Konvalin Franziska, Grosse-Wentrup Fabienne, Nenov-Matt Tabea, Fischer Kai, Barton Barbara B, Goerigk Stephan, Brakemeier Eva-Lotta, Musil Richard, Jobst Andrea, Padberg Frank, Reinhard Matthias A
Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.
Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany.
Front Psychiatry. 2021 Mar 12;12:608271. doi: 10.3389/fpsyt.2021.608271. eCollection 2021.
The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was developed for the treatment of persistent depressive disorder (PDD), where comorbid personality disorders (PD) are common. In contrast to other PD, comorbid borderline personality disorder (BPD) is often regarded as an exclusion criterion for CBASP. In clinical settings, however, subthreshold BPD symptoms are prevalent in PDD and may not be obvious at an initial assessment prior to therapy. As data on their impact on CBASP outcome are very limited, this naturalistic study investigates BPD features in PDD and their relevance for the therapeutic outcome of a multimodal CBASP inpatient program. Sixty patients (37 female, mean age 38.3, SD 11.9 years) meeting DSM-5 criteria for PDD underwent a 10 weeks CBASP inpatient program. BPD features (i.e., number of fulfilled DSM-5 criteria) together with childhood maltreatment and rejection sensitivity were assessed on admission. Before and after treatment, severity of depressive symptoms was measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI-II). BPD symptoms were assessed using the Borderline Personality Disorder Severity Index (BPDSI-IV) and the Borderline Symptom List (BSL-23). Intercorrelations of baseline characteristics and symptom change during treatment were analyzed. Patients with PDD met a mean of 1.5 (SD 1.6) BPD criteria with 4 patients fulfilling ≥5 criteria. BPD symptoms and depressive symptoms showed a strong correlation, and BPD symptoms were additionally correlated with emotional abuse and rejection sensitivity. There was no association between BPD features at baseline and improvement on the MADRS, however, BPD features tended to be associated with a lower response according to the BDI-II score after 10 weeks of treatment. Furthermore, BPD symptoms (i.e., abandonment, impulsivity and affective instability) were reduced after 10 weeks of CBASP treatment. BPD symptoms are prevalent in patients with PDD and highly intertwined with the experience of depressive symptoms. In this naturalistic study in PDD, BPD features at baseline did not limit the clinical response to CBASP. Future studies may extend the spectrum of PDD to comorbid subsyndromal or even syndromal BPD in order to develop tailored psychotherapeutic treatment for these complex affective disorders.
认知行为分析心理治疗系统（CBASP）是为治疗持续性抑郁障碍（PDD）而开发的，在PDD中，共病的人格障碍（PD）很常见。与其他人格障碍不同，共病的边缘型人格障碍（BPD）通常被视为CBASP的排除标准。然而，在临床环境中，阈下BPD症状在PDD中很普遍，在治疗前的初始评估中可能并不明显。由于关于它们对CBASP治疗结果影响的数据非常有限，这项自然主义研究调查了PDD中的BPD特征及其与多模式CBASP住院项目治疗结果的相关性。60名符合DSM-5 PDD标准的患者（37名女性，平均年龄38.3岁，标准差11.9岁）接受了为期10周的CBASP住院项目。入院时评估BPD特征（即符合DSM-5标准的数量）以及童年虐待和拒绝敏感性。治疗前后，使用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）和贝克抑郁量表（BDI-II）测量抑郁症状的严重程度。使用边缘型人格障碍严重程度指数（BPDSI-IV）和边缘症状清单（BSL-23）评估BPD症状。分析了基线特征与治疗期间症状变化的相互关系。PDD患者平均符合1.5项（标准差1.6）BPD标准，4名患者符合≥5项标准。BPD症状与抑郁症状呈强相关，BPD症状还与情感虐待和拒绝敏感性相关。基线时的BPD特征与MADRS的改善之间没有关联，然而，根据治疗10周后的BDI-II评分，BPD特征倾向于与较低的反应相关。此外，经过10周的CBASP治疗后，BPD症状（即遗弃、冲动和情感不稳定）有所减轻。BPD症状在PDD患者中很普遍，并且与抑郁症状的体验高度交织。在这项关于PDD的自然主义研究中，基线时的BPD特征并未限制对CBASP的临床反应。未来的研究可能会将PDD的范围扩展到共病的亚综合征甚至综合征性BPD，以便为这些复杂的情感障碍开发量身定制的心理治疗方法。
