Morales-Muñoz Isabel, Durdurak Buse Beril, Bilgin Ayten, Marwaha Steven, Winsper Catherine
Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
Nat Sci Sleep. 2021 Dec 20;13:2175-2202. doi: 10.2147/NSS.S311672. eCollection 2021.
Recent research indicates that sleep problems in childhood precede the development of borderline personality disorder (BPD) symptoms, but the mechanisms by which sleep problems associate with BPD are still unknown. This narrative review aims to provide some potential explanations for how early sleep problems might associate with BPD.
We used the biosocial developmental model of BPD as a framework to discuss how sleep problems may associate with BPD. Articles were identified via PubMed and Embase, and papers published between January 1991 and April 2021 were extracted. Authors made a series of literature searches using the following keywords: Sleep problems, Insomnia, Nightmares, Hypothalamic-Pituitary-Adrenal Axis (HPA), Prefrontal Cortex, Family Psychopathology, Disrupted Attachment, Child Maltreatment, Impulsivity, Emotion Regulation, Internalizing, Externalizing, Rumination, Childhood, Adolescence, Young people. The inclusion criteria were published in peer-reviewed journals; human studies or reviews; published in English. The exclusion criteria were commentaries; abstracts from conferences; studies with animal samples. A total of 96 articles were included for the purpose of this review.
The evidence from this review suggests that some biological factors and core features of BPD act as potential mechanisms mediating the associations between early sleep and subsequent BPD, while some family-related factors might constitute common risk factors for sleep problems and BPD.
The biosocial developmental model of BPD provides a plausible characterization of how sleep disruption might lead to subsequent BPD. Further research on new developmental and early intervention approaches to understand how sleep in early stages associates with BPD could have significant clinical impact on these patients and could inform targeted therapeutic interventions.
近期研究表明，儿童期睡眠问题先于边缘性人格障碍（BPD）症状出现，但睡眠问题与BPD相关的机制仍不清楚。本叙述性综述旨在为早期睡眠问题可能如何与BPD相关提供一些潜在解释。
我们以BPD的生物社会发展模型为框架，讨论睡眠问题可能如何与BPD相关。通过PubMed和Embase识别文章，并提取1991年1月至2021年4月发表的论文。作者使用以下关键词进行了一系列文献检索：睡眠问题、失眠、噩梦、下丘脑-垂体-肾上腺轴（HPA）、前额叶皮质、家庭精神病理学、依恋障碍、儿童虐待、冲动性、情绪调节、内化、外化、沉思、儿童期、青春期、年轻人。纳入标准为发表在同行评审期刊上；人体研究或综述；以英文发表。排除标准为评论；会议摘要；动物样本研究。本综述共纳入96篇文章。
本综述的证据表明，BPD的一些生物学因素和核心特征是介导早期睡眠与后续BPD之间关联的潜在机制，而一些与家庭相关的因素可能构成睡眠问题和BPD的共同风险因素。
BPD的生物社会发展模型为睡眠障碍可能如何导致后续BPD提供了一个合理的描述。对新的发展和早期干预方法进行进一步研究，以了解早期睡眠如何与BPD相关，可能对这些患者产生重大临床影响，并可为有针对性的治疗干预提供依据。
