From the Department of Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University (Hepp), Mannheim, Germany; Department of Psychological Sciences (Lane), Purdue University, West Lafayette, Indiana; Center for Alcohol and Addiction Studies, Brown University (Carpenter), Providence, Rhode Island; and Department of Psychological Sciences, University of Missouri (Trull), Columbia, Missouri.
Psychosom Med. 2020 Jan;82(1):90-98. doi: 10.1097/PSY.0000000000000728.
Borderline personality disorder (BPD) is associated with unstable interpersonal relationships, affective instability, and physical health problems. In individuals with BPD, intense affective reactions to interpersonal stressors may contribute to the increased prevalence of health problems.
BPD (n = 81) and depressed participants (DD; n = 50) completed six daily ambulatory assessment prompts for 28 days. At each prompt, participants reported interpersonal stressors (disagreements, rejections, feeling let down), negative affect, and health problems in four domains (gastrointestinal, respiratory, aches, depressive symptoms). In multilevel moderated mediation models, we examined the indirect effects of interpersonal stressors on health problems via negative affect, by group.
Interpersonal stressors were positively associated with negative affect in both groups (β values > 0.12, p values < .001), but more so for participants with BPD (βDay = 0.05, p < .001). Negative affect was positively associated with health problems across all domains (βMoment/Day values > 0.01, p values < .046), but associations were larger at the day level for respiratory symptoms in BPD (β = 0.02, p = .025) and for depressive symptoms in DD (β = 0.04, p < .001). Negative affect mediated the association of interpersonal stressors and health problems in both groups, with larger effects for the DD group for depressive problems (β = 0.02, p = .092) and for the BPD group for the other three domains (β values > 0.02, p values < .090).
Interpersonal stressors may contribute to increased physical health problems via an inability to regulate affective responses to such events. This pathway may be stronger in several health domains for those with BPD and may contribute to an elevated risk of morbidity and mortality in this disorder, suggesting a target for intervention to reduce these risks.
边缘型人格障碍（BPD）与不稳定的人际关系、情感不稳定和身体健康问题有关。在 BPD 患者中，对人际应激源的强烈情感反应可能导致健康问题的患病率增加。
BPD（n=81）和抑郁组（DD；n=50）完成了 28 天的每日六次动态评估提示。在每次提示时，参与者报告了人际应激源（分歧、拒绝、失望）、负性情绪和四个领域的健康问题（胃肠道、呼吸道、疼痛、抑郁症状）。在多层次调节中介模型中，我们按组检验了人际应激源通过负性情绪对健康问题的间接影响。
人际应激源与两组的负性情绪呈正相关（β值>0.12，p 值<.001），但 BPD 组的相关性更强（βDay=0.05，p<.001）。负性情绪与所有领域的健康问题均呈正相关（βMoment/Day 值>0.01，p 值<.046），但在 BPD 的呼吸道症状（β=0.02，p=0.025）和 DD 的抑郁症状（β=0.04，p<.001）中，日水平的相关性更大。负性情绪中介了人际应激源与健康问题的关系，DD 组在抑郁问题上的中介效应更大（β=0.02，p=0.092），BPD 组在其他三个领域的中介效应更大（β值>0.02，p 值<.090）。
人际应激源可能通过无法调节对这些事件的情感反应，从而导致身体健康问题增加。对于 BPD 患者，这种途径在多个健康领域可能更强，并可能导致该疾病的发病率和死亡率升高，提示干预该途径以降低这些风险的必要性。
