格障碍的危险因素:共病创伤后应激障碍/边缘型人格障碍组与单病种组的创伤背景和临床特征的系统综述。

Multiple and interpersonal trauma are risk factors for both post-traumatic stress disorder and borderline personality disorder: A systematic review on the traumatic backgrounds and clinical characteristics of comorbid post-traumatic stress disorder/borderline personality disorder groups versus single-disorder groups.

机构信息

Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.

School of Health and Social Care, Edinburgh Napier University, UK.

出版信息

Psychol Psychother. 2020 Sep;93(3):621-638. doi: 10.1111/papt.12248. Epub 2019 Aug 24.

DOI:10.1111/papt.12248
PMID:31444863
Abstract

BACKGROUND

Both borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) are associated with exposure to traumatic events and are highly comorbid. No review to date has addressed the clinical presentations and traumatic backgrounds associated with these disorders although this work is essential for the development of effective interventions.

OBJECTIVES

To systematically explore similarities and differences in traumatic history and clinical presentation in comorbid BPD and PTSD as compared to PTSD or BPD alone.

METHOD

The Web of Science, Cochrane Library, PsycINFO, MEDLINE, and PILOTS databases were searched systematically. Eligible studies included adult populations, compared comorbid BPD/PTSD to a single disorder, and published in English.

RESULTS

A total of 10,147 cases across 33 studies were included: 2,057 comorbid BPD/PTSD, 2,648 BPD only, and 5,442 PTSD only. The comorbid group overall reported greater exposure to multiple and interpersonal trauma and elevated emotion dysregulation compared to both single-disorder groups. In terms of methodological quality, most papers achieved a Fair rating with improvements required in minimizing bias through recruiting adequate and representative samples, and reporting on traumatic exposure.

CONCLUSION

Multiple and interpersonal trauma might have a unique role in the development of comorbid BPD/PTSD features, particularly so for emotion dysregulation. Future research is required to unravel the unique characteristics of interpersonal trauma that can generate BPD and PTSD symptoms.

PRACTITIONER POINTS

Practitioners should routinely assess for interpersonal trauma considering its impact. Tackling emotion regulation difficulties might promote recovery from both PTSD and BPD symptoms. Presence of self -injury might be used to discriminate between PTSD and BPD and offer suitable interventions.

摘要

背景

边缘型人格障碍(BPD)和创伤后应激障碍(PTSD)均与创伤暴露有关,且两者高度共病。迄今为止,尚无研究探讨与这些障碍相关的临床表现和创伤背景,尽管这对于开发有效的干预措施至关重要。

目的

系统探讨共病 BPD 和 PTSD 与 PTSD 或 BPD 单独存在时在创伤史和临床特征方面的异同。

方法

系统检索了 Web of Science、Cochrane Library、PsycINFO、MEDLINE 和 PILOTS 数据库。纳入研究为成年人群,比较了共病 BPD/PTSD 与单一疾病,并以英文发表。

结果

共有 33 项研究纳入了 10147 例患者:共病 BPD/PTSD 组 2057 例,BPD 组 2648 例,PTSD 组 5442 例。与单一疾病组相比,共病组总体报告了更多的多种和人际创伤经历以及更高的情绪调节障碍。在方法学质量方面,大多数论文的评分均为“公平”,需要通过招募足够和有代表性的样本以及报告创伤暴露来改进最小化偏倚的方法。

结论

多种和人际创伤可能在共病 BPD/PTSD 特征的发展中具有独特作用,尤其是对情绪调节障碍而言。需要进一步研究来阐明能够引发 BPD 和 PTSD 症状的人际创伤的独特特征。

从业者要点

从业者应常规评估人际创伤,因为其对患者有影响。解决情绪调节困难可能有助于从 PTSD 和 BPD 症状中恢复。自伤的存在可能用于区分 PTSD 和 BPD,并提供合适的干预措施。

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